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[User] Here they normally tell me they boil, they boil lemon leaves, then squeeze in it also the lemon,make some coco just to try and sooth the sore throat and cough of course I don’t know if it works for them but it just seems to me as if they end up with us to the hospital

[Assistant] Do you usually get patients coming in with sore throat? Is it a common tradition that is here?

[User] It is not, it’s not usually for patients to come complaining that they have a sore throat, they come when maybe I don’t know maybe because this is a regional referral hospital, they become when maybe its pneumonia, they are coughing badly they come with difficulties in breathing and they have tried with their cough elsewhere, it has progressed away from sore throat

[Assistant] So why that sore throat is is not taken like seriously?

[User] One, I think people have many problems that they try to ignore health conditions, they would want to try and pay attention to other things, they start paying attention to health situations when now the condition is worse but usually I think, I think according to their responses because usually we get patients when they are very sick, they come here when they are really very sick and when you ask them, they tell you how they have spent a long time home without getting help .one of it is not attaching much care or concerns to health but also the issues of economic problems but in most cases when you ask them, they tell you they come from very distant places, the distance from where are residence to the hospital usually it involves costs to transport themselves, am sure it’s one of the problem.

[Assistant]
The issue u know going to the health Center and you don’t get the drugs, these drugs they rarely just buy, sometimes they don’t get the drugs also available in the hospital day and they get reluctant to go to the health Center or to seek care but if you don’t have the money and you know you are going to hospital and what you need is not there, sometimes you end up trying local herbs, they delay to seek care

Ok and then talking about drugs, if you look at this facility here in the hospital, how are stocks?


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[User] Now I think it start with how to empowering people economically would be the way to go but of course it’s a long, long way to go but in like a short term, arrangement maybe you would encourage that the hospital be stocked with all the necessary drugs because they are not even very expensive, somehow in most cases like if you want a steriat, usually like cortisol steriat, they are not usually very expensive but you find this people are already broke, they don’t have money to buy so we can stock them ourselves, vendecine of course is there, vendecine penicillin but it’s also out of stock in most cases, it’s also not expensive out there

[Assistant] Ok, thank you. How, during your school years were you taught about the treatment option for RHD, of course I have heard you talking about the drugs

[User] Yes the different options?

[Assistant] Yes

[User] You see we were taught ,of course we answered those questions, we know the root cause now, we want to attack the bacteria, of course now in the heart the bacteria is not there, it’s now the anti-bodies against so we give vendecine peroxylaxis monthly dozes of vendecine depending on the ages, of course now we treat the symptoms that are coming with these anti bodies deposited, yes we can deal with the bacterial infections with anti-biotic broad spectrum preferably with penicillin best interactors and then we deal with the inflammations caused by the anti-bodies. we tend to, since we know there is anti-body production, we want to supress that process so we use cortisol steriat to suppress them and give ASAS for inflammation and the fevers we try to bring it down to respond and if there is candidiasis, we go and give them, if there is a heart failure, we give them heart failure arrangement inter blockers Castrol blockers, so that we try and lower the pressure and also reduce the heart rate

[Assistant] Ok, thank you, so what is your understanding about the long term prognosis of RHD? , looking in your own understanding


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[User] My own understanding is that if managed properly and effectively progress is good, prognosis is good, we can reverse the articulation, we keep giving them this anti- inflammatory, the cortisol steriat also for some times, also as we do physio therapy, they will always get up and with our monthly Benzathine Prophylaxis, we try and prevent the organisms from continuing to grow. yes they probably, the Benzathine penicillin, yeah, the prognosis is not very bad if managed early, if the heart, if the heart is not badly affected but of course if we delay and the valves are now badly damaged the heart is badly damaged, then the prognosis might not be good because it might involve that you do valve replacement or transplant which is not a good thing, it depends on when you come in and how far the extent of the damage to the heart valves

[Assistant] Ok, wonderful! Then let’s talk about the encounters with RHD patients, do you remember the last patient you worked on and how long you are...

[User] Right now I still have one, I think I have two, Right now on the ward, you saw it’s still a fresh thing

[Assistant] Yes

[User] And I expect anytime

[Assistant] Yes, give us a picture of how these patients presented and ...


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[User] Right now I still have one, I think I have two, Right now on the ward, you saw it’s still a fresh thing

[Assistant] Yes

[User] And I expect anytime

[Assistant] Yes, give us a picture of how these patients presented and ...

[User] These patients presented at emergency department with a very high fever, uncontrollable cough, and cough with joint pains, generally weak so at the emergency, the person who was there made a diagnosis of pneumonia and the patient was actually referred with pneumonia. So being on the ward, I received the patient and he is actually 15 years old and they were coughing, they were breathless and I immediately first put him on oxygen, then when I started my clinical exams. I saw this patient was remitting a joint criteria for rheumatic diagnosis of RHD, they already had ah...hydratory hytheritis with even spinal deformities, very high fever, the cicardia, the heart murmurs were already there, so I called for help as I told you, echo here, we don’t have as a hospital, so I came, asked for help from the project. Then we did the echo, first we did a throat swap, the rapid test was positive, so I knew I was on the right track, echo was also significant yeah so then we sat up together, we started the treatment, and the patient started improving. Now he has improved, what he is left with is the physio therapy not yet, what am left with is the physio therapy then I discharge him

[Assistant] Ok, good to hear that. then, so you said you mostly see children with RHD


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[User] Yes, Mostly children like between 10, ages between 10 and 20

[Assistant] and 20?

[User] I have seen most of them. I think there was only one who was less than 10 years because night duty is always long but mostly between 10, I can recall 3 with 15 years, 14, and 15

[Assistant] Ok

[User] Yes

[Assistant] And then could you be knowing if they were in school or out of school children


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[User] I have seen most of them. I think there was only one who was less than 10 years because night duty is always long but mostly between 10, I can recall 3 with 15 years, 14, and 15

[Assistant] Ok

[User] Yes

[Assistant] And then could you be knowing if they were in school or out of school children

[User] They are in school children

[Assistant] They are in school children?


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[User] Yes

[Assistant] And then could you be knowing if they were in school or out of school children

[User] They are in school children

[Assistant] They are in school children?

[User] They are actually in school children

[Assistant] Ok and then do you think they know the link between sore throat, acute rheumatic fever and RHD


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[User] They are in school children

[Assistant] They are in school children?

[User] They are actually in school children

[Assistant] Ok and then do you think they know the link between sore throat, acute rheumatic fever and RHD

[User] That is where there is a problem, there is so much knowledge gap in terms of health, they don’t know, exactly they don’t know at all, When you ask them, have you ever suffered a sore throat? They will admit it to you, did you treat, no it went, it went but now finally am getting cough again, yes but there are knowledge gaps. It’s somehow the knowledge gap, they don’t have that knowledge

[Assistant] Ok, and for them, what symptoms do they describe to you when they come?


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[User] They are actually in school children

[Assistant] Ok and then do you think they know the link between sore throat, acute rheumatic fever and RHD

[User] That is where there is a problem, there is so much knowledge gap in terms of health, they don’t know, exactly they don’t know at all, When you ask them, have you ever suffered a sore throat? They will admit it to you, did you treat, no it went, it went but now finally am getting cough again, yes but there are knowledge gaps. It’s somehow the knowledge gap, they don’t have that knowledge

[Assistant] Ok, and for them, what symptoms do they describe to you when they come?

[User] For them the symptoms they describe to me is the joint pain, general body pain, they say general body pain and stiffness in the body, stiffness in the body with swellings, yes and cough of course fever is getting high, they try with anti biotics and then they go down and being breathless, failure to breathe

[Assistant] So generally are they following their follow up and adherence to the things you tell them to do and the drug taking?


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[User] That is where there is a problem, there is so much knowledge gap in terms of health, they don’t know, exactly they don’t know at all, When you ask them, have you ever suffered a sore throat? They will admit it to you, did you treat, no it went, it went but now finally am getting cough again, yes but there are knowledge gaps. It’s somehow the knowledge gap, they don’t have that knowledge

[Assistant] Ok, and for them, what symptoms do they describe to you when they come?

[User] For them the symptoms they describe to me is the joint pain, general body pain, they say general body pain and stiffness in the body, stiffness in the body with swellings, yes and cough of course fever is getting high, they try with anti biotics and then they go down and being breathless, failure to breathe

[Assistant] So generally are they following their follow up and adherence to the things you tell them to do and the drug taking?

[User] The follow up according to me I think its zero, there is zero follow up according to me, ok as me , I have never tried to follow up because, we need the scope of plans, so and I don’t know whether there is follow up elsewhere

[Assistant] But do they adhere when you talk them


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[User] For them the symptoms they describe to me is the joint pain, general body pain, they say general body pain and stiffness in the body, stiffness in the body with swellings, yes and cough of course fever is getting high, they try with anti biotics and then they go down and being breathless, failure to breathe

[Assistant] So generally are they following their follow up and adherence to the things you tell them to do and the drug taking?

[User] The follow up according to me I think its zero, there is zero follow up according to me, ok as me , I have never tried to follow up because, we need the scope of plans, so and I don’t know whether there is follow up elsewhere

[Assistant] But do they adhere when you talk them

[User] Then adherence, we try and encourage them at the discharge to try and adhere but I can’t ensure, I can’t know what happens when they go home, especially that these drugs has to be bought, so I don’t know, you write but I don’t know whether they buy it but I think they buy it because I have no seen re-admission yet in this period of two months, I haven’t seen that

[Assistant] You have not seen any re-admission of RHD?


