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It was a sultry June morning in Lucasville,
Ohio. The mobile van of the Ohio University
College of Osteopathic Medicine (OUCOM) was
parked in the lot of the Valley Township
Volunteer Fire and Rescue as Lynn Smith, R.N.,
and Jan Johnson, R.N., of the Childhood
Immunization Program prepared and administered
vaccines for children and adults alike. Twelve
year old Sarah stood outside the clinic with her
mom and grandma. Her mom, Joyce, had completed
the intake forms provided by Richard Shuler
(another staff member of the clinic). Many of
Sarah’s peers from school had come and gone as
she remained outside. While outside and in
anticipation of the “doom” that immunizations
represented to her,
 Sarah
wrote her will on a paper napkin. “I will my
fish and my bike to my brother Andrew,” wrote
Sarah. Joyce reminded Sarah that she could not
start 7th grade until her
immunizations were up to date and that it would
be impossible for her to take off work to travel
with Sarah the forty miles to their family
physician’s office for the vaccination.
Moreover, they did not have insurance coverage
to cover the complete costs of the vaccination.
Sarah nodded that she understood but continued
to cry. Lynn came down the stairs of the van
and welcomed Sarah and Joyce to the clinic. Once
inside the examination room, Lynn talked to
Sarah and Joyce about the immunization Sarah
would receive and why it was important,
described what they could expect in terms of
potential side effects and when emergency care
should be sought, emphasized that this would be
Sarah’s last shot for ten years, swabbed Sarah’s
arm with alcohol and encouraged her to let her
arm hang loose like a wet noodle. “Ok, I’m
ready, go ahead and give me the shot,” Sarah
finally said as tears continued to stream down
her face. “It’s already done,” shared Lynn. “No
way, this is the first time I’ve got a shot that
didn’t hurt!” exclaimed Sarah. Joyce gently told
Sarah she could tear up her will. Throughout the
morning, Lynn, Jan, and Richard worked in tandem
to ease the tensions that naturally arise when
people, especially youth like Sarah, get
immunizations. As the van traveled back to
Athens on Highway 50, Dr. Lynn Harter, an
observer of the mobile clinic’s activities,
reflected on a billboard advertising a new state
of the art medical complex constructed of metal,
glass, cement and human suffering. “While you
are changing lanes, we are changing lives,” read
the billboard. In the case of the mobile clinic,
the staff are changing lanes and changing lives.
iseases such as polio, rubella, and mumps do not
occur often in this country due in large part to
immunizations. Through the tireless efforts of
Jan, Lynn, and Richard, the Childhood
Immunization Program (CHIP) works to make
immunizations and health information more
accessible to the general public by providing
curbside care at schools, community centers,
libraries, and at Parks Hall on the Ohio
University campus. Funded by the Ohio Department
of Health, the services of CHIP span 21 counties
of Southeast Ohio. Regardless of income or
insurance status, children up to 18 years of age
receive free immunizations and assistance with
kindergarten registration, and adults have
access to flu clinics, hepatitis B immunization
clinics, parent education, and referral
services. By changing lanes in order to change
lives, the CHIP clinic provides 21st
century “house calls” and offers a hopeful
vision for community-based health care.
Lynn and Jan don’t just “give shots,” although
they do administer immunizations skillfully and
with compassion. They also educate parents and
guardians about the physiological nature of
immunizations, emphasize the importance of
ensuring timely shots for children and
maintaining updated records, talk with guardians
about parenting issues, and make referrals when
health care issues arise that the staff are not
equipped to address. At any given clinic, the
staff listens to the concerns of clients,
answers questions and distributes information –
Tylenol dosage charts, directions on how to
properly restrain infants in car seats, how to
childproof homes, when the next clinics will
occur. Many of the clinics are choreographed by
Richard, who drives the 40-foot van and acts as
the record keeper to ensure that proper forms
are completed and copies of shot records are
electronically stored. Collectively, the staff
treats patients and guardians with respect,
often acknowledging people by their first names
and praising parents and children when they
model healthy behaviors. It is difficult to do a
ride-along with the van without bearing witness
to how the staff collaborates with
clients as partners in the accomplishment
of health care.
The staff of CHIP coordinates with county health
departments, school nurses, and local physicians
to ensure that services are provided in
appropriate spaces and at times that are least
disruptive to patients’ lives. For example, CHIP
hosts clinics in Parks Hall on Tuesdays and
Thursdays because local physicians try to
schedule well-child checkups on those same days,
making it easier for parents to take advantage
of CHIP services. CHIP represents an alternative
approach to organizing health care resources,
marrying traditional and alternative spaces in
an attempt to provide health care. Although
CHIP provides services for all populations, they
have a specific focus on the underserved
population of Appalachian Ohioans. Services like
CHIP are responding to the unheard voices and
unmet needs of community members. Some
populations in Appalachia have special concerns
that prohibit them from taking full advantage of
traditional health care (e.g., inability to pay
for services, geographic isolation and
separation from health care resources, inability
to leave work for appointments). CHIP answers
this call for care by using traditional space in
a fixed clinic at Parks Hall and a movable space
in the mobile clinic van. CHIP alleviates the
pressures of finding the time, money, and
transportation needed to visit a clinic by (1)
providing immunizations free of charge, and (2)
bringing care to the places where people live
and work. This curbside care guarantees that
people have the opportunity to get
immunizations, and in doing so shifts and
expands the traditional scenes of health care.
We have participated in CHIP activities over the
past two months, traveled over 450 miles and
spent more than 50 hours observing interactions
between staff and clients and talking with
staff. We have witnessed how CHIP’s curbside
care functions to disrupt material and
geographic barriers to health care as it shifts
the settings in which
 health
care unfolds, and remain convinced that
Appalachia is a healthier place to live because
of the efforts of CHIP staff. The public service
mission of Ohio University reflects its
responsibility to address the ongoing needs of
the region. Through CHIP, Ohio University
contributes to the overall well-being of
individuals in the Appalachian regions of Ohio.
Written by: Lynn M. Harter, Pamela Kenniston,
Heather Carmack, Elizabeth Rattine-Flaherty, and
Karen Deardorff, School of Communication
Studies, Ohio University
August 6th, 2005
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