San Diego is facing a public health emergency and our homeless neighbors are suffering most of all. It’s time to take action.
On September 1, 2017, city health officials declared a state of emergency in the County of San Diego. By October 17th, 577 people had contracted hepatitis A. 70% of those diagnosed were hospitalized. While some housed people did become infected, the large majority of people impacted by the outbreak were people experiencing homelessness and living on the streets. The viral infection killed 20 people in San Diego—most of whom were individuals without homes.
Due to the seriousness of the outbreak and the high level of infection among individuals experiencing homelessness, Father Joe’s Villages jumped into action promoting public education about Hep A. In this blog, we will outline the basics of Hep A, the actions we undertook to combat the public health crisis and how the community can help into the future.
Hep A: The Basics
Hepatitis A (often referred to as Hep A) is the least serious of the common hepatitis viruses. It is a highly contagious but typically mild illness. Hep A does not cause chronic liver disease, as do hepatitis B and C. Hepatitis A usually clears up on its own and does not require medical treatment. Most people who have hepatitis A recover completely within 2 weeks to 6 months. Once people recover, they are immune to the hepatitis A virus.
Hep A is spread person-to-person through a “fecal-oral” route, such as ingesting food or water that has been contaminated with the feces of an infected individual. That can happen when an infected person doesn’t wash his or her hands after going to the bathroom and then contaminates objects, food or water with which another person comes into contact.
Hepatitis A virus can also be directly transmitted through transfusions of blood or blood products, although this is much less common due to the brief period of time that hepatitis A virus remains in the blood of an infected person. The increased risk for hepatitis A infection among drug users is primarily due to poor hygiene rather than transmission through blood. Urine and saliva do not transmit hepatitis A virus.
Sanitation & Hep A
For this reason, practicing basic hand hygiene is the best way to prevent illness. There is also an effective vaccine available.
Hepatitis A is most commonly a mild illness that resolves itself with little medical intervention. Why then, are so many people who have contracted hep A in San Diego’s outbreak requiring hospitalization? Why are so many people dying? The answer lies at the heart of what it means to be homeless.
A large majority of the people that have contracted hep A since November 2016, when this outbreak began, are living in unsanitary conditions on San Diego’s streets and river banks.
Older people who contract hep A have a higher frequency of symptoms and tend to get a more severe illness. Medical experts say that hep A can, in rare cases, lead to death. Death most commonly occurs in people over 50 years old and those with chronic liver disease.
Father Joe’s Villages operates the San Diego Day Center for Homeless Adults (a program funded by the City of San Diego in partnership with the San Diego Housing Commission). In 2016, the Day Center provided showers, bathrooms, laundry facilities, mail services and other critical services to more than 7,000 people who were living on the streets of San Diego. Many of the people we serve there are individuals over 50 years old.
43% of the people served were aged 50 or older. 128 people who sought services were aged 70 or older. 37% of people served reported living with a long duration disability, such as a mental illness or chronic health condition.
Life on the streets is more difficult than most of us can imagine. People often have to sleep in unsafe and unsanitary conditions. They lack quick and easy access to bathrooms for washing their hands, brushing their teeth and defecating. Laundry facilities are scarce. People do not have ready access to regular meals and lack adequate nutrition. The quality of sleep for people who sleep on sidewalks is often poor.
Countless studies show that homelessness is clearly associated with poor health.
The National Health Care for the Homeless Council notes the average life expectancy in the homeless population is approximately 47 years, compared to 78 years in the general population. One study showed that mortality rates among street youths in are 9 times higher for males and 31 times higher for females, compared to the general population.
Homeless adults suffer from a wide range of chronic medical conditions, including seizures, chronic obstructive pulmonary disease and musculoskeletal disorders. Hypertension and diabetes are often inadequately controlled. Homeless people in their 40s and 50s often develop health disabilities that are commonly seen in persons who are decades older. Oral and dental health is poor.
Father Joe’s Villages Takes Action
For more than 67 years, Father Joe’s Villages has been in the forefront of providing emergency services to people living on the streets of San Diego. Our shelter, meals, medical care, showers and bathrooms have provided a beacon of hope for people in need since St. Mary of the Wayside Chapel, Father Joe’s Villages legacy program opened in April 1950 in downtown San Diego.
