#BTColumn – Easing the nightmare

Disclaimer: The views and opinions expressed by this author are their own and do not represent the official position of the Barbados TODAY Inc.

by April Clarke

Understandably, it was never reasonable to expect that a national vaccination exercise of this magnitude would be executed “without a hitch”. However, if the complaints voiced loudly from various quarters over the past weeks are any indication, there are several kinks which remain to be ironed out both to the advantage of weary healthcare workers and an irate public. Having had the unfortunate, yet character-building experience of waiting seven hours to have my 70-plus-year-old mother inoculated at the Globe Drive-In on Saturday, February 27, I spent much of that night contemplating ways in which this and the polyclinic experiences could possibly be improved.

Appointment? What Appointment?

Perhaps the source of the most frustration is the system put in place for elderly and chronically ill individuals to submit their information via e-mail or WhatsApp in order to receive an appointment to be vaccinated at one of the polyclinics or other inoculation sites across the island. This so-called registration process leaves much to be desired, as many persons dutifully followed the instructions given and weeks later are still waiting for any kind of follow-up or useful response. This radio silence is what then drives people to take matters into their own hands and try their luck by just showing up and waiting to be seen.

Maybe the automated response which registrants receive upon submitting their details can be updated to include some indication of an honest and realistic timeframe during which persons can expect to be contacted; whether it is one week or one month.

In this way, registrants’ expectations are better managed; the department or team responsible for categorising the data is not bombarded with resubmission of the same information and can dedicate their efforts to speedily allocating persons according to their conditions; and polyclinic personnel are not faced with large numbers of angry patrons who all cannot be accommodated in a day.

Another suggestion in this regard is to do away with appointments by time and simply instruct those vulnerable persons to report to the appropriate location between the hours of “x” and “y” in order to be vaccinated.

It is my belief that persons may be more amenable to waiting once there is the assurance of being seen in the order in which they arrived and the “cut-off” time is made clear, as opposed to being given an appointment for a specific time which is then delayed for hours. This requires some measure of planning and assessment of available resources (both human and otherwise) at each clinic to determine how many persons can be accommodated in a day before the scheduled closing time, taking into consideration lunch breaks and availability of relief staff. Polyclinics would then communicate their respective capacities to the appointments team, who would in turn allot a specific number of people each day at every clinic.

Enforceable criteria

Another loophole is that of identification; not the verification of one’s personal identity, but the validation that s/he is a member of any one of the groups who have been earmarked to receive the vaccine in the first phase, especially since the appointment system only seems to be for the ill and elderly at this stage.

Many businesses have issued letters as proof of employment for their staff members to present at the clinics, either in the absence of or in addition to their company-issued ID cards and/or emergency passes issued by the Ministry of Innovation and Smart Technology.

Yet, the majority of reports have been that they are not asked to present any of these documents to the medical or clerical personnel on location charged with taking their information. This lack of monitoring and enforcement allows for abuse of the system, thus taking valuable slots away from those who need them the most.

A few ways in which this challenge could be better managed and mitigated are:

• Actively and diligently check patrons’ IDs and other relevant documents upon arrival at the clinics. This could be the task of the security officers or receptionists, but requires an understanding of the categories of workers that constitute the essential services.
Staff IDs or signed and stamped letters from the respective businesses could be accepted but must be shown before being allowed to register.

• In the cases of persons who are not visibly sick but do suffer from chronic non-communicable diseases, a note from their primary healthcare providers or medication showing a prescription filled within the last six or nine months must be shown, in order to guard against those who may have submitted dishonest information simply to get an appointment.

The harsh reality is that robust enforcement of such requirements means that some persons will be turned away. However, if these measures are maintained consistently and impartially as a matter of standard protocol across all vaccination centres, then the message will be sent clearly that persons who are not authorised to receive the vaccine at this time will not be served and should not waste their time trying to “jump the queue”.

Drive-In debacle

The use of the Globe Drive-In as a vaccination centre was a great move, as it allowed elderly persons and those with health and mobility challenges to remain seated in the (relative) comfort of a vehicle, without the usual crowding and exposure to others. The members of the Barbados Defence Force who were on duty that day must be lauded for their patience and high spirits. Two female officers in particular made genuine efforts to engage with patrons as much as was practicable while keeping order.

The medical team, led by Dr. Elizabeth Ferdinand, was courteous and professional in their interactions with the public despite being visibly exhausted and under pressure by the time we inched closer to the gate at minutes to five in the evening.

Nonetheless, having joined the line of traffic just after 11 a.m., a wait time almost equivalent to an entire working day is unconscionable and lends itself to other types of discomfort, including psychological and physiological. Had it not been for a well-thought-out supply of water and snacks, my mother might not have had the inclination to endure such a wait. Therefore, I can only imagine that it was a test of willpower for many other people in her position that day.

The following recommendations could be considered as ways to streamline this exercise and hopefully shorten the length of time taken to move through the process:

• Once again, clear communication and enforcement of criteria is paramount. If the drive-in is meant to cater only to a specific subset of the population, then people who do not meet the relevant requirements should not be allowed to receive vaccinations

at this site.

• Documentation and/or appointment checks at the point of entry. Similar to my suggestion in respect of the polyclinics, persons en route to the drive-in should be required to show that either they or their passengers are authorised to be there. Because of the creation of three lanes along the rugged path leading to the drive-in after turning off of the main road (two lanes to enter and one to exit) it may be difficult to have someone stationed there to verify information. Thus, this check and balance may have to occur before entry to the vaccination area. Persons who do not meet the requirements would have to leave the venue; their “punishment” inherent in the time spent in the line of traffic only to leave unvaccinated. All it takes is for a few persons to fairly be made an example of for others to think twice before following suit and slowing down the process.

• At least two persons – one for each lane of entry traffic – are needed to even attempt to enter patient data into the computer system as quickly as the cards are being brought to them. Upon making it past the gate, it was another hour long wait from when a physician came to the car and recorded my mother’s information on the vaccination card, to when the card was returned to her as we passed what would normally be the pay window.

• Instead of having persons exit their vehicles to enter either one of the two vaccination tents, fully utilise the vast space and have a few attendants direct drivers to designated spaces and administer the shots to each person while still in their cars.

This may require extra manpower and resources to prepare enough syringes at a time, but perhaps student or retired nurses can be engaged on a volunteer basis for this purpose. After the advised 15-20 minute observation period, cars would be directed to leave in an orderly fashion.

• Finally, if this site is to continue being used for this purpose for the foreseeable future, it is critical that temporary lighting structures be assembled for the safety and comfort of the medical personnel after nightfall, who were forced to rely on their mobile phone flashlights to locate cars and return completed vaccination cards to patrons. If this cannot be done, then an earlier cut-off time must be established so that they are not forced to complete such important work in the dark.

What becomes apparent throughout the vaccination initiative in its entirety is that there is a desperate need for a centralised the information submitted by registrants and efficiently communicates with each vaccination point in real time. This would equip each location with an up-to-date listing of appointment holders, thereby making the task of verification and – by extension – crowd management exponentially easier. I am sure that there are many university students and others who would gladly volunteer to provide the necessary staffing in this regard.

Frequent post-mortems and evaluations across all locations must form part of an exercise such as this in order to identify shortcomings and come up with solutions in an iterative way. It is my sincere hope that the suggestions made here at the very least spark earnest thought and discussion amongst the powers that be to formulate and implement even better ideas with the ultimate aim of making this vaccination drive successful not only in terms of numbers, but also the overall experience of everyone involved.

April Clarke is a concerned Barbadian; this column with logistical suggestions was previously offered as a Letter to the Editor.