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

[User] No, for them they were just having a patient whom they were just keeping in the hospital, actually the unfortunate bit is that they had been hospitalized for two weeks on the ward with no proper diagnosis.

[Assistant] okay, so let us look at this child you remember very well, what were the symptoms this child was presenting with?

[User] for that young man, he had already grown too small, looking malnourished, there are some parts of his body that were darkening on his body and I saw, he was also having amm, I don’t remember exactly but I am trying to draw the picture of that young boy.

[Assistant] okay, and do you think these patients are generally good at follow-ups and adherence to their drugs?

[User] I think if you well explain to them their problem and you tell them that this will be the solution and when they swallow the drugs they see a change within the first few weeks, they can adhere because by the time those guys came into hospital, it was just at the extreme end.

[Assistant] okay, so is the problem not explaining to these patients?


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

[User] for that young man, he had already grown too small, looking malnourished, there are some parts of his body that were darkening on his body and I saw, he was also having amm, I don’t remember exactly but I am trying to draw the picture of that young boy.

[Assistant] okay, and do you think these patients are generally good at follow-ups and adherence to their drugs?

[User] I think if you well explain to them their problem and you tell them that this will be the solution and when they swallow the drugs they see a change within the first few weeks, they can adhere because by the time those guys came into hospital, it was just at the extreme end.

[Assistant] okay, so is the problem not explaining to these patients?

[User] that could be one of the cause, one if they don’t explain to these patients, two, even these cultural beliefs in them, you can convince the patient, the response to treatment I don’t know why it would always be slow, that one alone discourages patients from doing what, from taking these medications

[Assistant] is that from your own opinion?


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

[User] I think if you well explain to them their problem and you tell them that this will be the solution and when they swallow the drugs they see a change within the first few weeks, they can adhere because by the time those guys came into hospital, it was just at the extreme end.

[Assistant] okay, so is the problem not explaining to these patients?

[User] that could be one of the cause, one if they don’t explain to these patients, two, even these cultural beliefs in them, you can convince the patient, the response to treatment I don’t know why it would always be slow, that one alone discourages patients from doing what, from taking these medications

[Assistant] is that from your own opinion?

[User] that's from my own opinion

[Assistant] okay, and for them what do they say, these patients, what do they say are the barriers they commonly face to getting care


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

[User] that's from my own opinion

[Assistant] okay, and for them what do they say, these patients, what do they say are the barriers they commonly face to getting care

[User] these patients, now like that patient he was coming from very far, maybe from Isingiro, I don’t still remember, he had moved through several clinic, several health centres, several tradition healers to a point where by the mother realised things were too bad to bring him to Mbarara here, so what prevents them from getting health care, sometimes they find that the normal conventional way of getting treatment, they feel it’s not healthy

[Assistant] how?

[User] because most of them think some of these problems they have are because of their cultural beliefs, that is one, two some people don’t have money, some people are very poor, because even that patient was coming from a very poor home.

[Assistant] so you mean in this area people that are poor do not get the care, do not get treated?


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

[User] these patients, now like that patient he was coming from very far, maybe from Isingiro, I don’t still remember, he had moved through several clinic, several health centres, several tradition healers to a point where by the mother realised things were too bad to bring him to Mbarara here, so what prevents them from getting health care, sometimes they find that the normal conventional way of getting treatment, they feel it’s not healthy

[Assistant] how?

[User] because most of them think some of these problems they have are because of their cultural beliefs, that is one, two some people don’t have money, some people are very poor, because even that patient was coming from a very poor home.

[Assistant] so you mean in this area people that are poor do not get the care, do not get treated?

[User] in this area people who are poor they get treatment, they all get treatment, but

[Assistant] elaborate more, what you mean by they don’t have enough money


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

[User] because most of them think some of these problems they have are because of their cultural beliefs, that is one, two some people don’t have money, some people are very poor, because even that patient was coming from a very poor home.

[Assistant] so you mean in this area people that are poor do not get the care, do not get treated?

[User] in this area people who are poor they get treatment, they all get treatment, but

[Assistant] elaborate more, what you mean by they don’t have enough money

[User] by the time someone fails to treat a sore throat, you know there are things that we just see, now like a sore throat, it’s not something that maybe someone spends his money on to treat, are you seeing, and not so much people will take time to treat a sore throat, they think it resolves on its own and goes, are you seeing, so when it progresses on something like rheumatic heart disease, really a few people can afford to do some of these surgeries even to keep on these medications for long, even a mere hypertensive patient finds it so expensive to buy his own medicine, even a diabetic patient, you find them crying after telling them that we have run out of stock of such drugs maybe they can try somewhere else.

[Assistant] okay, so now this moves us to the local system health care barriers, I am going to mention here some pieces, you will tell me which ones work for you, in terms of giving care to patients, and you will tell me some which do not work for you and you will tell me why, so let us start with administration and leadership at the district does it work for you here at the hospital, in terms of you giving services to the hospital?


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

[User] in this area people who are poor they get treatment, they all get treatment, but

[Assistant] elaborate more, what you mean by they don’t have enough money

[User] by the time someone fails to treat a sore throat, you know there are things that we just see, now like a sore throat, it’s not something that maybe someone spends his money on to treat, are you seeing, and not so much people will take time to treat a sore throat, they think it resolves on its own and goes, are you seeing, so when it progresses on something like rheumatic heart disease, really a few people can afford to do some of these surgeries even to keep on these medications for long, even a mere hypertensive patient finds it so expensive to buy his own medicine, even a diabetic patient, you find them crying after telling them that we have run out of stock of such drugs maybe they can try somewhere else.

[Assistant] okay, so now this moves us to the local system health care barriers, I am going to mention here some pieces, you will tell me which ones work for you, in terms of giving care to patients, and you will tell me some which do not work for you and you will tell me why, so let us start with administration and leadership at the district does it work for you here at the hospital, in terms of you giving services to the hospital?

[User] that one, it very much helps me because even if I ran out of something here, the district can support me, it can do redistribution of medicines and they get medicines so that one alone reduces my stock out period.

[Assistant] okay, so it is working for you


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

[User] by the time someone fails to treat a sore throat, you know there are things that we just see, now like a sore throat, it’s not something that maybe someone spends his money on to treat, are you seeing, and not so much people will take time to treat a sore throat, they think it resolves on its own and goes, are you seeing, so when it progresses on something like rheumatic heart disease, really a few people can afford to do some of these surgeries even to keep on these medications for long, even a mere hypertensive patient finds it so expensive to buy his own medicine, even a diabetic patient, you find them crying after telling them that we have run out of stock of such drugs maybe they can try somewhere else.

[Assistant] okay, so now this moves us to the local system health care barriers, I am going to mention here some pieces, you will tell me which ones work for you, in terms of giving care to patients, and you will tell me some which do not work for you and you will tell me why, so let us start with administration and leadership at the district does it work for you here at the hospital, in terms of you giving services to the hospital?

[User] that one, it very much helps me because even if I ran out of something here, the district can support me, it can do redistribution of medicines and they get medicines so that one alone reduces my stock out period.

[Assistant] okay, so it is working for you

[User] for me it is working in good relationship

[Assistant] how about funding for healthcare in general is it working for you?


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

[User] that one, it very much helps me because even if I ran out of something here, the district can support me, it can do redistribution of medicines and they get medicines so that one alone reduces my stock out period.

[Assistant] okay, so it is working for you

[User] for me it is working in good relationship

[Assistant] how about funding for healthcare in general is it working for you?

[User] the funding in the healthcare system is okay but the few challenges that are there, some of them could be the inefficiencies within the system, like maybe the human resources, if someone tells you to make an order for medicines and maybe I choose to make an order of medicines that are irrelevant in the community, what happens is that I will have expiries what patients need, they do won’t get it.

[Assistant] and how about the funding for rheumatic heart disease in particular?


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

[User] for me it is working in good relationship

[Assistant] how about funding for healthcare in general is it working for you?

[User] the funding in the healthcare system is okay but the few challenges that are there, some of them could be the inefficiencies within the system, like maybe the human resources, if someone tells you to make an order for medicines and maybe I choose to make an order of medicines that are irrelevant in the community, what happens is that I will have expiries what patients need, they do won’t get it.

[Assistant] and how about the funding for rheumatic heart disease in particular?

[User] in particular, actually when it comes to ordering for some of these medicines, some of these things, we don’t go to the nitty-gritty of every disease that now this medicine is for caring for these people with rheumatic heart disease no, we try to consider what is on essential medicines, that is one thing, two we try to focus on what is very vital and essential then some of these non-essential we use some kind of principals to quantify and be able to procure some of these medicines we have.

[Assistant] okay, I am interested in knowing those ones that are very essential that you add on the essential drug list


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

[User] the funding in the healthcare system is okay but the few challenges that are there, some of them could be the inefficiencies within the system, like maybe the human resources, if someone tells you to make an order for medicines and maybe I choose to make an order of medicines that are irrelevant in the community, what happens is that I will have expiries what patients need, they do won’t get it.

