BACK IN BARROW…IN NEED OF ONE SIGNATURE AND THE FLU CLINICS

I learned when returning to the clinic in Barrow on Friday that my vacation request for two weeks in late March and early April is just one signature away from approval.  I can hardly wait to see Lisa, Josh, Jordan, Keira, Peter and Emily again along with many good friends.  I imagine spring flowers may be pushing their way up and that I’ll have a chance to take some long bike rides.  Lisa tells me that Jordan is making plans for my visit and I’m thrilled thinking about the fun we’ll have.  Lisa and Josh might take advantage of my coming and have a much-needed weekend away…so fun to think about contributing in this way again and spending quality time with them as well.  I’ll make a trip to Bellingham and spend several long and happy days there with Peter and Emily and their children, Ruby, a pit bull and Bobby, an American bull dog…it’s important for grandparents to be impartial and these two grand dogs are adorable.

I really enjoyed being back in the clinic on Friday after returning from Anchorage.  We held a flu clinic all day, so I gave many shots to children of all ages as well as to adults.  We pulled from four different stocks of vaccine, the 0.25 ml pediatric prefilled syringe for infants and toddlers from 6 through 35 months, 0.5 ml from a multi-dose FluZone for those between 36 months and 47 months, 0.5 ml of a different fund sourced multi-dose vial stock for people 4 to 18 years, intradermal prefilled syringes for people ages 19-64, and from a multi dose, high dose vial for those 65 and over.  When giving flu shots to children under 9 years of age, it’s important to look at the 2012-2013 CDC algorithm for flu vaccinations to determine if one dose will be sufficient or if a second dose is needed after four weeks.  Bertrand, Michelle and I all agreed that it was important to focus when choosing the vaccines and drawing them up, especially when we were in the med room at the same time.  It’s tempting to talk, but there was too big of a chance for error with so many things to consider.  Many of our clients were parents with multiple children of varying ages, so it wasn’t uncommon to be pulling, recording and drawing up from three different stocks of vaccine before returning to the exam room to administer. 

I love working with the parents and their children.  It’s gratifying to see an initially sulking or frightened child become visibly relaxed by asking them questions about themselves, exclaiming about how tall they are, how brave they are to have come in or what a good big brother or sister they seem to be.  I usually  give each child a sticker or a toy to play with while I draw up the vaccines in the med room, also helping to make early inroads in gaining their trust.  We administer shots in children’s thighs until they are five years old and the help of the parent is enlisted who holds both of their child’s legs between theirs and wraps their arms around their child’s upper body to prevent flailing legs and arms.  The shots are given quickly and by the time a colorful band aid is applied, most crying has stopped and attention is given to what sticker they’d like to choose and take home.

When I told one little boy that his shot would feel similar to a mosquito bite and that it would be helpful to think about something that made him very happy, his mother wisely said, “think about having a hot dog and marshmallow roast and there are just some mosquitos flying around.”  This helped tremendously and I used her idea on subsequent clients who all laughed.  The children in one little family all announced that they liked shots and that they were excited to be there.  When I knocked on the exam room after getting their vaccines, true to their initial mind set, they were very happy that I was back.  Their mother said that they were still excited.  I’m not sure what sort of ground work she laid before coming to the clinic, although in serious retrospect I should have asked.  So often, the parents’ attitude toward the immunizations is a large factor in how the child responds.  All of the children on Friday left looking very happy and proud that they had been brave.  And they had all forgiven me for poking them, sometimes twice, if they needed an additional immunization, like Hep A. 

I’m loving this work and am anxious to take the week long Maternal Child Health training in Juneau in early March.  I’ll be doing iLinc web/telephone training every other Friday in preparation, studying and being prepared to answer questions along with the other participants.  There is much to cover--it feels good to be getting closer to knowing how to do thorough well child and maternal postpartum checks.  I’ve done my first PKU on a two week old infant, so have been checked off and will continue to do them.  It worked out well the week before last to step in and do one as Bertrand was detained in the bathroom with a very upset two year old.  I had the easier of the two jobs and we both empathized with the young mother because there seemed to be quite a bit of high energy attention-getting behavior by the displaced two year old with a new sibling in the house.  Part of our work is educating parents on strategies to overcome these sorts of things, but this little guy had more energy than the other three of us put together.  Will be keeping him and his family in my prayers.

I assisted nurses from the hospital who were doing a flu clinic last Friday night in the lobby of the grocery store.  My only reservation was that the needles that the hospital had supplied them with were either 1 ½ inch large bore or 5/8 inch needles.  The large needles were too large to administer shots without a great deal of resistance when entering the skin and the small ones might not deliver the vaccine to an effective depth.  Reluctantly, I chose the larger needles and found myself trying to hide my wince each time I poked an arm and pushed through the skin to deliver the vaccine, but of course, not the full 1 ½ inches, not wanting to strike bone.  A fair amount of wincing was taking place on the other end of the needle, understandably, as well.  I decided to bring my own stock of 1 inch retractable needles if I assist again.  

Michelle and Bertrand chuckled at my description of how things went saying that they always bring their own needles when assisting too.  I was one question shy of gaining this information before leaving the clinic and going to the store to assist.  I think next time I’ll ask if there’s anything else that I might want to know.

I thoroughly enjoyed interacting with a different group of people than I normally do in my work with children.  Middle aged men and women came to the flu clinic in response to the influenza epidemic publicized in the news, anxious to receive immunizations.  It was delightful meeting the ones I helped and I loved seeing their interactions with each other.  The Inupiat people are very bright and have delightful senses of humor, teasing each other good-naturedly and most often finding something to laugh about.  They all sincerely thanked us for being there.  I had arrived at the store close to 4 pm feeling somewhat tired and left filled with energy when it ended at 7 pm.  What a fun experience.  Obviously more important than my observations and enjoyment is that close to 80 people received flu vaccinations, helping to curb the spread of influenza here in Barrow.