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

[User] Yeah.

[Assistant] I understand the information collected during the interview may be shared with other researchers for use and future research or teaching purposes and that the data will be thoroughly anonymize first

[User] Yeah.

[Assistant]
I understand that the interview will be audio video recorded typed out and that all my identifying personal details will be removed. Yes.

I understand the direct quotations may be taken from what I say and use in research and publications, but that I will not be identifiable from these quotations. Yeah.

I agree to take part in the above study

Yes. Excellent. There are just two other things here. If you would like to receive a copy of the research findings. Upon completion of this study, you can tell me that. Now, or you can email me. You know what I'm

[User] Interested

[Assistant]
Yeah, absolutely. So I'll send those to the email address that we've corresponded on

And if you'd like to receive a hard copy of the study documents by mail. I'm happy to send those to you, but I would need your mailing address for that.


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

[User] Yeah.

[Assistant]
I understand that the interview will be audio video recorded typed out and that all my identifying personal details will be removed. Yes.

I understand the direct quotations may be taken from what I say and use in research and publications, but that I will not be identifiable from these quotations. Yeah.

I agree to take part in the above study

Yes. Excellent. There are just two other things here. If you would like to receive a copy of the research findings. Upon completion of this study, you can tell me that. Now, or you can email me. You know what I'm

[User] Interested

[Assistant]
Yeah, absolutely. So I'll send those to the email address that we've corresponded on

And if you'd like to receive a hard copy of the study documents by mail. I'm happy to send those to you, but I would need your mailing address for that.

[User] Now, that's fine enough. Great. Okay.

[Assistant] All right, so that's that way. So we can go ahead and get started here. So you have one child. Is that right or one child in the age group?


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

[User] Interested

[Assistant]
Yeah, absolutely. So I'll send those to the email address that we've corresponded on

And if you'd like to receive a hard copy of the study documents by mail. I'm happy to send those to you, but I would need your mailing address for that.

[User] Now, that's fine enough. Great. Okay.

[Assistant] All right, so that's that way. So we can go ahead and get started here. So you have one child. Is that right or one child in the age group?

[User] That’s right, one child.

[Assistant] Can you tell me a little bit about them. What's their name? How old are they? All that, all that good stuff.


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

[User] Now, that's fine enough. Great. Okay.

[Assistant] All right, so that's that way. So we can go ahead and get started here. So you have one child. Is that right or one child in the age group?

[User] That’s right, one child.

[Assistant] Can you tell me a little bit about them. What's their name? How old are they? All that, all that good stuff.

[User] He's a little boy called [Child], he is four and a bit now, due to start school in September. He was very premature and so that's something that we take into account when we're thinking about things like his health, but he hasn’t got any lasting effects from that.

[Assistant] Okay, yeah. And how's he doing, he hasn't he hadn't started reception yet, right? So he's been home through all this?


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

[User] That’s right, one child.

[Assistant] Can you tell me a little bit about them. What's their name? How old are they? All that, all that good stuff.

[User] He's a little boy called [Child], he is four and a bit now, due to start school in September. He was very premature and so that's something that we take into account when we're thinking about things like his health, but he hasn’t got any lasting effects from that.

[Assistant] Okay, yeah. And how's he doing, he hasn't he hadn't started reception yet, right? So he's been home through all this?

[User] Yeah, thats right.

[Assistant] Uh huh. Oh, nice. Yeah. How has he been enjoying having everyone at home most of the time now?


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

[User] He's a little boy called [Child], he is four and a bit now, due to start school in September. He was very premature and so that's something that we take into account when we're thinking about things like his health, but he hasn’t got any lasting effects from that.

[Assistant] Okay, yeah. And how's he doing, he hasn't he hadn't started reception yet, right? So he's been home through all this?

[User] Yeah, thats right.

[Assistant] Uh huh. Oh, nice. Yeah. How has he been enjoying having everyone at home most of the time now?

[User] It's been interesting. He's coped quite well with it to be, to be fair. But he was able to go back to his nursery three weeks ago and he's absolutely loving being amongst some of his peers. With him being an only child. It's a bit boring for him to be home with us all the time.

[Assistant] Yeah, that social interaction with kids his age, I'm sure that's that's very important. I think a lot of the time for for young children, it's almost harder for the parents to adapt to the change than it is for the children.


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

[User] Yeah, thats right.

[Assistant] Uh huh. Oh, nice. Yeah. How has he been enjoying having everyone at home most of the time now?

[User] It's been interesting. He's coped quite well with it to be, to be fair. But he was able to go back to his nursery three weeks ago and he's absolutely loving being amongst some of his peers. With him being an only child. It's a bit boring for him to be home with us all the time.

[Assistant] Yeah, that social interaction with kids his age, I'm sure that's that's very important. I think a lot of the time for for young children, it's almost harder for the parents to adapt to the change than it is for the children.

[User] Mhm

[Assistant] So can you tell me a little bit about what you know about the flu? Sort of your first impressions when you hear the word flu, any symptoms, kind of, what do you think of when you hear the word flu?


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

[User] It's been interesting. He's coped quite well with it to be, to be fair. But he was able to go back to his nursery three weeks ago and he's absolutely loving being amongst some of his peers. With him being an only child. It's a bit boring for him to be home with us all the time.

[Assistant] Yeah, that social interaction with kids his age, I'm sure that's that's very important. I think a lot of the time for for young children, it's almost harder for the parents to adapt to the change than it is for the children.

[User] Mhm

[Assistant] So can you tell me a little bit about what you know about the flu? Sort of your first impressions when you hear the word flu, any symptoms, kind of, what do you think of when you hear the word flu?

