Lack of access to public toilets and basic hygiene centers has led to a hepatitis A outbreak in California, one that has already infected 32 people in Los Angeles County.  

“Homeless people do not have the privilege to use the bathroom whenever they want, except if it’s the public sidewalk,” said Louise “Frenchy” Mbella Sinai, a community organizer, advocate and Think Tank advisor.
Earlier in September, the LA County Department of Public Health (LACDPH) declared a local outbreak of hepatitis A (HAV) in the Los Angeles County. Hepatitis A is a highly contagious liver disease caused by the HAV virus and can lead to possible death. In fact, this statewide outbreak has already taken 19 lives across the state.

Although anyone is susceptible to the disease, people who are most at risk include the homeless population, men who have sex with men, those who use recreational drugs, or who travel or live in countries where the virus is common, according to the LACDPH.

“Public Health has been proactively preparing for an outbreak for some time and is working diligently to prevent spread in local communities,” Jeffrey Gunzenhauser, Interim Health Officer at the Los Angeles County, said in a press release. “Vaccination is the best protection against hepatitis A. With this in mind, our outreach teams and clinics are offering free vaccine to persons who are homeless, active drug users, and those who provide services and support to those individuals.”

Candace Leos, Communications Manager at The Midnight Mission, a homeless shelter in Skid Row, said that they partnered with the LACDPH as soon as the outbreak started, and they have been educating the community and providing free vaccinations onsite.
“We tend to be very proactive on our end,” she said. “Employees know, they wear gloves and they take the necessary precautions even before the outbreak started. There was some panic [at first], but everyone jumped to action and we’re taking care of it.”

The outbreak hasn’t worried them that much, Leos said, as she feels both The Midnight Mission and LACDPH have taken the necessary precautions. She also added the outbreak helped open the conversation about toilet access in Skid Row.

In fact, on October 19,  the Los Angeles City Council committee approved a plan for the city to consider a system of portable restrooms to address the lack of toilet access. The project will be modeled after San Francisco’s “Pit Stop” program, which provides the homeless population with all-day access to public toilets, sinks, used needle receptacles and dog waste.

The motion was directly connected to the hepatitis A outbreak, as Councilman Mike Bonin argued that without access to restrooms, people on the streets are at significantly higher risks of contracting diseases. The Homelessness and Poverty Committee approved the motion unanimously.

But Mbella, an advocate for the homeless community, is skeptical about the proposed changed actually taking effect.

“We need real help,” she said. “[Right now] nothing is built. Until I see a fresh, safe and public toilet and a mobile hygiene center, this is only in the conception phase.”

Mbella was a key strategist and advisor in “No Place to Go,” an audit of the public toilet crisis in Skid Row published in June 2017. Auditors evaluated toilets in Skid Row based on their accessibility, which was defined as toilets that were functioning, maintained, public, safe and private. They concluded that during overnight hours, there were only nine public toilets available for close to 1,800 homeless people.

This number does not meet the United Nations High Commission for Refugees’ (UNHCR) sanitation standards, as they require at least one toilet per 20 persons. As of now, Skid Row only has one toilet per 197 people.

Additionally, more than a third of audited toilets were not operating during said “open hours,” and most toilets lacked soap, paper towels, toilet paper and seat covers. Since hepatitis A can also be spread through fecal matter and urine, hygiene conditions in Skid Row make the community vulnerable to this and many other diseases.
Community advocates like Mbella have continually pressured LA City Council to approve 24-hour hygiene centers in homeless encampments.

Although this is a great step forward, the center will only be open during business hours until they can find more staffers; something Mbella said is one of the biggest issues.

“If a woman needs tampons or pads on a Friday, she cannot wait the whole weekend until a service provider opens on Monday morning and supplies her,” she said.
Back in April, City Council approved a motion that would allow for a part of the Measure H budget to go to providing a mobile hygiene center that would include showers, laundry services, public toilets, and attendants to monitor and assist with safety.  Measure H was approved in November 2016 and it raised the L.A. county sales tax by one-quarter so that revenues could go to provide services for the homeless.

This mobile hygiene center opened last Monday.