Is it okay or not okay to swab alcohol prior to injection and take paracetamol before or after vaccination?

Last week I accompanied our PHA Nurse under the DOH-HRH to give immunization to some of the kids who were absent during their School Based Immunization (SBI) which they recently conducted within the vicinity.  The schools were just walking distance from the Rural Health Unit where we were deployed and so I agreed readily when she asked me if I want to go with her.  

So why is there School-based immunization? According to World Health Organization, one of the objectives of Global Vaccine Action Plan is to equitably extend the benefits of immunization to adults, adolescents and children. School-based immunization is then a strategy for reaching older children and adolescents with vaccination services. This is deemed necessary especially for children who have missed their scheduled vaccinations. The increase in school enrollment rates, particularly in low income countries, makes the school a growing interest as a platform for immunization. 

Here in the Philippines, before School-based immunization became a yearly activity it was piloted in selected provinces and cities nationwide in 2013 and it was in 2015 when August was declared School-Based Immunization month. As of this year, 2019, the target populations to be vaccinated are school children from kindergarten to grade 7 (K-7).

The first school where we went is a private school, though school-based immunization targets public schools, private schools can access the vaccines as long as they have letter of intent. I was informed that this private school participates annually with the program.  We went to the faculty office and she talked to one of the teachers luckily, the kid’s adviser was there and so he went to get his student. A handsome boy with a dimpled smile came; his adviser then led us to their clinic.

Our nurse swabbed the injection site with water before administering the vaccine. She injected Mumps Measles Rubella Vaccine and Tetanus Diptheria on the other side after explaining to him in a calm and friendly way why he needed the vaccines. She was quick and the kid didn’t flinch or cry, he just gave us his sweet dimpled smile.  She applied tactile stimulation by rubbing the child’s skin near the injection site where in the mechanism is thought to be that the sensation of touch competes the the feeling of pain from the injection and thereby results in less pain. She didn’t give a dose of paracetamol as well which is right but just advised the kid to take paracetamol when he is going to have fever.

She then asked me if I was the one or was it our physician who informed during our previous meeting that alcohol is not necessary to swab prior to injection and I told her it wasn’t me, what I remember telling was about the use of paracetamol before and after vaccination that it could reduce the potency of vaccine to which she replied, “oh yes, that is why one of the midwives reminded us what you said when we went to the other school to conduct SBI, so we didn’t give the kids paracetamol”. I felt happy and admired more my fellow DOH-HRH NDP’s for going beyond their job description to help other people and the community as a whole. The data they have also been gathering were very helpful.

So why is it not necessary to use alcohol prior to injection? It is mentioned in the Vaccination Practical Guideline to “clean the skin with water if dirty, it is not necessary to use alcohol”. Alcohol could “sterilize/disinfect” the skin only if it is done properly which is not usually the case and most important alcohol can affect the quality of some vaccines like BCG vaccine which is administered intradermic.

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Bridges of Madison County

Bridges of Madison County

February 2019

Almost three decades after “The Bridges of Madison County” by Robert James Waller was published, I found a copy of the book in one of the bookshelves at a tiny provincial library in a small, quiet town of Philippines- a thousand miles away from Iowa where the story actually happened.

For the past three weeks and three days each week it became my routine to go to the library after dropping my two kids at their school. The town is 15 minutes away ride from the small village where we live and have to wait for a ride before we can go home so I decided to just stay in town while waiting for my kids to get out of school. I would spend two hours reading however books are old and very scarce. I only found 1 or 2 books I really like. They only have one book related to medicine and most are older editions about law, accountancy and social studies.

It was only last week when I saw the lone bookshelf near the window filled with old novels. One book caught my attention, there is an air of odd familiarity, I must have read or heard it somewhere or before, my subconscious mind reacted so I grabbed the book. Leafing through the pages, I found out it was an actual love story that happened in 1965 at a small town in Iowa. It is a love story of a couple almost 54 years ago in a town of Madison County, Iowa. Old country farm true love stories always excite me, it gives me a rush feeling, a connection only the universe knows as it brings me to another dimension where sometimes I feel I belong. I settled down to read.

My eyes were filled with tears, it was my 3rd day at the library and was reading the final chapter of the book, I was alone except for the librarian who was busy typing and the radio was playing the song “Let’s Make Love” by Faith Hill and Tim Mc Graw. I haven’t felt this deep feeling in the first and middle chapters of the book, I just admired how the author detailed the story; it was the final chapters that gave me a rush of emotions. It is so rustic, so real, so heart wrenching. I felt sad when I read Robert’s letter to Francesca and Francesca’s letter to her kids was heart wrenching. I wiped my tears and went out to blow my nose.

So what happened in the story? This is a story of a love shared by two people physically in just four days but the emotional bond and love lasted a lifetime. Is that possible? I don’t know, all I know is that it happened to two people, to Robert and Francesca.

They met in 1965 when Robert went to Madison County to take pictures of historic bridges for a National Geographic article. It was where he met Francesca when he was trying to ask for directions, Francesca at that time was married to an unromantic husband who was away at the Illinois State Fair for several days with their two kids. They fell in love at first sight with each other and shared love in four days they were together, they were both certain of their feelings and wanted so much to be together however they are not meant to be together or they choose to, out of respect for each other and what each one has.

They never contacted each other after Robert Kincaid’s left the town. Francesca’s husband, Richard died on 1979, he tried to contact Robert, but no one knows his whereabouts or what happened to him, she didn’t look further fearing something happened. Years later after her husband died she received a letter from a law firm on January 1982 stating that they are representing an estate Robert Kincaid left for her. You can imagine how she feels that time.

In his letter, he wrote how he loved her profoundly and never loved any woman than her, he also sent her a medallion with her name engraved on it. He wrote in his letter a lot of times he wanted to go see her and take her with him but said he remembered her words and he respect her. He ordered the firm to cremate his body and throw his ashes at Roseman bridge. Five years later after Francesca received that letter, she was found dead in her bed. She asked her children that her body be cremated and her ashes be thrown at Roseman bridge. Shortly after her death, her two grown children went back to their Iowa farm and discovered a box where they found mementos of Robert Kincaid and a letter from their mother telling them what happened back in 1965. 

The two grown children contacted James Waller who narrated their mom’s love story, which then becomes a novel. The book became a bestseller.

During the time Robert Waller was doing some research about Robert Kincaid, he met a Jazz musician whom Kincaid became friends with in his final years. Robert Kincaid told him about the woman he loved named Francesca and he decided to write a song for him and sing it every Tuesday night when Kincaid would go to the bar, a song he titled “Francesca”.

When I looked up the internet, I have learned that it became a well received Hollywood film in 1995. I wonder if things could have been different, if they did not recognize their feelings and have been afraid to show it, they would never have an experience that lasted a lifetime, there would be no Bridges of Madison County. Love is painful, love comes in all forms and love is true when it is not selfish.