Kahu Malama Nurses, Inc. responded to a call from
the Hawaii Department of Health to go into schools and provide education about,
and immunizations for, hepatitis B. The target population was 4th and 5th grade
students in over 180 schools, with a total target population of approximately
22,000 students per year. These children were born prior to the implementation
of the Infant Vaccination Program implemented in Hawaii in 1992, and it was
assumed that this cohort included a significant number of unvaccinated students.
The Take 3 Hep B program was launched in
September 1996. We established "teams" of licensed nurses who were
assigned to geographical areas delineated along school district lines. After a
letter of introduction from the school superintendent we contacted individual
schools and collected demographic statistics, such as number of classrooms of
grades 4 & 5, number of students, and information about the school such as
location of an appropriate "clinic" set up, contact name, dates of
holidays, teacher educations days, etc. The district teams then began a mass
distribution of information in packets sent home with students to their parents
(confidentiality restricted access to mailing addresses). The packets were
carefully designed to draw maximum attention, provide important information
about the disease and prevention, and elicit optimum response. The information
was made available in eight languages. Parents were asked to respond to whether
or not they wanted their child to receive free hepatitis B immunizations in
school based clinics. At the same time, a media campaign was conducted
consisting of television, radio, and print ads, many sponsored by contributions
from private business.
Once the demographics and participating
population were identified (which was an immense ongoing effort requiring
telephone follow-up, school memos, attendance at parent/teacher meetings, and
more) we scheduled the actual clinics.
The clinics were to last two hours. Adequate
staff was assigned to provide one registered nurse to administer vaccine to
approximately 25 students per hour. Volunteer staff assisted with check-in and
"crowd control." Three areas were delineated in the clinic area, one
for checking in the students, a vaccination area which provided some privacy,
and a post-vaccination area where the children were asked to remain 15 minutes
for observation. This area created the perfect opportunity for providing disease
prevention education and good health information.
Children were escorted to the clinic room by
their teachers in pre-scheduled increments at least 15-25 minutes apart. The
district team personnel arrived a half hour early to set up, then conducted the
immunization clinic, completed the paperwork, packed up supplies, cleaned the
area, and moved to another school. Some days as many as four clinics were
conducted by each team.
The result was that in that first school year
over 12,000 children received all three hepatitis B shots, and over 42,000 shots
were administered. All those vaccinated were cleared through parental consent
obtained in advance. Each child participated in fun educational activities and
was rewarded with prizes and incentives donated by local businesses.
The Take 3 Hep B Project was repeated during the
next two school years.