[Assistant] and how about the funding for rheumatic heart disease in particular?

[User] in particular, actually when it comes to ordering for some of these medicines, some of these things, we don’t go to the nitty-gritty of every disease that now this medicine is for caring for these people with rheumatic heart disease no, we try to consider what is on essential medicines, that is one thing, two we try to focus on what is very vital and essential then some of these non-essential we use some kind of principals to quantify and be able to procure some of these medicines we have.

[Assistant] okay, I am interested in knowing those ones that are very essential that you add on the essential drug list

[User] you see now the things that are very vital, we ensure that we always have Normal Saline and try whatever it takes to ensure that there are always fluids because its something that covers a very big number of patients, two, there are things that maybe serve like, gloves, cotton, goose, those ones, I will always ensure that they are always bought, because that is like first line of defence, so alone all those would consume a lot of budget but I know if all these ones I buy them, they still cut across to patients with rheumatic heart disease, if a patient comes here and we give him some of the treatment still they will use some of these as vehicles to transport these to the blood vessels.

[Assistant] okay, so let us look at the health care workers, in terms of the numbers and the quality of care they give, do you think it’s working for you, let’s start with the numbers of the healthcare workers working in this hospital, is that one working for you?


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

[User] in particular, actually when it comes to ordering for some of these medicines, some of these things, we don’t go to the nitty-gritty of every disease that now this medicine is for caring for these people with rheumatic heart disease no, we try to consider what is on essential medicines, that is one thing, two we try to focus on what is very vital and essential then some of these non-essential we use some kind of principals to quantify and be able to procure some of these medicines we have.

[Assistant] okay, I am interested in knowing those ones that are very essential that you add on the essential drug list

[User] you see now the things that are very vital, we ensure that we always have Normal Saline and try whatever it takes to ensure that there are always fluids because its something that covers a very big number of patients, two, there are things that maybe serve like, gloves, cotton, goose, those ones, I will always ensure that they are always bought, because that is like first line of defence, so alone all those would consume a lot of budget but I know if all these ones I buy them, they still cut across to patients with rheumatic heart disease, if a patient comes here and we give him some of the treatment still they will use some of these as vehicles to transport these to the blood vessels.

[Assistant] okay, so let us look at the health care workers, in terms of the numbers and the quality of care they give, do you think it’s working for you, let’s start with the numbers of the healthcare workers working in this hospital, is that one working for you?

[User] yes, the work load would be much bigger than the healthcare workers available, the work load could be bigger but I see, they always sail through.

[Assistant] okay, how about the quality of care that the health workers give, is it working for you?


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

[User] you see now the things that are very vital, we ensure that we always have Normal Saline and try whatever it takes to ensure that there are always fluids because its something that covers a very big number of patients, two, there are things that maybe serve like, gloves, cotton, goose, those ones, I will always ensure that they are always bought, because that is like first line of defence, so alone all those would consume a lot of budget but I know if all these ones I buy them, they still cut across to patients with rheumatic heart disease, if a patient comes here and we give him some of the treatment still they will use some of these as vehicles to transport these to the blood vessels.

[Assistant] okay, so let us look at the health care workers, in terms of the numbers and the quality of care they give, do you think it’s working for you, let’s start with the numbers of the healthcare workers working in this hospital, is that one working for you?

[User] yes, the work load would be much bigger than the healthcare workers available, the work load could be bigger but I see, they always sail through.

[Assistant] okay, how about the quality of care that the health workers give, is it working for you?

[User] if I am to go to my department here, I am very okay with the quality because literally I have not had any challenges for the past three years, yes there is no perfect system, unless it is only in heaven, you can always have mix ups here and there, but you always try to fix them and things keep moving

[Assistant] okay, let’s see about the waiting time of our patients, do you think it’s working for you, are you happy with it, the waiting time?


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

[User] yes, the work load would be much bigger than the healthcare workers available, the work load could be bigger but I see, they always sail through.

[Assistant] okay, how about the quality of care that the health workers give, is it working for you?

[User] if I am to go to my department here, I am very okay with the quality because literally I have not had any challenges for the past three years, yes there is no perfect system, unless it is only in heaven, you can always have mix ups here and there, but you always try to fix them and things keep moving

[Assistant] okay, let’s see about the waiting time of our patients, do you think it’s working for you, are you happy with it, the waiting time?

[User] it could be even shorter like I told you the volume of work is bigger than the staffs so it can be shortened if the volume of work is smaller than the staffs.

[Assistant] okay, so you are trying to, for starters, how long does each patient wait before getting services here?


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

[User] if I am to go to my department here, I am very okay with the quality because literally I have not had any challenges for the past three years, yes there is no perfect system, unless it is only in heaven, you can always have mix ups here and there, but you always try to fix them and things keep moving

[Assistant] okay, let’s see about the waiting time of our patients, do you think it’s working for you, are you happy with it, the waiting time?

[User] it could be even shorter like I told you the volume of work is bigger than the staffs so it can be shortened if the volume of work is smaller than the staffs.

[Assistant] okay, so you are trying to, for starters, how long does each patient wait before getting services here?

[User] maximally it would be like 10 to 15 minutes

[Assistant] that's what they wait for now


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

[User] it could be even shorter like I told you the volume of work is bigger than the staffs so it can be shortened if the volume of work is smaller than the staffs.

[Assistant] okay, so you are trying to, for starters, how long does each patient wait before getting services here?

[User] maximally it would be like 10 to 15 minutes

[Assistant] that's what they wait for now

[User] yes, if they are many, 10-15 minutes

[Assistant] okay, and let’s look at the medicines now, this is your department, particularly Benzathine penicillin, anti-coagulations and heart failure drugs, is that piece working for you are those drugs there?


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

[User] maximally it would be like 10 to 15 minutes

[Assistant] that's what they wait for now

[User] yes, if they are many, 10-15 minutes

[Assistant] okay, and let’s look at the medicines now, this is your department, particularly Benzathine penicillin, anti-coagulations and heart failure drugs, is that piece working for you are those drugs there?

[User] Benzathine penicillin is always there and sometimes it gets expired, yes

[Assistant] anti coagulation drugs?


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

[User] yes, if they are many, 10-15 minutes

[Assistant] okay, and let’s look at the medicines now, this is your department, particularly Benzathine penicillin, anti-coagulations and heart failure drugs, is that piece working for you are those drugs there?

[User] Benzathine penicillin is always there and sometimes it gets expired, yes

[Assistant] anti coagulation drugs?

[User] anti-coagulation like warfarin I think it has been out of stock for quite some time.

[Assistant] other anti-coagulation drugs, like cardiac aspirin?


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

[User] Benzathine penicillin is always there and sometimes it gets expired, yes

[Assistant] anti coagulation drugs?

[User] anti-coagulation like warfarin I think it has been out of stock for quite some time.

[Assistant] other anti-coagulation drugs, like cardiac aspirin?

[User] Cardiac aspirin, Clopidogrel, for cardiac aspirin is always available throughout, cardiac aspirin is among the essential medicine, so for that one is always in stock through out because it cuts across a bigger population of patients, so cardiac aspirin is always available but for things like Warfarin it’s always on and off, Clopidogrel on and off.

[Assistant] how about other heart failure drugs?


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

[User] anti-coagulation like warfarin I think it has been out of stock for quite some time.

[Assistant] other anti-coagulation drugs, like cardiac aspirin?

[User] Cardiac aspirin, Clopidogrel, for cardiac aspirin is always available throughout, cardiac aspirin is among the essential medicine, so for that one is always in stock through out because it cuts across a bigger population of patients, so cardiac aspirin is always available but for things like Warfarin it’s always on and off, Clopidogrel on and off.

[Assistant] how about other heart failure drugs?

[User] like Digoxin and all that? Yes Digoxin is always available, some are available some are not.

[Assistant] so does this mean that this piece is working for you or its not working for you?


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

[User] Cardiac aspirin, Clopidogrel, for cardiac aspirin is always available throughout, cardiac aspirin is among the essential medicine, so for that one is always in stock through out because it cuts across a bigger population of patients, so cardiac aspirin is always available but for things like Warfarin it’s always on and off, Clopidogrel on and off.

[Assistant] how about other heart failure drugs?

[User] like Digoxin and all that? Yes Digoxin is always available, some are available some are not.

[Assistant] so does this mean that this piece is working for you or its not working for you?

[User] it is not working, I would be happy if I had everything, that's my mission I would feel happy if a patient comes in and walks away with all the medicine he needs but when he wants three and I give him two, I am not happy about it because some of the patients they are going to swallow the two types and leaves out the third one and the therapeutic benefits is always small.

[Assistant] okay, I am interested in knowing actually why some anti-coagulation drugs like warfarin is not always there and it’s on and off, what brings that?


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

[User] like Digoxin and all that? Yes Digoxin is always available, some are available some are not.