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[User] The follow up according to me I think its zero, there is zero follow up according to me, ok as me , I have never tried to follow up because, we need the scope of plans, so and I don’t know whether there is follow up elsewhere

[Assistant] But do they adhere when you talk them

[User] Then adherence, we try and encourage them at the discharge to try and adhere but I can’t ensure, I can’t know what happens when they go home, especially that these drugs has to be bought, so I don’t know, you write but I don’t know whether they buy it but I think they buy it because I have no seen re-admission yet in this period of two months, I haven’t seen that

[Assistant] You have not seen any re-admission of RHD?

[User] Yes

[Assistant] So what sorts of barriers do they commonly state, barriers to getting care that they need, what do you think stops them from accessing the care


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[User] Then adherence, we try and encourage them at the discharge to try and adhere but I can’t ensure, I can’t know what happens when they go home, especially that these drugs has to be bought, so I don’t know, you write but I don’t know whether they buy it but I think they buy it because I have no seen re-admission yet in this period of two months, I haven’t seen that

[Assistant] You have not seen any re-admission of RHD?

[User] Yes

[Assistant] So what sorts of barriers do they commonly state, barriers to getting care that they need, what do you think stops them from accessing the care

[User] The barriers start with the economic status, distance from where they stay to the facilities and then you know poor economic status, funds to put into transport, buying drugs and the availability of drugs in those centers is another problem. In those centre they have very, very limited and they get out of their stocking

[Assistant] And then when you are discharging, am sure there are certain things you tell them to do or not to do


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[User] Yes

[Assistant] So what sorts of barriers do they commonly state, barriers to getting care that they need, what do you think stops them from accessing the care

[User] The barriers start with the economic status, distance from where they stay to the facilities and then you know poor economic status, funds to put into transport, buying drugs and the availability of drugs in those centers is another problem. In those centre they have very, very limited and they get out of their stocking

[Assistant] And then when you are discharging, am sure there are certain things you tell them to do or not to do

[User] Yes

[Assistant] Right, do you think they obey them?


[System] Act as an information elicitation agent for academic interviews.

[User] The barriers start with the economic status, distance from where they stay to the facilities and then you know poor economic status, funds to put into transport, buying drugs and the availability of drugs in those centers is another problem. In those centre they have very, very limited and they get out of their stocking

[Assistant] And then when you are discharging, am sure there are certain things you tell them to do or not to do

[User] Yes

[Assistant] Right, do you think they obey them?

[User] They rarely, they are but you see laughs. I can talk to you, most of the patients have been found to be patients of the very low class status. Even their ability to comprehend the information is very little, their ability, their capacity to understanding what you are talking about is very, very limited because before you choose, and you decide to discharge them. They want to go home, yes I don’t but you try to explain to them because we want since the ailment comes with articulation problems, it requires continuous you know physio therapy, rest and prophylaxis treatment, yes, continuous treatment of any other symptoms that comes like I told you the knowledge gaps like their ability to understand. I have not tested it, I have not gone to do research to find out whether they adhere to some of these but in my own thinking, in my opinion, I think they neglect, they don’t get, they don’t find time to pay attention towards this disease.

[Assistant] So when you give them appointments ah... I don’t know if you have given some to come back maybe you have been here for two months?


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[User] Yes

[Assistant] Right, do you think they obey them?

[User] They rarely, they are but you see laughs. I can talk to you, most of the patients have been found to be patients of the very low class status. Even their ability to comprehend the information is very little, their ability, their capacity to understanding what you are talking about is very, very limited because before you choose, and you decide to discharge them. They want to go home, yes I don’t but you try to explain to them because we want since the ailment comes with articulation problems, it requires continuous you know physio therapy, rest and prophylaxis treatment, yes, continuous treatment of any other symptoms that comes like I told you the knowledge gaps like their ability to understand. I have not tested it, I have not gone to do research to find out whether they adhere to some of these but in my own thinking, in my opinion, I think they neglect, they don’t get, they don’t find time to pay attention towards this disease.

[Assistant] So when you give them appointments ah... I don’t know if you have given some to come back maybe you have been here for two months?

[User] Yes, 2 months

[Assistant] 2 months? Have you had to give any to go back for appointment?


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[User] They rarely, they are but you see laughs. I can talk to you, most of the patients have been found to be patients of the very low class status. Even their ability to comprehend the information is very little, their ability, their capacity to understanding what you are talking about is very, very limited because before you choose, and you decide to discharge them. They want to go home, yes I don’t but you try to explain to them because we want since the ailment comes with articulation problems, it requires continuous you know physio therapy, rest and prophylaxis treatment, yes, continuous treatment of any other symptoms that comes like I told you the knowledge gaps like their ability to understand. I have not tested it, I have not gone to do research to find out whether they adhere to some of these but in my own thinking, in my opinion, I think they neglect, they don’t get, they don’t find time to pay attention towards this disease.

[Assistant] So when you give them appointments ah... I don’t know if you have given some to come back maybe you have been here for two months?

[User] Yes, 2 months

[Assistant] 2 months? Have you had to give any to go back for appointment?

[User] Yes

[Assistant] How was the turn up, did they turn up?


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[User] Yes

[Assistant] How was the turn up, did they turn up?

[User] Yes fortunately they come back

[Assistant] They come?

[User] Definitely they come, if you stress to them the importance of what you are telling them, they come back, you write it on their discharge form,

[Assistant] You have just answered what I was going to ask that why do you think they come back for their appointment, so it is stressing of the ...


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[User] Yes fortunately they come back

[Assistant] They come?

[User] Definitely they come, if you stress to them the importance of what you are telling them, they come back, you write it on their discharge form,

[Assistant] You have just answered what I was going to ask that why do you think they come back for their appointment, so it is stressing of the ...

[User] It’s the emphasis

[Assistant] emphasis that you put on?


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[User] Definitely they come, if you stress to them the importance of what you are telling them, they come back, you write it on their discharge form,

[Assistant] You have just answered what I was going to ask that why do you think they come back for their appointment, so it is stressing of the ...

[User] It’s the emphasis

[Assistant] emphasis that you put on?

[User] Yes

[Assistant] If you attach a lot of emphasis?


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[User] It’s the emphasis

[Assistant] emphasis that you put on?

[User] Yes

[Assistant] If you attach a lot of emphasis?

[User] Yes

[Assistant] They will come back


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[User] Yes

[Assistant] If you attach a lot of emphasis?

[User] Yes

[Assistant] They will come back

[User] Yes they will come back

[Assistant] What else do you think motivates them to really come back?


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[User] Yes they will come back

[Assistant] What else do you think motivates them to really come back?

[User] To really come back?

[Assistant] Yes

[User] You know the horrific status you find the patient usually at the peak of the disease, they get helpless and you think yes, we are losing the patient and now seeing this patient come back to life and able to live, walk, I think that also sends signal to them, so they want to listen to what we tell them to come back

[Assistant] So when they get better, then they are encouraged to come back?


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[User] To really come back?

[Assistant] Yes

[User] You know the horrific status you find the patient usually at the peak of the disease, they get helpless and you think yes, we are losing the patient and now seeing this patient come back to life and able to live, walk, I think that also sends signal to them, so they want to listen to what we tell them to come back

[Assistant] So when they get better, then they are encouraged to come back?

[User] The only thing I told you, yes, they are encouraged to come back, the only thing I am not sure about is the day today information you give them that daily dozes do this, give this physio therapy, give these drugs, go buy them that is what I don’t know whether they do but come back, they do come back

[Assistant] So those that come back, have you encountered, why do you think some people don’t come back for their appointment?


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[User] The only thing I told you, yes, they are encouraged to come back, the only thing I am not sure about is the day today information you give them that daily dozes do this, give this physio therapy, give these drugs, go buy them that is what I don’t know whether they do but come back, they do come back

[Assistant] So those that come back, have you encountered, why do you think some people don’t come back for their appointment?

[User] Sometimes I think because of transport issues

[Assistant] Transport issues?

[User] Yes, issues of no money to transport the child and even when they are here, they try to make call to fund their bills, what they eat and some drugs they buy, so at the end of the day when they get back home, it becomes a challenge given their status, I think that is one of them. I don’t want to attribute it to the negligence but I think I want to attribute it on the capacity to come back and take care, that is why am telling you that even the day to day care, I think it becomes a challenge because I think there are usually large families out because now others also have to eat, what to drink and other basic needs. They tend to ignore health issues, so basically and the late presentation in the hospital

[Assistant] You said they don’t really take health a priority that is why they come and present late?


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[User] Sometimes I think because of transport issues

[Assistant] Transport issues?

[User] Yes, issues of no money to transport the child and even when they are here, they try to make call to fund their bills, what they eat and some drugs they buy, so at the end of the day when they get back home, it becomes a challenge given their status, I think that is one of them. I don’t want to attribute it to the negligence but I think I want to attribute it on the capacity to come back and take care, that is why am telling you that even the day to day care, I think it becomes a challenge because I think there are usually large families out because now others also have to eat, what to drink and other basic needs. They tend to ignore health issues, so basically and the late presentation in the hospital

[Assistant] You said they don’t really take health a priority that is why they come and present late?

