1 RUBELLA SCREENING CLINIC Rubella screening clinic Rubella is a virus, commonly referred to as the German measles. This infectious disease has mild affects on adults and children, but can cause devastating affects to a developing fetus (Public Health Agency of Canada, 2012a). If a woman contacts the disease while pregnant, it can result in Congenital rubella syndrome (CRS). CRS can cause miscarriage, stillbirth and/or severe fetal malformations. CRS is often associated with the following fetal malformations, cataracts, deafness, congenital heart disease and mental retardation (Halperin & Pless, 2003; Public Health Agency of Canada, 2012a). The World Health Organization has estimated that more than 100,000 infants are born with CRS each year, world wide (as cited in Villagra, Delgado & Olea, 2011). Most reported cases of CRS are in developing countries where MMR immunizations are not a part of the vaccine schedule (Halperin & Pless, 2003). Fortunately, in Canada there have been “fewer than 100 cases of rubella…with only 1 to 2 cases of congenital rubella” (Halperin & Pless, 2003, p. 155). The low prevalence rate of Rubella in Canada is due to the “routine publicly funded MMR immunization programs [which] have resulted in sustained high rates of rubella immunity in the general population” (Macey, Tam, Lipskie, Tipples, & Eisbrenner, 2011, p. 586). The question was raised if hosting a rubella screening clinic is beneficial and necessary. Due to extensive immunization programs throughout Canada, Rubella and CRS are now considered to be eliminated as of 2010. Although this announcement exclaims success, it is only with caution; as there are still possibilities for an outbreak. Some believe that focusing our time and resources on the prevention of other communicable diseases more prevalent in Canada would be more cost effective and relevant. An opportunity to host a Chlamydia self swabbing clinic was presented to the Rubella planning group, however it did not have ethical approval
2 RUBELLA SCREENING CLINIC from the School of Health and Human Performance to be carried out as part of a class assignment. Therefore, we continued to plan and host a Rubella screening clinic. Planning process: Overall design Event title The title of our event was “Rubella screening clinic� this was the title we used when promoting our event to the public. Date and time The date of our event was on Tuesday November 20th, 2012. As a group we decided that certain days such as Fridays and Mondays may not produce the best results, therefore we choose to do our event on a Tuesday. Furthermore, we wanted to avoid planning our clinic too close to exam period, as we wanted maximum attendance. Another reason was that we wanted sufficient time to receive the results from Dalhousie Health Services and still be able to write the final report without a hassle. This date also worked well for us as a group as many of us had a lighter course load on Tuesdays. The duration of our event was from 2pm until 6pm, this allowed our event to run through the busiest times of the day and attract the most people. Location The location for our event was on Dalhousie University Studley campus in the Cameron Room of Howe Hall residence. The address is 6230 Coburg Road, Halifax, NS. Howe Hall is a high traffic area since it houses more than 700 Dalhousie Students. The Cameron room is located on the main level which offered great accessibility. The room has two main entrances, several large windows with coverings and is a large open space. The open layout worked to our
3 RUBELLA SCREENING CLINIC advantage as we were able to create distinguishable areas. Firstly, the registration area was set up immediately inside the main door to minimize any confusion and so the participants would receive clear instructions as soon as they entered. We realized that timely and efficient service was important as many participants had limited amount of extra time, either they were on their way to class, meal hall etc. Across from the registration table was a coat rack which encouraged a warm inviting environment. We had set up chairs along one wall to allow participants to come enjoy the food, beverages and atmosphere and to become educated about Rubella all while waiting for the next available laboratory technician. The focal point of the room was the large table of food. Adjacent to the food table was a table that offered a variety of beverages. Behind the beverage table was another table that had an IPod dock which played appropriate music for such an event which again promoted a welcoming environment. At the back of the room there were two privacy screens and behind those were two stations for blood sampling. To the left of the blood sampling stations were two beds. Moreover, there was a large round table set up to allow participants to fill out the evaluation form and just relax and enjoy the food, beverages and people. In addition, the room was across the hall from a washroom (appendix P, p.144). Event goals and objectives Our number one goal was to screen 100 female participants during our Rubella Screening clinic. We based our target number on recommendations from our professor, Lesley Barnes. In addition, our promotion efforts were geared towards Dalhousie students; therefore, the majority of participants were young women of childbearing age. Not only did we want to screen women for the antibody we also indented to raise awareness about Rubella. Therefore, our objective was to educate participants on the effects of Rubella. The table below outlines our goal and objective in regards to reaching our main outcome goal of screening 100 women.