[Assistant] so does this mean that this piece is working for you or its not working for you?

[User] it is not working, I would be happy if I had everything, that's my mission I would feel happy if a patient comes in and walks away with all the medicine he needs but when he wants three and I give him two, I am not happy about it because some of the patients they are going to swallow the two types and leaves out the third one and the therapeutic benefits is always small.

[Assistant] okay, I am interested in knowing actually why some anti-coagulation drugs like warfarin is not always there and it’s on and off, what brings that?

[User] some of these drugs, you find that, they are not on the essential medicines list, so when they are not on the essential medicines list, you cannot order for them, that is one, two, the level of care, as a Regional referral, we are not a specialised unit like you see heart institute is in Mulago, for it will always have these medicines like warfarin and others to treat these heart diseases because they are already specialised in that, but now us as a Regional referral and Mbarara is so unfortunate because of its location, it receivers those patients that are meant to be in heart institute but they would come here. That is what creates the inadequacy of the treatment that they don’t have but for our level of care, what they need we have it.

[Assistant] okay, so the reasons are because it is not a specialized hospital and some of these drugs are actually not on the essential drugs list, okay and now let’s look at health information medical record systems, is that one working for you here?


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

[User] it is not working, I would be happy if I had everything, that's my mission I would feel happy if a patient comes in and walks away with all the medicine he needs but when he wants three and I give him two, I am not happy about it because some of the patients they are going to swallow the two types and leaves out the third one and the therapeutic benefits is always small.

[Assistant] okay, I am interested in knowing actually why some anti-coagulation drugs like warfarin is not always there and it’s on and off, what brings that?

[User] some of these drugs, you find that, they are not on the essential medicines list, so when they are not on the essential medicines list, you cannot order for them, that is one, two, the level of care, as a Regional referral, we are not a specialised unit like you see heart institute is in Mulago, for it will always have these medicines like warfarin and others to treat these heart diseases because they are already specialised in that, but now us as a Regional referral and Mbarara is so unfortunate because of its location, it receivers those patients that are meant to be in heart institute but they would come here. That is what creates the inadequacy of the treatment that they don’t have but for our level of care, what they need we have it.

[Assistant] okay, so the reasons are because it is not a specialized hospital and some of these drugs are actually not on the essential drugs list, okay and now let’s look at health information medical record systems, is that one working for you here?

[User] the healthy management information system, yes it’s working.

[Assistant] okay, let’s look at the registers here, do you have specific registers for some diseases where you record for example, rheumatic fever, rheumatic heart disease?


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

[User] some of these drugs, you find that, they are not on the essential medicines list, so when they are not on the essential medicines list, you cannot order for them, that is one, two, the level of care, as a Regional referral, we are not a specialised unit like you see heart institute is in Mulago, for it will always have these medicines like warfarin and others to treat these heart diseases because they are already specialised in that, but now us as a Regional referral and Mbarara is so unfortunate because of its location, it receivers those patients that are meant to be in heart institute but they would come here. That is what creates the inadequacy of the treatment that they don’t have but for our level of care, what they need we have it.

[Assistant] okay, so the reasons are because it is not a specialized hospital and some of these drugs are actually not on the essential drugs list, okay and now let’s look at health information medical record systems, is that one working for you here?

[User] the healthy management information system, yes it’s working.

[Assistant] okay, let’s look at the registers here, do you have specific registers for some diseases where you record for example, rheumatic fever, rheumatic heart disease?

[User] we only give time to things like HIV.

[Assistant] you only have separate registers for HIV?


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

[User] the healthy management information system, yes it’s working.

[Assistant] okay, let’s look at the registers here, do you have specific registers for some diseases where you record for example, rheumatic fever, rheumatic heart disease?

[User] we only give time to things like HIV.

[Assistant] you only have separate registers for HIV?

[User] HIV, TB but these other ones it’s a one register.

[Assistant] one register, okay do you have the guidelines and protocols for rheumatic heart disease care, here in your department?


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

[User] we only give time to things like HIV.

[Assistant] you only have separate registers for HIV?

[User] HIV, TB but these other ones it’s a one register.

[Assistant] one register, okay do you have the guidelines and protocols for rheumatic heart disease care, here in your department?

[User] the guidelines we have should be what is in the UCG and maybe some other guide that I might have.

[Assistant] how about these other guidelines designed specifically within the department like for HIV or TB, those charts that are specifically designed for rheumatic heart disease, do you have them?


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

[User] HIV, TB but these other ones it’s a one register.

[Assistant] one register, okay do you have the guidelines and protocols for rheumatic heart disease care, here in your department?

[User] the guidelines we have should be what is in the UCG and maybe some other guide that I might have.

[Assistant] how about these other guidelines designed specifically within the department like for HIV or TB, those charts that are specifically designed for rheumatic heart disease, do you have them?

[User] there are guidelines we use, the ones in the UCG, that's what we follow plus what we read but as a department we have not designed that guideline in fact we are in the process of designing what we call a hospital formula, in that hospital formula is where we shall identify the common diseases that we always treat and what is our recommended kind of treatment as per what suites the setting that we are in because we have realised that some medicines might be working in Jinja regional referral but when they can’t work on patients in Mbarara.

[Assistant] okay that will be a great idea.


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

[User] the guidelines we have should be what is in the UCG and maybe some other guide that I might have.

[Assistant] how about these other guidelines designed specifically within the department like for HIV or TB, those charts that are specifically designed for rheumatic heart disease, do you have them?

[User] there are guidelines we use, the ones in the UCG, that's what we follow plus what we read but as a department we have not designed that guideline in fact we are in the process of designing what we call a hospital formula, in that hospital formula is where we shall identify the common diseases that we always treat and what is our recommended kind of treatment as per what suites the setting that we are in because we have realised that some medicines might be working in Jinja regional referral but when they can’t work on patients in Mbarara.

[Assistant] okay that will be a great idea.

[User] it’s something that might take time but we are doing it through the medicine and therapeutics committee.

[Assistant] so we are going to go through them again, administration you said it’s working for you?


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

[User] there are guidelines we use, the ones in the UCG, that's what we follow plus what we read but as a department we have not designed that guideline in fact we are in the process of designing what we call a hospital formula, in that hospital formula is where we shall identify the common diseases that we always treat and what is our recommended kind of treatment as per what suites the setting that we are in because we have realised that some medicines might be working in Jinja regional referral but when they can’t work on patients in Mbarara.

[Assistant] okay that will be a great idea.

[User] it’s something that might take time but we are doing it through the medicine and therapeutics committee.

[Assistant] so we are going to go through them again, administration you said it’s working for you?

[User] yes, administration at the district.

[Assistant] okay leadership at the district is working for you, funding for health care in general, you said its working for you, and the health care systems, numbers and the qualifications of the health workers and the waiting time for patients is working for you, and the health information system, medical records, you said its working for you, plus the registers, and the guidelines, it’s also working for you, that's it?


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

[User] it’s something that might take time but we are doing it through the medicine and therapeutics committee.

[Assistant] so we are going to go through them again, administration you said it’s working for you?

[User] yes, administration at the district.

[Assistant] okay leadership at the district is working for you, funding for health care in general, you said its working for you, and the health care systems, numbers and the qualifications of the health workers and the waiting time for patients is working for you, and the health information system, medical records, you said its working for you, plus the registers, and the guidelines, it’s also working for you, that's it?

[User] yes

[Assistant] alright, let’s go to the last piece of questions now, do you think the patients get the care they need, especially the rheumatic heart disease patients?


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

[User] yes, administration at the district.

[Assistant] okay leadership at the district is working for you, funding for health care in general, you said its working for you, and the health care systems, numbers and the qualifications of the health workers and the waiting time for patients is working for you, and the health information system, medical records, you said its working for you, plus the registers, and the guidelines, it’s also working for you, that's it?

[User] yes

[Assistant] alright, let’s go to the last piece of questions now, do you think the patients get the care they need, especially the rheumatic heart disease patients?

[User] that is subjective to patient.

[Assistant] in your own opinion


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

[User] yes

[Assistant] alright, let’s go to the last piece of questions now, do you think the patients get the care they need, especially the rheumatic heart disease patients?

[User] that is subjective to patient.

[Assistant] in your own opinion

[User] actually the patients who leave this place cured are more than, are far from they could even be more than 100 times, bigger than those who leave here with more complications to refer to Mulago for further management, so which I think they are getting the care they need, because if you have close to 400 patients a day, and you may receive a death of one patient or non, don’t you think you are doing a good job, this is a very small percentage of the 400, so they must be getting good treatment.

[Assistant] okay, talking about death, do you have any patient safety concerns, quality of care concerns, for example, have you had any preventable death here?


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

[User] that is subjective to patient.

[Assistant] in your own opinion

[User] actually the patients who leave this place cured are more than, are far from they could even be more than 100 times, bigger than those who leave here with more complications to refer to Mulago for further management, so which I think they are getting the care they need, because if you have close to 400 patients a day, and you may receive a death of one patient or non, don’t you think you are doing a good job, this is a very small percentage of the 400, so they must be getting good treatment.