[User] Yes, because I think they try local remedies, because they try chances, they give it to chance, they delay to present and probably shared negligence to health related issues might also be one of them and then also the ‘’big animal’ ’poverty, poor economic situation that is eating us

[Assistant] That is eating...laughs


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[User] Yes, issues of no money to transport the child and even when they are here, they try to make call to fund their bills, what they eat and some drugs they buy, so at the end of the day when they get back home, it becomes a challenge given their status, I think that is one of them. I don’t want to attribute it to the negligence but I think I want to attribute it on the capacity to come back and take care, that is why am telling you that even the day to day care, I think it becomes a challenge because I think there are usually large families out because now others also have to eat, what to drink and other basic needs. They tend to ignore health issues, so basically and the late presentation in the hospital

[Assistant] You said they don’t really take health a priority that is why they come and present late?

[User] Yes, because I think they try local remedies, because they try chances, they give it to chance, they delay to present and probably shared negligence to health related issues might also be one of them and then also the ‘’big animal’ ’poverty, poor economic situation that is eating us

[Assistant] That is eating...laughs

[User] Yes

[Assistant] Ok and then let’s look at the local health system barriers here, what is not working for you on your side here in lira hospital, you want to do this but you are let down


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[User] Yes, because I think they try local remedies, because they try chances, they give it to chance, they delay to present and probably shared negligence to health related issues might also be one of them and then also the ‘’big animal’ ’poverty, poor economic situation that is eating us

[Assistant] That is eating...laughs

[User] Yes

[Assistant] Ok and then let’s look at the local health system barriers here, what is not working for you on your side here in lira hospital, you want to do this but you are let down

[User] sorry to say this but investigations are so limited, investigations are so limited here in lira hospital. Investigations are done outside the hospital from private settings and yet we also discovered that not all private facilities give correct results from the investigations, so you can’t investigate properly

[Assistant] So you said that you don’t have, you don’t have a ECG machines?


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[User] sorry to say this but investigations are so limited, investigations are so limited here in lira hospital. Investigations are done outside the hospital from private settings and yet we also discovered that not all private facilities give correct results from the investigations, so you can’t investigate properly

[Assistant] So you said that you don’t have, you don’t have a ECG machines?

[User] Now here if I am to point out, the only thing here is the ultra sound and x-ray. for a CBC you can’t, I can’t do a CBC within, we can’t do echo, I can’t do CT, I can’t do...of course CT is now too much to ask but I can’t do a CT,I can’t do any electrolytes, you get it! I can’t do any microbiology related investigations. You don’t think of a culture or of chemistry or any other things, I don’t think even just of a gram stain of course I can’t analyse urine laughs, so I don’t know why those challenges are persistent but that is the picture, what I can only do is an x-ray and ultra sound, those two are not enough to investigate the patient and they are far from helping the patient, so that’s one of the barriers, another barrier to help would also be the series of those I listed. Being a regional hospital, people come from very far and when they come here, they find it hard to maintain themselves, you want to keep the patient but the attendants have nothing to eat, they have nothing to help them, so that becomes also a barrier, that becomes a barrier coming from the side of the patient

[Assistant] ok

[User] Patient’s side

[Assistant] In Mulago, patients gets some food, Are patients here given food in the hospital?


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[User] Now here if I am to point out, the only thing here is the ultra sound and x-ray. for a CBC you can’t, I can’t do a CBC within, we can’t do echo, I can’t do CT, I can’t do...of course CT is now too much to ask but I can’t do a CT,I can’t do any electrolytes, you get it! I can’t do any microbiology related investigations. You don’t think of a culture or of chemistry or any other things, I don’t think even just of a gram stain of course I can’t analyse urine laughs, so I don’t know why those challenges are persistent but that is the picture, what I can only do is an x-ray and ultra sound, those two are not enough to investigate the patient and they are far from helping the patient, so that’s one of the barriers, another barrier to help would also be the series of those I listed. Being a regional hospital, people come from very far and when they come here, they find it hard to maintain themselves, you want to keep the patient but the attendants have nothing to eat, they have nothing to help them, so that becomes also a barrier, that becomes a barrier coming from the side of the patient

[Assistant] ok

[User] Patient’s side

[Assistant] In Mulago, patients gets some food, Are patients here given food in the hospital?

[User] They are not given food, food is not there

[Assistant] There is no food, you are to cater?


[System] Act as an information elicitation agent for academic interviews.

[User] Patient’s side

[Assistant] In Mulago, patients gets some food, Are patients here given food in the hospital?

[User] They are not given food, food is not there

[Assistant] There is no food, you are to cater?

[User] There is no kitchen working because even me, I don’t eat food here

[Assistant] laughs...even you, you don’t eat food?


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[User] They are not given food, food is not there

[Assistant] There is no food, you are to cater?

[User] There is no kitchen working because even me, I don’t eat food here

[Assistant] laughs...even you, you don’t eat food?

[User] laughs...

[Assistant] laughs...I thought it was across because like in kawempe where I work, you get food


[System] Act as an information elicitation agent for academic interviews.

[User] There is no kitchen working because even me, I don’t eat food here

[Assistant] laughs...even you, you don’t eat food?

[User] laughs...

[Assistant] laughs...I thought it was across because like in kawempe where I work, you get food

[User] We don’t get food here, we have been trying with the director on that, we can’t be hungry

[Assistant] So when you look at funding for health care


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[User] laughs...

[Assistant] laughs...I thought it was across because like in kawempe where I work, you get food

[User] We don’t get food here, we have been trying with the director on that, we can’t be hungry

[Assistant] So when you look at funding for health care

[User] Funding for the health care I think it’s still far below the belt, funding for health care is still below

[Assistant] And then for RHD care?


[System] Act as an information elicitation agent for academic interviews.

[User] We don’t get food here, we have been trying with the director on that, we can’t be hungry

[Assistant] So when you look at funding for health care

[User] Funding for the health care I think it’s still far below the belt, funding for health care is still below

[Assistant] And then for RHD care?

[User] For RHD care becomes very serious, indeed it turns out to be like a luxury, they will not because if they cannot provide those others, food and the rest, singling RHD might be a long way to go, for health, for the hospital and for the ministry or for the budget ok, to take care, it will be a challenge, to me i think so unless your justification but I see it as a problem

[Assistant] And then let’s look at the administration, how do you look at it?


[System] Act as an information elicitation agent for academic interviews.

[User] Funding for the health care I think it’s still far below the belt, funding for health care is still below

[Assistant] And then for RHD care?

[User] For RHD care becomes very serious, indeed it turns out to be like a luxury, they will not because if they cannot provide those others, food and the rest, singling RHD might be a long way to go, for health, for the hospital and for the ministry or for the budget ok, to take care, it will be a challenge, to me i think so unless your justification but I see it as a problem

[Assistant] And then let’s look at the administration, how do you look at it?

[User] Administration, I have not paid much attention to the issues of the administration much in this period of 2 months. But so far I see administration is there, there is no gap, I don’t see the gap because I see the director is around, all the offices are occupied ,the SPNO is there, the heads of departments are there ok so they can be there. What happens in the administration is not just people occupying the offices, work going on and that is a sensitive part that someone had to talk about

[Assistant] So in case you need something to ease your work and you raise the issues to the administration, what is the response?


[System] Act as an information elicitation agent for academic interviews.

[User] For RHD care becomes very serious, indeed it turns out to be like a luxury, they will not because if they cannot provide those others, food and the rest, singling RHD might be a long way to go, for health, for the hospital and for the ministry or for the budget ok, to take care, it will be a challenge, to me i think so unless your justification but I see it as a problem

[Assistant] And then let’s look at the administration, how do you look at it?

[User] Administration, I have not paid much attention to the issues of the administration much in this period of 2 months. But so far I see administration is there, there is no gap, I don’t see the gap because I see the director is around, all the offices are occupied ,the SPNO is there, the heads of departments are there ok so they can be there. What happens in the administration is not just people occupying the offices, work going on and that is a sensitive part that someone had to talk about

[Assistant] So in case you need something to ease your work and you raise the issues to the administration, what is the response?

[User] What was the response? The response is simplified to lets work within our means, its simplified to that level, just we use what you have available, what you don’t have, patients can go do it.if they cannot, if the miss schedule are not within, you refer to the national referral and that’s why we can refer patients just for INR to Mulago with far bleeding issues

[Assistant] Ok taking it to a higher level leadership within the district do you see any concern for the health issues?


[System] Act as an information elicitation agent for academic interviews.

[User] Administration, I have not paid much attention to the issues of the administration much in this period of 2 months. But so far I see administration is there, there is no gap, I don’t see the gap because I see the director is around, all the offices are occupied ,the SPNO is there, the heads of departments are there ok so they can be there. What happens in the administration is not just people occupying the offices, work going on and that is a sensitive part that someone had to talk about

[Assistant] So in case you need something to ease your work and you raise the issues to the administration, what is the response?

[User] What was the response? The response is simplified to lets work within our means, its simplified to that level, just we use what you have available, what you don’t have, patients can go do it.if they cannot, if the miss schedule are not within, you refer to the national referral and that’s why we can refer patients just for INR to Mulago with far bleeding issues

[Assistant] Ok taking it to a higher level leadership within the district do you see any concern for the health issues?

