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Elizabeth made her first carrot cake (with help from mommy) last Saturday.  Her favourite part was softening the cream cheese....


   



Elizabeth is eight months old today!  At eight months, she is a very, very busy girl.  She now holds her hands up when she wants "up" or "out" (of the exersaucer) and spends a significant amount of time climbing on things. 

 

She's very frustrated by her inability to stand unassisted, but is practising at every chance she gets.  Unfortunately this means we have to be quite vigilant in watching her because she'll stand up, let go of whatever it is she used to pull herself up and then gravity takes over...

 

No longer can we let her crawl around the bathroom by herself during our own showers as she tries to join in.  After an unfortunate toilet seat licking incident, mom and dad daren't let her prop herself up against the toilet...

 

Preparing meals is more difficult too.  When she's not propelling herself towards the shiny metal strip that edges the step in the kitchen, she's eating your slippers or grabbing your leg.  We do have a playpen in the kitchen, but for some reason Elizabeth screams and screams when placed there.



   



If you've read the news today, you may have gotten the impression that the slow lines are caused by a lack of nurses or maybe pesky flu shot receivers who ask too many questions.  After my first-hand experience getting the H1N1 flu shot at Tom Brown Arena yesterday, I think that while more nurses will certainly help, the real culprit is a total lack of organizational planning and/or ability.

 

They did improve how they worked as they went along yesterday (getting people to pull numbers, allowing them to fill out the form in advance) and it sounds like they have made some improvements since yesterday (Tom Brown arena has a shelter setup and they've hired more nurses), but the speed through the line could be further increased with some simple improvements.  I wonder how many people got sick from all the standing around in the cold!

 

1) Publish the information printed on the back of the form on the City of Ottawa website.  Better yet, get people to download the form and fill it out at home before they come.  That would also give the city an idea of how many people to expect.  Updated: the City is doing this now! Download the form here http://ottawa.ca/residents/health/conditions/swine_influenza/h1n1_consent_en.pdf

2) Put the complete list of questions the nurses ask on the form so that people are ready for them.  The list should be consistent.  We weren't sure whether they were asking the same question in different words because they were trying to trick us or because they were disorganized...  A number of people commented that they were taken aback by being asked whether they were allergic to formaldehyde, not ever having thought about the question before. 

3) If people have to wait outside in the cold, bump the obviously "medically fragile" to the front of the line. 

4) Have a nurse available to field general questions, so that the nurse giving the shot can focus on doing just that.

5) Increase the number of staff registering names.  I observed numerous nurses waiting around with their hands in the air.

6) Once people are registered, have them remove their sweaters and be ready for the shot before their name is called.

7) Have a nurse available in the registered waiting area to run the questions by the people waiting, so that the nurse giving the shot either doesn't have to ask any questions.

8) If the program in use has a search function, the nurses need training on how to use it, as it would be more efficient than having nurses look for a name on the screen.  Ideally, the nurses should be given patients in order so that they aren't having to search or hunt at all though!



   



H1N1 flu shots became available to those of us in the high risk priority group today, and Auntie Janice, myself, Elizabeth and Brendan duly headed out to Tom Brown arena.

 

The plan was for Auntie Janice and myself to receive the shot as we didn't think Brendan was eligible and based on the information I had I was not super comfortable getting the full-strength shot for Elizabeth. We decided to bring her so that she could see that other people get shots too!

 

When we arrived at 5pm, the line looked pretty daunting, snaking out the building and around the parking lot (the photo is from about 5:45pm - by this time we'd actually made it about half way from the end of the line to the door).  We looked at each other.  Did we really want to get the shot now?  Since it takes about ten days to become effective, and since H1N1 is definitely in our community, we decided that the earlier the better.  Furthermore, Auntie Janice didn't have time during the rest of the week to get immunized, so it was either now or next week sometime. We got out of the car.

 

Although the parking lot looked extremely full and there were cars lining the streets around the arena, Brendan found a parking space right next to the line.  This was good, because I'd no sooner gotten into line than Elizabeth needed to be changed.  Janice held my place while I headed to the car for diaper changing supplies.

 

We weren't in the line for more than a few minutes when we discovered some disquieting facts.  First, some people had apparently started lining up at noon.  Secondly, our line had not moved one inch in over half an hour.  Thirdly, the person who was standing at the top of the line outside had been in line since 2:30pm, when the clinic officially opened.  In other words, the line was moving slower than molasses.

