Delivering Covid-19 vaccines to rural and small town communities

The HCTM mobile vaccination team visits a bedbound patient and his family at home in Parit Sulong to vaccinate them. — Photos: Dr HARDIP SINGH GENDEH

Makcik Kiah (not her real name), 82, has lived in a kampung (village) house built by her husband for the past 60 years.

They have raised four children who are now residing in cities to earn a living.

Her husband is bedbound due to a stroke and she is his only caregiver, looking after all his needs and cleaning up after him.

Makcik Kiah has heard about Covid-19 on the evening news and is aware that vaccination is important to reduce the risk of contracting the infectious disease.

However, she feels helpless as she is unable to leave her husband unattended to travel to the vaccination centre in town.

She also does not own a smartphone, only a feature phone for her children to check in on her and her husband from time to time.

She hopes that she and her husband can be vaccinated soon.

Hers is the tale of many elderly Malaysians living in rural areas who have restricted access to Covid-19 vaccinations due to a lack of technology or the inability to travel to a vaccination centre.

It is for them that outreach vaccination services have been initiated by the government.

From Bangi to Batu Pahat

One of the smaller vaccination centres set up in a community hall in Seri Medan.One of the smaller vaccination centres set up in a community hall in Seri Medan.

Aside from the Health Ministry, two universities under the aegis of the Higher Education Ministry have also joined in this effort.

One of them is Universiti Kebangsaan Malaysia (UKM).

Beginning with a pilot project on June 14 and 15 (2021), the university’s outreach vaccination service based at Parit Sulong in Batu Pahat, Johor, went into full swing on June 22 (2021).

This small town with a population of approximately 60,000, was selected as it is part of the constituency of Higher Education Minister Datuk Seri Dr Noraini Ahmad, making coordination easier between local authorities and the university.

According to UKM Pro Vice-Chancellor and Kuala Lumpur Health Campus head Professor Datuk Dr Hanafiah Harunarashid, the outreach vaccination service is delivering vaccines in three ways:

  • A vaccination centre based at Maktab Rendah Sains Mara (MRSM) Batu Pahat's hall
  • Mobile outreach centres stationed at community halls in the nearby towns of Semerah and Seri Medan, and
  • Home visits in the areas of Semerah and Seri Medan.

Such an effort is not without its challenges.

Realising the potential difficulties that might be in store, a pilot project was planned to identify and resolve any problems and shortcomings before the start of the programme.

About 300 doses of the Pfizer/BioNTech vaccine were administered during home visits over the two days of the project.

The set-up for the vaccination centres, both at MRSM Batu Pahat and the various community halls, drew on the team’s prior experience with the university’s vaccination centres at its Bangi, Selangor, campus and its teaching hospital, Hospital Tuanku Canselor Muhriz (HCTM).

For physical distancing and crowd control, a similar floor flow was employed.

Volunteers from the local health district office managed the flow and registration desks.

The HCTM healthcare team was divided into doctors, who managed consent, observation and medical issues, and nurses and healthcare assistants, who administered the vaccines.

Vaccination rooms were erected for privacy and allocated according to gender.

Meanwhile, a close working relationship between the Johor Covid-19 Immunisation Task Force (CITF), state health department and Batu Pahat health district office ensured a continued supply of vaccines, which were escorted by the Royal Malaysia Police.

The vaccines were stored at a nearby health facility in order to allow for quick delivery to the centres before they opened for the day.

Active outreach

While appointments were given to prevent overcrowding and ensure that the vaccine supply was fully utilised, extra effort was taken to reach out to the community.

District health officers were charged with identifying elderly folk with no transportation and who were not registered for vaccination via the MySejahtera app.

They then liaised with the Ketua Kampung (Village Head) or division heads to ensure that these senior citizens were called for vaccination.

Volunteers would also call the elderly’s next of kin to remind them of their vaccination appointments.

Vehicles were provided by Universiti Teknologi Malaysia to pick up those without any transportation at their homes and send them to MRSM Batu Pahat, as well as send them home afterwards.

Upon arrival at the centre, these individuals were registered on the My Vaccine platform, enabling them to be easily traced for their second vaccine dose.

Home visits were also vital in reaching bedbound patients and those with mobility restrictions, who would otherwise find it very difficult to get to a vaccination centre.

Such visits not only ensure that this group of people are not overlooked, but also allowed for counselling of their family members to register for vaccinations via the MySejahtera app.

Prof Hanafiah explains that the home vaccination visits adhered strictly to the National Covid-19 Guidelines for Patients Stranded at Home, which includes carrying along the required safety medications, as well as home consent and monitoring forms for any side effects.

The local Klinik Kesihatan (Health Clinic) and Hospital Sultanah Nora Ismail at Batu Pahat were also placed on standby to provide any emergency care or if a person needed to be vaccinated at a hospital due to their medical condition.

Collaborative effort

According to UKM vice-chancellor Prof Datuk Dr Mohd Ekhwan Toriman, a total of 5,489 people have been vaccinated with both Pfizer/BioNTech and Sinovac vaccines through the outreach vaccination service as of July 11 (2021).Dr Hardip assesses a woman at the satellite vaccination centre in MRSM Batu Pahat.Dr Hardip assesses a woman at the satellite vaccination centre in MRSM Batu Pahat.

The team is expected to deliver over 11,000 doses of vaccine in total to the community before the programme ends.

HCTM director Prof Datuk Dr Razman Jarmin notes that in addition to the hospital’s doctors who volunteered their services, general practitioners (GPs) and medical students from the International Medical University Batu Pahat campus also volunteered for the programme.

The nurses and health assistants from HCTM, who were selected from the hospital’s experienced vaccination frontline team, were rostered for weekly shifts throughout the programme.

Meanwhile, ambulance and clinical waste services were provided by the nearby Putra Specialist Hospital, Batu Pahat, and assistance was also received from the Batu Pahat Municipal Council, Yong Peng District Council, National Higher Education Fund Corporation (PTPTN), Industrial Training Institute, People’s Volunteer Corps (Rela) and the local parliamentary office.

The writers, who recently spent a week volunteering their services at the centre, appreciated the opportunity to witness firsthand the struggles and difficulties faced in rural vaccination efforts.

Being able to chat with those being vaccinated on a more personal level and help manage their more general medical problems was a good change of pace compared to conducting their usual ear, nose and throat (ENT) surgeries in the heart of Kuala Lumpur.

While mega vaccination centres in large cities have people coming to them for vaccines, outreach vaccination services such as this bring the vaccines to the people.

Hopefully, the success of this collaborative effort will inspire the creation of more such mobile vaccination services so that our National Covid-19 Immunisation Programme can reach into all corners of the country, especially the smaller towns and rural areas in both Peninsula and East Malaysia.

Dr Hardip Singh Gendeh and Associate Professor Dr Mawaddah Azman are lecturers and ENT surgeons at HCTM. For more information, email The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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