Such was the scene I arrived at on Wednesday last week at the municipal health center at Kyllö, Jyväskylä, Finland. A queue extended a hundred meters beyond the door. It was not hard to guess what it was about, as it had been announced that the pandemic influenza A/H1N1 vaccine would be administered there to people in specific risk groups from 10 am to 3:30 pm.
I should explain here the Finnish health care setup. There are three parallel systems – a comprehensive public health care system maintained by the municipalities to standards set by the state, a network of private for-profit health care providers, and a national foundation dedicated to university student health care. Employers are required by law to provide a minimal level of health care to their employees, and most of them also provide, free of charge to the employees, access to near-comprehensive general-practice-level care; most employers buy this service from the for-profit providers. The public system suffers from resource starvation at the general-practice level but provides excellent care in the central hospitals that handle the difficult cases.
Anyway, the H1N1 vaccine is only available through the public system and through the foundation – free of charge if you qualify for the vaccine, and no amount of money buys it for you in this country if you don’t. Thus, I and many others, normally cared by the employee services, found ourselves queuing up at a public health care institute. And clearly, the public health care system was overwhelmed on that first day.
When I entered the queue, its tail was a traffic hazard. Fortunately, the queue moved faster than new people arrived thereafter, and the hazard ended. The queue moved surprisingly fast – it took me one hour to advance the 100 meters to the door. Even so, this was a failure in the system – there is no good reason to have people with underlying illnesses (and we all had them, to qualify for the vaccine) stand around in freezing cold weather for an hour!
Once, a nurse came and asked us if any of us was 63 years old or older. Apparently no-one was, since no-one was asked to leave (they will be vaccinated later). Later, another nurse asked everyone in the queue outside to show their KELA cards – KELA is the national health insurance system, and its card carries information about extra coverage one qualifies for due to underlying illnesses.
Eventually, I reached the door. Two guards stopped anyone who tried to enter directly, sidestepping the queue, and let in only those who had legitimate business other than vaccination. The main hall was full of people, and I quickly realized that the queue took a full circle inside the hall to reach the multiplexing point. It took me another hour to slowly advance my way though the hall. At the multiplexing point, I was asked to wait a bit, and then I was assigned a vaccination room and a waiting number.
Some twenty minutes later I was called in. The vaccination room I was assigned to was a nurse’s office. Two nurses were there, one who would administer the vaccine, and another at the computer, to keep a record. I gave them my KELA card, and shed my coat and my outer shirt, and bared my left shoulder. I was quickly given the pandemic vaccine; there was no question I was qualified for it, not with my obesity being obvious.
Then they asked what my diagnosis was. “Prmarily I’m here because of my obesity,” I said. “But I also have paroxysmal atrial fibrillation.”
“That’s not what your KELA card says,” accused the nurse at the computer.
“The diagnosis is so new,” I countered. “There has been no time to do the paperwork for KELA.” (And indeed, I later learned, it would come up in my next checkup in the spring.)
They stared at each other.
“I can show you my prescriptions,” I said, making no move for them.
I stared back.
“Do you want the seasonal vaccine or not?” asked the nurse with the injectors.
I lauged briefly. “I might as well.” It had, honestly, never crossed my mind that I might qualify.
She injected me on my right shoulder. “You should stay in out there for ten minutes.”
I picked up my clothes and found the cafeteria with coffee and pastry.
Then the real fun started. Next day, I woke with horrible upper back pain. The thermometer showed mild fever; but since i didn’t have any respiratory symptoms, I decided to go to work. In the evening, turning in bed was excruciatingly painful. It took days for the pain to subside.
I left the building three hours after I arrived at the end of the queue. What? You think that’s excessive? So do I and many others; queuing feels so Soviet Union! But honestly, while it did take time, it worked. I am vaccinated; are you?