Did you know that we celebrate “World Immunization Day” on the tenth of November every year?
We at BeingTheDoctor have covered a number of articles on vaccines, their schedule and special programmes to promote immunization. You can find those informative articles here.
In this post, I’ll tell you the activities that goes behind the scene on a particular day of a field level immunization programme. To make things easier to understand, the post is described in the form of a time-line.
9.00 AM
I reach the OPD and start the consultations together with the second doctor. The field staff who are supposed to attend the immunization session also reach the PHC by the time we start the consultation. On some occassions, when one doctor is on leave or when the medical officer has to attend meetings or trainings, we have to arrange for a duty doctor from the neighbouring PHC or CHC. This is mandatory because without a doctor, the field staff are not authorised to conduct an immunization session.
The field staff (JPHN and JHI) then collects the vaccines from the ice lined refrigerator and store them in vaccine carriers. Ice packs are collected from the PHC’s deep freezer and stored in cold boxes. All these steps are done in order to maintain the cold chain.
Cold chain is a system of storage and transport of vaccines in order to maintain the potency and efficacy of vaccines. To learn more about cold chain, please follow this link.
9:30 AM
The driver from the higher centre, a Taluk hospital in our case reaches the PHC with the department vehicle. None of the PHCs in Kerala have their own vehicle and hence the same facility is provided by the immediate higher level of health centre.
In case the department vehicle is not available for a particular day, we have to hire a private taxi to conduct the immunization session. I don’t need to mention the requirement of a vehicle for a field level programme, right?
Seven out of 10 times the department vehicles are not available for a PHC’s field immunization. Special immunization programmes like “Immune-Walk” and “Mission Indradanush” are mostly conducted with hired vehicles. The fund for such vehicle hiring is provided to every health centre by NHM.
9:40 AM
The field staff including 2 JPHNs, one JHI, PHN, HI and the doctor board the vehicle with all the vaccines, ice packs, and other supplies needed for the immunization. The other stuff mostly consists of syringes, sterile cotton, surgical spirit, needle hub cutter, hypochlorite solution,emergency(AEFI) kit, waste bags, immunization registers, immunization cards and some IEC materials.
For special programmes like Mission Indradanush, MR Campaign banners and posters are also carried with the health team to the immunization site.
10:00 AM
We reach the first immunization site which is mostly an Anganwadi. In some areas where anganwadis are not functioning, clubs or libraries are chosen as the site for delivering the vaccines. For fixed outreach immunization sessions, the chosen sites are permanent. But, this is not the case when we conduct special immunization programmes like immune walk and mission indradanush, the sites are temporary and are changed according to the number of children who are eligible for vaccination. We have conducted vaccine administration even at some houses.
ASHA workers and anganwadi teachers are supposed to keep the immunization site ready for vaccine administration. The site has to be clean, dust and dirt free with good lighting and ventilation. ASHAs and anganwadi teachers have an additional responsibility of mobilising mothers with their children and pregnant women to attend the immunization site. They should actually hand over a rough list of vaccine beneficiaries (children and pregnant women) to the concerned JPHN at the site.
One or two tables are cleaned and laid down with the vaccine carriers, new vials of vaccines and ice packs. An area to wash the hands is also made ready before starting the session. Care is taken to administer the vaccine under the strictest aseptic conditions and all the multi purpose health workers are given appropriate instructions according to the available conditions.
I’ve seen the ASHA workers and JPHNs calling the mothers to hurry up and reach the immunization site within time for vaccinating their young babies.
The JHI or the HI sits at the registration table with the immunization register. It’s their job to educate mothers and parents about the vaccines, probable side effects and next scheduled vaccination day. Immunization cards are issued and marked by the JHI at the registration table.
10:15 AM
Everything is set and we’re ready to start the vaccinations. Mothers with babies are invited into the room after registration. Information about the different vaccines are given to the mothers by the JPHN before vaccination.
Then they are sent to the doctor’s table where the doctor examines the baby, enquires about any illness like fever, cold, history of seizures. After a quick physical examination and ruling out any potential contraindications of vaccinations, the doctor writes down the details of the vaccines to be given.
Mothers are given clear instructions on how to properly hold the baby while vaccinating. A small area for breast-feeding is also arranged and used when required. Vitamin A supplements are given first, followed by sub-cutaneous injections. Intra-muscular injections which are the most painful ones are administered as the last injection.
Mothers are then educated about potential adverse effects following immunization (AEFI) and paracetamol drops or tablets are supplied and dosages are explained clearly. Every baby or child is kept under observation for at least 15 minutes before they are sent home. Information about the next scheduled vaccination date is also given to the parents.
11:30 AM
Twenty to thirty babies are vaccinated in an hour approximately. The vaccination site is usually filled with the cries of babies and children along with the soothing voices of parents and health staff. There’s usually a tea break for 10 minutes at the end of the first session.
As we leave the first site, notes on the vaccination programme are entered in the “visitor’s book”. A list of children who had not shown up at the site is also collected. Final phone calls are done to find out if any more parents are on their way to the site or not.
Used vials of vaccines, cotton balls, destroyed needles and syringes and other wastes are properly classified and carried back to the PHC from the vaccination site.
11:45 AM
We reach the second vaccination site and the same routine follows here too. The programme is continued till the very last child or baby is sent home after the 15 minutes mandatory observation time. It usually ends by 1:30 PM.
2:00 PM
We reach the PHC where all the bio-waste are disposed off properly. Some vaccines (DPT, pentavalent, TT) are stored even if the vials were opened at the vaccination site. There’s something called as the “open vial policy” for using certain vaccines which will be explained in another post. Vaccines like BCG, Measles, MR and MMR are usually not stored if the vial has been open for more than 2 hours.
Data regarding that particular day’s vaccination programme are entered in the online portal by the concerned JPHNs. It’s known as the “mother and child tracking system” or MCTS which is a fully fledged web based application developed and run by the ministry of health, government of India.
Well, that’s it. Do you have any more questions on this topic? Simply use the comments section below and I’ll get back to you as soon as possible.
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