When an outbreak of hepatitis A spread among residents who are homeless last year, public health workers in Spokane leaped into action.
They went to shelters, the county jail and clinics to offer vaccinations to more than 1,000 people. The virus wreaks havoc on the liver and can be fatal. So far this year, new cases of hepatitis A are on the decline.
The experience has prompted the Spokane Regional Health District to respond to the region’s ongoing struggles with homelessness as a matter of public health by hiring a homeless outreach coordinator.
The new position will serve as a contact for the health district’s work with service providers to the homeless. The district’s efforts already intersect with homelessness through services such as the Nurse-Family Partnership and the Women, Infants, and Children nutrition program.
“People look to us for addressing these types of issues,” said Dr. Bob Lutz, the county’s health officer.
The health district “is but one component” of the region’s response to homelessness, Lutz said, and can bring “certain resources to bear.”
Although the health district is not a direct service provider to the homeless, Lutz said there are many issues that can be viewed through the lens of public health.
He compared it to the way the National Physicians Alliance has waded into the debate over gun violence.
“We’ve heard the (National Rifle Association) say, ‘Physicians, get back in your lane.’ … But it’s also a public health issue,” Lutz said.
People who are homeless have higher rates of chronic disease than the general population. According to the 2016 Point in Time Count – an annual survey of the nation’s homeless population – people living in shelters nationwide were more than twice as likely to have a disability than the general population.
Of the 1,309 people who are identified as homeless in Spokane’s own Point in Time Count in 2019, there were 485 who reported having HIV or AIDS, a serious mental illness or a drug addiction.
There is a regular “huddle” at SNAP’s offices of providers who conduct outreach to people who are homeless, meetings in which workers with various agencies help keep each other current on what’s going on in the community, said Bob Peeler, a homeless coordinator with SNAP.
With a homeless outreach coordinator, the health district would be able to have a representative consistently at meetings like SNAP’s huddles.
“It’s a great opening. Spokane always has partnerships, people from other communities, we’re all willing to coordinate,” Peeler said.
Peeler noted that the health district already has been participating in homeless outreach for years.
“They’ve just been coming to the table and been great,” Peeler said, pointing to the health district’s needle exchange program as an example.
At the city’s warming center on Cannon Street, operated by Jewels Helping Hands, the health district provides immunizations and sponsors its over-the-counter medication distribution. It allows people who are homeless to access basic medicine like ibuprofen.
At the health district, everybody has different specialties, but homeless services are specific, said Jewels Helping Hands founder Julie Garcia.
“It would be amazing to have somebody we could just call as a one-stop for the health district. It’s absolutely needed,” Garcia said.
Catholic Charities of Eastern Washington, which operates the Hope House shelter downtown, routinely collaborates with the health district. In a statement, Catholic Charities spokeswoman Sarah Yerden said that based on its job description, the outreach coordinator could “help ensure that health-related data stays a part of the community dialogue around homelessness.”
As of last week, there were 85 confirmed cases of hepatitis A in Spokane County since the outbreak began last year. Of those, 80% were people who have experienced homelessness or have a substance use disorder. More than 70% of those patients required hospitalization, and three people died.
But the number of new cases since has fallen.
The number of new cases peaked at 20 in October. In December, five people were diagnosed with the infection, followed by nine in January and two thus far in February.
As part of an ongoing commitment to restructure the health district, it plans to hire for the position internally. The position was posted last week, and Lutz expects the new hire to begin in March.
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