An old-fashioned term for horrible diarrhea, dysentery, has long been linked with Oregon. This is due to the video game Oregon Trail from the 1980s, where millions of gullible avatars perished from dysentery and were buried beneath pixelated tombstones.
Thanks to modern therapy, the bacterial condition, which can also produce cramping, vomiting, and fevers, is rarely fatal these days. However, it is extremely contagious and can cause weeks-long illness.
Additionally, it’s generally no longer a major plumbing problem. One of the main groups at risk of consuming one of the four strains of shigella bacteria that cause the incapacitating symptoms is Americans returning from vacations in nations with less developed sanitation systems.
However, Multnomah County’s health department reports that the number of infections among non-citizens than doubled last year, reaching 158 in 2024. Forty instances were confirmed in January alone, and the number seems to be increasing.
According to medical professionals who talked with The Oregonian/OregonLive, they believe the true number of infections is higher since many sick people choose not to seek medical attention. They also concurred that the increase in infections has been exacerbated by the county’s escalating unsheltered homelessness situation.
According to Dr. Amanda Risser, senior medical director of Central City Concern, a Portland-based health care and housing services organization, “any situation where (you are) unable to wash your hands regularly will put you at risk for Shigella, and I think unsheltered homelessness certainly contributes to people just really not having places to do that.”
Increasing access to restrooms and handwashing stations would be a simple solution, according to Risser and Dr. John Townes, medical director for infection prevention and control at Oregon Health & Science University.
According to Townes, providing toilets, soap, and water is the best way to prevent a Shigella outbreak. Additionally, you teach them hand washing techniques.
According to the most recent county statistics given by The Oregonian/OregonLive, Multnomah County has about 6,000 residents living outside. However, a count by The Oregonian/OregonLive found that Portland has just roughly 116 publicly maintained bathrooms. This includes restrooms in libraries that are closed at night and restrooms in parks that are locked during the winter.
Although everyone would prefer housing and a private bathroom, Risser stated that having a sink with hand soap and a container for infectious stool in a public washroom is vastly preferable to the alternative, which is to defecate on the pavement. In that case, the sick individual is left on the street, allowing the resilient bacteria to attach themselves to shoe bottoms, and they have nowhere to wash their hands, which makes it simple to spread infections to others. Unfortunately, she remarked, she has noticed a lot of the sidewalk-as-toilet scenario lately.
“I see human poop outside pretty much every day I go to work, and that’s new,” Risser added. She said that there was no medical explanation for the rise that was related to drug use. She believes it to be an infrastructure problem instead. I believe that when people have nowhere else to go, they poop outside.
Human waste outside is a persistent issue, according to Adam Solano, dispatch manager for Ground Score, the group that removes litter from numerous Portland streets. He claimed that two to six times a day, his cleanup teams call him to report it. After that, he must contact the city’s biohazard cleaning crew.
There are other ways to get sick besides living outside. According to Risser, one recent instance occurred at a wedding when a food preparer was unwell and neglected to wash their hands.
While cleaning the restrooms at the Clark Center, a residential facility in Southeast Portland for males involved in the Multnomah County community court system, J. W. Mosher is quite certain he contracted the bacteria.
Mosher told The Oregonian/OregonLive that it’s not enjoyable. Before I went to the hospital, I had severe diarrhea for two weeks.
Mosher would have only had to consume a tiny quantity of the bacteria to get sick, and he was still ill a week after his hospital stay. One of the traits that makes persons living in communal environments or without access to frequent handwashing more vulnerable is the ease with which Shigella spreads.
Mosher said that he was not the only one at the Clark Center with the disease, based on what he observed left on the toilets he cleaned. Every year, shelters with communal restrooms serve thousands of homeless people—11,912 in 2024.
Mosher stated that they should post a notice on the wall that reads, “Hey, if you have diarrhea, you need to go to the hospital.” We are all crammed into a 90-bed facility, so I’m not sure if they’ve held a meeting and informed everyone of this.
According to Clifton Roberts, spokesman for Transition Projects, the nonprofit organization that oversees the residential program, residents of Clark Center who report feeling sick are presently given priority appointments with medical professionals.
We are keeping a careful eye on the situation and have not received any new complaints of Shigella in our facility. An email sent last week was written by Transition Projects CEO Tony Bernal. Regular deep cleaning and frequent cleaning of toilets, showers, and other common areas are part of our standard operating procedure.