[Assistant] okay, talking about death, do you have any patient safety concerns, quality of care concerns, for example, have you had any preventable death here?

[User] but I think every death is preventable (laughs)

[Assistant] there are those deaths you really see and be like, oh this person wouldn’t have died, have you had those occasions?


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

[User] actually the patients who leave this place cured are more than, are far from they could even be more than 100 times, bigger than those who leave here with more complications to refer to Mulago for further management, so which I think they are getting the care they need, because if you have close to 400 patients a day, and you may receive a death of one patient or non, don’t you think you are doing a good job, this is a very small percentage of the 400, so they must be getting good treatment.

[Assistant] okay, talking about death, do you have any patient safety concerns, quality of care concerns, for example, have you had any preventable death here?

[User] but I think every death is preventable (laughs)

[Assistant] there are those deaths you really see and be like, oh this person wouldn’t have died, have you had those occasions?

[User] personally not.

[Assistant] okay, do you think there are many patients there in the community dying without presenting here in the hospital?


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

[User] but I think every death is preventable (laughs)

[Assistant] there are those deaths you really see and be like, oh this person wouldn’t have died, have you had those occasions?

[User] personally not.

[Assistant] okay, do you think there are many patients there in the community dying without presenting here in the hospital?

[User] that is true.

[Assistant] what do you think happens, why don’t they actually surface?


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

[User] personally not.

[Assistant] okay, do you think there are many patients there in the community dying without presenting here in the hospital?

[User] that is true.

[Assistant] what do you think happens, why don’t they actually surface?

[User] some of them could be believing like I told you these cultural beliefs, others might be thinking that when they take their tradition medicine it will work for them, others might not know even that they are sick, then others could be in the community and could be having some of these diseases, but when they go to these health facilities, maybe the lower healthy facilities, they don’t find solutions, so they now get to know that even if they go for further management, there will be no solution to help their problems.

[Assistant] any other reason?


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

[User] that is true.

[Assistant] what do you think happens, why don’t they actually surface?

[User] some of them could be believing like I told you these cultural beliefs, others might be thinking that when they take their tradition medicine it will work for them, others might not know even that they are sick, then others could be in the community and could be having some of these diseases, but when they go to these health facilities, maybe the lower healthy facilities, they don’t find solutions, so they now get to know that even if they go for further management, there will be no solution to help their problems.

[Assistant] any other reason?

[User] some of them maybe could not be having money, I am not meaning money to pay, I mean money that could help to transport themselves to hospitals and someone cannot be lacking something to eat and they get money to present to hospitals, this normal one will first eat, then if they are to die the die.

[Assistant] okay, so poverty, cultural beliefs, ignorance because you said that some of them they might not know that they are actually sick, okay is that all you can think of?


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

[User] some of them could be believing like I told you these cultural beliefs, others might be thinking that when they take their tradition medicine it will work for them, others might not know even that they are sick, then others could be in the community and could be having some of these diseases, but when they go to these health facilities, maybe the lower healthy facilities, they don’t find solutions, so they now get to know that even if they go for further management, there will be no solution to help their problems.

[Assistant] any other reason?

[User] some of them maybe could not be having money, I am not meaning money to pay, I mean money that could help to transport themselves to hospitals and someone cannot be lacking something to eat and they get money to present to hospitals, this normal one will first eat, then if they are to die the die.

[Assistant] okay, so poverty, cultural beliefs, ignorance because you said that some of them they might not know that they are actually sick, okay is that all you can think of?

[User] I told you five.

[Assistant] you told me five, cultural beliefs, poverty, ignorance of their diseases...


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

[User] some of them maybe could not be having money, I am not meaning money to pay, I mean money that could help to transport themselves to hospitals and someone cannot be lacking something to eat and they get money to present to hospitals, this normal one will first eat, then if they are to die the die.

[Assistant] okay, so poverty, cultural beliefs, ignorance because you said that some of them they might not know that they are actually sick, okay is that all you can think of?

[User] I told you five.

[Assistant] you told me five, cultural beliefs, poverty, ignorance of their diseases...

[User] others have a bias towards like I have told you, if they go to the lower health facilities and they fail to get solutions, they know they will never get the solutions

[Assistant] Now, the last thing in your own opinion, what are one or two important things you think ministry of health can do to improve the outcome of our patients


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

[User] I told you five.

[Assistant] you told me five, cultural beliefs, poverty, ignorance of their diseases...

[User] others have a bias towards like I have told you, if they go to the lower health facilities and they fail to get solutions, they know they will never get the solutions

[Assistant] Now, the last thing in your own opinion, what are one or two important things you think ministry of health can do to improve the outcome of our patients

[User] in matters of rheumatic heart disease?

[Assistant] in general, you can talk about it in general even in this side of rheumatic heart disease


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

[User] others have a bias towards like I have told you, if they go to the lower health facilities and they fail to get solutions, they know they will never get the solutions

[Assistant] Now, the last thing in your own opinion, what are one or two important things you think ministry of health can do to improve the outcome of our patients

[User] in matters of rheumatic heart disease?

[Assistant] in general, you can talk about it in general even in this side of rheumatic heart disease

[User] one thing about is it should get more if ministry of health can see disease don’t read books, you can see even of late we used to say that young kids don’t get typhoid, isn’t it but even we see these days young kids with typhoid, so there is much to invest in research, there is a lot to invest in research so that they can get the new trends of management of some of these diseases are even preventable, so there is that need of even sensitizing the community, and some of these very preventable diseases that could even be leading to some of these problems that we are having and I know that one will reduce on the cost burden of the health care system

[Assistant] okay, any other, apart from that?


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

[User] in matters of rheumatic heart disease?

[Assistant] in general, you can talk about it in general even in this side of rheumatic heart disease

[User] one thing about is it should get more if ministry of health can see disease don’t read books, you can see even of late we used to say that young kids don’t get typhoid, isn’t it but even we see these days young kids with typhoid, so there is much to invest in research, there is a lot to invest in research so that they can get the new trends of management of some of these diseases are even preventable, so there is that need of even sensitizing the community, and some of these very preventable diseases that could even be leading to some of these problems that we are having and I know that one will reduce on the cost burden of the health care system

[Assistant] okay, any other, apart from that?

[User] most of these diseases are preventable so if they can give those preventive measures which could be, like they have done with malaria, give out mosquito nets then do that and all that, then again sensitize, and for people who have had heart diseases like those hypertensions, those are preventable diseases, people who have diseases like maybe diabetes, yes it is genetic component but you can delay it, but all that comes on how you empower the community with knowledge.

[Assistant] any specific thing they should do as far as rheumatic heart disease is concerned?


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

[User] one thing about is it should get more if ministry of health can see disease don’t read books, you can see even of late we used to say that young kids don’t get typhoid, isn’t it but even we see these days young kids with typhoid, so there is much to invest in research, there is a lot to invest in research so that they can get the new trends of management of some of these diseases are even preventable, so there is that need of even sensitizing the community, and some of these very preventable diseases that could even be leading to some of these problems that we are having and I know that one will reduce on the cost burden of the health care system

[Assistant] okay, any other, apart from that?

[User] most of these diseases are preventable so if they can give those preventive measures which could be, like they have done with malaria, give out mosquito nets then do that and all that, then again sensitize, and for people who have had heart diseases like those hypertensions, those are preventable diseases, people who have diseases like maybe diabetes, yes it is genetic component but you can delay it, but all that comes on how you empower the community with knowledge.

[Assistant] any specific thing they should do as far as rheumatic heart disease is concerned?

[User] rheumatic heart disease being among the cardiovascular diseases that we are having, the only thing I can ask for is like the heart institute in Mulago but Mulago alone may not be able to manage some of these diseases because of the problem of numbers, these is an upward trend to some of these diseases maybe rheumatic heart diseases, so if at a regional referral if some of these units are set up and they are well equipped with whatever they need, this would not be a problem rheumatic heart disease would not be a problem.

[Assistant] that's great, is there any other thing you would want to say before we finish?


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

[User] Okay.

[Assistant] Okay. Would you like a preamble or should we just get into it?

[User] Oh, we could just get into it.

[Assistant]
OK, great.

So how old are you?

[User] 30.

[Assistant] And where do you live?


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

[User] Oh, we could just get into it.

[Assistant]
OK, great.

So how old are you?

[User] 30.

[Assistant] And where do you live?

[User] I live in [city]

[Assistant] Is that where you work?


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

[User] 30.

[Assistant] And where do you live?

[User] I live in [city]

[Assistant] Is that where you work?

[User] Yes.

[Assistant] What's your current position?


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

[User] I live in [city]

[Assistant] Is that where you work?

[User] Yes.

[Assistant] What's your current position?

[User] My current position is technically fire service paramedic.

[Assistant] You do medical?


