Nurses Michelle Farnum, left, Trish Culver, and Marguerite Crocker volunteer at the flu clinic at Melville Elementary School, Portsmouth.

The Providence Journal / John Freidah

In the evening, dozens of white cardboard boxes are delivered to a warehouse backed up to the woods of West Greenwich. They are medium-sized boxes, lined with blue coolant packing, easily carried by one person.

The contents: vaccine against swine flu.

The destination: the arms of Rhode Island’s children.

Each day, Erin McDonough arrives at the warehouse around 5:30 in the morning to help load the boxes and other equipment into eight rented Penske vans or trucks.

McDonough once had an easy job. At least that’s how she describes her six years coordinating Rhode Island medical professionals who want to volunteer in emergencies, a group known as the Medical Reserve Corps, or MRC.

That all changed one day in September, when her boss and father-in-law, Tom Lawrence, came back from a meeting and, after hemming and hawing, broke the news: “I just told them we would vaccinate every child in Rhode Island.” Well, not every child, just every one of school age –– 158,000 youngsters in kindergarten through 12th grade, in 462 clinics to be held at 462 schools.

Her job is not so easy anymore, although she seems at ease doing it. McDonough, 31, is at the center of an extraordinary effort to marshal volunteers from around the state and bring swine-flu vaccine to all schoolchildren whose parents want them vaccinated –– so far, about 75 percent of them. While other states, such as Maine, have held school-based clinics, no other state has orchestrated such a centralized, comprehensive program to vaccinate children. The school clinics started Nov. 2 and will continue until mid-December, with about a dozen clinics held each day.

Nowadays, McDonough all but lives in the office attached to the warehouse of the Disaster Medical Assistance Team, the parent group of the MRC. Perched in front of a laptop, an iPhone and a Nextel walkie-talkie, she keeps track of every delivery truck, every volunteer, the start and finish of every clinic, the arrival of the next day’s vaccine, and the scheduling plans for the days ahead. “I really never leave this spot,” she says. Her office is attached, oddly, to a fully furnished house with a kitchen. It’s a good thing because McDonough, along with other workers, is on the job until 10 every night.

Her feathery blond hair pulled into a ponytail, McDonough looks over the next day’s staffing one recent morning. A school is expecting 500 children, but only one vaccinator has volunteered. McDonough starts typing an e-mail to the volunteers.

Her pool of medical workers are the 749 nurses, doctors, pharmacists and emergency medical technicians who underwent background checks and a special training program for these clinics. Her laptop contains a program called T-Rex, short for Tool for Resource Exchange. Completed just a week before training started, it connects volunteers with the clinics and makes the whole endeavor possible.

“Staffing needs for FRIDAY!!! It’s almost FRIDAY!!!” McDonough types.

She’s not worried. People always come through, especially when it looks urgent. “They can see my desperation,” she says.

And, so far, not one volunteer has failed to show up as scheduled. “I’ve learned that I like volunteers,” she says.

Ron Viveiros, who shows up at the warehouse shortly after noon, is one such volunteer, though he’s not a medical person. He’s a laid-off trucker who drives one of the vans to deliver vaccine from the warehouse to the clinics. The van he will drive is already loaded with about 900 doses –– in three white refrigerated boxes –– for three schools in Newport and Portsmouth. They are among 14 clinics being held that day.

Viveiros, 47, has been out of work since August. Volunteering with the clinic effort keeps him busy in between looking for work, and as the father of two young children who will benefit, he feels good about helping out. He enters the three schools’ addresses into a GPS machine and heads out to grab a cup of coffee.

After stops at the Coggeshall School in Newport and St. Philomena’s School in Portsmouth, he drives to the Melville School in Portsmouth. There had been a delay in Newport, and now it’s almost 4 p.m., the scheduled start time for the clinic.

Swiftly the volunteers help him unload the equipment: a green canvas gym bag containing oxygen and medical supplies; a stretcher; a black case holding a defibrillator; a brown cardboard box filled with syringes, gloves, alcohol rubs; a plastic box full of paperwork; and Benedryl and Epi-pens in case anyone has an allergic reaction.

And, of course, the white cardboard box with the vaccine.

Although some children have cried, fainted or vomited from nervousness, so far there have been no bad reactions to the vaccine –– but the school clinics are equipped to handle such occurrences. Two police cars and an ambulance wait outside.

The boxes are brought into the school gym and placed on the stage. Robert Church, the clinic manager, starts going through the boxes with Viveiros to make sure everything is accounted for. Church is the Portsmouth deputy fire chief, now volunteering on his own time. He’s been a longtime member of the Disaster Medical Assistance Team and the Medical Reserve Corps. Church helped vaccinate thousands of people in New Orleans after Hurricane Katrina. A few hundred kids in an elementary school? Piece of cake.

“It’s all a group effort,” he says. “Everyone pitches in.” In addition to four volunteer nurses, the school nurse, the principal, the superintendent of schools and volunteer parents and teachers have gathered to set up, check consent forms, handle the paperwork and move the children through the gym.

They are starting to line up in the hallway. Some 300 are expected.

Three nurses stand in front of the stage, ripping open packages, assembling the syringes, and filling them with vaccine. They need to load at least half the syringes ahead of time so that things will go smoothly.

Trish Culver pokes a needle inside a tiny vial of clear liquid. Carefully she extracts the exact amount of vaccine for a single dose, flicks her finger against the syringe and places it in a basket. Culver, who lives in Portsmouth, is a nurse who handles education and infection control at a nursing home in Newport. Why is she here at the Melville School? “I feel like I should do my part,” she says, reaching for another syringe.

Michelle Farnum, of Newport, is helping Culver with the syringes. In her regular job, Farnum is a nurse at Newport Hospital’s birthing center. “To vaccinate all the kids –– this is a huge undertaking,” she says. “It’s exciting to be part of it.”

Another nurse, Marguerite Crocker, takes a seat at one of the tables where children will get their shots. She starts opening the little packages with Band-Aids, so they can be quickly applied. Her regular job is as a school nurse in Bristol, hometown of the first child to die of H1N1 this season. “Since I was the school nurse, I was right in the middle of all the poor kids getting sick,” Crocker says. “I feel like I’m trying to keep everybody healthy.”

It’s past 4 p.m. You can hear the kids waiting in line outside the gym.

Schools Supt. Susan Lusi asks whether she can help and sits down to tackle the Band-Aids. Asked whether the vaccine clinics are a burden to the schools, Lusi says: “Is it something else for us to do? Yes. We’re glad to do it. I really have to say the Department of Health has really done a great job of keeping us informed and coordinating this along with the Department of Education. The most important thing is to keep people healthy.”

Church, the clinic manager, indicates that the time has come. Visitors are told to clear out; the Health Department has decreed that flu clinics are private.

In moments, a choreographed group effort will begin, and the first dose of vaccine from the chilled white box –– vaccine to prevent an awful illness –– will make its way into the arm of a child.

ffreyer@projo.com