[User] And well I think flu is quite a, quite severe illness really. And I believe I've only had proper flu once. I think the word flu gets bandied around quite light heartedly sometimes when to me, proper flu is it, is a is, an illness that brings coughing, trouble breathing, kind of cold symptoms, but my experience of it was basically a week of being really, really ill. So like I say that was only once in my life. It's, it's, it's something serious and it obviously can have potential complications like pneumonia. So it's not something that I would take lightly. personally

[Assistant] Yeah. So do you worry about [Child] getting the flu or is it something that you think is mostly a concern for adults, or can you give me a sense for that?


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

[User] Mhm

[Assistant] So can you tell me a little bit about what you know about the flu? Sort of your first impressions when you hear the word flu, any symptoms, kind of, what do you think of when you hear the word flu?

[User] And well I think flu is quite a, quite severe illness really. And I believe I've only had proper flu once. I think the word flu gets bandied around quite light heartedly sometimes when to me, proper flu is it, is a is, an illness that brings coughing, trouble breathing, kind of cold symptoms, but my experience of it was basically a week of being really, really ill. So like I say that was only once in my life. It's, it's, it's something serious and it obviously can have potential complications like pneumonia. So it's not something that I would take lightly. personally

[Assistant] Yeah. So do you worry about [Child] getting the flu or is it something that you think is mostly a concern for adults, or can you give me a sense for that?

[User] Um, I don't know whether I i would say I worry about him getting it. And I think it's probably unlikely that he's gonna get it. It is a is a seasonal thing every year, isn't it. So there is always the potential.

[Assistant] Yeah, sure. So it sounds like what you're saying is, like, it's not something you are actively worrying about but its not something that, you know, you would ever want him to have.


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

[User] And well I think flu is quite a, quite severe illness really. And I believe I've only had proper flu once. I think the word flu gets bandied around quite light heartedly sometimes when to me, proper flu is it, is a is, an illness that brings coughing, trouble breathing, kind of cold symptoms, but my experience of it was basically a week of being really, really ill. So like I say that was only once in my life. It's, it's, it's something serious and it obviously can have potential complications like pneumonia. So it's not something that I would take lightly. personally

[Assistant] Yeah. So do you worry about [Child] getting the flu or is it something that you think is mostly a concern for adults, or can you give me a sense for that?

[User] Um, I don't know whether I i would say I worry about him getting it. And I think it's probably unlikely that he's gonna get it. It is a is a seasonal thing every year, isn't it. So there is always the potential.

[Assistant] Yeah, sure. So it sounds like what you're saying is, like, it's not something you are actively worrying about but its not something that, you know, you would ever want him to have.

[User] Mhm, yeah.

[Assistant] So can you explain to me what do you think getting sick with the flu is like specifically for children like what, what would you expect to see if your son was getting the flu?


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

[User] Um, I don't know whether I i would say I worry about him getting it. And I think it's probably unlikely that he's gonna get it. It is a is a seasonal thing every year, isn't it. So there is always the potential.

[Assistant] Yeah, sure. So it sounds like what you're saying is, like, it's not something you are actively worrying about but its not something that, you know, you would ever want him to have.

[User] Mhm, yeah.

[Assistant] So can you explain to me what do you think getting sick with the flu is like specifically for children like what, what would you expect to see if your son was getting the flu?

[User] I'm not, I'm not really sure whether I have an expectation of that. I assume he would present with usual cough or cold kind of symptoms, but be very ill with that for a.. Well not very ill, but more than a normal cold if that makes any sense. I don't particularly know anything really about how flu would affect a child versus how it would affect an adult. But again, like I said with with him being very premature, he was born at 29 weeks gestation, and he had chronic lung disease due to ventilation and and obviously lung immaturity. And so anything like that, although we don't believe he has any lasting complications from that, there is that little bit of that at the back of me mind going "Well, I wouldn't really want him to get something that's going to be heavy on the chest". [Inaudible]... even if [Inaudible]... speak well...[Inaudible].

[Assistant] Yeah that makes sense why, you know, even if there's no lasting effects I can see why you wouldn't you know you wouldn't be wanting to take any chances with it.


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

[User] Mhm, yeah.

[Assistant] So can you explain to me what do you think getting sick with the flu is like specifically for children like what, what would you expect to see if your son was getting the flu?

[User] I'm not, I'm not really sure whether I have an expectation of that. I assume he would present with usual cough or cold kind of symptoms, but be very ill with that for a.. Well not very ill, but more than a normal cold if that makes any sense. I don't particularly know anything really about how flu would affect a child versus how it would affect an adult. But again, like I said with with him being very premature, he was born at 29 weeks gestation, and he had chronic lung disease due to ventilation and and obviously lung immaturity. And so anything like that, although we don't believe he has any lasting complications from that, there is that little bit of that at the back of me mind going "Well, I wouldn't really want him to get something that's going to be heavy on the chest". [Inaudible]... even if [Inaudible]... speak well...[Inaudible].

[Assistant] Yeah that makes sense why, you know, even if there's no lasting effects I can see why you wouldn't you know you wouldn't be wanting to take any chances with it.

[User] Yeah, I think it's just something that kind of in the back of my mind really

[Assistant] Yeah. So do you know anyone whose child has gotten sick with the flu, maybe like any of his friends or, you know, people that you know with children who might be around his age?


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

[User] I'm not, I'm not really sure whether I have an expectation of that. I assume he would present with usual cough or cold kind of symptoms, but be very ill with that for a.. Well not very ill, but more than a normal cold if that makes any sense. I don't particularly know anything really about how flu would affect a child versus how it would affect an adult. But again, like I said with with him being very premature, he was born at 29 weeks gestation, and he had chronic lung disease due to ventilation and and obviously lung immaturity. And so anything like that, although we don't believe he has any lasting complications from that, there is that little bit of that at the back of me mind going "Well, I wouldn't really want him to get something that's going to be heavy on the chest". [Inaudible]... even if [Inaudible]... speak well...[Inaudible].