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

[User] Yes.

[Assistant] What's your current position?

[User] My current position is technically fire service paramedic.

[Assistant] You do medical?

[User] Yeah. Yeah, that's just the title. They refer to it as on the job.

[Assistant] And how long have you been there?


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

[User] My current position is technically fire service paramedic.

[Assistant] You do medical?

[User] Yeah. Yeah, that's just the title. They refer to it as on the job.

[Assistant] And how long have you been there?

[User] Um, I've been where I'm at right now for five years.

[Assistant] So was this where you were working in January 2020?


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

[User] Yeah. Yeah, that's just the title. They refer to it as on the job.

[Assistant] And how long have you been there?

[User] Um, I've been where I'm at right now for five years.

[Assistant] So was this where you were working in January 2020?

[User] Yes.

[Assistant] So can you tell me about the time that you first heard about COVID?


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

[User] Yes.

[Assistant] So can you tell me about the time that you first heard about COVID?

[User] I think I first heard about it late October early November 2019, when it was just kind of a whisper saying how, oh, there's something going on in China. I think it was around that time where it's like people just started mentioning it.

[Assistant] October?

[User] I think it was like October, November 2019. When they’re first making mentions of a virus spreading through China. I may be off, but I feel like that's when it was just slowly being mentioned.

[Assistant] Are you sure you're not talking about the plague outbreak that was there?


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

[User] I think I first heard about it late October early November 2019, when it was just kind of a whisper saying how, oh, there's something going on in China. I think it was around that time where it's like people just started mentioning it.

[Assistant] October?

[User] I think it was like October, November 2019. When they’re first making mentions of a virus spreading through China. I may be off, but I feel like that's when it was just slowly being mentioned.

[Assistant] Are you sure you're not talking about the plague outbreak that was there?

[User]
Uh, I'm not fully sure. All I remember is that around that time of year, maybe closer to December, in all honesty, ‘cause it's been that long, that mentions of a virus from China just started hitting the news. But at that point it was like, oh, these outbreaks happen. They get dealt with fairly quickly. So it was just like on the back burner.

No one cared about it.

And I guess especially during the years prior, every time there was a big scare, some sort of virus that had a large scale capability of, you know, disrupting things, it was usually handled relatively quickly.

[Assistant] So what were you thinking at first?


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

[User] I think it was like October, November 2019. When they’re first making mentions of a virus spreading through China. I may be off, but I feel like that's when it was just slowly being mentioned.

[Assistant] Are you sure you're not talking about the plague outbreak that was there?

[User]
Uh, I'm not fully sure. All I remember is that around that time of year, maybe closer to December, in all honesty, ‘cause it's been that long, that mentions of a virus from China just started hitting the news. But at that point it was like, oh, these outbreaks happen. They get dealt with fairly quickly. So it was just like on the back burner.

No one cared about it.

And I guess especially during the years prior, every time there was a big scare, some sort of virus that had a large scale capability of, you know, disrupting things, it was usually handled relatively quickly.

[Assistant] So what were you thinking at first?

[User] Um, like I said, based off of like initial reports at the start, I thought nothing of it um.

[Assistant] Why? Why did you think that?


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

[User]
Uh, I'm not fully sure. All I remember is that around that time of year, maybe closer to December, in all honesty, ‘cause it's been that long, that mentions of a virus from China just started hitting the news. But at that point it was like, oh, these outbreaks happen. They get dealt with fairly quickly. So it was just like on the back burner.

No one cared about it.

And I guess especially during the years prior, every time there was a big scare, some sort of virus that had a large scale capability of, you know, disrupting things, it was usually handled relatively quickly.

[Assistant] So what were you thinking at first?

[User] Um, like I said, based off of like initial reports at the start, I thought nothing of it um.

[Assistant] Why? Why did you think that?

[User] Like I said, previous big name viruses that kind of take over the news space, they usually are dealt with fairly easily. You hear about them for a couple of weeks. The powers that be do their job. And then if they do hit U.S. soil, it'll be in small numbers and then kind of just not spoken about from there.

[Assistant]
Thank you for that.

OK, so were you- did you talk about the new virus with anyone around this time?


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

[User] Um, like I said, based off of like initial reports at the start, I thought nothing of it um.

[Assistant] Why? Why did you think that?

[User] Like I said, previous big name viruses that kind of take over the news space, they usually are dealt with fairly easily. You hear about them for a couple of weeks. The powers that be do their job. And then if they do hit U.S. soil, it'll be in small numbers and then kind of just not spoken about from there.

[Assistant]
Thank you for that.

OK, so were you- did you talk about the new virus with anyone around this time?

[User] No.

[Assistant] No? Nobody on the rig?


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

[User] Like I said, previous big name viruses that kind of take over the news space, they usually are dealt with fairly easily. You hear about them for a couple of weeks. The powers that be do their job. And then if they do hit U.S. soil, it'll be in small numbers and then kind of just not spoken about from there.

[Assistant]
Thank you for that.

OK, so were you- did you talk about the new virus with anyone around this time?

[User] No.

[Assistant] No? Nobody on the rig?

[User] No, no, no. Because, I mean, I follow a lot of global news, so that's probably why I heard like even the slightest inkling of it that early.

[Assistant] But- okay, so when it started getting into it, so let's say around January or February. Yeah. Then it starts coming into the news more, right?


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

[User] No.

[Assistant] No? Nobody on the rig?

[User] No, no, no. Because, I mean, I follow a lot of global news, so that's probably why I heard like even the slightest inkling of it that early.

[Assistant] But- okay, so when it started getting into it, so let's say around January or February. Yeah. Then it starts coming into the news more, right?

[User] Yeah. That's when I felt like it made more of a global presence and early March 2020 is when I feel like it really started to hit U.S. soil.

[Assistant] But, um, around January, February, were your thoughts changing at all.


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

[User] No, no, no. Because, I mean, I follow a lot of global news, so that's probably why I heard like even the slightest inkling of it that early.

[Assistant] But- okay, so when it started getting into it, so let's say around January or February. Yeah. Then it starts coming into the news more, right?

[User] Yeah. That's when I felt like it made more of a global presence and early March 2020 is when I feel like it really started to hit U.S. soil.

[Assistant] But, um, around January, February, were your thoughts changing at all.

[User]
No, no, sorry. I said we were too use to these stories hittingthe news. They stay in like the mind space of the public for a couple of weeks and then just kinda dissipate away without anyone having to do anything. Well, not anyone, but anyone as in the everyday common man. There's always organizations that be who deal with them accordingly.

But it's out of sight, out of mind.

[Assistant] Okay, so in in January and February, though, were you talking with anyone about this?


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

[User] Yeah. That's when I felt like it made more of a global presence and early March 2020 is when I feel like it really started to hit U.S. soil.

[Assistant] But, um, around January, February, were your thoughts changing at all.

[User]
No, no, sorry. I said we were too use to these stories hittingthe news. They stay in like the mind space of the public for a couple of weeks and then just kinda dissipate away without anyone having to do anything. Well, not anyone, but anyone as in the everyday common man. There's always organizations that be who deal with them accordingly.

But it's out of sight, out of mind.

[Assistant] Okay, so in in January and February, though, were you talking with anyone about this?

[User] Nah.

[Assistant] Um, I guess so, I mean, it was, they said out of sight, out of mind. You trust the organizations that are responsible for disease control or pandemic control or prevention… Did that change at all for you before March?


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

[User]
No, no, sorry. I said we were too use to these stories hittingthe news. They stay in like the mind space of the public for a couple of weeks and then just kinda dissipate away without anyone having to do anything. Well, not anyone, but anyone as in the everyday common man. There's always organizations that be who deal with them accordingly.

But it's out of sight, out of mind.

[Assistant] Okay, so in in January and February, though, were you talking with anyone about this?

[User] Nah.

[Assistant] Um, I guess so, I mean, it was, they said out of sight, out of mind. You trust the organizations that are responsible for disease control or pandemic control or prevention… Did that change at all for you before March?

[User] I think the first time I really- it really stuck in my head this may become a problem is when the news stories started coming out of Italy. And I think that was like around maybe a couple of weeks prior to hitting the US soil.

[Assistant] And then what were you thinking when you saw those?


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

[User] Nah.

[Assistant] Um, I guess so, I mean, it was, they said out of sight, out of mind. You trust the organizations that are responsible for disease control or pandemic control or prevention… Did that change at all for you before March?

[User] I think the first time I really- it really stuck in my head this may become a problem is when the news stories started coming out of Italy. And I think that was like around maybe a couple of weeks prior to hitting the US soil.

[Assistant] And then what were you thinking when you saw those?

[User] I was thinking, was this interesting…

[Assistant] And other people around you.


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

[User] I think the first time I really- it really stuck in my head this may become a problem is when the news stories started coming out of Italy. And I think that was like around maybe a couple of weeks prior to hitting the US soil.

[Assistant] And then what were you thinking when you saw those?

