America's North Shore Journal

On Thurs­day, Novem­ber 19, and Sat­ur­day, Novem­ber 21, 2009, I spent about five hours each day work­ing as a vol­un­teer at a vac­ci­na­tion clinic run by the Mon­roe County Pub­lic Health Depart­ment (DPH). It was one of five each day held to vac­ci­nate at risk groups for pan­demic H1N1, the Swine Flu. I worked at the one held at the for­mer Med­ley Cen­ter Mall in Irondequoit.

The DPH did a great job pub­li­ciz­ing the clin­ics, with the coop­er­a­tion of the local media. Atten­dance on Thurs­day was some­what over­whelm­ing, while that on Sat­ur­day was more even in flow.

The DPH con­tracted with pri­vate com­pa­nies for the actual vac­cine admin­is­tra­tion. DPH per­son­nel and vol­un­teers were used for crowd control.

The obser­va­tions in this piece apply only to the loca­tion I worked at, unless oth­er­wise stated.

The Mall is empty. That meant no heat either day, and some­what uneven hall­way light­ing. It also meant sparse san­i­tary facil­i­ties, and the men's room had been dam­aged by van­dal­ism prior to the clinic. In fact, it was flooded on Sat­ur­day. The Iron­d­e­quoit Kiwa­nis had cof­fee and donuts ear­lier on Thurs­day and through about 2 on Sat­ur­day. There were no other sources for food and drink in the Mall.

On Thurs­day, there were four to six peo­ple giv­ing the vac­cines at any one time. The pri­vate con­trac­tors made sure that they got all their breaks in. In the late after­noon there were some 400 peo­ple in line, and a four hour wait. I was told by DPH staff that the holdup was that the providers were hav­ing to answered ques­tions. While that may have been the case, it was clear that there were far too few providers for the demand.

Just before 5 p.m. we were told to refuse entry to any addi­tional patients, even though the clinic had been adver­tised as open until 8 p.m. Most peo­ple took the news with some grace, though sev­eral self-important indi­vid­u­als chose to cre­ate a problem.

I had begun work at 2:30. Through­out the after­noon it was obvi­ous that the five clin­ics did not seem to be talk­ing to each other. We were get­ting news from patients who had been turned away from other clin­ics and came to the Mall. We were not the first clinic to close its doors, as far as I can determine.

On Sat­ur­day, some changes had been made. There were now about eight to ten providers, and a sep­a­rate line for peo­ple with chil­dren. We were given hand­outs to pro­vide patients that would answer many of the com­mon questions.

We closed at six on the dot. Dur­ing the time I was work­ing, there were no lines beyond the clinic area, and the only real wait was in the children's line in the clinic, per­haps 15 minutes.

Both days, we took patients with move­ment or other issues straight to the clinic, about 50 yards from the Mall entrance, rather than ask them to make the much longer trek around to the clinic entrance. Even then, the dis­tance was a lit­tle daunt­ing for some.

Sig­nage was poor. There were two man­u­fac­tured signs, one that said "Clinic here" and another that gave the tar­get groups for the clinic. The remain­ing signs were made on a com­puter, did not last well in the rain on Thurs­day and did not look at all professional.

We had no hand­outs on Thurs­day and ran out of the hand­outs on Saturday.

Far too many adults over 65 came. Whether they thought it was the sea­sonal flu vac­ci­na­tion or not, I do not know. The clinic was not intended for them and those doses could have gone to more at-risk pop­u­la­tions. The only peo­ple turned away had valid med­ical rea­sons for the denial, such as an allergy to eggs or being ill with a fever.

On Thurs­day, the clinic closed before the hour adver­tised. There seemed to be no inter­est on the part of the DPH staff in con­tin­u­ing to give vac­ci­na­tions while they had demand.

The Mon­roe County DPH has about 239 employ­ees. It would seem log­i­cal that the depart­ment would be able to staff these clin­ics with­out vol­un­teers from other county depart­ments and from the pub­lic. In fact, other depart­ments did have vol­un­teers there, and those county employ­ees will receive comp time for the hours that they worked past their nor­mal quit­ting time.

Most of the pub­lic prob­a­bly is not aware that clin­ics like this have been planned and dis­cussed for years, as the poten­tial for bioter­ror­ism arose. A great deal of time and effort has been devoted to the prob­lem of dis­pens­ing vac­ci­na­tions to a large pop­u­la­tion in a short period of time. Sites have been selected, and plans made. I can­not deter­mine if the clinic I par­tic­i­pated in was the result of this plan­ning. If so, a lot of peo­ple wasted their time in the last seven years.

Why was it nec­es­sary to use con­trac­tors to give the vac­ci­na­tions? The DPH employs many peo­ple with the train­ing and qual­i­fi­ca­tions to give injec­tions. They also have, in their plans for this even­tu­al­ity, other groups of peo­ple they could have called upon, such as para­medics or hos­pi­tal staffs.

Why were vol­un­teers needed? The DPH had a cou­ple hun­dred employ­ees at work on Thurs­day who could have worked at a clinic. Those same employ­ees could have been used on Sat­ur­day, as well. If it was all about over­time pay or union con­tracts, then just how would the clin­ics have worked if small­pox had been used in a ter­ror­ist attack as all of those folks planned for?

Thurs­day was cold and rainy. Sat­ur­day was cold. I kinda resent being cold and wet while DPH sec­re­taries sat in warm offices and surfed the Web. If the depart­ment charged with pre­serv­ing and pro­tect­ing pub­lic health in Mon­roe County can­not gen­er­ate an "all hands" response for a project like the Swine Flu vac­cine clin­ics, I have to won­der just what they would do in a more seri­ous situation.

The Iron­d­e­quoit clinic vac­ci­nated many, many peo­ple in the hours that I worked. In that respect, it achieved its goals. More clin­ics are being dis­cussed for December.

For the future clin­ics to be suc­cess­ful, there must be:

• More com­mu­ni­ca­tion among the sites
• Site loca­tions suit­able for large crowds, to include heat, light­ing, bath­rooms and refreshments
• More com­mu­ni­ca­tion with the media, espe­cially when it comes to clos­ing sites early
• Pro­fes­sional sig­nage — it can be reused
• a per­cep­tion that the Mon­roe County Depart­ment of Pub­lic Health, as an orga­ni­za­tion, takes the mat­ter seriously