[Assistant] Yeah that makes sense why, you know, even if there's no lasting effects I can see why you wouldn't you know you wouldn't be wanting to take any chances with it.

[User] Yeah, I think it's just something that kind of in the back of my mind really

[Assistant] Yeah. So do you know anyone whose child has gotten sick with the flu, maybe like any of his friends or, you know, people that you know with children who might be around his age?

[User] No, I don't think I do, to be honest.

[Assistant] Yeah. So when you want to learn about a sickness, like the flu, where would you go to get that information


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

[User] Yeah, I think it's just something that kind of in the back of my mind really

[Assistant] Yeah. So do you know anyone whose child has gotten sick with the flu, maybe like any of his friends or, you know, people that you know with children who might be around his age?

[User] No, I don't think I do, to be honest.

[Assistant] Yeah. So when you want to learn about a sickness, like the flu, where would you go to get that information

[User] The NHS website.

[Assistant] The NHS website. Are there any others that you use, or is it just straight to the NHS?


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

[User] No, I don't think I do, to be honest.

[Assistant] Yeah. So when you want to learn about a sickness, like the flu, where would you go to get that information

[User] The NHS website.

[Assistant] The NHS website. Are there any others that you use, or is it just straight to the NHS?

[User] Just straight to the NHS. Its just, I'm fully confident in the information that will be on there and that things will be accurate. I mean, you can you can troll around the internet and find all sorts of stuff. You know, if I'm, if I'm looking for something like that. I've got to go to something that I'm sure is a trusted source.

[Assistant] Yeah sure that that makes sense to me. Have you ever talked to [Child]'s GP about the flu or any like medical professional at all?


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

[User] The NHS website.

[Assistant] The NHS website. Are there any others that you use, or is it just straight to the NHS?

[User] Just straight to the NHS. Its just, I'm fully confident in the information that will be on there and that things will be accurate. I mean, you can you can troll around the internet and find all sorts of stuff. You know, if I'm, if I'm looking for something like that. I've got to go to something that I'm sure is a trusted source.

[Assistant] Yeah sure that that makes sense to me. Have you ever talked to [Child]'s GP about the flu or any like medical professional at all?

[User] No, I don't think I have. No.

[Assistant] Okay. So my next few questions are to help me learn my your thoughts around the flu vaccine and kind of whether or not it's something that would be beneficial for your child. So what do you think the benefits of the flu vaccine are?


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

[User] Just straight to the NHS. Its just, I'm fully confident in the information that will be on there and that things will be accurate. I mean, you can you can troll around the internet and find all sorts of stuff. You know, if I'm, if I'm looking for something like that. I've got to go to something that I'm sure is a trusted source.

[Assistant] Yeah sure that that makes sense to me. Have you ever talked to [Child]'s GP about the flu or any like medical professional at all?

[User] No, I don't think I have. No.

[Assistant] Okay. So my next few questions are to help me learn my your thoughts around the flu vaccine and kind of whether or not it's something that would be beneficial for your child. So what do you think the benefits of the flu vaccine are?

[User] Ah well, it, it just, it just removes some of the risk of him getting ill. I mean, obviously I am aware that that strains of flu are many and varied and that they change every year and that the flu vaccine is only going to be efffective against a percentage of those. It, it just removes some of the risk of him getting really quite ill. Bit of a no brainer for me.

[Assistant] Yeah, absolutely. No, that does sound like a benefit. So I guess when you think about the benefits you thinking, mostly about the benefit to his health. Like, do you see any sort of other benefits or is it just straightforward. You know, he's not going to get sick, so he's going to be healthier.


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

[User] No, I don't think I have. No.

[Assistant] Okay. So my next few questions are to help me learn my your thoughts around the flu vaccine and kind of whether or not it's something that would be beneficial for your child. So what do you think the benefits of the flu vaccine are?

[User] Ah well, it, it just, it just removes some of the risk of him getting ill. I mean, obviously I am aware that that strains of flu are many and varied and that they change every year and that the flu vaccine is only going to be efffective against a percentage of those. It, it just removes some of the risk of him getting really quite ill. Bit of a no brainer for me.

[Assistant] Yeah, absolutely. No, that does sound like a benefit. So I guess when you think about the benefits you thinking, mostly about the benefit to his health. Like, do you see any sort of other benefits or is it just straightforward. You know, he's not going to get sick, so he's going to be healthier.

[User] Ah, I've probably never particularly thought much beyond that, really. I mean, that is that is my number one concern. I have, I don't really have an understanding of how things like herd immunity and reducing spread in the community can be beneficial and not beneficial to those who cant have it. Obviously I understand that thats significant with things like measles. So I assume there to be some kind of element of that with with the flu vaccine as well. But, to be perfectly honest, if you hadn't asked me the question I probably wouldn't look at it ;ole that.

[Assistant] Yeah, no, that's, that's great to know, you know, it's, I'm just trying to figure out sort of what the, what the most important parts are so it's good to know that. You know, it makes sense to me, you think flu is serious, get the vaccine, like you said, it's kind of a no brainer.


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

[User] Ah well, it, it just, it just removes some of the risk of him getting ill. I mean, obviously I am aware that that strains of flu are many and varied and that they change every year and that the flu vaccine is only going to be efffective against a percentage of those. It, it just removes some of the risk of him getting really quite ill. Bit of a no brainer for me.