4 RUBELLA SCREENING CLINIC Outcomes Goals/ Targets and Indicator Outcome
Outcome Goal/ Target
Screen women for the Rubella antibody.
Screen 100 women for the Rubella antibody.
Educate the participants about the effects of Rubella during pregnancy.
Educate all participants by asking each participant to fill out an evaluation
Indicator(s) Screened 76 women for the Rubella antibody, kept count on a sign in sheet found at the registration table during the entire event. Evaluations reviled that 48/61, participants wrote something they knew about Rubella. 55/59 participants knew that Rubella is commonly referred to as the German Measles and 58/59 participants knew that Rubella can cause congenital Rubella Syndrome during pregnancy.
Event description: Overview of the clinic As part of the disease prevention course, a group of students planned and implemented a Rubella screening clinic. The goal of a clinic was to screen 100 young females for the Rubella antibody. Any female could be screened however, they needed to have a Canadian health card. The clinic set up had a logical flow. Once participants entered the room, they were greeted by two of the group members at the registration table. Participants were registered by providing their provincial health care card number in order to fill out the requisition form. In addition, all participants had to sign a consent form. Participants then usually moved towards the blood sampling stations. Once finished giving a small sample of blood participants were able to enjoy complimentary food and beverages while they filled out an evaluation sheet. After
5 RUBELLA SCREENING CLINIC participants hand in their completed evaluation sheet they then received a ballot for the raffle draw. In total, the entire process took about five to eight minutes depending on the line for blood sampling. Preliminary clinic logic model We had few resources to help us throughout out planning process. We implemented key activities to promote and market our event. All of the resources we used helped us to plan a very successful event. All of the inputs, processes, outputs, short-term outcomes, intermediate outcomes and long-term outcomes are listed in below:
Inputs
People: members of the group, Mary Ann and Janet, participants
Donations and time
Preliminary Program Logic Model Short-term Intermediate Processes Outputs Outcomes Outcomes Posters around campus and mini posters in women’s locker rooms and Rubella Attitudes washrooms, inScreening towards Program class Clinic From Rubella: planning announcements 2pm until realizing the skills for the with 6pm on devastating students PowerPoint November 20, impacts it can involved slide, 2012 cause online advertising through Facebook, Event, Advertising Participants Opinions Behaviour: during the were mostly About personal event in the students Rubella choice Howe Hall whether or cafeteria not to participate and find out
Long-term Outcomes
To Screen and inform each participant of her Rubella immune status.
Decrease the likelihood of pregnant females passing along the Rubella
6 RUBELLA SCREENING CLINIC
Partnerships: Dalhousie Health Services, BD Diagnostics
Materials and Equipment (I.E. Tables, Chairs, medical supplies) Cameron Room in Howe Hall Technology (World Wide Web) Money
Background Research
Advertising through inclass announcements and PowerPoint slides giving to professors Recruiting Mary Ann and Janet as volunteers, creating partnerships for donations and funding purposes Creating promotional material Group planning meetings Needs Assessment of room Food, gift basket for raffle draw and gifts for Mary Ann and Janet
Programme planning Strategies • Walked into the room.
Able to screen 76 participants during our screening clinic
Increase knowledge about Rubella
100 people attended* the screening Clinic
Awareness about Rubella and its effects
their immune status
virus to their developing fetus; decrease the prevalence of Congenital Rubella Syndrome.
Educational
Better health outcomes for the future
7 RUBELLA SCREENING CLINIC Agenda Our agenda for the day started at 11:00 AM when we were allowed in the Cameron Room to begin to set up. We first arranged the tables, chairs and privacy screens appropriately in a logical manner. We then arranged for beds to be set up in the room. Two members of the group placed arrows to provide direction to the Cameron Room. We also placed two large poster boards one in the main lobby and one outside the main entrance to Cameron Room. In addition, we tastefully decorated the room with purple streamers and purple, pink, white and blue balloons. It took us approximately two and a half hours for the room to be completely set up. Small errands had to be made on the day of the clinic such as buying milk, coffee cream and stir sticks for the coffee and tea station. Around 12:30 PM, two of the group members went and printed evaluation sheets, consent forms and fact sheets. During this time the other group members wrapped and wrote cards for each of the volunteers, Mary Ann and Janet, the two laboratory technicians. Our event started at 2:00 PM and our first participants arrived right at 2:00 PM. We ended our event at 6:00 PM. The timing of our clinic worked out well because Mary Ann and Janet did not need to take a break for lunch or dinner. One of the group members took the last batch of blood samples to the lab while the others stayed behind to clean up. After the clinic we presented Mary Ann and Janet with gifts of appreciation and we finished cleaning up around 7:00 PM. Responsibilities: My role The following table outlines my contributions and responsibilities for the planning and implementation of the Rubella screening clinic. Responsibilities
