Vaccination on Wheels- Take It to the Streets

State: ND Type: Model Practice Year: 2009

Twenty-seven refugee children received 93 vaccinations and protection against 12 vaccine-preventable diseases. The refugee children were able to attend childcare and start school on time. The identified barriers to vaccination were eliminated. By entering the children’s immunization histories in the North Dakota Immunization Information System, the children now can receive accurate and timely follow-up vaccination services from any provider in North Dakota. Collaborative efforts by the project’s partners displayed community commitment to the refugee population.
Each year, Grand Forks serves as a resettlement site for approximately 100 refugees from various countries such as Bhutan, Burundi, Iraq, and Somalia. They arrive with no financial resources, no health insurance, no means of transportation, limited or no English skills, and incomplete vaccination histories. Our medical system is foreign to them. As our refugee population increases, the demand for medical services increases, often overwhelming the local healthcare system. To become a resettlement site, one of the criteria a community must be able to provide is medical services to its refugee population. After one year of residency, most refugees want to apply for their Green Card, which gives them permanent residency status. The Green Card enables them to apply for better jobs and obtain a permanent driver’s license, thus empowering them to give back to their new home/community. It is a stepping stone to United States citizenship. Vaccination on Wheels provides the leadership, format, and buy-in for addressing other refugee health issues as well. Mobile Health Clinics are not a new concept. But, taking a vacant FEMA trailer and converting it into a Vaccination Clinic on Wheels is a novel idea and good use of existing resources. In the past, individual refugee families presented at various agencies requesting physicals, lab work, vaccinations, and general healthcare. Language, transportation, time, and cost produced a hardship for refugee families seeking services. Language, time, and reimbursement issues have been a burden on individual agencies. Vaccination on Wheels takes the healthcare service to the target population rather than the target population trying to access services at public and private healthcare agencies.
Agency Community RolesGrand Forks Public Health Department brought the community partners to the table. The department played a leadership role in planning and implementation of Vaccination on Wheels. The department will provide follow-up vaccination services for refugee families. New American Services identified refugee children needing vaccination. The Grand Forks Refugee Coalition provided the volunteers and translators who assisted parents with understanding forms and giving consent for vaccinations. They accompanied the children to and from the mobile clinic. They provided incentives, comfort, and support to the vaccinated children and their anxious parents waiting outside. The Grand Forks Police Department donated the vacant FEMA trailer and transported it back and forth from the clinic site. Grand Forks School Nurses will monitor the refugee children’s compliance with North Dakota School Immunization Requirements. A Grand Forks Public Health staff nurse is a New American Services Advisory Board Member, a member of the Grand Forks Refugee Coaliton, and plays an active role in medical case management of refugee families. These activities foster good working relationships with our community partners. Involving all partners from the beginning of the project yields greater buy-in. Having media coverage of the event and giving recognition to all partners involved enhances our community partnerships. Nominating community partners for various service awards demonstrates the community’s appreciation of their efforts. Novel ideas generate better buy-in from community partners. Costs and ExpendituresThere was no cost for this activity. All community partners provided staff and materials in-kind. ImplementationGrand Forks Refugee Coalition volunteers were familiar with the refugee families and already had a relationship with them. Involving these volunteers in bringing vaccination information to the families created an atmosphere of trust. Working with the volunteers the evening of Vaccination on Wheels extended that atmosphere of trust to public health. Interpreters eliminated the language barriers and the mobile clinic eliminated the need for transportation. The clinic day and time was based on refugee family and public health staff and coalition volunteer availability. Data entry into the statewide immunization registry made for ease of follow-up with accurate and timely vaccinations. Vaccination of 27 children ranging in age from 2 through 18 years with 93 vaccines has resulted in zero vaccine-prevetable diseases reported. New American Services provided the medical histories for children who were behind with their vaccinations. Grand Forks Public Health nursing staff reviewed and assessed the refugee children’s immunization history. Administrative staff entered vaccination histories into the North Dakota Immunization Information System. A Registration Form and Vaccine Administration Record (consent form) was generated for each child. Education and training was provided to volunteers and translators. Volunteers and translators took appropriate forms to parents in their apartments for review and consent. Nursing staff secured and prepared a FEMA trailer for use as a mobile vaccination clinic. The scheduled vaccination clinic lasted two hours, with set-up and take-down an additional two hours.
Using volunteers who were familiar with the refugee families created a trusting atmosphere. Vaccination on Wheels became a Refugee Family Event with parents and children socializing outside the mobile clinic. The FEMA trailer was provided by the police department. The only marking on the mobile clinic was a Grand Forks Public Health Department Banner. Police staff and emblems were not visible during the clinic to avoid any negative connections refugee families may have had in their war-torn countries.
The community continues to receive refugee families. Accessing healthcare services continues to be an issue. Vaccination on Wheels accomplished all its objectives. In addition, the clinic relieved the burden on community healthcare agencies and the entire activity was funded in-kind. The clinic serves as a model practice for addressing other refugee healthcare issues. Community Partners have now collaborated in providing medical services at after-hour clinics for refugee families. Participating in successful activities yields sustained buy-in. Vaccination on Wheels is available anytime there is a need to vaccinate a large number of individuals. The mobile clinic has its own generator, which eliminated clinic location as a barrier. The concept can be applied to different healthcare issues and other target populations. Vaccination on Wheels is available to “Take It to the Street” whenever the community identifies the need.