[Assistant] Yeah, absolutely. No, that does sound like a benefit. So I guess when you think about the benefits you thinking, mostly about the benefit to his health. Like, do you see any sort of other benefits or is it just straightforward. You know, he's not going to get sick, so he's going to be healthier.

[User] Ah, I've probably never particularly thought much beyond that, really. I mean, that is that is my number one concern. I have, I don't really have an understanding of how things like herd immunity and reducing spread in the community can be beneficial and not beneficial to those who cant have it. Obviously I understand that thats significant with things like measles. So I assume there to be some kind of element of that with with the flu vaccine as well. But, to be perfectly honest, if you hadn't asked me the question I probably wouldn't look at it ;ole that.

[Assistant] Yeah, no, that's, that's great to know, you know, it's, I'm just trying to figure out sort of what the, what the most important parts are so it's good to know that. You know, it makes sense to me, you think flu is serious, get the vaccine, like you said, it's kind of a no brainer.

[User] Yeah.

[Assistant] So if you want to learn about a vaccine, like whether it, you know, whether it would be beneficial for your child, whether it's something he needs, something he doesn't need, where would you go to get that information?


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

[User] Yeah.

[Assistant] So if you want to learn about a vaccine, like whether it, you know, whether it would be beneficial for your child, whether it's something he needs, something he doesn't need, where would you go to get that information?

[User] Um, I probably have an inherent trust of vaccinations and if, if the health community are advising me to have a vaccination for my child, then it's it's not it's not really something I'd look a great deal further into, I don't think. Um, if the GP, If the NHS are telling me that this is a vaccine that they advise my child to have, then I'm pretty much okay with that.

[Assistant] Yeah.

[User] I don't think I've ever actively gone and looked at any more detail beyond that, to be honest.

[Assistant] Sure. So it sounds like what you're saying is it's just, you know, if a GP recommends it to you or if some other medical professional recommends it to you, that's kind of all the all the extra information you need to be worth it.


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

[User] Um, I probably have an inherent trust of vaccinations and if, if the health community are advising me to have a vaccination for my child, then it's it's not it's not really something I'd look a great deal further into, I don't think. Um, if the GP, If the NHS are telling me that this is a vaccine that they advise my child to have, then I'm pretty much okay with that.

[Assistant] Yeah.

[User] I don't think I've ever actively gone and looked at any more detail beyond that, to be honest.

[Assistant] Sure. So it sounds like what you're saying is it's just, you know, if a GP recommends it to you or if some other medical professional recommends it to you, that's kind of all the all the extra information you need to be worth it.

[User] Yeah. For something to be on a on a childhood vaccination schedule, then that's gone through all kinds of levels of consideration and whether thats medical, whether thats ethical. All of those kinds of decisions, I think probably have been made by people with much more of an understanding of everything that I do. I'm lay when it comes to medicine. So I'm pretty happy to take their word for it, if that make sense.

[Assistant] Yeah no absolutely it just sort of trust. You know, trust the medical experts, essentially, is what it sounds like you're saying.


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

[User] I don't think I've ever actively gone and looked at any more detail beyond that, to be honest.

[Assistant] Sure. So it sounds like what you're saying is it's just, you know, if a GP recommends it to you or if some other medical professional recommends it to you, that's kind of all the all the extra information you need to be worth it.

[User] Yeah. For something to be on a on a childhood vaccination schedule, then that's gone through all kinds of levels of consideration and whether thats medical, whether thats ethical. All of those kinds of decisions, I think probably have been made by people with much more of an understanding of everything that I do. I'm lay when it comes to medicine. So I'm pretty happy to take their word for it, if that make sense.

[Assistant] Yeah no absolutely it just sort of trust. You know, trust the medical experts, essentially, is what it sounds like you're saying.

[User] yeah.

[Assistant] So sort of related to that. Do you think there are any downsides of having your child get the flu vaccine?


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

[User] Yeah. For something to be on a on a childhood vaccination schedule, then that's gone through all kinds of levels of consideration and whether thats medical, whether thats ethical. All of those kinds of decisions, I think probably have been made by people with much more of an understanding of everything that I do. I'm lay when it comes to medicine. So I'm pretty happy to take their word for it, if that make sense.

[Assistant] Yeah no absolutely it just sort of trust. You know, trust the medical experts, essentially, is what it sounds like you're saying.

[User] yeah.

[Assistant] So sort of related to that. Do you think there are any downsides of having your child get the flu vaccine?

[User] No. No it's, it's a quick and painless thing then its over in a second. I wouldn't have expected him to have any after effects because of it and that’s whats happened, that’s whats bourne out. So no downside to it.

[Assistant] Sure. Um, so have you ever talked to a medical professional about the flu vaccine. Specifically, kind of, how did you... I guess what I'm trying to learn here is like how did you know that [Child] could get the flu vaccine? Was that a conversation you had with someone? did you, you know, get a letter? Did you find out online?


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

[User] yeah.

[Assistant] So sort of related to that. Do you think there are any downsides of having your child get the flu vaccine?

[User] No. No it's, it's a quick and painless thing then its over in a second. I wouldn't have expected him to have any after effects because of it and that’s whats happened, that’s whats bourne out. So no downside to it.

[Assistant] Sure. Um, so have you ever talked to a medical professional about the flu vaccine. Specifically, kind of, how did you... I guess what I'm trying to learn here is like how did you know that [Child] could get the flu vaccine? Was that a conversation you had with someone? did you, you know, get a letter? Did you find out online?