Planning
Implementation
Group communications
- I created the group
- I made several phone calls
8 RUBELLA SCREENING CLINIC Facebook page.
to my group members
- I created an excel
during the set up of the
spreadsheet for group availability. - I attended all of the group meetings.
clinic. - I phoned Brenda once as she was transporting the blood to the Mackenzie building because she forgot the list.
Partnership with Dalhousie Health Services
- I was in contact with Brenda Standing, the head nurse. I obtained the requisition forms and learned how to
Promotions for the clinic
fill them out - I posted mini posters in the
- Throughout the clinic I went
women’s washrooms and
around the meal hall and
locker rooms at Dalplex, in
recruited women to be
every bathroom in
screened.
Newcombe (female
- I stood outside the clinic
residence located in Sheriff
doors and recruited passer-
Hall), as well as in the
bys to be screened.
Tupper building. I also posted the flyers in women’s washrooms at various local coffee shops. - I contacted two of my
9 RUBELLA SCREENING CLINIC professors regarding bonus points and class announcements. - I made a verbal class announcement in my Human Nutrition class which is roughly 200 Fundraising: Bake sales
students. - I coordinated the bake sales by communicating time and place to my other group members. I created the bake sale posters and bought table cloth, balloons and streamers. I also made the donation box. - I also brought at least two different baked goodies or treats to each of the bake sales. - I asked students who held bake sales in the past for their
Donations
advice. - I had the gift basket donated to me by my parents. - I was in communications with the Armed Forces for possible
Documents: PowerPoint, consent form, meeting minutes
medical supplies. - I created two PowerPoint
- I printed off 120 consent
slides for the purpose of in
forms, 120 evaluation forms
class announcements
and 25 pages fact sheets
- I also created the consent form. - I was the minute taker for
(4per page, coloured paper used).
10 RUBELLA SCREENING CLINIC two of the group meetings. Supplies and services at the
- I brought a box of pens
clinic
- I brought the table cloth and streamers - I provided thank you cards for Mary Ann and Janet. - I brought extra glass platters and utensils for the food table. - I help set up the room, moved chairs, tables, helped decorate - I helped place the directional arrows - I asked the maintence staff for two beds, linen and pillows for
Food and Drinks
each. - I make three large veggie trays, about two dozen chocolate chip cookies, and about 24 cupcakes. - I provided the use of my Tassimo machine along with an assortment of T-Discs. - I provided an electric kettle and various types of tea.
Post-Clinic
- I brought sugar for the coffee and tea station. - I helped with the clean up of the facilities. - I retrieved the clinic results and asked about Rubella vaccines for those women who are not immune and found out relevant information such as if they would need an appointment, what time injections are given and if there are any associated fees. - I called the participants to let them know their immune status. - I provided the participants with their medical report stating their immunity at their request. - I uploaded necessary documents for my other group members
11 RUBELLA SCREENING CLINIC to use. - I attended additional group meeting to debrief and discuss the positive/negative aspects of the clinic as well as recommendations for future clinics.