Father Joe’s Villages has responded to the outbreak by enhancing and expanding upon existing emergency services.
Staff at the San Diego Day Center for Homeless Adults and in Interim and Transitional Housing have been handing out specialized hand wipes to homeless individuals and placed educational signage in multiple languages throughout our facilities, including in the bathrooms and showers, to encourage hygiene. Additionally, Father Joe’s Villages worked with the County to install hand-washing stations outside the Day Center, the Joan Kroc Center and the entrance to the Franklin Antonio Public Lunch line (open 24 hours a day). We have also hosted numerous vaccination and hygiene kit distribution events with the County of San Diego. Staff members are working diligently to educate clients about the importance of hand-washing and vaccination.
Vaccines & Medical Care
Our Village Family Health Center has implemented several strategies to stop the spread of hep A. Our clinic staff works around the clock to keep our homeless neighbors and our entire community as safe and healthy as possible. The Health Center offers vaccines to ALL patients who come to our clinic and the County is on-site 3-4 days a week to provide further vaccines to individuals. They also constantly monitor patients for symptoms of hep A in order to provide immediate medical care and prevent further infection.
Working with the City of San Diego, Father Joe’s Villages will erect a short-term shelter on our campus. The facility will be housed in a large industrial tent and will house up to 150 beds with restrooms, showers, meals and 24-hour security. The shelter will not only provide homeless San Diegans with a safe and sanitary refuge but also bring them closer to life-saving resources that are already on our campus, such as health care, alcohol and substance abuse counseling, job search training and more. We are working closely with the City and our on track to open by December 1st.
The tent will augment our existing 350 beds of interim housing for single adults that is funded by the City of San Diego and 138 beds of interim housing for families with children that is funded solely by private donations.
We continue to offer access to restrooms 24 hours a day, 7 days a week. We began doing so as a service to our community in East Village and because we felt it was important to preserve the most basic of human dignities for our neighbors. But now more than ever, access to restrooms is an issue of public health. Operating these facilities presents considerable challenges for us, but for the sake of those who are homeless and for the broader community, we feel it is an indispensable amenity that must be available to people. Earlier this year we implemented the policy of cleaning our bathrooms every two hours to maintain sanitation. We continually pursue improvements to the bathrooms to ensure that they are safe and accessible as hygiene facilities.
Franklin Antonio Public Lunch Program
Improving access to nutritious food has always been a cornerstone of our mission. Each day, 365 days a year, the Franklin Antonio Public Lunch program serves a hot, nutritious meal. The program serves an average of 650 people a day. All guests are welcome to additional helpings, which is critical for the adults and children who may be enjoying their only meal of the day. Many individuals who are homeless learn about our housing programs and supportive services after their first meal in our public lunch line.
Continuing to Serve
Perhaps most importantly, Father Joe’s Villages continues to provide the life-saving services that move individuals off the streets and into their own permanent homes. Our programs give our neighbors the tools necessary to face hurdles such as unemployment, addiction, mental health barriers, chronic illness, disability, obtaining childcare, finding affordable housing and more. Our goal is to help neighbors end their homelessness permanently by delivering Compassionate, Respectful, Empathetic, Empowering and Dignified services. If we truly want to rid San Diego of Hep A, the best thing we can do is continue to work toward ending homelessness.
How to Help
We need the support of the entire community to help us face this crisis. You can help your neighbors in need in several different ways:
- Father Joe’s Villages needs to continue providing services to homeless individuals and families to help them move off the streets into homes that are safe and secure. Donate now to help Father Joe’s Villages end homelessness, one life at a time. We need YOUR support to save lives.
- Our volunteers make it possible for Father Joe’s Villages to serve thousands of people every day. They are essential to helping our doors stay open. We need your help now more than ever. Sign up to become a volunteer today. Together, we can see all of San Diego shine.
- Education and awareness about hep A and homelessness is key if we’re going to stop the epidemic. We need to foster empathy for our neighbors in need so we can face homelessness as a community. Please share this blog post or our animated short film Shine to encourage San Diego to work together to see an end to homelessness.
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