TDAP IMMUNIZATIONS IN POINT LAY

I packed three boxes of Tdap vaccine (tetanus, diphtheria and aculluar pertussis) into the insulated bag on Thursday morning.  I had learned that these particular vaccines needed to be kept at temperatures ranging from 35 – 46ᵒ F at all times or otherwise they could not be used.  I placed two ice blocks on the bottom of the bag, made a second layer of bubble wrap, a third of refrigerated cold packs, a fourth of the immunizations, and the final layer of cold packs.  A thermometer was calibrated, inserted into a plastic bottle and placed inside the bag to ensure that the vaccines were kept within their required temperature range.  This bag could not leave my sight on the trip to Point Lay where I would be offering Tdap immunizations to adults at the Health Fair that afternoon.  The Public Health Department is working to make sure that an outbreak of pertussis on the North Slope is prevented.  There have been no cases reported since mid October. 

Our support staff at the Wellness Center is as good as any I’ve ever been a part of.  This is the first position I’ve held where I haven’t been support staff, but am on the other side, being reminded that I can ask for help when needed and that it is almost instantaneously provided.  Nellie ran me a due list so I could see the number of people in Point Lay between 18 – 65 years who needed to be updated with Tdap immunizations.  There was an appreciable 33 on the list.  In planning, I thought that if I were able to call ahead that this would ensure that at least some of the people needing boosters would come to the Health Fair and receive one.  Ressie printed out health summaries including telephone numbers for each person on the list, so manned with this information, I settled into two hours of calling.  Many of the numbers were not working or there was no answer, but those I did reach were grateful and said they’d be at the health fair.  I’m told that like any community, I probably wouldn’t see as many as I was hoping for. 

I shared my table at the Health Fair with Aigoul, a young woman from a country near Siberia.  Although she said the name of her country several times, getting her name down seemed more important and that even took a while.  She works for the Samuel Simmons Memorial Hospital in Barrow and was offering screening for colon cancer at the Health Fair.  Because she didn’t foresee this taking up a lot of her time, she offered to do my blood pressure screening.  I focused on giving Tdap immunizations, educating about pertussis, encouraging young people to take brochures about sexually transmitted diseases and talking with young parents about the importance of immunizing their children. 

I was happy that eight people came by for their Tdap boosters and with each one felt more confident.  As a relatively new nurse, I had given less than 30 shots so far and was still in the process of perfecting my poke.  Watching the other nurses in Barrow, I could see that they used the needle more as a dart while I was slower and cautious, probably if not certainly, prolonging my clients’ discomfort.  I was using the dart-like method today and could see where it was more effective…just in, inject the vaccine and out all in quick and fluid succession. 

We’re using retractable 1” needles, so there is no danger of poking oneself after the shot.  This vaccine is given in the deltoid muscle and because the tetanus vaccine can cause one’s arm to be sore for a day or two, I recommended giving them in people’s non-predominant arm.  It makes recording the site of administration for each person easier as well as most are right handed. 

Necessary paperwork included questions regarding allergies to food or medications, recent immunizations, present state of health, nervous system disorders, pregnancy, etc.  I provided a VIS containing much information about the vaccine as well as reactions that might be experienced.  I enjoyed my interactions with each person and congratulated them on helping to protect themselves and the community. 

One young man sat down and talked about wanting to be immunized, but that he had a longstanding fear of needles.  We talked about the benefits of being immunized as opposed to the short discomfort of receiving a shot, but he said he just didn’t think he could do it.  He came back close to the time I began packing up, saying that he was still thinking about being immunized.  He had brought a friend with him for moral support and shared with both of us that the last time he’d received a shot, it took eight people to hold him down.  His friend bolstered his confidence by saying, “don’t worry, William…Susi is very seasoned at giving shots…she’s a pro.  You have nothing to worry about.”  This didn’t bolster my confidence, but I’ve learned over the years that blanking out any sense of fear and proceeding directly through it gets me, most times, safely and successfully, to the other side.  I was reluctant to draw the vaccine up into the needle with William sitting in front of me, wondering if he might change his mind, but with some distraction from his friend, we were all set for the big moment.  I smiled at William who was hanging onto his friend’s hand, rubbed alcohol on his arm and told him how impressed I was with his bravery…I really was.  Just a quick dart later and William was passed out on the floor.  Just kidding…he did very well, seemed very happy to have overcome his fear and to have done his part to help prevent the spread of pertussis.

I returned to the Wellness Center after returning to Barrow, unloaded the vaccines and put them safely back into the refrigerator.  Because the thermometer wasn’t packed tightly enough in and against the vaccines and cold packs, I was concerned that its readings weren’t consistently within the required temperature range.  I was sure that the vaccines had been secure within the layers of cold packs though, so knew that they hadn’t been damaged.  It was interesting watching Bertrand plug the thermometer into the USB port on his computer Friday morning and download a graph with the temperatures as well as the humidity level in the immunization bag since my leaving until this download.  We talked about how my throwing in several more cooler packs next time would give an accurate measure of the temperature of the vaccines.  I’m learning.