Pre-clinic logistics Overall pre-clinic logistics In the disease prevention course (HPRO 3335) at Dalhousie University, an option al assignment is to plan and implement a Rubella screening clinic. A group of five interested students was created within the first two weeks of class. The professor, Lesley Barnes was on hand to offer continual aid and support throughout the entire process. The group’s main form of communication was through a Facebook group (appendix F, p. 53) that was created by one of the group members. This proved to be an effective way of communicating, sharing documents and later uploading photos. One advantage to using Facebook as a source for communication is the fact you can tell when someone has seen the post. As a group we decided it would also be beneficial for the group member to “like” the post once read, that way we can assure everyone is up to date. Formal group meetings were arranged every second week in the beginning stages and then more frequently closer to the clinic date. The time that worked best for the group was on Thursdays from 1:00 pm until 2:30 pm. Prior to group meetings each of the group members were asked to list important issues that must be discussed. This helped us stay focused and use our
12 RUBELLA SCREENING CLINIC time efficiently. Meeting minutes were recorded at each meeting and then uploaded to the Facebook group for the entire group to refer back to (appendix A, p. 35). Marketing and promotion As a group we formulated what we thought would be an effective marketing and promotion plan to enable us to reach our goal of 100 participants. We brainstormed ideas early on in the planning process. As a group we decided that social media would be effective source and allowed us to reach countless number of people. Therefore, we created a Facebook event page. We launched the page two week prior to the event date. Each group member invited as many people as they could. The event page was managed by all of the group members as we were given“host” status. The event page contained updates during the event to help remind people to attend. Photos of the delicious free food were also posted in hopes of persuading potential participants to come to the clinic. In addition, a Facebook message was sent to all member of the Facebook event who said they would be attending. For a look at the Facebook event page please refer to appendix H (p.124). Bake sales were not only for fundraising but it also was an effective promotion strategy. All together we hosted four bake sales, three of which ran about five hours long and the one ran approximately one hour in length. During the bake sales, we tried to recruit as many participants before the clinic as possible. Printed promotional materials included the main full size 8.5’X11’ poster (appendix D, p. 50) and a mini poster. The mini posters were only placed in women’s washrooms and women’s locker rooms. Throughout the event, the mini posters were also handed out to women in the meal hall of Howe Hall and near the entrance of the Cameron Room.
13 RUBELLA SCREENING CLINIC An important promotional strategy was to have professors offer bonus point to their students if they attended the clinic. We were fortunate to have three courses offer bonus points, HAHP 1000, HPRO 1195 and HPRO 3360. Although, bonus points were given, it came to our attention that one of the professors did not make a class announcement informing their students. Although roughly a dozen professors were contacted and asked to offer bonus points many could not accommodate this request as it would interfere with their class syllabus. The alternative to providing bonus points was to allow a group member make an in class announcement; many professors allowed this to happen. Sponsorship Potential sponsors identified for the clinic included Dalhousie Peer Health, Dalhousie Health Services, Capital Health, other community health organizations, Student Association for Health and Human Performance (SAHHPer), other Dalhousie student societies that are health focused, and businesses of any size to donate food, beverages or money. The opportunities for potential sponsors were vast. In the end we received sponsorship from Dalhousie Health Services, BD Diagnostics, Burger King (Truro), Howe Hall and we have not yet heard back from SAHHPer, although they have confirmed they will donate. Their donation will help reimburse a portion of the financial contributions offered by each of the group members. We were fortunate to have Mary Ann and Janet; the graciously donated a full day to volunteer at the clinic. Moreover, it is important to note that each group member contributed above and beyond what was expected from them. Clinic budget
14 RUBELLA SCREENING CLINIC The following table describes out budget for the entire planning and implementation for the clinic. Item Personnel: Janet Barteaux (5hrs x $36) Mary Anne Robinson (5hrs x $34) Travel expenses for Janet and Mary Anne ($0.43per/km @ 400km)
Value
Cost
Comments
$180.00
$0
$170.00
$0
$172.00
$0
Volunteer (time donated in kind) Volunteer (time donated in kind) Donated in kind by Janet and Mary Anne
Facilities Cameron Room
$0
Donated in kind by Howe Hall Donated in kind by team Donated in kind by team Donated in kind by team Donated in kind by Burger King Truro Donated in kind by team Donated in kind by BD Diagnostics
Supplies Bake Sales
$138.00
$0
Food for the clinic
$131.82
$65.40
Decorations and plastic utensils Paper cups
$48.81
$0
$25.00
$0
225 Flyers ($0.11 each)
$24.75
$0
Blood collection supplies
$225.00
$0
$313.39
$200.00
$113.39 in kind by
$65.00
$0
$1493.77
$265.40
Donated in kind by Brenna’s parents $1228.37 in donations
Other Gifts for Janet and Mary Anne Gift basket for door prize TOTAL:
Item
Value
Cost
Earnings
Comments
15 RUBELLA SCREENING CLINIC Bake Sale Total:
N/A $0.00
N/A $0.00
TOTAL CASH REVENUES
TOTAL CASH EXPENSES
$265.40
$265.40
$265.40 $265.40
Total Revenues: $265.40
TOTAL REVENUES – TOTAL EXPENSES = (+/-) 0
Internal inventory The resources we used during the planning and implementation of the clinic were: •
Facilities: The Cameron Room in Howe Hall
•
Equipment and materials: tables, chairs, privacy screens, two beds with linen and pillows, promotional boards with paper.
