The system in place!

April 4, 2021

An account of a visit to the Expo Centre which is currently operating as a vaccination facility

— Photo by Rahat Dar

Lahore’s Expo Centre — once the city’s largest Covid-19 treatment facility — is currently operating as an adult vaccination centre (AVC) under the National Immunisation Management System (NIMS). The centre is now administering coronavirus vaccine to people aged 50 and above. It is scheduled to operate for 12 hours — that is, from 8am to 8pm — each day. A recent visit to the site with my parents allowed the observation of the system in place, and highlight possible opportunities for improvement.

To start with, the Expo Centre has ample parking space. Golf carts serve as shuttles between the parking and the event halls now turned into field hospitals. Volunteers from the Civil Defence Department are on hand with wheelchairs and provide assistance to visitors as required.

The process starts by lining up at a counter where officials from the Punjab government’s Primary and Secondary Healthcare Department (P&SHD) verify identification cards and generate computer receipts. Despite at least two dozen officials on site, including teams from the Health Information Services Delivery Unit (HISDU), barely half the desks were manned during my visit. This cause unnecessary queuing. Entry to the queues designated for handicapped persons was not controlled. This created an additional problem for those needing assistance.

Once the paperwork was completed, the screening process started. This was done by officials from the Punjab Emergency Services (Rescue 1122), who took vitals such as blood pressure and temperature. These officials complained about the poor upkeep of equipment. I personally saw an inoperable sphygmomanometer.

There is a sufficient number of screening stations; however, the layout is such that most people crowd into the first two or three stations. There is little guidance or direction to move along to vacant spots.

Following the preliminary screening, the vaccination occurred. This was done by medical technicians, who had a handful of people waiting in queues to get the vaccines. Following the administration of the dose, visitors were advised to wait for 15 minutes or so to detect any unexpected reactions. A doctor was on hand to address any complications.

There was an ample waiting room, and social distancing could easily be maintained at this stage. After the waiting time, visitors were free to go home. They were instructed to SMS details to 1166 for the second dose of their vaccine.

One of the major concerns throughout this process was that no one wore gloves — not the staff registering citizens, nor the Rescue 1122 officials conducting screening, and certainly not the medical technicians administering the vaccines. Upon inquiry, the officials maintained that they were not provided any gloves. The Civil Defence staff reported that they had been given thin plastic gloves which easily tore off and weren’t usable throughout their eight- or twelve-hour shift.

The lack of social distancing at entry/exit and in the queues for registration was also worrying. (Controlling the number of individuals in the halls should not be difficult considering that entry is restricted.) The presence of the shuttle service and a small tuck shop near the entrance to the halls is a welcome facility and should be maintained.

Dealing with hundreds of visitors during these trying times is not easy. It certainly takes a toll on the behaviour and response of the officials at the site. Unlike the volunteers, the government officials made little effort to put the visitors at ease, or extend accommodation. (A Rescue 1122 official was seen struggling with a broken blood pressure monitor instead of promptly closing his station, or replacing the malfunctioning equipment.)

Some visitors pointed to the non-cooperative behaviour of staff. I met with people who had shown up at the centre before closing time the day before, but were turned away because the screening staff/vaccinators had left for the day before the 8pm closing time. Staff members agreed on the need to improve general administration at the Expo Centre.

Lack of meals and transportation, including for the volunteer staff, stands out as a potential impediment that must be addressed in order to retain competent and skilled staff. Throughout the process, the perseverance and humility of the Civil Defence volunteers stood out. Bearing the sweltering heat and sunlight for hours on end, these volunteers don’t get any monetary benefits whatsoever. Sadly, most of the time they don’t even get a simple “thank you” for their effort. Their spirit, however, underscores the need for the Federation to revive the Civil Defence Department as an institution to build resilience across communities in the country.

I’d like to conclude by emphasising that vaccinating is better than not vaccinating at all. Consult your family physician, and take the older members of your family to get them inoculated. You don’t need an appointment/SMS confirmation for individuals over the age of 60; just their NIC. And don’t forget to wear a mask.

The writer is a development sector professional with nearly a decade of experience in communications and reporting. He has supported the implementation of The World Bank’s Disaster and Climate Resilience Improvement Project (DCRIP) and ADB’s Flood Emergency Reconstruction and Resilience Project (FERRP) in Pakistan

The system in place!