Pandemic public washroom closures a critical issue for people with IBD, those experiencing homelessness

TORONTO — For many people, going for a walk is one of the most reliable ways to get some fresh air and alleviate stress during the COVID-19 pandemic.

But for people like Claudia Tersigni, the closure of public washrooms during lockdowns has made leaving the house even to go to the park a struggle.

The 25-year-old has ulcerative colitis, a condition which, among other things, causes her to be struck with more frequent and urgent needs to use the washroom.

“It is an inflammatory condition and autoimmune condition where my immune system attacks my digestive tract,” she told CTVNews.ca in a phone interview. “So the symptoms can be anywhere from bloody diarrhea [to] having to use the washroom more often and more urgently as well.”

When the need comes upon her, she has around five minutes to make it to a washroom — a tall task during the pandemic, when lockdowns have closed not only businesses but even public washrooms connected to parks in some regions.

“Before the pandemic, I would struggle with commuting or with simple tasks like going to the grocery store. So I would make sure I knew, whatever route I was going, I knew where all of the washrooms were from point A to point B. I knew where my safe spots were,” Tersigni said.

“So already, living with the fear of not knowing where the closest washroom is going to be was an added stress in my life. But with the pandemic, it was worsened tenfold because now all these places that used to be my safe spaces that I relied on to be open, I didn’t know if they weren’t going to be open or closed. And […] for the majority, they were closed.”

Ulcerative colitis is a type of inflammatory bowel disease (IBD), a term which includes other conditions such as Crohn’s disease.

“One in 140 Canadians have inflammatory bowel disease, so [it’s] quite a lot,” Tersigni said.

Dr. Naheed Dosani, a palliative care physician and health justice activist in Toronto, said the issue of public washrooms affects not only the IBD community, but also older people and those experiencing homelessness, two communities already negatively impacted by the pandemic.

“I do a lot of my work in the inner city providing health care for people experiencing homelessness,” he told CTVNews.ca in a phone interview. “Basically, palliative care for people living on the streets and in shelters.

“There are so many people I care for who experience frailty, advanced illnesses and an older age who are not able to enjoy the outdoors, green spaces or public spaces because of an inability to access the washroom.”

He said people he’s cared for have experienced “accidents while outdoors.

“People who have had episodes or flare ups of their gastrointestinal illness and then not had access to a coffee shop or a mall bathroom, for example, and didn’t have time to make it home,” he said.

“It can be embarrassing and it can be limiting for people, which can affect a person’s overall psyche and affect their mental health in the long run.”

He pointed out that spending time outdoors is one of the safest ways people can get some exercise and have fun during the pandemic, and that access to the outdoors is important for mental health.

A lack of public washrooms, exacerbated by the pandemic closures of the ones that do exist, makes amenities like parks inaccessible to thousands of Canadians.

Tersigni explained that during a flare-up of her ulcerative colitis last summer, her stress was made worse by the inability to take walks to her local park.

“I used to live in an area that was close to a public park, which had a washroom originally, which was great because I could go for walks and not have to worry,” she said. “But then at the start of COVID, [that washroom] closed as well, and it’s stayed closed.

“I would rather stay home than have that stress.”

The lack of reliable public washrooms has been an issue with infrastructure long before COVID-19, but the pandemic has thrown it into relief with the closure of businesses and thus the washrooms connected to them, experts say.

At the start of the pandemic, our limited understanding of how COVID-19 spread meant that everything was shut down out of an abundance of caution.

One would assume that a year after the start of the pandemic, washrooms might be open more often, but Tersigni said it is still “hit and miss,” particularly in regions such as Toronto that have been in some variety of lockdown for months.

Some businesses have had their washrooms closed even when they’ve been permitted to be open, “just out of fear,” she said.

‘DISCRIMINATION VIA PUBLIC DESIGN’

A resource that Tersigni’s used before is the GoHere app, developed by Crohn’s and Colitis Canada, where businesses can let users of the app know that their location has a public washroom available for use. But not everyone is aware of the app and flags their washrooms as open, and during the pandemic it hasn’t been accurate all the time due to the shifting nature of lockdowns.

Tersigni, who volunteers with Crohn’s and Colitis Canada and also works with children who have IBD through her work as a research co-ordinator at SickKids, said she’s heard her concerns echoed by other members of the community.

“We’ve all expressed concern and discomfort with leaving our house already because it’s scary because of COVID, but also because of trying to find washrooms at this time.”

She suggested that one way businesses could help is to make it clear through signage or apps like GoHere that their washrooms are open to the public when businesses are permitted to allow people indoors.

“That would help patients that have deemed certain locations as a safe place to know, if the doors are open [than] the washrooms are open as well,” she said.

On the public policy side, it might help to have more clear policies on whether public washrooms should be open in order to avoid the uncertainty, Dosani said.

“I would very much welcome announcements from our leaders to clarify that access to washrooms is a priority,” he said.

He said to tackle the broader problem as it exists outside of the pandemic, we need to think about health equity when we make plans to build new structures and sites within our cities.

“We think about spaces, we think about who’s going to access them. And we think about who won’t be able to access them right now,” he said.

He pointed out that failing to put in more public washrooms is a form of hostile architecture, a term for when public spaces and amenities are specifically designed to discourage those who are experiencing homelessness from being able to use them.

“It’s a form of discrimination via public design,” Dosani said.

He added that while spikes under overpasses and on benches designed to prevent people from sleeping there are more obvious forms of hostile architecture, the lack of public washrooms in cities with a significant population of unhoused people “is a really good example of discriminatory practice.”

“It’s an issue that’s so much bigger than the pandemic,” Tersigni said. “Everyone needs to use the washroom, it’s inevitable.”

She added that her friends without IBD who have experienced difficulty locating a washroom while out during the pandemic have “reached out to me and said, ‘I honestly don’t know how you do this every day.”

Dosani hopes that these issues being brought up during the pandemic will lead to greater change.

“I know that there’s a lot of discussion that cities of the future will be more inclusive, but why can’t the future be right now?” he said.

“If this pandemic has showed us anything, it’s that people who experience inequities are in our society and they are not thought of, and they’re not included in our day-to-day practices. Discussions about future cities are great, but we need to transition the way we live now to be more inclusive of all people. And having washrooms available, it’s a really good step in the right direction.” 


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