[User] I was thinking, was this interesting…

[Assistant] And other people around you.

[User]
Um.

The people closest to me at work weren't really making a big deal of it. It wasn't really something that was spoken about. The first time it really became a topic of discussion of course, once it started affecting the daily lives of people. once we started realized, Hey, we have to ramp up PPE usage. Hey, we have to screen for this and act certain questions.

And then once you saw the influx of both lockdowns and acutely ill patients presenting with COVID, that's when it became a true discussion.

[Assistant] So it started affecting your field practices?


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

[User] I was thinking, was this interesting…

[Assistant] And other people around you.

[User]
Um.

The people closest to me at work weren't really making a big deal of it. It wasn't really something that was spoken about. The first time it really became a topic of discussion of course, once it started affecting the daily lives of people. once we started realized, Hey, we have to ramp up PPE usage. Hey, we have to screen for this and act certain questions.

And then once you saw the influx of both lockdowns and acutely ill patients presenting with COVID, that's when it became a true discussion.

[Assistant] So it started affecting your field practices?

[User] Yes.

[Assistant] Do you remember when that started kicking off?


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

[User]
Um.

The people closest to me at work weren't really making a big deal of it. It wasn't really something that was spoken about. The first time it really became a topic of discussion of course, once it started affecting the daily lives of people. once we started realized, Hey, we have to ramp up PPE usage. Hey, we have to screen for this and act certain questions.

And then once you saw the influx of both lockdowns and acutely ill patients presenting with COVID, that's when it became a true discussion.

[Assistant] So it started affecting your field practices?

[User] Yes.

[Assistant] Do you remember when that started kicking off?

[User] Um, about, I'd say like a week or two after the lockdown took place, that's when I started seeing like acutely ill COVID patients.

[Assistant] Did you have a like a Eureka moment or like an oh shit moment when you realized how bad things were going to be.


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

[User] Yes.

[Assistant] Do you remember when that started kicking off?

[User] Um, about, I'd say like a week or two after the lockdown took place, that's when I started seeing like acutely ill COVID patients.

[Assistant] Did you have a like a Eureka moment or like an oh shit moment when you realized how bad things were going to be.

[User] Yes. When I would listen to the radio and there was like a couple nursing homes- nursing homes are hotbeds for disease. They due to like the proximity to patients and poor conditions. Disease spreads fairly quickly, do nursing homes. That's why I like you'll see like runs of sepsis and like upper respiratory infections in like nursing. I mean, like skilled nursing facilities that primarily have ventilated patients so I remember this one nursing home in West Philly almost every hour on the hour someone was getting dispatched for a cardiac arrest in there. now granted they would be, I guess, the target population that you’d expect for this to affect them negatively, but the frequency that it was affecting it, it was just kind of staggering.

[Assistant] So in like the weeks leading up to that point.


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

[User] Um, about, I'd say like a week or two after the lockdown took place, that's when I started seeing like acutely ill COVID patients.

[Assistant] Did you have a like a Eureka moment or like an oh shit moment when you realized how bad things were going to be.

[User] Yes. When I would listen to the radio and there was like a couple nursing homes- nursing homes are hotbeds for disease. They due to like the proximity to patients and poor conditions. Disease spreads fairly quickly, do nursing homes. That's why I like you'll see like runs of sepsis and like upper respiratory infections in like nursing. I mean, like skilled nursing facilities that primarily have ventilated patients so I remember this one nursing home in West Philly almost every hour on the hour someone was getting dispatched for a cardiac arrest in there. now granted they would be, I guess, the target population that you’d expect for this to affect them negatively, but the frequency that it was affecting it, it was just kind of staggering.

[Assistant] So in like the weeks leading up to that point.

[User] Yeah.

[Assistant] Did you do anything to prepare personally?


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

[User] Yes. When I would listen to the radio and there was like a couple nursing homes- nursing homes are hotbeds for disease. They due to like the proximity to patients and poor conditions. Disease spreads fairly quickly, do nursing homes. That's why I like you'll see like runs of sepsis and like upper respiratory infections in like nursing. I mean, like skilled nursing facilities that primarily have ventilated patients so I remember this one nursing home in West Philly almost every hour on the hour someone was getting dispatched for a cardiac arrest in there. now granted they would be, I guess, the target population that you’d expect for this to affect them negatively, but the frequency that it was affecting it, it was just kind of staggering.

[Assistant] So in like the weeks leading up to that point.

[User] Yeah.

[Assistant] Did you do anything to prepare personally?

[User] Um, I'd say I just like, read, just like the base knowledge that was out there, how to prevent infection, how to protect yourself as a provider. What signs and symptoms to look for. At the same time, it was just like such a varying degree of symptoms that was just kinda hard.

[Assistant] And did you like change your personal behavior at all?


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

[User] Yeah.

[Assistant] Did you do anything to prepare personally?

[User] Um, I'd say I just like, read, just like the base knowledge that was out there, how to prevent infection, how to protect yourself as a provider. What signs and symptoms to look for. At the same time, it was just like such a varying degree of symptoms that was just kinda hard.

[Assistant] And did you like change your personal behavior at all?

[User] Um, I wouldn’t- I wouldn't say I changed my personal behavior. I just was kind of rolling with what was being dealt with.

[Assistant] OK. And, uh, how did [organization] prep?


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

[User] Um, I'd say I just like, read, just like the base knowledge that was out there, how to prevent infection, how to protect yourself as a provider. What signs and symptoms to look for. At the same time, it was just like such a varying degree of symptoms that was just kinda hard.

[Assistant] And did you like change your personal behavior at all?

[User] Um, I wouldn’t- I wouldn't say I changed my personal behavior. I just was kind of rolling with what was being dealt with.

[Assistant] OK. And, uh, how did [organization] prep?

[User]
That's the thing. A lot of people didn't have much prep time because they didn't think it was going to hit as hard as it did. So it was kind of dealing with it in real time. We're trying to get PPE as we could. That was difficult for everybody. People were using N95s, we were using face masks. We were using like one piece suits to try and mitigate the possible spread of COVID.

We were trying to heavily decon[taminate] trucks in between runs so.

[Assistant] Were there any meetings or group discussions like in February, say, about this?


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

[User] Um, I wouldn’t- I wouldn't say I changed my personal behavior. I just was kind of rolling with what was being dealt with.

[Assistant] OK. And, uh, how did [organization] prep?

[User]
That's the thing. A lot of people didn't have much prep time because they didn't think it was going to hit as hard as it did. So it was kind of dealing with it in real time. We're trying to get PPE as we could. That was difficult for everybody. People were using N95s, we were using face masks. We were using like one piece suits to try and mitigate the possible spread of COVID.

We were trying to heavily decon[taminate] trucks in between runs so.

[Assistant] Were there any meetings or group discussions like in February, say, about this?

[User]
Um, the ultimate issue with that is the way my organization is structured. It doesn't really prioritize keeping the people on the lowest part of the totem pole in the loop. So I'm pretty sure the higher ups were having their meetings, but they weren't feeding information to us as quick as they can. They were sending out regular emails in regards to how to deal with these patients, how to deal with the possible exposure and all those things.

But it was like, there was no like verbal communication between us and that.

[Assistant] What was the protocol for a possible exposure?


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

[User]
That's the thing. A lot of people didn't have much prep time because they didn't think it was going to hit as hard as it did. So it was kind of dealing with it in real time. We're trying to get PPE as we could. That was difficult for everybody. People were using N95s, we were using face masks. We were using like one piece suits to try and mitigate the possible spread of COVID.

We were trying to heavily decon[taminate] trucks in between runs so.

[Assistant] Were there any meetings or group discussions like in February, say, about this?

[User]
Um, the ultimate issue with that is the way my organization is structured. It doesn't really prioritize keeping the people on the lowest part of the totem pole in the loop. So I'm pretty sure the higher ups were having their meetings, but they weren't feeding information to us as quick as they can. They were sending out regular emails in regards to how to deal with these patients, how to deal with the possible exposure and all those things.

But it was like, there was no like verbal communication between us and that.

[Assistant] What was the protocol for a possible exposure?

[User] Um, I don't remember because it's obviously changed so many times, but I think early on it was like, I think early on, like early, early COVID was like if you would, if you had someone who's COVID positive, they were taking you off the streets immediately.

[Assistant] That must have changed pretty quickly.


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

[User]
Um, the ultimate issue with that is the way my organization is structured. It doesn't really prioritize keeping the people on the lowest part of the totem pole in the loop. So I'm pretty sure the higher ups were having their meetings, but they weren't feeding information to us as quick as they can. They were sending out regular emails in regards to how to deal with these patients, how to deal with the possible exposure and all those things.

But it was like, there was no like verbal communication between us and that.

[Assistant] What was the protocol for a possible exposure?

[User] Um, I don't remember because it's obviously changed so many times, but I think early on it was like, I think early on, like early, early COVID was like if you would, if you had someone who's COVID positive, they were taking you off the streets immediately.