[User] At the district? Yeah, at the district I have not yet broadened my...,I don’t know because I have only been here for a short period of two months, in a short period of time to know how they engage at that level. I have not yet taken time to study their engagement and development about our matters

[Assistant] How about health information system, medical record system at this place when you look at it, is it working for you?


[System] Act as an information elicitation agent for academic interviews.

[User] What was the response? The response is simplified to lets work within our means, its simplified to that level, just we use what you have available, what you don’t have, patients can go do it.if they cannot, if the miss schedule are not within, you refer to the national referral and that’s why we can refer patients just for INR to Mulago with far bleeding issues

[Assistant] Ok taking it to a higher level leadership within the district do you see any concern for the health issues?

[User] At the district? Yeah, at the district I have not yet broadened my...,I don’t know because I have only been here for a short period of two months, in a short period of time to know how they engage at that level. I have not yet taken time to study their engagement and development about our matters

[Assistant] How about health information system, medical record system at this place when you look at it, is it working for you?

[User] Yes, we have a record office, let me show you how it flows, we have an outpatient, we have an emergency department, so from the outpatient for these requiring emergency, management and possible admission, they come, they open for them a file from record office. Now at the record office, all patients’ information is kept there, it’s usually hard copy and I think digital computer

[Assistant] You call it digital?


[System] Act as an information elicitation agent for academic interviews.

[User] Yes, we have a record office, let me show you how it flows, we have an outpatient, we have an emergency department, so from the outpatient for these requiring emergency, management and possible admission, they come, they open for them a file from record office. Now at the record office, all patients’ information is kept there, it’s usually hard copy and I think digital computer

[Assistant] You call it digital?

[User] I think they have a computer system

[Assistant] Ok

[User] Where they keep some information about the patients, what I know is we have a record office where patient’s information are

[Assistant] Just in case I wanted to go today and I just look at the RHD that they saw from January- November, will it be possible to get the information?


[System] Act as an information elicitation agent for academic interviews.

[User] I think they have a computer system

[Assistant] Ok

[User] Where they keep some information about the patients, what I know is we have a record office where patient’s information are

[Assistant] Just in case I wanted to go today and I just look at the RHD that they saw from January- November, will it be possible to get the information?

[User] That needs a trial, we need to try the system, I need..., I haven’t checked but I need to find out like I told you, office can be there like this record office but that does not be the thing there but the activity there, are they going on, are there, is there capacity to do the right thing, are people doing the right thing, that detail I need to find out but for the structure, the organogram, I see the structure is there, I don’t know whether it’s giving, its doing what it’s supposed to do

[Assistant] Why I’m asking is because we find some health facilities, you just reach there and then you have the boards


[System] Act as an information elicitation agent for academic interviews.

[User] That needs a trial, we need to try the system, I need..., I haven’t checked but I need to find out like I told you, office can be there like this record office but that does not be the thing there but the activity there, are they going on, are there, is there capacity to do the right thing, are people doing the right thing, that detail I need to find out but for the structure, the organogram, I see the structure is there, I don’t know whether it’s giving, its doing what it’s supposed to do

[Assistant] Why I’m asking is because we find some health facilities, you just reach there and then you have the boards

[User] Boards?

[Assistant] Statistics

[User] Statistics of this...you are right, those statistics, that feedback, that information is not available, you cannot go to my office and you are able to see on boards the disease patterns or distribution of the disease and easily. I don’t know whether that information is at the records office but at my level, it’s not available

[Assistant] Ok, do you have, could you be having guidelines and protocols for RHD care here?


[System] Act as an information elicitation agent for academic interviews.

[User] Statistics of this...you are right, those statistics, that feedback, that information is not available, you cannot go to my office and you are able to see on boards the disease patterns or distribution of the disease and easily. I don’t know whether that information is at the records office but at my level, it’s not available

[Assistant] Ok, do you have, could you be having guidelines and protocols for RHD care here?

[User] Not yet

[Assistant] Not yet?

[User] Not yet

[Assistant] Do you have CME’s here?


[System] Act as an information elicitation agent for academic interviews.

[User] Not yet

[Assistant] Not yet?

[User] Not yet

[Assistant] Do you have CME’s here?

[User] We get here CME’s

[Assistant] Have you attended any of the RHD training?


[System] Act as an information elicitation agent for academic interviews.

[User] Not yet

[Assistant] Do you have CME’s here?

[User] We get here CME’s

[Assistant] Have you attended any of the RHD training?

[User] Not yet, the CME’s we have attended are mostly to do with gyne, to do with gyne issue and other emergencies, RHD not yet

[Assistant] Not yet ehh...? Will you find them important if at all?


[System] Act as an information elicitation agent for academic interviews.

[User] We get here CME’s

[Assistant] Have you attended any of the RHD training?

[User] Not yet, the CME’s we have attended are mostly to do with gyne, to do with gyne issue and other emergencies, RHD not yet

[Assistant] Not yet ehh...? Will you find them important if at all?

[User] Yes, it would actually be very important to give capacity to health workers, start with the health worker capacity to have knowledge on how to manage it and also how to maintain the patient. After the treatment, how to keep the patients, it’s very important if we could have the training

[Assistant] So would you go for having the protocols for RHD and guidelines?


[System] Act as an information elicitation agent for academic interviews.

[User] Not yet, the CME’s we have attended are mostly to do with gyne, to do with gyne issue and other emergencies, RHD not yet

[Assistant] Not yet ehh...? Will you find them important if at all?

[User] Yes, it would actually be very important to give capacity to health workers, start with the health worker capacity to have knowledge on how to manage it and also how to maintain the patient. After the treatment, how to keep the patients, it’s very important if we could have the training

[Assistant] So would you go for having the protocols for RHD and guidelines?

[User] Yes, but do you think, I would go for if you asked me, I would go for CME’s to create, to increase, to raise these people’s suspicion index, you need to raise these people’s suspicion index because I have found, I told you of one who went through the emergency department and reached to the ward and he was getting treated of pneumonia without anyone thinking of RHD, that shows the knowledge gap, so you raise the suspicion index then you bring the material for people who already suspicious of the disease or is aware of the incidence of the disease. Then materials will help, so the protocols are there, how to manage, the outcomes and how to advise these people subsequently after hospital stay, now at home, how they should take care of themselves, home care and the rest of it, those ones now would benefit those who are already with the highest suspicion and are knowledgeable about this disease.so if you asked me, CME’s first then eventually protocols and guidelines, would be coming

[Assistant] Ok did you talk, do you have ah...how are your stocks for heart failure drugs, anti-coagulations drugs and then the BPG


[System] Act as an information elicitation agent for academic interviews.

[User] Yes, but do you think, I would go for if you asked me, I would go for CME’s to create, to increase, to raise these people’s suspicion index, you need to raise these people’s suspicion index because I have found, I told you of one who went through the emergency department and reached to the ward and he was getting treated of pneumonia without anyone thinking of RHD, that shows the knowledge gap, so you raise the suspicion index then you bring the material for people who already suspicious of the disease or is aware of the incidence of the disease. Then materials will help, so the protocols are there, how to manage, the outcomes and how to advise these people subsequently after hospital stay, now at home, how they should take care of themselves, home care and the rest of it, those ones now would benefit those who are already with the highest suspicion and are knowledgeable about this disease.so if you asked me, CME’s first then eventually protocols and guidelines, would be coming

[Assistant] Ok did you talk, do you have ah...how are your stocks for heart failure drugs, anti-coagulations drugs and then the BPG

[User] Heart failure drugs especially congesting heart failure?

[Assistant] Yes

[User] We have stocked phroximide, we are stocked with phroximide but that goes along with spironatol but when it comes to hypertensive drugs, they are usually not available, they are out of stock. I have always, a part from propanol as the inter blocker, the rest they have to buy

[Assistant] Why do you think that it’s always like that?


[System] Act as an information elicitation agent for academic interviews.

[User] Heart failure drugs especially congesting heart failure?

[Assistant] Yes

[User] We have stocked phroximide, we are stocked with phroximide but that goes along with spironatol but when it comes to hypertensive drugs, they are usually not available, they are out of stock. I have always, a part from propanol as the inter blocker, the rest they have to buy

[Assistant] Why do you think that it’s always like that?

[User] I don’t know, I don’t know, I think, I think it still goes back to the budget allocations to help, most of the drugs we have are for the basic care, basic care, you know for the serious treatment, patients have to go and buy,

[Assistant] And buy for themselves?


[System] Act as an information elicitation agent for academic interviews.

[User] I don’t know, I don’t know, I think, I think it still goes back to the budget allocations to help, most of the drugs we have are for the basic care, basic care, you know for the serious treatment, patients have to go and buy,

[Assistant] And buy for themselves?

[User] Yes, for instance the hypertensive drugs are hard to find in the pharmacy

[Assistant] In pharmacy?

[User] In the hospital pharmacy, it’s very hard

[Assistant] So looking at the system here, the local health system here, what has worked for you?


[System] Act as an information elicitation agent for academic interviews.

[User] What has worked for me?

[Assistant] And why?