[User] It, we, I think, yeah, we had, we had a letter inviting him. Actually, this, this has made me think a bit more now because I did look into whether he could have it at a younger age. Um, sort of like the one to two year range. Yeah, kind of that range because of, because of the circumstances of birth and that was something that I did look into. So I did get in touch with his GP and asked whether that was possible. I think, I think it's only kind of children with with specific conditions and stuff like that that are eligible for that. And it turned out that he wasn't. So that that was a conversation that I had with... That would have been the GP, yeah. But as far as and when he was eligible and and I got the letter off that it was available for him. Then I didn't have any any conversation with anyone about that.

[Assistant] Yeah. So, once you decided to have him vaccinated for the flu this year. Can you walk me through the process of what it was like. You know, to get the vaccination. Was it very simple, you just phone the GP, you had an appointment, you brought him in? Or was it, you know, a little more complicated than that?


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

[User] No, it was, it was, it was absolutely straightforward. Got the notification through the post and gave them a call, booked an appointment, went in and then showed up for it. The nurse was, the nurse out our practice is lovely and and it was just a very quick and simple, couple of drops up the nose and he was done, got to the end of it and everything was hunky dory.

[Assistant] Yeah, that sounds about as easy as it can get. So how important was it to you, you know, when you got that letter that said he can get this vaccine. How important was it to that he get it? Was it something that you were like picking up the phone, I'm going to ring them right now and get this appointment? Or was it something you were more like well you know if the opportunity arises will do it?

[User] Ah I think I probably arranged the appointment that day.

[Assistant] Yeah?

[User] Yeah, more or less straight away. Yeah.

[Assistant] Yeah. So it sounds like I'm just sort of based on everything that you said, I'm just trying to make sure I'm understanding you correctly, it sounds like you know you have faith in vaccination and in medical professionals. So you're, that faith kind of motivates you to seek out that protection, whenever possible, is that, does that sound accurate to you?


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

[User] Ah I think I probably arranged the appointment that day.

[Assistant] Yeah?

[User] Yeah, more or less straight away. Yeah.

[Assistant] Yeah. So it sounds like I'm just sort of based on everything that you said, I'm just trying to make sure I'm understanding you correctly, it sounds like you know you have faith in vaccination and in medical professionals. So you're, that faith kind of motivates you to seek out that protection, whenever possible, is that, does that sound accurate to you?

[User] Yeah, yeah.

[Assistant] So I do have a few other questions that you've sort of already spoken to, you've been pretty clear, but we'll just kind of go through them in case you have anything to add about them. So has has [Child] received any other vaccinations, like the childhood ones?


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

[User] Yeah, more or less straight away. Yeah.

[Assistant] Yeah. So it sounds like I'm just sort of based on everything that you said, I'm just trying to make sure I'm understanding you correctly, it sounds like you know you have faith in vaccination and in medical professionals. So you're, that faith kind of motivates you to seek out that protection, whenever possible, is that, does that sound accurate to you?

[User] Yeah, yeah.

[Assistant] So I do have a few other questions that you've sort of already spoken to, you've been pretty clear, but we'll just kind of go through them in case you have anything to add about them. So has has [Child] received any other vaccinations, like the childhood ones?

[User] Yeah, yeah he's fully up to date with all of that.

[Assistant] Yeah. And how did you decide for that he would have those vaccinations? Or do you feel like it even was a decision?


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

[User] Yeah, yeah.

[Assistant] So I do have a few other questions that you've sort of already spoken to, you've been pretty clear, but we'll just kind of go through them in case you have anything to add about them. So has has [Child] received any other vaccinations, like the childhood ones?

[User] Yeah, yeah he's fully up to date with all of that.

[Assistant] Yeah. And how did you decide for that he would have those vaccinations? Or do you feel like it even was a decision?

[User] Uhm I, for me it wasn't really a decision I needed to make. It was, it was a foregone conclusion. And for me, and I did check in with what his dad thought, what is that thought at the time, and he was on the same page, so that was, was just not, not yet, not, not really a decision.

[Assistant] Yeah, just, you know, it's recommended. It's the thing kind of that you're supposed to do. So you just sort of do it.


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

[User] Yeah, yeah he's fully up to date with all of that.

[Assistant] Yeah. And how did you decide for that he would have those vaccinations? Or do you feel like it even was a decision?

[User] Uhm I, for me it wasn't really a decision I needed to make. It was, it was a foregone conclusion. And for me, and I did check in with what his dad thought, what is that thought at the time, and he was on the same page, so that was, was just not, not yet, not, not really a decision.

[Assistant] Yeah, just, you know, it's recommended. It's the thing kind of that you're supposed to do. So you just sort of do it.

[User] Yeah. Yeah.

[Assistant] Have you personally had the flu vaccine this year?


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

[User] Uhm I, for me it wasn't really a decision I needed to make. It was, it was a foregone conclusion. And for me, and I did check in with what his dad thought, what is that thought at the time, and he was on the same page, so that was, was just not, not yet, not, not really a decision.

[Assistant] Yeah, just, you know, it's recommended. It's the thing kind of that you're supposed to do. So you just sort of do it.

[User] Yeah. Yeah.

[Assistant] Have you personally had the flu vaccine this year?

[User] Yes, I have. I've paid for the vaccine for quite a few years now, and my other half gets it free, because of his previous medical history. So it's something that that we've kind of done and I kind of shoehorn him to get on with it, get cracking. It, actually me, me getting the vaccine this year was more upseting for [Child] than him getting his own

[Assistant] Oh yeah? In what way was that?


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

[User] Yeah. Yeah.

[Assistant] Have you personally had the flu vaccine this year?

[User] Yes, I have. I've paid for the vaccine for quite a few years now, and my other half gets it free, because of his previous medical history. So it's something that that we've kind of done and I kind of shoehorn him to get on with it, get cracking. It, actually me, me getting the vaccine this year was more upseting for [Child] than him getting his own

[Assistant] Oh yeah? In what way was that?