According to the county health department, individuals without permanent housing have accounted for 44% of shigellosis cases reported in Multnomah County since 2017 when overseas travel was not a contributing factor. Among the confirmed instances of shigellosis in the county, men who take drugs and have sex with other men are also overrepresented. But according to health department officials, the percentage of diseases among homeless individuals has increased recently.
According to an email from Sarah Dean, a Multnomah County Health Department spokesman, 56% of cases in the most recent clusters have involved individuals with insecure housing, and 55% of cases have involved methamphetamine and/or opiate use.
Placing numerous red portable toilets near places where there are a lot of homeless campers was one of the city’s pandemic-era innovations to address the same problems—a shortage of public restrooms and a corresponding increase in Shigella infections. According to The Oregonian/OregonLive, the city once paid $75,000 a month to maintain 123 portable restrooms, but the locals detested them.
The Oregonian/OregonLive reported in December 2020 that items have been dumped in toilets, rendering them useless, sinks and toilet paper dispensers have been stolen, and units have been spray-painted, torched, and tipped on their sides.
According to The Oregonian/OregonLive article, all 30 units were declared a complete loss, and every single unit was damaged in some form. Homeowners attempted to physically prevent city contractors from erecting a new unit in at least one instance.
According to a city official who spoke to The Oregonian/OregonLive last week, the city was unlikely to install a large number of more red portable restrooms at this time due to the negative publicity that was generated at the time.
One of 123 red portable toilets installed by Portland’s impact reduction initiative for homelessness and urban camping, seen here in 2020. Before the city discontinued the program, every potty that had been placed had some sort of damage. There are currently seven of these portable restrooms in the city.
Additionally, it’s not as easy as it might seem to use the existing infrastructure, such as reopening the Parks Bureau of Portland’s closed-for-winter restrooms. According to an email from bureau spokeswoman Mark Ross, the pipes for those sites aren’t winterized and could burst in a frost.
According to Ross, a thorough system-wide assessment of the infrastructure and plumbing would be necessary to ascertain what would be required to maintain park restrooms open during the winter. The agency lacks the resources necessary for this project, which would undoubtedly require a large capital investment.
For months, Parks officials have been warning that the bureau’s services and activities are in danger due to cost increases brought on by inflation, growing wages, and other factors. Additionally, municipal councilors postponed until November an attempt to introduce a new parks levy for voter approval.
According to the county health department, the bacteria species that are now in circulation in Multnomah County are not among the most harmful. According to Townes, the elderly, immunocompromised, and infants are most at risk for serious sickness.
The majority of individuals who get sick should avoid cooking for other people, drink a lot of water, get lots of sleep, and wash their hands frequently. Medical advise from the nonprofit Mayo Clinic states that anyone who has blood in their stool or has had diarrhea for longer than two days should see a doctor.
Similar to antibiotics, antimicrobials are available for severe instances but are not administered in milder cases due to the fact that many Shigella germs are resistant to therapy, making treatment more difficult.
“That is a big worry,” Townes stated. Antibiotics cannot be used carelessly to treat these diseases. The best course of action for a patient who is not severely ill is to isolate them and let their condition resolve itself.
Mosher had been feeling ill for a few weeks, but she was reluctant to tell anyone since nobody wants to discuss excessive diarrhea.
After two weeks, he eventually visited the hospital and received a diagnosis. While he healed, the county health department gave food and cleaning supplies and temporarily placed him in a motel. Mosher claimed to be alone in the motel room, bored but thankful.
This summer, the Multnomah County Health Department launched a trial program for supportive housing for people with communicable diseases, spending $337,033 in one-time funds for the current fiscal year. The majority of that money is allocated to staff, including a supervisor’s wage. When someone has a reportable sickness, such as whooping cough, shigella, or Mpox, a dedicated staff member calls them, sets up their motel stay, and then makes an effort to assist them in finding accommodation. Reducing the spread of infectious diseases and helping 50 people by June are the objectives.
Twenty-four persons have benefited from the program since it started. Of them, twenty had shigellosis.
For The Oregonian, Lillian Mongeau Hughes writes about mental health and homelessness. For advice or inquiries, send her an email [email protected]. Or follow her on X at @lrmongeau or [email protected].
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