[User] And why

[Assistant] Yes

[User] Ok, as like I told you, as an intern doctor, what has worked for me is my working relations with the senior staffs and the supervisors, it has worked for me because I make decisions that are verified, some cases corrected and for me that works for me and also the drugs for basic needs are always available, in most cases, they run out for a short while the deliveries are made, when they are made, at least they are sure of having basic needs which are substantial to buy anti biotics to start with as you think of out there yes and space because with that space you can do your work

[Assistant] Ok for the things you have mentioned, what has worked for you?


[System] Act as an information elicitation agent for academic interviews.

[User] And why

[Assistant] Yes

[User] Ok, as like I told you, as an intern doctor, what has worked for me is my working relations with the senior staffs and the supervisors, it has worked for me because I make decisions that are verified, some cases corrected and for me that works for me and also the drugs for basic needs are always available, in most cases, they run out for a short while the deliveries are made, when they are made, at least they are sure of having basic needs which are substantial to buy anti biotics to start with as you think of out there yes and space because with that space you can do your work

[Assistant] Ok for the things you have mentioned, what has worked for you?

[User] At least after basic education, the relations with the staffs

[Assistant] How about the numbers, are you comfortable with it


[System] Act as an information elicitation agent for academic interviews.

[User] Ok, as like I told you, as an intern doctor, what has worked for me is my working relations with the senior staffs and the supervisors, it has worked for me because I make decisions that are verified, some cases corrected and for me that works for me and also the drugs for basic needs are always available, in most cases, they run out for a short while the deliveries are made, when they are made, at least they are sure of having basic needs which are substantial to buy anti biotics to start with as you think of out there yes and space because with that space you can do your work

[Assistant] Ok for the things you have mentioned, what has worked for you?

[User] At least after basic education, the relations with the staffs

[Assistant] How about the numbers, are you comfortable with it

[User] Ohh! That is one of the thing that has not worked for me, the number are soooo big but with limited staffs and so ok,the numbers are very big, yeah and the staffing is small so the patient –doctor ratio is very small, sorry, it’s so huge, the other way round, the numbers are big

[Assistant] You said there is a gap in the staffing?


[System] Act as an information elicitation agent for academic interviews.

[User] Ohh! That is one of the thing that has not worked for me, the number are soooo big but with limited staffs and so ok,the numbers are very big, yeah and the staffing is small so the patient –doctor ratio is very small, sorry, it’s so huge, the other way round, the numbers are big

[Assistant] You said there is a gap in the staffing?

[User] There is a very big gap in the staffing

[Assistant] Where specifically?

[User] Especially the doctors, the number of doctors is very, it’s really very small, the nurses can be there, they get help from the nursing students, they can administer drugs but when it comes to the real clinical care of the patient, you need a doctor’s hand on the patient and you see when the numbers are big, you try to reduce on the number of time you spend with the patients and that causes a lot of problems in terms of making effective diagnosis and care to the patients, so you try to distribute your time to many people, you see this one briefly, they talk to this one faster, faster, you pick what you can do to save them, you start with urgent situation, you be with them, you don’t pay much attention or give enough time thoroughly to get the information that help the patient out of the problem leading to a longer stay in the ward

[Assistant] So in case of the RHD that are ..., have you ever referred any?


[System] Act as an information elicitation agent for academic interviews.

[User] There is a very big gap in the staffing

[Assistant] Where specifically?

[User] Especially the doctors, the number of doctors is very, it’s really very small, the nurses can be there, they get help from the nursing students, they can administer drugs but when it comes to the real clinical care of the patient, you need a doctor’s hand on the patient and you see when the numbers are big, you try to reduce on the number of time you spend with the patients and that causes a lot of problems in terms of making effective diagnosis and care to the patients, so you try to distribute your time to many people, you see this one briefly, they talk to this one faster, faster, you pick what you can do to save them, you start with urgent situation, you be with them, you don’t pay much attention or give enough time thoroughly to get the information that help the patient out of the problem leading to a longer stay in the ward

[Assistant] So in case of the RHD that are ..., have you ever referred any?

[User] I have not yet referred RHD patient because the ones I have managed, I have been able to discharge, so I have not yet

[Assistant] So do you have any guidelines in this on how to refer them?


[System] Act as an information elicitation agent for academic interviews.

[User] I have not yet referred RHD patient because the ones I have managed, I have been able to discharge, so I have not yet

[Assistant] So do you have any guidelines in this on how to refer them?

[User] I haven’t gotten the guidelines

[Assistant] No guidelines?

[User] I am still using my piece of knowledge

[Assistant] Would you find them important


[System] Act as an information elicitation agent for academic interviews.

[User] I haven’t gotten the guidelines

[Assistant] No guidelines?

[User] I am still using my piece of knowledge

[Assistant] Would you find them important

[User] Very important, very important to have these guidelines because you know guidelines help in simplifying on time you take thinking of what to do in this situation, you just have the outlines there and then you tailor the information very accurately to the patient, also your approach is well tailored, it guides you

[Assistant] Do you feel satisfied with what you went through?


[System] Act as an information elicitation agent for academic interviews.

[User] I am still using my piece of knowledge

[Assistant] Would you find them important

[User] Very important, very important to have these guidelines because you know guidelines help in simplifying on time you take thinking of what to do in this situation, you just have the outlines there and then you tailor the information very accurately to the patient, also your approach is well tailored, it guides you

[Assistant] Do you feel satisfied with what you went through?

[User] It is a struggle, it’s still a challenge

[Assistant] You know why we even ask the health workers this question


[System] Act as an information elicitation agent for academic interviews.

[User] Very important, very important to have these guidelines because you know guidelines help in simplifying on time you take thinking of what to do in this situation, you just have the outlines there and then you tailor the information very accurately to the patient, also your approach is well tailored, it guides you

[Assistant] Do you feel satisfied with what you went through?

[User] It is a struggle, it’s still a challenge

[Assistant] You know why we even ask the health workers this question

[User] Yes

[Assistant] It’s because it will require an integration just in case ah...the health workers thinks they are giving enough care, laughs, time and the other side the patients cannot


[System] Act as an information elicitation agent for academic interviews.

[User] It is a struggle, it’s still a challenge

[Assistant] You know why we even ask the health workers this question

[User] Yes

[Assistant] It’s because it will require an integration just in case ah...the health workers thinks they are giving enough care, laughs, time and the other side the patients cannot

[User] If I cannot do a follow up, echo, I cannot do follow up, ECG’S, i cannot do you know do those other investigations to make sure the patient is out of danger then what is my right? I can’t be satisfied that I have done enough. I only base on the symptoms, the resolutions of the symptoms, ah... you go give us space

[Assistant] Can patients access surgery here, RHD patients?


[System] Act as an information elicitation agent for academic interviews.

[User] Yes

[Assistant] It’s because it will require an integration just in case ah...the health workers thinks they are giving enough care, laughs, time and the other side the patients cannot

[User] If I cannot do a follow up, echo, I cannot do follow up, ECG’S, i cannot do you know do those other investigations to make sure the patient is out of danger then what is my right? I can’t be satisfied that I have done enough. I only base on the symptoms, the resolutions of the symptoms, ah... you go give us space

[Assistant] Can patients access surgery here, RHD patients?

[User] No

[Assistant] It’s not done?


[System] Act as an information elicitation agent for academic interviews.

[User] No, this is a referral

[Assistant] laugh

[User] You can IO’s, sometimes we can have a dysfunctional theatre and cannot do IO’s here

[Assistant] laughs

[User] We have not touched the heart valves, so it’s far, it’s far from that

[Assistant] Do you think there are some deaths here which occurred that surely would have been prevented?


[System] Act as an information elicitation agent for academic interviews.

[User] You can IO’s, sometimes we can have a dysfunctional theatre and cannot do IO’s here

[Assistant] laughs

[User] We have not touched the heart valves, so it’s far, it’s far from that

[Assistant] Do you think there are some deaths here which occurred that surely would have been prevented?

[User] Very many because sometimes we can have very many cases that patients die of anaemia because we don’t have the blood bank. Patients die because they cannot afford the good antibiotics to...I give anti biotics to treat them, patients die because doctors sometimes are out of the station

[Assistant] Ok last bit that we are looking at, let’s look at the perception of the patient’s outcomes, generally do you think they get the care that they need here?


[System] Act as an information elicitation agent for academic interviews.

[User] We have not touched the heart valves, so it’s far, it’s far from that

[Assistant] Do you think there are some deaths here which occurred that surely would have been prevented?

[User] Very many because sometimes we can have very many cases that patients die of anaemia because we don’t have the blood bank. Patients die because they cannot afford the good antibiotics to...I give anti biotics to treat them, patients die because doctors sometimes are out of the station

[Assistant] Ok last bit that we are looking at, let’s look at the perception of the patient’s outcomes, generally do you think they get the care that they need here?

[User] We struggle with that aspect, patient satisfaction like I told you, you are the only doctor running around, the patients are looking at you, the whole day you are there you don’t have time to see them, after maybe after one day, I think patients satisfaction is lacking’ I don’t think they are satisfied

[Assistant] They are not satisfied?


[System] Act as an information elicitation agent for academic interviews.

[User] Very many because sometimes we can have very many cases that patients die of anaemia because we don’t have the blood bank. Patients die because they cannot afford the good antibiotics to...I give anti biotics to treat them, patients die because doctors sometimes are out of the station

[Assistant] Ok last bit that we are looking at, let’s look at the perception of the patient’s outcomes, generally do you think they get the care that they need here?