[User] Well, yeah, we were, we were sitting there in, I think I got it done at the local Tesco. I was sitting there and he was, he was on my knee and he saw the needle coming towards my arm, and it really, really scared him. Like "wow! Dont worry, they're sticking it in me not you!"

[Assistant] Well, it's nice that he was, he was looking out for you didn't, didn't want anybody getting any injections that day. So he when he was vaccinated, he had the nasal spray, Is that right?


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

[User] Yes, I have. I've paid for the vaccine for quite a few years now, and my other half gets it free, because of his previous medical history. So it's something that that we've kind of done and I kind of shoehorn him to get on with it, get cracking. It, actually me, me getting the vaccine this year was more upseting for [Child] than him getting his own

[Assistant] Oh yeah? In what way was that?

[User] Well, yeah, we were, we were sitting there in, I think I got it done at the local Tesco. I was sitting there and he was, he was on my knee and he saw the needle coming towards my arm, and it really, really scared him. Like "wow! Dont worry, they're sticking it in me not you!"

[Assistant] Well, it's nice that he was, he was looking out for you didn't, didn't want anybody getting any injections that day. So he when he was vaccinated, he had the nasal spray, Is that right?

[User] Yeah

[Assistant] So do you think that him having a nasal spray. Like, do you think it would have been kind of a more difficult experience for you and for him if he had needed to get an injection or do you think, you know, what do you think had the setting been a little different?


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

[User] Well, yeah, we were, we were sitting there in, I think I got it done at the local Tesco. I was sitting there and he was, he was on my knee and he saw the needle coming towards my arm, and it really, really scared him. Like "wow! Dont worry, they're sticking it in me not you!"

[Assistant] Well, it's nice that he was, he was looking out for you didn't, didn't want anybody getting any injections that day. So he when he was vaccinated, he had the nasal spray, Is that right?

[User] Yeah

[Assistant] So do you think that him having a nasal spray. Like, do you think it would have been kind of a more difficult experience for you and for him if he had needed to get an injection or do you think, you know, what do you think had the setting been a little different?

[User] Ah I think, I think he would still get freaked out, a bit freaked out more than he did with the nasal spray but that would have been very quickly. And again, that wouldn't stop me, yeah.

[Assistant] Yeah. Yeah. So yeah, so I can imagine that as a parent, when your child needs an injection. You know you it's unpleasant for them, of course, but you sort of know that now in 20 minutes. They're going to be fine. They will have forgotten about this whole situation.


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

[User] Yeah

[Assistant] So do you think that him having a nasal spray. Like, do you think it would have been kind of a more difficult experience for you and for him if he had needed to get an injection or do you think, you know, what do you think had the setting been a little different?

[User] Ah I think, I think he would still get freaked out, a bit freaked out more than he did with the nasal spray but that would have been very quickly. And again, that wouldn't stop me, yeah.

[Assistant] Yeah. Yeah. So yeah, so I can imagine that as a parent, when your child needs an injection. You know you it's unpleasant for them, of course, but you sort of know that now in 20 minutes. They're going to be fine. They will have forgotten about this whole situation.

[User] Right, right. Yeah.

[Assistant] Yeah, but that's nice that you had the nasal spray so that you could sort of avoid that whole, that whole episode. So that's all the questions that I have. So kind of what I like to close with is just asking, is there anything else. That you'd like to say about the flu or the flu vaccine or vaccination in general just anything that I didn't ask that you were hoping you could speak to


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

[User] Ah I think, I think he would still get freaked out, a bit freaked out more than he did with the nasal spray but that would have been very quickly. And again, that wouldn't stop me, yeah.

[Assistant] Yeah. Yeah. So yeah, so I can imagine that as a parent, when your child needs an injection. You know you it's unpleasant for them, of course, but you sort of know that now in 20 minutes. They're going to be fine. They will have forgotten about this whole situation.

[User] Right, right. Yeah.

[Assistant] Yeah, but that's nice that you had the nasal spray so that you could sort of avoid that whole, that whole episode. So that's all the questions that I have. So kind of what I like to close with is just asking, is there anything else. That you'd like to say about the flu or the flu vaccine or vaccination in general just anything that I didn't ask that you were hoping you could speak to

[User] And I don't think so. I mean, the possibly, the only other relevant bit of information really is that my mum's a nurse. So I've grown up around hospitals and around, you know, that. And so I think that is quite a big part in my thinking about how much trust in, in the institutions and that's the only other thing, right.

[Assistant] Yeah, no, that's interesting. So you think just because you've been, you know, sort of, since since you were young exposed to kind of people who people who had faith in medicine, you know, as a nurse, of course. She of course has faith in medicine.


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

[User] Right, right. Yeah.

[Assistant] Yeah, but that's nice that you had the nasal spray so that you could sort of avoid that whole, that whole episode. So that's all the questions that I have. So kind of what I like to close with is just asking, is there anything else. That you'd like to say about the flu or the flu vaccine or vaccination in general just anything that I didn't ask that you were hoping you could speak to

[User] And I don't think so. I mean, the possibly, the only other relevant bit of information really is that my mum's a nurse. So I've grown up around hospitals and around, you know, that. And so I think that is quite a big part in my thinking about how much trust in, in the institutions and that's the only other thing, right.

[Assistant] Yeah, no, that's interesting. So you think just because you've been, you know, sort of, since since you were young exposed to kind of people who people who had faith in medicine, you know, as a nurse, of course. She of course has faith in medicine.

[User] Yeah.

[Assistant] So you think that it was sort of something that it was the environment you grew up in that sort of instilled those values and you?


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

[User] Yes please. It’s okay.

