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