[User] We struggle with that aspect, patient satisfaction like I told you, you are the only doctor running around, the patients are looking at you, the whole day you are there you don’t have time to see them, after maybe after one day, I think patients satisfaction is lacking’ I don’t think they are satisfied

[Assistant] They are not satisfied?

[User] But as long as the symptoms are resolved they will feel happy.

[Assistant] So do you feel that they get the treatment that they need before they go away


[System] Act as an information elicitation agent for academic interviews.

[User] We struggle with that aspect, patient satisfaction like I told you, you are the only doctor running around, the patients are looking at you, the whole day you are there you don’t have time to see them, after maybe after one day, I think patients satisfaction is lacking’ I don’t think they are satisfied

[Assistant] They are not satisfied?

[User] But as long as the symptoms are resolved they will feel happy.

[Assistant] So do you feel that they get the treatment that they need before they go away

[User] They get the basic

[Assistant] laughs, they get the basics?


[System] Act as an information elicitation agent for academic interviews.

[User] But as long as the symptoms are resolved they will feel happy.

[Assistant] So do you feel that they get the treatment that they need before they go away

[User] They get the basic

[Assistant] laughs, they get the basics?

[User] laughs, they get the basic treatment, I think they are not getting enough treatment that they deserve, even if they get it ,they delay in getting it but at the end of the day ,whatever they get ,it is helping them to go home

[Assistant] Ok, so what do you think causes it?


[System] Act as an information elicitation agent for academic interviews.

[User] They get the basic

[Assistant] laughs, they get the basics?

[User] laughs, they get the basic treatment, I think they are not getting enough treatment that they deserve, even if they get it ,they delay in getting it but at the end of the day ,whatever they get ,it is helping them to go home

[Assistant] Ok, so what do you think causes it?

[User] That question actually would be best answered by those patients

[Assistant] By the patient?


[System] Act as an information elicitation agent for academic interviews.

[User] laughs, they get the basic treatment, I think they are not getting enough treatment that they deserve, even if they get it ,they delay in getting it but at the end of the day ,whatever they get ,it is helping them to go home

[Assistant] Ok, so what do you think causes it?

[User] That question actually would be best answered by those patients

[Assistant] By the patient?

[User] Yes, do you think..., do you feel, that is a perceptive because for me now, when I see you, yes, you are good enough to go home. I think you have gotten already what you need but the feedback should also be there and the drugs are available or nurses are not available to extend to the immediate needs of the patients, patients die because the required drugs cannot be found anywhere within like I had similar case, a severe hypertension, hypertensive crisis patient who could not get glabeterol IV and we could not save him immediately or even night hour, so there are so many deaths that would be prevented

[Assistant] That would be prevented?


[System] Act as an information elicitation agent for academic interviews.

[User] That question actually would be best answered by those patients

[Assistant] By the patient?

[User] Yes, do you think..., do you feel, that is a perceptive because for me now, when I see you, yes, you are good enough to go home. I think you have gotten already what you need but the feedback should also be there and the drugs are available or nurses are not available to extend to the immediate needs of the patients, patients die because the required drugs cannot be found anywhere within like I had similar case, a severe hypertension, hypertensive crisis patient who could not get glabeterol IV and we could not save him immediately or even night hour, so there are so many deaths that would be prevented

[Assistant] That would be prevented?

[User] Preventable deaths occurring but not to allow, we try with whatever we have to save lives

[Assistant] How about the patient’s safety, do you have any concerns about their safety?


[System] Act as an information elicitation agent for academic interviews.

[User] Yes, do you think..., do you feel, that is a perceptive because for me now, when I see you, yes, you are good enough to go home. I think you have gotten already what you need but the feedback should also be there and the drugs are available or nurses are not available to extend to the immediate needs of the patients, patients die because the required drugs cannot be found anywhere within like I had similar case, a severe hypertension, hypertensive crisis patient who could not get glabeterol IV and we could not save him immediately or even night hour, so there are so many deaths that would be prevented

[Assistant] That would be prevented?

[User] Preventable deaths occurring but not to allow, we try with whatever we have to save lives

[Assistant] How about the patient’s safety, do you have any concerns about their safety?

[User] Safety is broad, is it security, or it is health?

[Assistant] Yes in health


[System] Act as an information elicitation agent for academic interviews.

[User] Preventable deaths occurring but not to allow, we try with whatever we have to save lives

[Assistant] How about the patient’s safety, do you have any concerns about their safety?

[User] Safety is broad, is it security, or it is health?

[Assistant] Yes in health

[User] How they are managed, the safety I would say provided the doctor is available and the doctor is knowledgeable, the patients are safe. For now I would think really that the patient are safe that is the reason they kept coming, flocking because they go back discharged some of them, the safety is...i think is at least above the belts, its abit fair, they feel safe

[Assistant] Ok, do you think that there are some patients who have died in the community without even stepping into the hospital?


[System] Act as an information elicitation agent for academic interviews.

[User] Safety is broad, is it security, or it is health?

[Assistant] Yes in health

[User] How they are managed, the safety I would say provided the doctor is available and the doctor is knowledgeable, the patients are safe. For now I would think really that the patient are safe that is the reason they kept coming, flocking because they go back discharged some of them, the safety is...i think is at least above the belts, its abit fair, they feel safe

[Assistant] Ok, do you think that there are some patients who have died in the community without even stepping into the hospital?

[User] There are some deaths of arrivals, it is also in big number, I have also realised that private clinics admits patients when they see the patients are about to...they are failing to handle the conditions, they send patient here to die, they delay them in the private hospital

[Assistant] How about the RHD patients in particular, do you think they have some...


[System] Act as an information elicitation agent for academic interviews.

[User] How they are managed, the safety I would say provided the doctor is available and the doctor is knowledgeable, the patients are safe. For now I would think really that the patient are safe that is the reason they kept coming, flocking because they go back discharged some of them, the safety is...i think is at least above the belts, its abit fair, they feel safe

[Assistant] Ok, do you think that there are some patients who have died in the community without even stepping into the hospital?

[User] There are some deaths of arrivals, it is also in big number, I have also realised that private clinics admits patients when they see the patients are about to...they are failing to handle the conditions, they send patient here to die, they delay them in the private hospital

[Assistant] How about the RHD patients in particular, do you think they have some...

[User] RHD’s I haven’t, I haven’t heard of death on arrival or death due to RHD yet in this period of two months or maybe as time goes on but not ,I haven’t

[Assistant] what is your opinion? Give me two most important things ministry of health should do to improve on RHD outcomes


[System] Act as an information elicitation agent for academic interviews.

[User] I was reading through the concept yes the project, this is a project?

[Assistant] It is a research

[User] It is a research project?

[Assistant] Yes

[User] How long is it?

[Assistant] We have two hands, she is directly handling quantitative and the qualitative is on, it might go on because we have four district to cover, we are going to Mbale, we are going to mbarara, we are going to Kampala and we have stared with lira, so we might run for the next one year and a half


[System] Act as an information elicitation agent for academic interviews.

[User] It is a research project?

[Assistant] Yes

[User] How long is it?

[Assistant] We have two hands, she is directly handling quantitative and the qualitative is on, it might go on because we have four district to cover, we are going to Mbale, we are going to mbarara, we are going to Kampala and we have stared with lira, so we might run for the next one year and a half

[User] So when do I get my feedback because it says that there will be a feed back?

[Assistant] We will give feedbacks in case there are findings, new findings that would be having an impact on your work


[System] Act as an information elicitation agent for academic interviews.

[User] How long is it?

[Assistant] We have two hands, she is directly handling quantitative and the qualitative is on, it might go on because we have four district to cover, we are going to Mbale, we are going to mbarara, we are going to Kampala and we have stared with lira, so we might run for the next one year and a half

[User] So when do I get my feedback because it says that there will be a feed back?

[Assistant] We will give feedbacks in case there are findings, new findings that would be having an impact on your work

[User] Ok

[Assistant] So that comes after we have analysed all the data


[System] Act as an information elicitation agent for academic interviews.

[User] So when do I get my feedback because it says that there will be a feed back?

[Assistant] We will give feedbacks in case there are findings, new findings that would be having an impact on your work

[User] Ok

[Assistant] So that comes after we have analysed all the data

[User] That is after one year

[Assistant] laughs...one and a half


[System] Act as an information elicitation agent for academic interviews.

[User] Ok

[Assistant] So that comes after we have analysed all the data

[User] That is after one year

[Assistant] laughs...one and a half

[User] One and a half?

[Assistant] And we shall disseminate the information, am sure when we are doing that we shall call your representatives


[System] Act as an information elicitation agent for academic interviews.

[User] That is after one year

[Assistant] laughs...one and a half

[User] One and a half?

[Assistant] And we shall disseminate the information, am sure when we are doing that we shall call your representatives

[User] That is ok

[Assistant] Ok and also use the publications to disseminate the information


[System] Act as an information elicitation agent for academic interviews.

[User] Actually, we have internal example... There was one startup, a Finnish startup, which, which was both kind of a parallel to our activities. And it was never integrated... practically all relevant people left. It's a shell of what it was before. And money losing operation more or less...

