Mobile vaccination clinic for reaching a South Dakota reservation

The Pine Ridge Reservation, home to over 14,000 Oglala Sioux and other tribal members, encompasses two million acres in southwestern South Dakota. Access to healthcare services is limited due to a lack of medical professionals, as well as a shortage of transportation. Shannon County, which includes much of the reservation, is the second-poorest county in the nation. With the threat of a challenging 2009/2010 flu season looming, this population was considered at high risk for experiencing severe negative health outcomes.

Indian Health Services, Oglala Tribal Health, Rapid City Regional Health, and the South Dakota Departments of Health and Social Services joined forces to obtain a grant from the Centers for Medicaid and Medicare Services (CMS) office of the US Department of Health and Human Services (HHS) to develop a mobile medical clinic to provide services to pregnant women and children on the reservation. The mobile unit and staff are part of a two year, $1.6 million grant intended to reduce the non-emergent use of the emergency room. Future plans include using third-party payments to support the cost of staff and other operational expenses of the mobile unit.

In response to the pandemic, the mobile unit's mission expanded to administer the novel H1N1 influenza vaccine to remote reservation communities as well. Partners collaborated to ensure that the identified target populations would have access to both the novel H1N1 and seasonal flu vaccines. The mobile unit was provided vaccine through the allocation sent first to the state and then to Indian Health Services at Pine Ridge and Rapid City Regional Health offices.

To advertise the service, welcoming ceremonies were held. In addition, KILI Radio Station, Voice of the Lakota Nation, helped to spread the word on the mobile unit and its vaccine distribution plans. The mobile unit also will administer vaccinations at popular local events, such as at the Lakota Nation Invitational, a huge annual tournament that draws large crowds from SD reservations.

Initial results have been successful. The Pine Ridge Reservation is comprised of nine isolated districts, some of which are more than 85 miles apart. The mobile medical clinic is able to routinely travel to schools and communities in these remote districts to administer vaccine. For example, in Red Shirt Table, a small community 50 miles from the nearest medical services, the mobile clinic gave 73 people novel H1N1 vaccinations. Many of them also were able to receive a seasonal flu vaccination as well. At the American Horse School in Allen, 70 students were vaccinated; more are scheduled to receive the H1N1 immunization during a return visit later this month. Additionally, the mobile clinic vaccinated 58 students at Porcupine School during its first immunization clinic.

While these numbers may seem small, these are very isolated schools whose families have limited access to healthcare and transportation services. With the mobile unit traveling to a different school four days a week, it is possible to deliver novel H1N1 vaccine to a significant number of people in this often underserved population.

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