[Assistant] Can you tell me a little bit about yourself, how old are you sir?

[User] I am 35 years.

[Assistant] And what are your qualifications?

[User] I have PLE, Senior four, Senior six, Bachelors, masters and Masters in Internal medicine and a little training; minimal training in cardiology.

[Assistant] Okay. Nice to meet you.


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

[User] I am 35 years.

[Assistant] And what are your qualifications?

[User] I have PLE, Senior four, Senior six, Bachelors, masters and Masters in Internal medicine and a little training; minimal training in cardiology.

[Assistant] Okay. Nice to meet you.

[User] Nice to meet you too.

[Assistant] Okay, so where did you train from?


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

[User] I have PLE, Senior four, Senior six, Bachelors, masters and Masters in Internal medicine and a little training; minimal training in cardiology.

[Assistant] Okay. Nice to meet you.

[User] Nice to meet you too.

[Assistant] Okay, so where did you train from?

[User] In Mbarara University

[Assistant] How long ago did you qualify?


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

[User] Nice to meet you too.

[Assistant] Okay, so where did you train from?

[User] In Mbarara University

[Assistant] How long ago did you qualify?

[User] For a doctor, 10 years ago. As a specialist physician, 6 years ago.

[Assistant] Wonderful. So when you look at the demographics of the patients in your practice, what are the common illnesses and who are these patients you see?


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

[User] In Mbarara University

[Assistant] How long ago did you qualify?

[User] For a doctor, 10 years ago. As a specialist physician, 6 years ago.

[Assistant] Wonderful. So when you look at the demographics of the patients in your practice, what are the common illnesses and who are these patients you see?

[User] Well it’s hard to tell but they are so many patients. Well, for me in my line of specialism I tend to see more of non-communicable diseases although when I am doing general, I see a lot of HIV, malaria, streptococcus, TB. But in my area of specialization I do a cardiology clinic, so I see a lot of heart failure, hypertension, RHD and diabetes.

[Assistant] Okay. Wonderful. So by age group which is the ... ?


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

[User] For a doctor, 10 years ago. As a specialist physician, 6 years ago.

[Assistant] Wonderful. So when you look at the demographics of the patients in your practice, what are the common illnesses and who are these patients you see?

[User] Well it’s hard to tell but they are so many patients. Well, for me in my line of specialism I tend to see more of non-communicable diseases although when I am doing general, I see a lot of HIV, malaria, streptococcus, TB. But in my area of specialization I do a cardiology clinic, so I see a lot of heart failure, hypertension, RHD and diabetes.

[Assistant] Okay. Wonderful. So by age group which is the ... ?

[User] By age group the majority I see are in the youth bracket and a few elderly ones. Especially for the non-communicable diseases, I see elderly ones with heart failure and hypertension. But for these other diseases of RHD, they tend to be any age but majority between 20 and 40 years.

[Assistant] 20 and 4o, for RHD!


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

[User] Well it’s hard to tell but they are so many patients. Well, for me in my line of specialism I tend to see more of non-communicable diseases although when I am doing general, I see a lot of HIV, malaria, streptococcus, TB. But in my area of specialization I do a cardiology clinic, so I see a lot of heart failure, hypertension, RHD and diabetes.

[Assistant] Okay. Wonderful. So by age group which is the ... ?

[User] By age group the majority I see are in the youth bracket and a few elderly ones. Especially for the non-communicable diseases, I see elderly ones with heart failure and hypertension. But for these other diseases of RHD, they tend to be any age but majority between 20 and 40 years.

[Assistant] 20 and 4o, for RHD!

[User] Yes but I have seen elderly with RHD.

[Assistant] Okay. Then those ones with RHD, are they school or working. The majority.


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

[User] By age group the majority I see are in the youth bracket and a few elderly ones. Especially for the non-communicable diseases, I see elderly ones with heart failure and hypertension. But for these other diseases of RHD, they tend to be any age but majority between 20 and 40 years.

[Assistant] 20 and 4o, for RHD!

[User] Yes but I have seen elderly with RHD.

[Assistant] Okay. Then those ones with RHD, are they school or working. The majority.

[User] The majority, I cannot point majority because I would have to have figures to know whether it is the majority, but I can say many of them are in school and also a good number are not.

[Assistant] Okay. So let’s talk a little bit about your training in RHD; have you received any specific training during school?


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

[User] Yes but I have seen elderly with RHD.

[Assistant] Okay. Then those ones with RHD, are they school or working. The majority.

[User] The majority, I cannot point majority because I would have to have figures to know whether it is the majority, but I can say many of them are in school and also a good number are not.

[Assistant] Okay. So let’s talk a little bit about your training in RHD; have you received any specific training during school?

[User] Yes, I received training during a cardiology fellowship about RHD, and I have run with colleagues RHD clinics at the heart institute and also here. So that’s the basic training that I got.

[Assistant] Wow, that’s good. So where did you train from?


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

[User] The majority, I cannot point majority because I would have to have figures to know whether it is the majority, but I can say many of them are in school and also a good number are not.

[Assistant] Okay. So let’s talk a little bit about your training in RHD; have you received any specific training during school?

[User] Yes, I received training during a cardiology fellowship about RHD, and I have run with colleagues RHD clinics at the heart institute and also here. So that’s the basic training that I got.

[Assistant] Wow, that’s good. So where did you train from?

[User] Like I told you, Mbarara University for Bachelors and Masters. Then I went to Uganda Heart Institute in Kampala where I studied most of the RHD knowledge that I have.

[Assistant] So how often do you see RHD patients? Is it per day, a week? How many can you say in week?