[Assistant] And obviously, you know what you're doing and know the industry well, and, I think it's impressive to have the ambition and courage to be the r&d guy in a world of the sales, business devs community that you've participated in, which would be a change process for you personally as well

[User] Actually, to be honest, I was always very much interested in the business but also in the R&D. I really, really hated to, to just count the projects and run the KPIs and so on, and I'm really not the KPI guy. Even when I was in r&d, when people asked me, What's your role in the company? I said: "to make money".

[Assistant] What did you perceive was the biggest revelation from this change? Because obviously, you've made the results. On the other hand, you mentioned that there's been some turbulence in the team. Was this turbulence a natural thing? You know, people got bored with the project and started something else?

[User] No, I think it was, it was, I was expecting this to happen when we went back (to the Mother company). Because some people couldn't really see themselves especially in the pair, okay, in the regular environment. (one of the team members) perceived herself as super, super innovative and so on. Though, in reality, when she was in the role with us... her, her contribution was not really in innovation. Her contribution was only in the diversity. So now many people talk about diversity and inclusion. I mean, she was deliberately put into the team, to break this mindset which because all the rest were engineers, and she is anthropologist.

[Assistant] Do you think she was kind of the driver of resistance or kind of, you know, questioning too much? Questioning the status quo, disrupting things where they shouldn't have been disrupted?


[System] Act as an information elicitation agent for academic interviews.

[User] Actually, to be honest, I was always very much interested in the business but also in the R&D. I really, really hated to, to just count the projects and run the KPIs and so on, and I'm really not the KPI guy. Even when I was in r&d, when people asked me, What's your role in the company? I said: "to make money".

[Assistant] What did you perceive was the biggest revelation from this change? Because obviously, you've made the results. On the other hand, you mentioned that there's been some turbulence in the team. Was this turbulence a natural thing? You know, people got bored with the project and started something else?

[User] No, I think it was, it was, I was expecting this to happen when we went back (to the Mother company). Because some people couldn't really see themselves especially in the pair, okay, in the regular environment. (one of the team members) perceived herself as super, super innovative and so on. Though, in reality, when she was in the role with us... her, her contribution was not really in innovation. Her contribution was only in the diversity. So now many people talk about diversity and inclusion. I mean, she was deliberately put into the team, to break this mindset which because all the rest were engineers, and she is anthropologist.

[Assistant] Do you think she was kind of the driver of resistance or kind of, you know, questioning too much? Questioning the status quo, disrupting things where they shouldn't have been disrupted?

[User] She always questioned herself... If she was good enough for the team.

[Assistant] What would you like to emphasize as a key learning of the whole process and you know, the way that people have adapted to that, because you've mentioned you have to influence like 2000 people a day, if I remember correctly, was a large scale.


[System] Act as an information elicitation agent for academic interviews.

[User] No, I think it was, it was, I was expecting this to happen when we went back (to the Mother company). Because some people couldn't really see themselves especially in the pair, okay, in the regular environment. (one of the team members) perceived herself as super, super innovative and so on. Though, in reality, when she was in the role with us... her, her contribution was not really in innovation. Her contribution was only in the diversity. So now many people talk about diversity and inclusion. I mean, she was deliberately put into the team, to break this mindset which because all the rest were engineers, and she is anthropologist.

[Assistant] Do you think she was kind of the driver of resistance or kind of, you know, questioning too much? Questioning the status quo, disrupting things where they shouldn't have been disrupted?

[User] She always questioned herself... If she was good enough for the team.

[Assistant] What would you like to emphasize as a key learning of the whole process and you know, the way that people have adapted to that, because you've mentioned you have to influence like 2000 people a day, if I remember correctly, was a large scale.

[User] Surely, it's, I would say a very old wisdom, you cannot do anything by force.

[Assistant] Did you use any specific metaphors, which kind of occurred over and over and over during the years? Is there a metaphor that you could use for this story?


[System] Act as an information elicitation agent for academic interviews.

[User] She always questioned herself... If she was good enough for the team.

[Assistant] What would you like to emphasize as a key learning of the whole process and you know, the way that people have adapted to that, because you've mentioned you have to influence like 2000 people a day, if I remember correctly, was a large scale.

[User] Surely, it's, I would say a very old wisdom, you cannot do anything by force.

[Assistant] Did you use any specific metaphors, which kind of occurred over and over and over during the years? Is there a metaphor that you could use for this story?

[User] Sure, I used the story of several companies who didn't do it right? Especially in this model, IBM was a wonderful example or Michelin or similar. Because if you... if you really use this model, you can see how great ideas fell, fell to the floor, because they were not properly nested in the Company. This was one thing, the other thing we actually came to, to a very strong ecosystem understanding So now, now, we are doing partnerships, coopetition agreement, stuff like this... So like, okay, one story, for instance, when… when Apple came with the first phone, they went to Verizon, and said, you will sell this phone? I think it was 399. I said no way, we will not. Go away. We are selling Nokia's for 5099. So so they went to AT and T 18. T said what the heck we heard, I think it was right. So so at&t took took Apple phone into their subscription model. In in six months, 30% of the Verizon subscription went to at&t.

[Assistant] What's the moral of the story?


[System] Act as an information elicitation agent for academic interviews.

[User] Who had bigger a bigger value proposition? A component Or? Or? system? Obviously, component? I like the Aspirin metaphor, you know, take one thing goes away three hours later pains back. Yeah, that's a simple metaphor. You don't, you don't heal the root cause. Reduce the pain? Yeah, yeah. And root cause was, in these cases, I think it was more in the personality part. But the hit actually, the backtrack from the goal...

[Assistant] Okay, that makes perfect sense for me. And to kind of wrap this up this part where we do the storytelling element. A quick, quick question for you. If you had to, you know, on the spot, decide who was the protagonist of the story? And who was the bad guy of the story?

[User] Actually protagonist was my team. These people really, really fought for this, what was really breaking the thing was old product management, or product management structure, partly because they were, they were feeling competition. It was partly but more of us because of the personality of certain people, each of them.

[Assistant] Would you say the personality of these people within the company, which were kind of more alike, or the personality of your team, which was a little bit different?

[User] No, it's personality of these people who… who were incapable of thinking big, but only incremental. You can call them the corporate guys (laughs). I would say it's more or less with almost always Lower Mid mid management. So just the ones who are, like, above individual contributors.

[Assistant] Yeah, makes sense. Makes sense. Being mindful of your time, I'd like to thank you once again, for taking the time to talk through these details. I'm going to do the narrative analysis, all of these elements, do the follow up report with you to kind of take a look at the grander like, meta narrative of these individual change stories, if that's something that's


[System] Act as an information elicitation agent for academic interviews.

[User] Actually protagonist was my team. These people really, really fought for this, what was really breaking the thing was old product management, or product management structure, partly because they were, they were feeling competition. It was partly but more of us because of the personality of certain people, each of them.

[Assistant] Would you say the personality of these people within the company, which were kind of more alike, or the personality of your team, which was a little bit different?

[User] No, it's personality of these people who… who were incapable of thinking big, but only incremental. You can call them the corporate guys (laughs). I would say it's more or less with almost always Lower Mid mid management. So just the ones who are, like, above individual contributors.

[Assistant] Yeah, makes sense. Makes sense. Being mindful of your time, I'd like to thank you once again, for taking the time to talk through these details. I'm going to do the narrative analysis, all of these elements, do the follow up report with you to kind of take a look at the grander like, meta narrative of these individual change stories, if that's something that's

[User] Yeah, that will be very interesting... Because obviously, I will need to repeat this with another business. Similar symptoms as the one before...

[Assistant] Another intrapreneurial story. Cool. Like I said, I'm gonna prepare to you a more detailed in depth report. Maybe that will be helpful to you. Thanks again and wish you a safe trip.


[System] Act as an information elicitation agent for academic interviews.

[User] I am fine and you?

[Assistant] I am also fine, Mother I would like to know your age?

[User] I am 40 years old.

[Assistant] What was the major event happened in your community by the time you were born may be your parents told you if something happened?

[User] There was drought,

[Assistant] And what else happened?


[System] Act as an information elicitation agent for academic interviews.

[User] I am 40 years old.

[Assistant] What was the major event happened in your community by the time you were born may be your parents told you if something happened?

[User] There was drought,

[Assistant] And what else happened?

[User] They told me there was a big ceremony when I was born.

[Assistant] Which Village were you born and grew up?


[System] Act as an information elicitation agent for academic interviews.

[User] There was drought,

[Assistant] And what else happened?

[User] They told me there was a big ceremony when I was born.

[Assistant] Which Village were you born and grew up?

[User] Melela.

[Assistant] Melela in which district?


[System] Act as an information elicitation agent for academic interviews.

[User] They told me there was a big ceremony when I was born.

[Assistant] Which Village were you born and grew up?

[User] Melela.

[Assistant] Melela in which district?

[User] Mvomero District.

[Assistant] And it is in which ward?


[System] Act as an information elicitation agent for academic interviews.

[User] Melela.

[Assistant] Melela in which district?

[User] Mvomero District.

[Assistant] And it is in which ward?

[User] Kolola Ward.

[Assistant] Mother I would like to know your family structure when you were living with your parents? I mean were you living in the same house father, mother and children in your own house, or was it father, mother and children in the same homestead, or were you living father, mother, children, grandfather, grandmother and cousins and things of that sort.