•
Two volunteer Laboratory Technologies (Mary Ann and Janet)
•
Contacts with Dalhousie Health Services (Brenda Standing, head nurse), Dalhousie Peer Health (Derrick), Todd Hatchette, and Prof. Lesley Barnes,
•
Requisition forms provided by Dalhousie Health Services
•
Medical supplies donation by BD Diagnostics
•
Cups donated by Burger King (Truro)
•
Fundraising for the budget
16 RUBELLA SCREENING CLINIC •
Stationary supplies: pens, paper
•
Food and beverages bought or donated by members of the group
•
Fact sheets, mini posters, consent forms, photo release form, main sign in sheet, bonus points sign in sheets all supplied by members of the group.
•
IPod dock and music supplied by a member of the group
•
Decorations bought or donated by members of the group
Positive aspects Each year for Introduction to Disease Prevention (HPRO 3335) you have the option to plan and implement a Rubella Screening Clinic as an assignment. For the past three years I have been in the Health Promotion program I have attended all three screening events. I observed over the years aspects of each clinic which I thought worked well and what I liked. Such as location, room set up, food, door prizes and evaluations. It was easy to speak with classmates who hosted the event in previous years in order to gain insight and applicable knowledge. One of the most positive aspects of our group dynamic was having a well rounded group. Four of the group members are in Health Promotion and have a variety of networks. For example Desiree Scott had previous connections with Derrick from Dalhousie Peer Health and Brenna Coles had connections with Brenda Standing, the head nurse at Dalhousie Health Services. In addition, another major resource was Olivia Barteaux’s mother is a laboratory technician and we were able to use it to our advantage. Furthermore, I very much appreciated having someone in the group from outside Health Promotion; Brenda Rooney has a background in microbiology.
17 RUBELLA SCREENING CLINIC She had strong relations with Todd Hatchette who is the department head of the laboratory. Having such a well rounded multidisciplinary group helped to fill the gaps to minimize weakness. Five group members seemed to be the right amount as the workload was evenly distributed and coordinating our schedules was not as difficult if it were a larger group. Throughout the planning process our group had great communication. We created a Facebook group early on in the planning process. The Facebook group acted as out main source of communication between the group members. It worked to our advantage because we could see who read each comment and we could share files among ourselves. We often posted when and where our next meeting would be and group members would confirm their attendance by commenting on the initial post. The cohesiveness between all group members was wonderful. During our first meeting we were very well organized and we quickly delegated tasks to each group member. The majority of us had past experience from Program Planning which was a great asset. We divided up the work load based on specific skill sets and previous experience. Each group member skills and personalities complemented the others very well. The entire group was dedicated, enthusiastic and creative. When the clinic date finally arrived I would say that we worked our best as a team. The morning of the clinic each of us knew our responsibilities and the timeline for everything, therefore the set up and preparations ran very smoothly. The implantation of the clinic had many positive aspects as well; one of the most evident was the warm inviting atmosphere. The layout of the room enhanced and promoted a personal yet private setting and the effective and timely flow made it quick and easy for participants. The directional arrows that we placed throughout Howe Hall were well used, many participants had positive comments regarding how easy it was to follow the arrows and fine the room.
18 RUBELLA SCREENING CLINIC Furthermore, we quickly identified a “community champion� a man working in the meal hall recruited approximately six participants. Other promotional strategies such as actively recruiting people in the meal hall and outside the Cameron room entrance and displaying our gift basket seemed effective. Negative aspects For many years Dalhousie University has hosted a Rubella Screening Clinic each year. I attended the clinic the last three years in a row. In addition, four out of the five group members all have participated in a Rubella Screening Clinic the past three years as well. A major challenge was recruiting participants outside of our usual group of friends and classmates. We had to be creative and target a different population. Unfortunately, a major negative was that we were unable to reach our target goal of screening 100 females. With that said I can theorize what barriers contributed to a less successful Rubella screening clinic. During the planning process we were faced with many constraints. Some of the major constraints were, time, confirming facilities, creating partnerships for donations and money. It was frustrating at times that such simple things took weeks to confirm. The two major drawbacks that we encountered in our planning process were the time it took to confirm the room and the time it took to find an organization to donate medical supplies. Those two issues caused a lot of stress on the entire group. The room booking was confirmed on October 29th and took nearly three weeks. As for the medical supplies, it was November 14th when we finally got confirmation that BD Diagnostics would donate medical supplies. A possible solution might have been meeting in person rather than communicating through emails. This would cut down the time spent on something that appears so simple.
