Saturday, September 8, 2012

NJPHA visits Tent City Lakewood

Sarah Simpson, USA

The New Jersey Public Health Association recently visited Tent City located in the Pine Barren woods in Lakewood, New Jersey. For those of you unfamiliar with tent cities, they are makeshift, homeless communities that are springing up all over the United States. These communities are labeled as such because residents live in tents and other collapsible, mobile living quarters. Started in 2005, Tent City Lakewood consists of a community of about seventy people from diverse backgrounds. The camp is led by Reverend Steven Brigham, who was kind enough to show us around the grounds. While, these communities continue to spring up around American cities, this tent city and others like it do raise some concern for the health of its inhabitants and their local communities. Below are some areas of concern observed during our visit to Tent City Lakewood.

Solid and Human Waste Disposal

One of Tent City Lakewood’s biggest issues is their solid and human waste disposal. There is currently a dumpster on the outskirts of Tent City, which is collected by the municipality. However, trucks often have trouble getting to the dumpster, which is located in a small, pot-holed clearing of the woods. Allowing for road paving would help make garbage collection easier.

Another concern is that their bathroom facilities currently consist of pit latrines, which are made by digging a hole into the ground and placing an outhouse type structure over it. Once this hole is filled waste, it is filled in with dirt and a new hole for the latrine is dug. While there are some advantages to using a pit latrine, such as they are cheap and simple to build, there are also some worrying disadvantages. One disadvantage is that this system can lead to the attraction of insects such as mosquitoes and horseflies and vermin such as rats. These possible vectors are attracted to the odor and gases of decaying fecal matter. Another disadvantage is possible seepage into underground water tables because of its location on porous sandy land. If the weather is bad enough, local flooding could flow human sewage into local water systems or into gardens grown by the residents, which can lead to health problems such as norovirus. Some other health issues that were noted were the lack of adequate hand washing facilities at the toilets and in the communal kitchen area.

Food Safety

Unsafe food handling practices might also be a cause for concern, as there is only one chest freezer.  Food is prepared in a central location with grills where residents prepare shared meals using donated food; however the food handling methods employed might be unsafe. Factors such as improper holding temperatures for potentially hazardous foods and inadequate storage of the mostly donated food supply, especially with the summer heat, can lead to serious food-borne illnesses. A closer look at their food safety practices is definitely needed. 

Injury Risk

During the cold New Jersey winters, the residents use wood burning stoves as the primary way to heat their tents, along with propane tanks. While there is a fire extinguisher located near every housing structure, these stoves and propane tanks pose a great risk to injury in the case that there is a fire. With no carbon monoxide detectors, carbon monoxide also poses a risk if smoke ventilation isn’t good. Injuries such as sprains, falls and other accidents should also be of concern along with hypothermia in case residents are not able to properly heat their homes.

Animal and Pest Control

As the community lives with domesticated animals such as dogs, cats and chickens, it is important that there is proper animal and pest control. Cats and dogs must be vaccinated, receive flea treatment and fed properly. If they are not properly being cared for, they become infested with ticks, mosquitoes, and lice, or can be infected with diseases like rabies. Mosquitoes, ticks and other insects also pose a risk to human health,  and exposure to such pests is increased by its location.

There is also a population of chickens being bred on the grounds. Chickens being raised within such close human contact pose a health risk as there are diseases that are communicable from chickens to humans. Bacterial diseases such as salmonella and campylobacteriosis can be contracted through direct contact and exposure to manure. Elderly and other susceptible persons are at risk to severe illness if exposed. However, it should be noted that there are no children living in the Lakewood Tent City.

Other Potential Risks for Illness

Some of the potential risks for illness such as those associated with unsafe food and hand washing safety practices, inadequate waste disposal and animal pest control were mentioned above. Some other illnesses of concern would be influenza and tuberculosis, which are transmitted through the air. For example if residents don’t receive their yearly influenza vaccination and become sick, they pose a greater risk to other residents. Coupled with inadequate hand washing practices and the other risks mentioned before, this could lead to a highly infected population who pose a risk to the local community during regular interactions.

Mental Health Services

We also learned that many residents might suffer from mental health illnesses, which would require targeted mental health services. A needs assessment should be performed in order to see if they are indeed in need of such services. 

Lessons Learned

Overall, tent cities can present some serious environmental health challenges. Even with support, they require vigilance in order to avoid or mitigate pending public health issues. Some recommendations can include adopting guidelines used for disaster camps and shelters such as the Center for Disease Control and Prevention Shelter Assessment Tool. Portable toilets are a short term solution to the human waste problem, but unpaved roads hinder waste pickup by trucks. Proper hand-washing and food safety practices should be reinforced, perhaps through signs and through classes taught by a health educator from the local health department. Proper training can prevent disease transmission and contraction. Tent City Lakewood also provides us with a unique opportunity to understand environmental health issues associated with disaster camps. As we continue to experience extreme weather events, such information would be important to public health responders in understanding critical human needs and protection in disaster situations. NJPHA recognizes that a more in depth assessment is needed, so be sure to stay tuned for our continued involvement with Tent City Lakewood.

About the author of the article: Ms. Sarah Simpson is presently the MPH Epidemiology Candidate, University of Medicine & Dentistry of New Jersey, NJPHA secretary

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