[System] Act as an information elicitation agent for academic interviews.

[User] Mvomero District.

[Assistant] And it is in which ward?

[User] Kolola Ward.

[Assistant] Mother I would like to know your family structure when you were living with your parents? I mean were you living in the same house father, mother and children in your own house, or was it father, mother and children in the same homestead, or were you living father, mother, children, grandfather, grandmother and cousins and things of that sort.

[User] We were living in one homestead with several houses and I was living with my father, mother and my siblings.

[Assistant] So were you eating together as family or how was it?


[System] Act as an information elicitation agent for academic interviews.

[User] Kolola Ward.

[Assistant] Mother I would like to know your family structure when you were living with your parents? I mean were you living in the same house father, mother and children in your own house, or was it father, mother and children in the same homestead, or were you living father, mother, children, grandfather, grandmother and cousins and things of that sort.

[User] We were living in one homestead with several houses and I was living with my father, mother and my siblings.

[Assistant] So were you eating together as family or how was it?

[User] We were eating together as family.

[Assistant] Only you family or with other relative?


[System] Act as an information elicitation agent for academic interviews.

[User] We were living in one homestead with several houses and I was living with my father, mother and my siblings.

[Assistant] So were you eating together as family or how was it?

[User] We were eating together as family.

[Assistant] Only you family or with other relative?

[User] It was only our family.

[Assistant] I would like to know when you were young you what were your parents economic activities so as they could earn a living?


[System] Act as an information elicitation agent for academic interviews.

[User] We were eating together as family.

[Assistant] Only you family or with other relative?

[User] It was only our family.

[Assistant] I would like to know when you were young you what were your parents economic activities so as they could earn a living?

[User] They were pastoralist only.

[Assistant] Which responsibilities or duties were for the men in your family by that time?


[System] Act as an information elicitation agent for academic interviews.

[User] It was only our family.

[Assistant] I would like to know when you were young you what were your parents economic activities so as they could earn a living?

[User] They were pastoralist only.

[Assistant] Which responsibilities or duties were for the men in your family by that time?

[User] Boys duty were to look after the cattle’s taking them to graze only

[Assistant] What about Men in your family like father what was his responsibilities?


[System] Act as an information elicitation agent for academic interviews.

[User] They were pastoralist only.

[Assistant] Which responsibilities or duties were for the men in your family by that time?

[User] Boys duty were to look after the cattle’s taking them to graze only

[Assistant] What about Men in your family like father what was his responsibilities?

[User] He was responsible for his family affairs like to provide food for his family.

[Assistant] Apart from providing food for his family what else did he do?


[System] Act as an information elicitation agent for academic interviews.

[User] Boys duty were to look after the cattle’s taking them to graze only

[Assistant] What about Men in your family like father what was his responsibilities?

[User] He was responsible for his family affairs like to provide food for his family.

[Assistant] Apart from providing food for his family what else did he do?

[User] He was working in order to earn an income.

[Assistant] Apart from working and providing food what was his other duties and responsibilities?


[System] Act as an information elicitation agent for academic interviews.

[User] He was responsible for his family affairs like to provide food for his family.

[Assistant] Apart from providing food for his family what else did he do?

[User] He was working in order to earn an income.

[Assistant] Apart from working and providing food what was his other duties and responsibilities?

[User] He was doing farming and rearing of animals.

[Assistant] When you were born were Maasai involved in farming?


[System] Act as an information elicitation agent for academic interviews.

[User] He was working in order to earn an income.

[Assistant] Apart from working and providing food what was his other duties and responsibilities?

[User] He was doing farming and rearing of animals.

[Assistant] When you were born were Maasai involved in farming?

[User] No, Maasai were not involved in farming.

[Assistant] So, your father was involved in what?


[System] Act as an information elicitation agent for academic interviews.

[User] He was doing farming and rearing of animals.

[Assistant] When you were born were Maasai involved in farming?

[User] No, Maasai were not involved in farming.

[Assistant] So, your father was involved in what?

[User] He was selling cows so as to buy maize and other foodstuff for the family.

[Assistant] And what were the responsibilities of your mother or women?


[System] Act as an information elicitation agent for academic interviews.

[User] No, Maasai were not involved in farming.

[Assistant] So, your father was involved in what?

[User] He was selling cows so as to buy maize and other foodstuff for the family.

[Assistant] And what were the responsibilities of your mother or women?

[User] Household chores like cooking, washing utensils, cleaning house fetching water and fetching firewood.

[Assistant] And what about female children what were their main responsibilities?


[System] Act as an information elicitation agent for academic interviews.

[User] He was selling cows so as to buy maize and other foodstuff for the family.

[Assistant] And what were the responsibilities of your mother or women?

[User] Household chores like cooking, washing utensils, cleaning house fetching water and fetching firewood.

[Assistant] And what about female children what were their main responsibilities?

[User] Fetching firewood, cooking, sweeping the ground and helping the mother in other household chores.

[Assistant] Was there any one in your family, who went to school at that time?


[System] Act as an information elicitation agent for academic interviews.

[User] Household chores like cooking, washing utensils, cleaning house fetching water and fetching firewood.

[Assistant] And what about female children what were their main responsibilities?

[User] Fetching firewood, cooking, sweeping the ground and helping the mother in other household chores.

[Assistant] Was there any one in your family, who went to school at that time?

[User] No.

[Assistant] Mother when you were young can you tell me how you’re eating like was? What kind of food were you eating?


[System] Act as an information elicitation agent for academic interviews.

[User] Fetching firewood, cooking, sweeping the ground and helping the mother in other household chores.

[Assistant] Was there any one in your family, who went to school at that time?

[User] No.

[Assistant] Mother when you were young can you tell me how you’re eating like was? What kind of food were you eating?

[User] We used to drink milk most of the time whether is fermented milk or fresh milk and sometimes we used to eat ugali.

[Assistant] What kind of food were you eaten rarely when you were young?


[System] Act as an information elicitation agent for academic interviews.

[User] No.

[Assistant] Mother when you were young can you tell me how you’re eating like was? What kind of food were you eating?

[User] We used to drink milk most of the time whether is fermented milk or fresh milk and sometimes we used to eat ugali.

[Assistant] What kind of food were you eaten rarely when you were young?

[User] Rice and vegetables.

[Assistant] Which type of food was prepared for special people only may be you prepare a special food for children or visitors or mothers?


[System] Act as an information elicitation agent for academic interviews.

[User] We used to drink milk most of the time whether is fermented milk or fresh milk and sometimes we used to eat ugali.

[Assistant] What kind of food were you eaten rarely when you were young?

[User] Rice and vegetables.

[Assistant] Which type of food was prepared for special people only may be you prepare a special food for children or visitors or mothers?

[User] Sometimes kande was prepared when we had visitors?

[Assistant] Where did your family get the food from?


[System] Act as an information elicitation agent for academic interviews.

[User] Rice and vegetables.

[Assistant] Which type of food was prepared for special people only may be you prepare a special food for children or visitors or mothers?

[User] Sometimes kande was prepared when we had visitors?

[Assistant] Where did your family get the food from?

[User] We were buying them.

[Assistant] What about food from the wild or forest?


[System] Act as an information elicitation agent for academic interviews.

[User] Sometimes kande was prepared when we had visitors?

[Assistant] Where did your family get the food from?

[User] We were buying them.

[Assistant] What about food from the wild or forest?

[User] Yes there are wild fruits that children used to eat them are called furu, mkole they are so many.

[Assistant] Okay tell me what else?


[System] Act as an information elicitation agent for academic interviews.

[User] We were buying them.

[Assistant] What about food from the wild or forest?

[User] Yes there are wild fruits that children used to eat them are called furu, mkole they are so many.

[Assistant] Okay tell me what else?

[User] There are many but I know them in Maasai language like iloma, Elgomu.

[Assistant] Mother when you were young who was making decision on what to be bought in your family?


[System] Act as an information elicitation agent for academic interviews.

[User] Yes there are wild fruits that children used to eat them are called furu, mkole they are so many.

[Assistant] Okay tell me what else?

[User] There are many but I know them in Maasai language like iloma, Elgomu.

[Assistant] Mother when you were young who was making decision on what to be bought in your family?

[User] My father.

[Assistant] And by the time you were young who else was making decision together with the father?


[System] Act as an information elicitation agent for academic interviews.

[User] There are many but I know them in Maasai language like iloma, Elgomu.

[Assistant] Mother when you were young who was making decision on what to be bought in your family?

[User] My father.

[Assistant] And by the time you were young who else was making decision together with the father?

[User] The mother.

[Assistant] And whose money was used to buy food?


[System] Act as an information elicitation agent for academic interviews.

[User] My father.

[Assistant] And by the time you were young who else was making decision together with the father?

[User] The mother.

[Assistant] And whose money was used to buy food?

[User] My father’s money.

[Assistant] Mama you told me you were born in Melela Village isn’t?


[System] Act as an information elicitation agent for academic interviews.

[User] The mother.

[Assistant] And whose money was used to buy food?

[User] My father’s money.

[Assistant] Mama you told me you were born in Melela Village isn’t?

[User] Yes.

[Assistant] So in your Melela community how did you know when a girl has matured and was there an initiation ceremony like the dances or what are the things or indicator of her maturity?