Karen Miller’s week started a little earlier than planned when an automatic call came in: the clinic went out of electricity.
At least it was about seven in the morning and at the Englewood Clinic, where she had already planned to work that day. In her 14 years with the Three County Health Department, she called at 11:00 pm and 3:00 am, some of them on the other side of the department grounds.
However, time was ticking: the vaccines remained at the correct temperature for two hours, but if the power outage continued, she and everyone else who was in stock would need to start packing the refrigerators.
“This is when we have to start making some decisions,” she said Monday morning in October, shortly before the electronics in her office came back to life, about an hour and 15 minutes after the shutdown. The crisis was averted, but the fires had to be extinguished: Wi-Fi and the printer were still not working, and the first patient was supposed to arrive in 15 minutes.
Miller, Nurse Immunization Program Manager for the Three Counties County Health Department, oversees the department’s five clinics that offer vaccinations in Adams, Arapaho, and Douglas counties and helps the team coordinate COVID-19 vaccination implementation and messaging. Douglas County has formed its own Health Council to avoid Three County Public Health orders related to the virus, but the Department of Health still operates vaccination clinics there.
On that day, Miller worked with nurse Hannah Kundert, who began work in May and completed most of her training, but still needed to re-check how to handle patients who were not adhering to their usual vaccination schedule.
While observing vaccinations may seem straightforward to those of us who primarily remember our vaccinations as short-term pain followed by a cartoon-style patch and perhaps a lollipop if we were brave, it is not at all.
Doses must be stored at different temperatures. Some end up in the muscles, some in the fat under the skin. And heaven will help you if you give the dose that is meant for uninsured children to someone with private insurance, or vice versa – it doesn’t hurt the patient, but you just bought yourself a paperwork nightmare.
Given all the complexities, it could be months for a new nurse to be comfortable working alone and had more interns than usual. No one left the immunization program two years before the pandemic, Miller said, but five have left since then: two to move closer to their families, and three for other public health jobs in Colorado. They also had to hire 45 temporary clinical and clerical workers, she said, first to assist with contact tracing and then to distribute COVID-19 vaccines.
Englewood Clinic has two vaccination stations that look like converted booths with screens through which they can be closed for privacy. It’s a relatively Spartan space, aside from two Van Gogh-style paintings on mustard-colored walls, although stickers and snack trays suggest that the main clientele is young.
After Miller and Kundert vaccinated five children and two adults together, there was a brief lull that Miller used to answer a few email questions about boosters and set a time for the state health department to pick up stored doses of Moderna COVID-19. in the Three County warehouse. Downtime in October, when schools notify parents that images of their children are pending, are unusual, Miller said.
“This is usually a very busy time of year for us, and it’s strange that we are on hiatus right now,” she said.
The break was short; Shortly thereafter, an elderly couple arrived to get their shingles shots, and Kundert called an interpreter’s line to convey possible side effects in Mandarin Chinese. After getting them vaccinated and wishing them a good day, Kundert joked that the clinic had examined the entire spectrum of patients that morning, with the exception of a baby or someone who had been vaccinated in another language.
Less than 20 minutes later, mother and son entered. The boy’s notes were spread out on several sheets of paper, some in English and some in Spanish. He had a lot to knock out that day, judging by the English-language entries, but after Miller and Kundert translated the articles and cross-referenced, he got away with only two: one from measles, mumps and rubella, and one from winter. flu shot.
According to Miller, most people end up in the health department after something goes wrong: they’ve lost their jobs and insurance, or life has become difficult and their children have fallen behind vaccinations, creating problems for the school. Sometimes it’s as simple as if their pediatrician ran out of doses that the federal government provides and sent them to a place where eligible children could be vaccinated for free.
“We’re kind of a last resort for them,” she said.