19 RUBELLA SCREENING CLINIC Another issue was the donation letter, as a group we decided very early on that we need to have food and door prized donated in addition to the medical supplies. Therefore, having a donation letter drafted as soon as possible and sent to Lesley for approval was detrimental to the success of our clinic. Unfortunately, it was November 5th when the donation letter was finalized and once we received it back it did not have a letter head on it. We decided due to time constrains we would put our own Dalhousie letter head on it to make it look official and more professional. In my eyes the donation letter should have been completed in the first week. I know from past experiences that you need to approach organizations weeks in advance if you are going to be successful in receiving any type of donations. Since their was a major delay in receiving the donation letter, our marketing and promotional plans were greatly affected. This is because we did not secure the donation of the medical supplied until one week prior to the clinic and since we did not have the supplies group members held back on the promotions. Threats to our clinic being a success would have included the time of year. In late November, students may be preparing for exams or writing final papers and may not have had the time to attend the clinic. Weather could have an impact on the outcome of our clinic, if it had of been raining, snowing or very cold participants may have decided to stay home. Locations was a threat in the sense that parking was not readily available therefore participants who drive to campus may avoid the hassle of finding and perhaps paying for parking as it would be an added stress. Again, location may have been a threat because majority of the participants may not know where the Cameron Room is located. Another threat may have been food allergies. During the promotion of our clinic we announced free food and beverages would be available throughout the clinic as an added benefit and draw in for participants however, we had to be cautious regarding food allergies.
20 RUBELLA SCREENING CLINIC Antibody results Immune versus not immune We had 76 participants screened during the Rubella screening clinic. Each participant provided a sample of blood which was used to screen for the amount of Rubella antibody present. The results were received two weeks after the clinic was held and the results were divided into two groups, immune and not immune. The results are as follows: Immune Number 70
Not immune Percent 92.10%
Number 6
Percent 7.89%
Immune status analysis Our clinic results found that in our small sample 7.89% did not have sufficient Rubella antibodies, therefore were not immune. The Centres for Disease Control and Prevention claim that 95% of people who receive a single does of the MMR vaccine have a sufficient immune response and therefore become immune (Centres for Disease control and prevention, 2008). The Public Health Agency of Canada and National Advisory Committee on Immunization (NACI) recommend MMR vaccinations be given at 12 months of age and once again between four and six years of age (Public Health Agency of Canada, 2012). Furthermore, the Centres for Disease Control and Prevention (2008) also claim that the individuals who do not develop immunity with his/her first dose, then the second dose “gives immunity to almost all of those who did not respond to the first dose� (para. 8). The MMR vaccine has been recommended as part of the immunization schedule in all of the Canadian provinces since 1983 (Halperin & Pless, 2003).
21 RUBELLA SCREENING CLINIC Since we only screened participants with a Canadian health card and most of whom were young women of childbearing age, this percentage surprising. An explanation for the portion of participants not immune (7.89%) may be a part of the group (or parents were) who do not receive any immunizations due to personal, religious or cultural beliefs and/ or values. Another theory that could explain why some participants were not immune is that they may have immigrated to Canada after the routine immunizations (12 months and four to six). If participants were born outside of Canada it is possible that their birth country did not have MMR vaccine as part of their immunizations schedule. Halperin and Pless, (2003) state that most Rubella cases in Canada are more commonly found in foreign born women. Macey et al., (2011) describes a third possible explanation: Importation into a community that opposes immunization, demonstrates that multiple chains of transmission can be reestablished where pockets of low vaccine coverage exist. While there has been no evidence of indigenous circulation of rubella viruses since the 2005 outbreak, population groups with low vaccine coverage remain at risk following disease importation (585). Due to Canada’s diversity, “pockets” or gaps in populations who have not received the MMR vaccine is quite possible. Perhaps a good example of this is the 2007 outbreak in Quebec; where there were 95 cases of Rubella. These cases were among unvaccinated population and the strain of Rubella was confirmed to be foreign (Macey, et al., 2011). Moreover, due to the under vaccinated populations, either due to their own choice or new Canadian immigrants, this will always be a barrier of truly eliminating the disease. These populations pose a threat of future
22 RUBELLA SCREENING CLINIC outbreaks in Canada, therefore the need for immunizing, screening and continued surveillance is essential for the prevention of Rubella. Rubella screening clinic evaluation Evaluation Plan Prior to the clinic we created an evaluation form for participants to fill out. The rationale behind having an evaluation was to see if our objective was met; educate the participants about the effects of Rubella during pregnancy. We also wanted to see how many people knew if they had been vaccinated against Rubella in the past. Evaluation results The evaluation was completed by 59 of the 76 participants. The results of the evaluation are summarized below. 1. Have you been vaccinated against the Rubella Virus (MMR)? Yes No Unsure
24 10 25
2. Please indicate what you know about Rubella. Pretty much nothing except what I learned today. German measles, bad for fetuses. Can be harmful for babies during pregnancy. Virus, __ for kids, fetuses in danger of blindness, ... Etc. Had never heard of it until this clinic! A sexual transmitted virus that would damage fetus. It affects women who are pregnant, specifically the fetus.