[Assistant] That must have changed pretty quickly.

[User] Yeah, that, that evolved with the times to the point where… you already know how it is now. you can come to work Covid positive and they don’t care.

[Assistant] I don't know because I have a job khkhkh


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

[User] Um, I don't remember because it's obviously changed so many times, but I think early on it was like, I think early on, like early, early COVID was like if you would, if you had someone who's COVID positive, they were taking you off the streets immediately.

[Assistant] That must have changed pretty quickly.

[User] Yeah, that, that evolved with the times to the point where… you already know how it is now. you can come to work Covid positive and they don’t care.

[Assistant] I don't know because I have a job khkhkh

[User]
Khkhkh Oh, okay.

Well, yeah, initially there was like the, the- they were trying their best to limit exposure and like I said, anyone tested positive, everyone who worked in that firehouse that day was immediately taken off the streets. They were deconning firehouses head to toe and it did take a toll on staffing. So I think at one point we were down like a quarter of staff members.

[Assistant]
OK that's interesting actually.

I'm going to come back to you on that one.

Okay. So in- was anyone trying to push for more action to be taken before it really started to hit?


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

[User]
Khkhkh Oh, okay.

Well, yeah, initially there was like the, the- they were trying their best to limit exposure and like I said, anyone tested positive, everyone who worked in that firehouse that day was immediately taken off the streets. They were deconning firehouses head to toe and it did take a toll on staffing. So I think at one point we were down like a quarter of staff members.

[Assistant]
OK that's interesting actually.

I'm going to come back to you on that one.

Okay. So in- was anyone trying to push for more action to be taken before it really started to hit?

[User] No.

[Assistant] So no.

[User] Not, at least no one that I saw or know of. No.

[Assistant] Were there any conversations with your partner like, hey, we should we should be more worried about this?


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

[User] No.

[Assistant] So no.

[User] Not, at least no one that I saw or know of. No.

[Assistant] Were there any conversations with your partner like, hey, we should we should be more worried about this?

[User] No.

[Assistant] Okay. So looking back on it, do you think what do you wish that the organization had done differently?


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

[User] Not, at least no one that I saw or know of. No.

[Assistant] Were there any conversations with your partner like, hey, we should we should be more worried about this?

[User] No.

[Assistant] Okay. So looking back on it, do you think what do you wish that the organization had done differently?

[User] I guess transparency, but that's like an issue that's always going to exist. You gotta learn to be a bit more forthcoming and learn to communicate better with field staff. But that's, that's not unique to Covid and it's not unique to my organization. It's just an issue all of us exist with this job.

[Assistant] And what would you have done differently as an individual?


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

[User] No.

[Assistant] Okay. So looking back on it, do you think what do you wish that the organization had done differently?

[User] I guess transparency, but that's like an issue that's always going to exist. You gotta learn to be a bit more forthcoming and learn to communicate better with field staff. But that's, that's not unique to Covid and it's not unique to my organization. It's just an issue all of us exist with this job.

[Assistant] And what would you have done differently as an individual?

[User] I think I personally fared incredibly well during the COVID, so… I did I could to limit exposure personally. I tried to keep all my equipment clean. I wasn't really going out, but no one could because there was nowhere to go. So yeah, I did all I could and I wouldn't really change anything in terms of my response.

[Assistant] Did you, were you still like going to bars and socializing in February and March?


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

[User] I guess transparency, but that's like an issue that's always going to exist. You gotta learn to be a bit more forthcoming and learn to communicate better with field staff. But that's, that's not unique to Covid and it's not unique to my organization. It's just an issue all of us exist with this job.

[Assistant] And what would you have done differently as an individual?

[User] I think I personally fared incredibly well during the COVID, so… I did I could to limit exposure personally. I tried to keep all my equipment clean. I wasn't really going out, but no one could because there was nowhere to go. So yeah, I did all I could and I wouldn't really change anything in terms of my response.

[Assistant] Did you, were you still like going to bars and socializing in February and March?

[User] Only people I was interacting with were people from work. So other paramedics other EMTs sometimes and firefighters.

[Assistant] Okay. Were you working in emergency medicine during Ebola?


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

[User] I think I personally fared incredibly well during the COVID, so… I did I could to limit exposure personally. I tried to keep all my equipment clean. I wasn't really going out, but no one could because there was nowhere to go. So yeah, I did all I could and I wouldn't really change anything in terms of my response.

[Assistant] Did you, were you still like going to bars and socializing in February and March?

[User] Only people I was interacting with were people from work. So other paramedics other EMTs sometimes and firefighters.

[Assistant] Okay. Were you working in emergency medicine during Ebola?

[User] I don't remember, to be honest. What year was that.

[Assistant] 13, I think.


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

[User] Only people I was interacting with were people from work. So other paramedics other EMTs sometimes and firefighters.

[Assistant] Okay. Were you working in emergency medicine during Ebola?

[User] I don't remember, to be honest. What year was that.

[Assistant] 13, I think.

[User] 13.

[Assistant] 12 or 13.


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

[User] I don't remember, to be honest. What year was that.

[Assistant] 13, I think.

[User] 13.

[Assistant] 12 or 13.

[User] I was an EMT at the time, but I don't remember anything from there.

[Assistant] Do you know if any of the [city] hospitals got hit pretty bad?


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

[User] 13.

[Assistant] 12 or 13.

[User] I was an EMT at the time, but I don't remember anything from there.

[Assistant] Do you know if any of the [city] hospitals got hit pretty bad?

[User] Oh, yeah, yeah, yeah. It was, it was horrible.

[Assistant] Were any, any worse than others?


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

[User] I was an EMT at the time, but I don't remember anything from there.

[Assistant] Do you know if any of the [city] hospitals got hit pretty bad?

[User] Oh, yeah, yeah, yeah. It was, it was horrible.

[Assistant] Were any, any worse than others?

[User] Well, if I remember correctly, this coincided kinda with when Hahnemann shut down which was a major hospital, of course, in the city. Um, so Temple was already overwhelmed by essentially an ever growing area of coverage, and that didn't make any things better.

[Assistant] Okay, so let's- just looking at the time from, like, when you first heard about it to when it really started to hit, like can you tell me about how you felt?


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

[User] Oh, yeah, yeah, yeah. It was, it was horrible.

[Assistant] Were any, any worse than others?

[User] Well, if I remember correctly, this coincided kinda with when Hahnemann shut down which was a major hospital, of course, in the city. Um, so Temple was already overwhelmed by essentially an ever growing area of coverage, and that didn't make any things better.

[Assistant] Okay, so let's- just looking at the time from, like, when you first heard about it to when it really started to hit, like can you tell me about how you felt?

[User] Uh, Like I said, it was just kind of a thing that was in the background that I wasn't thinking too heavily about. And of course, until it actually hit, everyone was kind of just ‘meh’ about it, including myself.

[Assistant] But did you think it was going to be a problem?


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

[User] I didn't think it was going to be what it became.

[Assistant] Why not?

[User]
Like I said, any time we've had an issue like this arise in the past, it's always been dealt with incredibly well. But due to changes in administration and those in power, it wasn't taken care of the way it should have been. Granted just with how large of a scale it was on the global stage. It was going to hit the US shores regardless.

There was going be no way around that. But I think it could have been handled a bit better by the administration who was in power at the time.

[Assistant] The federal.

[User] Yeah. On a federal level.

[Assistant] But you think- You think it was just going to- you thought it was just going to be a matter of time.


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

[User]
Like I said, any time we've had an issue like this arise in the past, it's always been dealt with incredibly well. But due to changes in administration and those in power, it wasn't taken care of the way it should have been. Granted just with how large of a scale it was on the global stage. It was going to hit the US shores regardless.

There was going be no way around that. But I think it could have been handled a bit better by the administration who was in power at the time.

[Assistant] The federal.

[User] Yeah. On a federal level.

[Assistant] But you think- You think it was just going to- you thought it was just going to be a matter of time.

[User] I thought it was going to be. I thought it was. I never thought it was going to be... I never thought it was going to change my daily ongoings. I never thought it was going to be that severe.

[Assistant] What other follow up question did I have… were you surprised?


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

[User] Yeah. On a federal level.

[Assistant] But you think- You think it was just going to- you thought it was just going to be a matter of time.

[User] I thought it was going to be. I thought it was. I never thought it was going to be... I never thought it was going to change my daily ongoings. I never thought it was going to be that severe.

[Assistant] What other follow up question did I have… were you surprised?

[User] I'd say I was. Like when they first initially announced the US lockdowns, I was like, Oh, okay, this is a thing that's happening.

[Assistant] Were you working that night?


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

[User] I thought it was going to be. I thought it was. I never thought it was going to be... I never thought it was going to change my daily ongoings. I never thought it was going to be that severe.

[Assistant] What other follow up question did I have… were you surprised?

[User] I'd say I was. Like when they first initially announced the US lockdowns, I was like, Oh, okay, this is a thing that's happening.