 

By 5:30pm, one public health official started going up and down the line to let people know that if they had not made it into the doors by 8:30pm, they would not get a flu shot.  How long is the wait?  People asked.  "We have no idea" he responded, but went on to say that they "only had 15 nurses" and that these needed to have breaks since "we probably didn't want to have someone give us a shot who had been doing nothing else for three hours".  He added they were so busy "the nurses didn't even have time to take bathroom breaks"... Then he went on to comment that he'd "called his wife and kids and told them not to bother coming for the next two weeks. That's how long it will take for the lines to get under control." I'm not sure that his goal was to encourage people to leave, but certainly a number of people did!  This caused the line to advance rapidly, so we decided to stay.  Not that many people arrived for their shots after about 6:00pm.  We're not sure whether this was because of the negative news coverage, but suspect so. 

 

Night fell, and the temperature plummeted. We continued to stand in line outdoors.  By 6:15pm Elizabeth was getting cold and hungry, so I took her to the car to warm up.  While we were there I heard the 6:30pm news, which told people to "please stay home" since facilities were completely overwhelmed.  Dr. Isra Levy, Ottawa's medical officer of health was on the radio smugly telling the city that "our surveys have shown that there would be a lot of interest", so he wasn't surprised by the turnout.  People around us in line were rather outraged to hear this!  We spent quite a bit of time amusing ourselves with math problems.  "If there are 15 nurses giving injections at a rate of 15 minutes per person, how many people can they vaccinate?"  "Now, what if at any given time three of the nurses are taking a break?"  (Based on our calculations, it will be pretty challenging to hit the 10,000 to 12,000 person per day target!)  Despite the chill, the long wait with no end in sight and the fact that the officials kept trying to get people to give up, the mood in line was patient.  Some of the diabetics half-joked that the officials should let them give themselves their own needles in order to speed up the line.

 

It took until just before 8pm before they finally let us inside.  The indoor waiting area was full, but not jam packed and I have no idea why they forced so many people to wait outdoors for so long, especially given how many people in line were somewhat "medically fragile".  We were asked to pull a number and then milled around watching the local hockey game and waiting for our number to be announced by the poor security guard.  Our crew pulled numbers 361 through 363, but apparently they didn't start using the numbered system until quite late, so I don't know how representative that is.  They started letting people upstairs to the clinic in batches of 10, and then increased the batches to 15.  Out of curiosity, we timed the batches when they switched to calling 15 people at a time.   Batch #1 took 13 minutes, #2 took 12 minutes, #3 took 11 minutes and #4 took 14 minutes.   By the time we were timing batch #4, someone decided it might speed up the line if people had a chance to read and fill out the release forms before presenting themselves to the triage nurses.  Hmm...  We were called at the end of batch #4 (8:35pm).

 

I was glad to have a chance to read the forms, as we realized that Brendan was in fact eligible for a shot by virtue of being in contact with me.  Unlike the information available online through the city, the information on the back of the form was very informative.  It turned out that children under the age of 10 would only be offered a half-dose of the vaccine, with the second dose to be given after a minimum of 21 days.  The front of the form was rather badly designed, asking for your age in three different places (birth date, age and age range).

 

We walked up the stairs, handed our release forms to the registration desk, and were sent to a second waiting area. 

 

The registration desk was responsible for entering our information into the computer.  They swiped our health cards and asked us for the name of our family doctor.  They only had five or so people registering names.  Once you were registered, you'd wait a few minutes until your name was called.  They ushered us over to a free nurse, who then searched her computer screen to locate your name.  She gave the shot and then raised her hand to indicate that she was finished.  My nurse had a hard time finding my name.  The nurse next to her ended up finding it, counting down the screen and then telling my nurse to count "six names from the bottom".  Once we were finished, we headed to waiting area #3 for fifteen minutes to receive our vaccination proof and make sure we weren't about to experience adverse effects.

 

All in all it was a rather surreal experience which made me wonder just how prepared our city really is for an actual emergency.



   



Our new diapers arrived today and not a moment too soon!  Yeah, okay so we first noticed that Elizabeth was growing out of her cloth diapers back at the beginning of July...   We dithered a bit, retired our Polar Bummi covers (only good to 13 pounds) and learned to put the Super Whisper Covers on very very loosely.  But with Elizabeth now crawling and teetering on the edge of 15 pounds which is the complete upper limit, she was popping her velcro and making us nervous.

 

It was time.

 

Although we looked at many, many different options, we ended up getting the same types of diapers, from the same place.  Why mess with what worked?  The prices were good and we didn't have to leave the house to order them.  With any luck, these ginormous things will be the last diapers Elizabeth will ever wear.  They may be huge, but the frightening thing is that they fit!



   

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