Sanitation as a Basic Human Right.

For MPH student Debbie Perez and recent graduates Kati Moran (’16) and Becca Walmer (’16), a class project on access to showers among homeless Bostonians continued long after the final presentation.

“All along our goal has always been to produce something that’s useful and helpful to the city,” says Moran. “We never just wanted to do this project and then leave all the data somewhere and never talk about it.”

Project SUDS (Serving Up Dignity with Showers), which won the Boston University Initiative on Cities (IOC) Urban Research Award in 2015 and the School of Public Health Dean’s Award this past April, is a survey of homeless people and service providers for that population, looking at access and barriers when it comes to showers, bathrooms, and laundry.

It began in the spring of 2015, when Perez, Moran, and Walmer took Yvette Cozier’s social epidemiology course (EP775), which focuses on the social determinants of health, like race, class, and gender. The final project was the creation of an NIH grant proposal for research related to health disparities. The team was inspired by Lava Mae, a program in San Francisco that turns buses into mobile shower and bathroom facilities for the city’s homeless population.

The students created a proposal to work with the Boston Health Care for the Homeless Program (BHCHP) to gather qualitative data from service providers and people experiencing homelessness. They also proposed looking at medical record data to investigate the disease burden and health-related costs that may be associated with irregular personal hygiene.

After their final presentation in Cozier’s class, the team used their NIH-formatted grant proposal to apply for, and win, the IOC Urban Research Award. The students then got to work, advised by Cozier and Assistant Professor of Environmental Health Jessica Leibler, who is affiliated faculty with the IOC (much of her research focuses on environmental exposures and hygiene access for people experiencing homelessness—including a project assisted by Perez).

The team conducted a survey with 34 BHCHP patients during the winter and spring of 2016, asking them about how and where they are able to take showers, use the bathroom, and wash their clothes.

Walmer says the majority reported major difficulties accessing showers, with concerns about theft being the biggest barrier. “One man mentioned that sometimes he takes his personal belongs and puts them in a trash bag,” she says, “and actually takes them into the shower with him to avoid getting them stolen.”

Privacy—or lack thereof—can also be a barrier to using a wide-open public shower. “Not everyone really likes getting showers like that,” Moran says. “I know I wouldn’t, and if I were homeless then I wouldn’t like it then either.” Several respondents also spoke about their history of sexual trauma and how it made them reluctant to use a communal shower, Walmer says.

Walmer says the team also found restroom access “is just as much of an issue—if not more so.” Entering a Starbucks, for example, is a privilege reserved for people who don’t “look” homeless—and going to the bathroom outside can lead to arrest and being deemed a sex offender, making finding a job or housing even more difficult.

As for laundry, the team found simply discarding clothes and buying new ones at Goodwill was easier for many homeless people. They also heard about friends pooling their money to wash their clothes together in one machine at a laundromat.

“What we’ve really found in talking with all of these homeless people is how resilient they are and how savvy they are with making do with what they have,” Moran says.

For the next step, the team is creating a whitepaper report to present to stakeholders in Boston, and begin working toward effecting change with their findings. Perez says the timing is vital: Cost of living in Boston continues to rise, while the availability of affordable housing drops—making rates of homelessness likely to rise.

“We want to bring the conversation back to the idea of dignity,” Perez says. “This project isn’t going to end homelessness, but we feel that it might spark a broader conversation about social justice, and the basic human right of access to water and sanitation.”

—Michelle Samuels