23 RUBELLA SCREENING CLINIC It affects the fetus. German measles. It's not good for the fetus if you get it while pregnant. It's the medical term for German measles and children are vaccinated against it. It can cause miscarriage and harm the fetus if contracted during pregnancy. It affects pregnant females. If a pregnant woman becomes infected, especially during early stages, fetus may die. Contagious. Contagious, caused by a virus. Can result in problems with pregnancy. Vaccine became available in 1969. It's really dangerous for pregnant women/the fetus. It has to do with pregnancy. Very little. Important to get screened if you plan to have children. Also known as German measles. Also known as German measles. Causes severe birth defects in infants. Only that it can affect the fetus. It can affect the fetus. Most people are vaccinated for it. Affects children. Like measles, it can affect a woman during pregnancy and it can be detrimental to the baby's health. It can cause miscarriage or even still birth. So, it is advised to take the vaccine prior to becoming pregnant. No answer (N.A.). Measles. Contagious. Known as German measles. Contagious. Protects against measles. Causes problems during pregnancy. Virus. Harmful to pregnant women/babies. Not much. I know it can be harmful to your fetus if you're pregnant. Not normally very harmful but very damaging to the fetus during pregnancy, especially during the first trimester?! It is bad for foeti. I don't want it. N.A. Not too much. German measles virus. Risk for neg. Pregnancy outcomes with different affects a different stages of pregnancy. Less severe later in pregnancy. Antibodies. N.A. N.A. Rubella can harm the baby during pregnancy and result in problems with the child. Caused by a virus and can receive a vaccination. Rubella can result in disruptions in a developing fetus. Detrimental to fetus if not immune and are pregnant.
24 RUBELLA SCREENING CLINIC Harmful to children. That it can be dangerous in pregnancy if the mother has it. When pregnant it can cause problems with the fetus. It is also a contagious disease. Caused by a virus. Important women to be tested when considering having children because it can lead to congenital Rubella Syndrome. It can be dangerous to women who are pregnant. It is a disease that is harmful to the fetus if acquired during pregnancy. That if you have it, it can be highly damaging to the fetus and thus you shouldn't have children. Nothing. Virus that affects fetuses (I learnt this from the clinic). I didn't know anything until today when I was approached. But now I know that it almost never causes serious illness in young children. Is associated with measles and that is about it. (Prior to reading the fact sheet). It's contagious. In pregnancy can lead to congenital Rubella Syndrome. I don't know anything about Rubella. Nothing. Can affect child births. Not serious in young children, only in pregnant women. Nothing.
