With the start of 2023, many Canadians are hopeful that it may finally mark the end of the COVID-19 pandemic. After three years of testing, masking, isolating and vaccinations, the loosening restrictions seem to signal the end. However, if we have learned anything from these past few years, it's that there is always new surprises and challenges for us to learn from.
In our February installment of the 2022-2023 Speaker Series, we have the chance to hear from Alisha D'souza, former charge clerk at Trillium Health Partners mass vaccination clinic, and current nursing student. This written interview will delve into the behind-the-scenes operation of healthcare, the highs and the lows of working at a mass vaccination clinic, and the important role of the caregiver/family in major illness and disability.
Please enjoy this interview!
Alisha D'souza is a nursing student in the second-entry accelerated Bachelor of Science in Nursing program at McMaster University and currently works in the Critical Care Unit at the Hospital for Sick Children (SickKids) in Toronto as a patient information clerk. Alisha has a passion for working with children and families experiencing major illnesses and disabilities and has worked and volunteered in this area for nearly a decade. In the last few years, she has taken on a variety of non-clinical roles and aims to transfer the skills she has learned and apply them to her future career in nursing.
Can you tell us a bit about yourself?
I knew I wanted to work within healthcare for a very long time. Unfortunately, my family experienced severe childhood illness leading to long-term disability when I was very young, and we are still dealing with the side effects of it 15 years later. It's given me a wide perspective on the world of healthcare and what goes on both inside and outside of hospitals. And while I haven't been a patient, I've had to love someone who has been sick and has been facing the discrimination that comes with disability for almost my whole life. This has led to me seeking out opportunities to be involved with other children and families navigating major illness and disability.
In the last few years, I've taken that role from things like exposure and volunteering into working within various sectors of healthcare. I started out in 2020 working to help my local hospital network switch their electronic medical records to a newer application. Around the same time that job ended, the first COVID-19 vaccines were approved in Canada, and I became involved with my hospital network’s vaccination clinic, which eventually turned into two mass vaccine clinics running out of the University of Toronto Mississauga and the Mississauga Hospital (Trillium Health Partners). After working administratively as a clerk for a few months, I was given the opportunity to take on the role of charge clerk. I worked in that role from May 2021 to the closure of the clinic later in the year. And that was really inspiring; it showed me the harder parts of healthcare and the administrative side of running something at that capacity. It also led to me wanting to take on a more clinical role and understand how the worlds of leadership and administration interact with it. Currently, I am working in the pediatric ICU and cardiac critical care unit at the Hospital for Sick Children as well as completing my studies at the accelerated nursing program at McMaster.
What is the role of charge clerk?
A charge clerk is very similar to that of someone you might consider to be a clinical supervisor. Essentially, I wasa point of contact; I would oversee clinic operations and handle any patient complaints and praise. As well, I would ensure that all of our staff working in different departments and roles had what they needed and were supported to complete their tasks throughout the day.
What were some challenges you encountered at the vaccine clinic?
Two major challenges come to mind.
The first major challenge would be the Pfizer shipment delay in June of 2021. On June 18th,we received word that there would be an indefinite delay in the arrival of the Pfizer BioNTech vaccine, causing mass cancellations and high no-show rates in our clinics. Although we only had 3-5 days of impacted vaccine administration, there were approximately 11,000 canceled or no-show appointments between our two sites that we had to reschedule. On top of that, many of our clients received an email just 24 hours before their appointment, so many of them would still arrive on site. Our clinical staff would counsel on the safety and efficacy of vaccine mixing, but many chose to delay as opposed to getting their second dose at that time, and it created a lot ofchallenges to navigate. This situation took many weeks to resolve after we had the Pfizer BioNTech vaccine back.
The second large challenge that we faced on a regular basis was the usage of vaccines in time. The Pfizer BioNTech vaccine comes in a vial containing a certain number of doses. Once it's been prepared, it has to be used within a certain amount of time. Ensuring that there were no wasted doses at the end of the day was something that could be challenging, especially with cancellations and no-shows.
The strategy that stuck was having a waitlist of people and they would show up at the end of the day. Depending on how many doses there were, we would give them to the individuals who had shown up. If they were not able to receive a dose at that time due to the vial being completely finished, we would give them a guaranteed dose the next day.
What were some of the most memorable moments at the vaccine clinic?
I think that there were a lot of memorable moments, both positive and difficult, that will stay with me forever.
I can recall having the partner of an organ transplant recipient come to our clinic to receive a vaccine but at that time only transplant recipients themselves were eligible. And that was very difficult. This person who came to my clinic fully broke down in front of me and was terrified that they would bring home COVID-19 and harm their immunocompromised partner. I will always remember them because it shows that there's so much vulnerability in coming for something as simple as a vaccine. It might be easy for someone on the other side to say, “well, just come back when you're eligible”, but to someone who is immunocompromised or living with somebody who is immunocompromised, those first few months - honestly those first few years - in the dark were really difficult.
There are also so many incredible happy moments and milestones. Going from an emergency tent to the J wing in the Mississauga Hospital and opening up into the University of Toronto Mississauga were all memorable and momentous moments. I remember when we closed with nearly 500k doses done in our clinics, and the celebrations for the very last dose. The vaccine clinic was such an immense team effort and the sheer amount of work it took to make that clinic go round and do thousands of doses every day was astonishing.
It might be easy for someone on the other side to say, “well, just come back when you're eligible”, but to someone who is immunocompromised or living with somebody who is immunocompromised, those first few months - honestly those first few years - in the dark were really difficult.
Hindsight is 20/20,but if you could go back to that clinic, are there any changes that you would like to make?
I wish we had more access to resources for non-English speakers and individuals with lower levels of literacy. Having a larger variety of multi language resources, and being able to offer translation support on a higher level would make those who do not speak the language of majority more comfortable coming in. I'm grateful that there were many free resources produced by public health and various organizations, but that comes with limits. So further improvement in health literacy and these resources to facilitate easier access to health care would have been really great.
What do you hope the future of health will look like in Canada?
I think that our current model of healthcare is still very based on sick care. And I would really love to see a model that switched towards the promotion of preventative care, and to have more resources that not only allow people to self manage any chronic or acute conditions they may be facing, but also to recognize the signs and prevent having those occur. We have seen incredible advances in that over the last few decades, with common acronyms people know like FAST for stroke recognition. And I think that having those kinds of easy-to-remember-and-access tools available to people are important to help them recognize that they can take control over their own health.
What do you hope to pursue in the future?
A true passion of mine and one of the driving forces behind why I've done almost everything I do is supporting caregivers and family when an individual experiences major illness. Something that I'm incredibly passionate about is having resources for families, and the recognition that illness impacts the entire family. A decision like whether or not people receive certain vaccinations or go through various procedures or treatments can be something that deeply impacts every member of the family and other people in their lives. I hope to lead my future career toward the creation of a world that advocates for and supports not only the impacted individual, but those around them so that they can assist each other in thriving.
A true passion of mine and one of the driving forces behind why I've done almost everything I do is supporting caregivers and family when an individual experiences major illness.
This interview was edited for length and clarity.
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