[Assistant] Were you working that night?

[User] I don't remember. I don't remember where I was when they first announced the lockdowns.

[Assistant] You don't remember?


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

[User] I'd say I was. Like when they first initially announced the US lockdowns, I was like, Oh, okay, this is a thing that's happening.

[Assistant] Were you working that night?

[User] I don't remember. I don't remember where I was when they first announced the lockdowns.

[Assistant] You don't remember?

[User] No, I don't remember where I was when they first initially announced them.

[Assistant] But did did you talk about this with anyone on the on the truck?


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

[User] I don't remember. I don't remember where I was when they first announced the lockdowns.

[Assistant] You don't remember?

[User] No, I don't remember where I was when they first initially announced them.

[Assistant] But did did you talk about this with anyone on the on the truck?

[User] Oh, yeah, yeah. I mean, that was a topic of conversation because like I said, everyone's daily life was massively disrupted. People had to adjust. Schools were shut down, so that affected a lot of people. People couldn't do the activities that they grown to, you know, essentially do on a daily basis to kind of keep them sane.

[Assistant] Do you remember what those conversations were like?


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

[User] Oh, yeah, yeah. I mean, that was a topic of conversation because like I said, everyone's daily life was massively disrupted. People had to adjust. Schools were shut down, so that affected a lot of people. People couldn't do the activities that they grown to, you know, essentially do on a daily basis to kind of keep them sane.

[Assistant] Do you remember what those conversations were like?

[User] A lot of annoyance, a lot of anger, a lot of confusion.

[Assistant] Confusion?

[User]
Yeah. We… we as a collective, never got like anything like this in our lives before. And we had massive issues, but nothing like this.

This is this essentially affected every facet of life.

[Assistant] OK that’s really it actually. I have a few follow up questions. these interviews are really variable in length because some people really like to talk.


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

[User] A lot of annoyance, a lot of anger, a lot of confusion.

[Assistant] Confusion?

[User]
Yeah. We… we as a collective, never got like anything like this in our lives before. And we had massive issues, but nothing like this.

This is this essentially affected every facet of life.

[Assistant] OK that’s really it actually. I have a few follow up questions. these interviews are really variable in length because some people really like to talk.

[User] Gotcha.

[Assistant] So did you ever feel, um. You ever feel scared at any point, like before, Like before, like late March?


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

[User]
Yeah. We… we as a collective, never got like anything like this in our lives before. And we had massive issues, but nothing like this.

This is this essentially affected every facet of life.

[Assistant] OK that’s really it actually. I have a few follow up questions. these interviews are really variable in length because some people really like to talk.

[User] Gotcha.

[Assistant] So did you ever feel, um. You ever feel scared at any point, like before, Like before, like late March?

[User] No. No.

[Assistant] What area do you work in of [city].


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

[User] Gotcha.

[Assistant] So did you ever feel, um. You ever feel scared at any point, like before, Like before, like late March?

[User] No. No.

[Assistant] What area do you work in of [city].

[User] [neighborhood].

[Assistant] All right, so, um, so you covered this before. Um, so what would you like to tell me about how you were feeling in early 2020?


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

[User] No. No.

[Assistant] What area do you work in of [city].

[User] [neighborhood].

[Assistant] All right, so, um, so you covered this before. Um, so what would you like to tell me about how you were feeling in early 2020?

[User]
I'd say me in early 2020… Just like anything else in life, I kind of just deal with things as they go. There's no time for irrational thinking. So it was kind of just, listen to... Well, for me. I understood the fact that since we were actively dealing with an issue that we have not dealt with before, it's a new disease process.

They don't know what they're looking at, what signs and symptoms to look forward. They don't know how to properly treat it. So I knew that information was constantly going to be changing. As time went on, I knew that treatments were going to change. I knew signs and symptoms are going to change. I knew everything was just going to be in constant flux.

So I kept reminding myself of that. So when one day they're like, Hey, we're looking for respiratory related signs and symptoms to, Hey, now these people have a lot of GI issues. And so on and so forth. I just knew that essentially that could be either cause of the virus mutating or just the fact that we're dealing with something so new.

You're getting information from so many different data points that the essential assumption, whole algorithm is going to constantly be changing. So for me, I always dealt with things and tried to remain as adaptive as possible. So that's another reason why I didn't necessarily feel one way or another, or feel like some severe emotional distress in regards of this.

[Assistant] How did you handle that uncertainty?


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

[User] [neighborhood].

[Assistant] All right, so, um, so you covered this before. Um, so what would you like to tell me about how you were feeling in early 2020?

[User]
I'd say me in early 2020… Just like anything else in life, I kind of just deal with things as they go. There's no time for irrational thinking. So it was kind of just, listen to... Well, for me. I understood the fact that since we were actively dealing with an issue that we have not dealt with before, it's a new disease process.

They don't know what they're looking at, what signs and symptoms to look forward. They don't know how to properly treat it. So I knew that information was constantly going to be changing. As time went on, I knew that treatments were going to change. I knew signs and symptoms are going to change. I knew everything was just going to be in constant flux.

So I kept reminding myself of that. So when one day they're like, Hey, we're looking for respiratory related signs and symptoms to, Hey, now these people have a lot of GI issues. And so on and so forth. I just knew that essentially that could be either cause of the virus mutating or just the fact that we're dealing with something so new.

You're getting information from so many different data points that the essential assumption, whole algorithm is going to constantly be changing. So for me, I always dealt with things and tried to remain as adaptive as possible. So that's another reason why I didn't necessarily feel one way or another, or feel like some severe emotional distress in regards of this.

[Assistant] How did you handle that uncertainty?

[User] The uncertainty?

[Assistant] The uncertainty, yeah.


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

[User]
I'd say me in early 2020… Just like anything else in life, I kind of just deal with things as they go. There's no time for irrational thinking. So it was kind of just, listen to... Well, for me. I understood the fact that since we were actively dealing with an issue that we have not dealt with before, it's a new disease process.

They don't know what they're looking at, what signs and symptoms to look forward. They don't know how to properly treat it. So I knew that information was constantly going to be changing. As time went on, I knew that treatments were going to change. I knew signs and symptoms are going to change. I knew everything was just going to be in constant flux.

So I kept reminding myself of that. So when one day they're like, Hey, we're looking for respiratory related signs and symptoms to, Hey, now these people have a lot of GI issues. And so on and so forth. I just knew that essentially that could be either cause of the virus mutating or just the fact that we're dealing with something so new.

You're getting information from so many different data points that the essential assumption, whole algorithm is going to constantly be changing. So for me, I always dealt with things and tried to remain as adaptive as possible. So that's another reason why I didn't necessarily feel one way or another, or feel like some severe emotional distress in regards of this.

[Assistant] How did you handle that uncertainty?

[User] The uncertainty?

[Assistant] The uncertainty, yeah.

[User] It I guess I feel like in the field that I work, there's a lot of uncertainty, as is. There's a lot of just flying by the seat of your pants and just dealing with an issue as it arises.

[Assistant] It makes a lot of sense, actually.


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

[User] The uncertainty?

[Assistant] The uncertainty, yeah.

[User] It I guess I feel like in the field that I work, there's a lot of uncertainty, as is. There's a lot of just flying by the seat of your pants and just dealing with an issue as it arises.

[Assistant] It makes a lot of sense, actually.

[User] How so?

[Assistant]
because more so I've been into I've been doing some interviews and I've interviewed some- you, I've interviewed an emergency medicine doctor and both of both of you have said you know, there's going to be uncertainty. You know what best practice is going to work? Infection control, source control and everything else.

You kind of deal with it as it comes.


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

[User] It I guess I feel like in the field that I work, there's a lot of uncertainty, as is. There's a lot of just flying by the seat of your pants and just dealing with an issue as it arises.

[Assistant] It makes a lot of sense, actually.

[User] How so?

[Assistant]
because more so I've been into I've been doing some interviews and I've interviewed some- you, I've interviewed an emergency medicine doctor and both of both of you have said you know, there's going to be uncertainty. You know what best practice is going to work? Infection control, source control and everything else.

You kind of deal with it as it comes.

[User] Yeah.

[Assistant] And you two seem to have dealt with this and it seems, that seems to have been a very healthy response. Um, are there any questions that you think I should have asked that I didn't.


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

[User] How so?

[Assistant]
because more so I've been into I've been doing some interviews and I've interviewed some- you, I've interviewed an emergency medicine doctor and both of both of you have said you know, there's going to be uncertainty. You know what best practice is going to work? Infection control, source control and everything else.

You kind of deal with it as it comes.

[User] Yeah.

[Assistant] And you two seem to have dealt with this and it seems, that seems to have been a very healthy response. Um, are there any questions that you think I should have asked that I didn't.

[User] Um, not necessarily. I Think you essentially covered like the mind space of a medical practitioner in early COVID space, which is what matters.

[Assistant] And is there anything else that you like to tell me?