3. Rubella is commonly known as the German measles. True False
55 4
4. Rubella in pregnancy can cause congenital Rubella Syndrome (CRS). True False Unsure
5. How did you hear about this clinic?
58 0 1
25 RUBELLA SCREENING CLINIC Announcement in class Friend Facebook Professor Poster
15 21 9 11 1 where: 4
Other
1 3
how:
Cafeteria Bathroom in McCain School Cafeteria Howe Hall Killam Library Howe Hall Bathroom - LSC LSC Building Washroom in LSC Bathrooms LSC, outside, Howe Hall I think Bathroom LSC Tupper Building Walking past it Some representative told In my residence Walking passed it Bake sale Walked by
Recommendations for the future As stated above, hosting a Rubella screening clinic may be unnecessary in Canada. Mass vaccinations have been shown to be highly effective and thus resulted in the elimination of rubella and congenital rubella syndrome (Macey, Tam, Lipskie, Tipples & Eisbrenner, 2011; Tipples, 2011). A recommendation for future Rubella screening clinics would be to focus on the immigrant population or international students. This would be a worthy cause because some countries do not have routine Rubella immunizations a part of their immunization schedule (Halperin & Pless, 2003). Furthermore, it is recommended that other options for disease
26 RUBELLA SCREENING CLINIC prevention program be established for the future disease prevention course. For example, the Chlamydia self swabbing clinic that Todd Hatchette suggested, late in to the semester. Recommendations useful for any program planning and implementation process include, starting early. We recognized the importance of establishing partnerships/sponsorships is vital part to ensure a successful clinic. Having a donation letter complete in a timely manner would aid in securing these collaborations. In addition, it may help create a budget of the supplies you will have donated and will need to purchase. Having a clear idea of what you will need to contribute financially will then determine your fundraising plan. Promotions and marketing play a big factor and can measure how successful a clinic will be. Exhausting all measures should be a top priority. There are a lot of opportunities for advertizing; think outside the box. In regards to facilities, do not rely on one option, have other options available and work on securing your date and time, you can always cancel once choosing the best option. Personal Reflection I was so excited before coming into the disease prevention course because I knew I wanted to help plan and implement the Rubella screening clinic. I had attended the clinic two consecutive years prior and wanted to be a part of the next group to host one. I had past experience through my program planning course where I helped coordinate the OneMatch swabbing clinic. That was by far the most I invested into a project. I lived and breathed OneMach for about six weeks. I was looking forward to the same type of experience with the Rubella screening clinic. However, it was a very different experience. I thoroughly enjoyed working with my group members; we had a great team dynamic. The biggest difference was that OneMatch you were securely partnered with their liaison, who
27 RUBELLA SCREENING CLINIC hosts swabbing events as her career. We were provided will all of the supplies and promotional materials. With OneMatch, they had already fully branded their clinic; half the work was done for us. I got a truer sense of how planning an event like this works when I helped plan and implement the Rubella screening clinic. I loved the hands on experience that this assignment provided me. Although it was very stressful at times, like not have the facilities book and not having medical supplies donated until one week before the clinic, I would do the implementation part all over again. When choosing this assignment option to build my grade scheme, I realized the time commitment and the effort it takes however, I did not take into consideration that I needed complete an individual report at the end. With that said, I do not think I would have chosen this option for that sole reason. It was extremely stressful having the Rubella screening report due, a resource unit due and a final exam all on the same day. Nevertheless, I enjoyed the whole experience. The skills that I am left with are worth every bit of stress endured. I was very proud of the way the actual clinic turned out, the day of everything just felt into place. I also enjoyed working in a team setting and I hope this reflects how well my internship will go. Conclusion Extensive time and effort was put into the planning and implementation of this clinic. Although the primary goal of screening 100 participants was not met, I do not consider this a failure. We notified six young women that they were not immune and that exemplifies disease prevention at its most basic form. In addition, we educated numerous individuals, at bake sales,
28 RUBELLA SCREENING CLINIC during in class announcements and during our clinic about the harmful effects Rubella can have on a developing fetus.
References
29 RUBELLA SCREENING CLINIC Centers for Disease Control and Prevention. (2008). Vaccines and Preventable Diseases: Halperin, S., & Pless, R. (2003). Immunization in Canada: a success to build on. Journal Of The Canadian Chiropractic Association, 47(3), 153-160. Macey, J., Tam, T., Lipskie, T., Tipples, G., & Eisbrenner, T. (2011). Rubella elimination, the canadian experience. Journal Of Infectious Diseases, 204S585-92. doi:10.1093/infdis/jir406 Measles - Q&A about Disease & Vaccine. Retrieved on December 15, 2012 from http://www.cdc.gov/. Public Health Agency of Canada. (2012a). Rubella. Retrieved on December 15, 2012 from http://www.phac-aspc.gc.ca/. Public health agency of Canada. (2012b). Immunization Schedules: Recommendations from the National Advisory Committee on Immunization (NACI). Retrieved on December 15, 2012 from http://www.phac-aspc.gc.ca/. Tipples, G. (2011). Rubella diagnostic issues in Canada. Journal Of Infectious Diseases, 204S659-63. doi:10.1093/infdis/jir430 Villagra, E., Delgado, L., & Olea, A. (2011). Enhanced surveillance for congenital rubella syndrome following mass rubella vaccination of girls and reproductive-aged women. Journal Of Infectious Diseases, 204S642-6. doi:10.1093/infdis/jir481