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

[User] Yes, I received training during a cardiology fellowship about RHD, and I have run with colleagues RHD clinics at the heart institute and also here. So that’s the basic training that I got.

[Assistant] Wow, that’s good. So where did you train from?

[User] Like I told you, Mbarara University for Bachelors and Masters. Then I went to Uganda Heart Institute in Kampala where I studied most of the RHD knowledge that I have.

[Assistant] So how often do you see RHD patients? Is it per day, a week? How many can you say in week?

[User] In a week I see like 2.

[Assistant] Like 2. Do you see outpatients or inpatients?


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

[User] Like I told you, Mbarara University for Bachelors and Masters. Then I went to Uganda Heart Institute in Kampala where I studied most of the RHD knowledge that I have.

[Assistant] So how often do you see RHD patients? Is it per day, a week? How many can you say in week?

[User] In a week I see like 2.

[Assistant] Like 2. Do you see outpatients or inpatients?

[User] Yes, most of them are outpatients.

[Assistant] Okay that’s good. So I am interested in what you were taught, what are the causes? What do you understand to be the causes of RHD?


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

[User] In a week I see like 2.

[Assistant] Like 2. Do you see outpatients or inpatients?

[User] Yes, most of them are outpatients.

[Assistant] Okay that’s good. So I am interested in what you were taught, what are the causes? What do you understand to be the causes of RHD?

[User] I understand streptococcus to be the cause of RHD and I also understand that it comes usually during early childhood like 3-5 years, teenage; early exposure to sore throat. So what I know is that the sore throat usually the one which is streptococcus maybe treated insufficiently or maybe go away on its own but there’s an element of molecular mimicry. Like to simplify it, the immune system of an individual will recognize with infection and try to fight it, but what I might call a body accident; the body will also produce a mechanism which will target other organs accidentally. So mostly, it will target the heart valves. Remember it was trying to clear the sore throat but many years later, the immune response attacks the valves of the heart, but it can also attack the joints and brain. So that’s what I know as the cause.

[Assistant] Okay. So you have answered my next question, I will not ask it. So what can done to prevent RHD?


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

[User] Yes, most of them are outpatients.

[Assistant] Okay that’s good. So I am interested in what you were taught, what are the causes? What do you understand to be the causes of RHD?

[User] I understand streptococcus to be the cause of RHD and I also understand that it comes usually during early childhood like 3-5 years, teenage; early exposure to sore throat. So what I know is that the sore throat usually the one which is streptococcus maybe treated insufficiently or maybe go away on its own but there’s an element of molecular mimicry. Like to simplify it, the immune system of an individual will recognize with infection and try to fight it, but what I might call a body accident; the body will also produce a mechanism which will target other organs accidentally. So mostly, it will target the heart valves. Remember it was trying to clear the sore throat but many years later, the immune response attacks the valves of the heart, but it can also attack the joints and brain. So that’s what I know as the cause.

[Assistant] Okay. So you have answered my next question, I will not ask it. So what can done to prevent RHD?

[User] Quite a lot of things but the first one is to promptly diagnose and treat sore throat and treat it adequately with penicillin. But that is treating a case, and then the other thing is to prevent cases. One of the things is to avoid overcrowding of our children especially kids at school; nowadays they crowd in one room like this one. You find like 20 kids in a dormitory and if one has a sore throat and it is contagious and they will all get it. So reduce congestion and reduce poverty levels as well because if there was no poverty, children would be brought for screening for sore throat but because of poverty, they don’t.

[Assistant] They don’t bring them!


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

[User] I understand streptococcus to be the cause of RHD and I also understand that it comes usually during early childhood like 3-5 years, teenage; early exposure to sore throat. So what I know is that the sore throat usually the one which is streptococcus maybe treated insufficiently or maybe go away on its own but there’s an element of molecular mimicry. Like to simplify it, the immune system of an individual will recognize with infection and try to fight it, but what I might call a body accident; the body will also produce a mechanism which will target other organs accidentally. So mostly, it will target the heart valves. Remember it was trying to clear the sore throat but many years later, the immune response attacks the valves of the heart, but it can also attack the joints and brain. So that’s what I know as the cause.

[Assistant] Okay. So you have answered my next question, I will not ask it. So what can done to prevent RHD?

[User] Quite a lot of things but the first one is to promptly diagnose and treat sore throat and treat it adequately with penicillin. But that is treating a case, and then the other thing is to prevent cases. One of the things is to avoid overcrowding of our children especially kids at school; nowadays they crowd in one room like this one. You find like 20 kids in a dormitory and if one has a sore throat and it is contagious and they will all get it. So reduce congestion and reduce poverty levels as well because if there was no poverty, children would be brought for screening for sore throat but because of poverty, they don’t.

[Assistant] They don’t bring them!

[User] Yeah

[Assistant] Okay and then what were you taught are treatment options for Rhd?


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

[User] The first treatment is usually penicillin. Yeah Penicillins. Whether you give them PEN-V but we would want to see what stage is the RHD; how much has it done so far? So we would do an ECHO, a simple scan so that I can see that really is the RHD there? Is it mild or it is severe? How many valves are involved? Is the patient in heart failure or not? So from there, you make a decision; if it is mild or if there are early changes, because there are also early changes, what we call early rheumatic changes. When you do an ECHO it could be that. Then that one is a case of follow up; you advise promptly to treat the sore throat. Okay?

[Assistant] Yes.

[User] Or you give some shots of Benzathine penicillin, they will come back and you repeat the ECHO, and interestingly, some of them regress. You find those changes have gone back in the very early stages.

[Assistant] Wow.

[User] But when you have an established disease, now that is a permanent diseases, a severe one because heart failure will need medicine for 3 things; the first one is to prevent recurrent sore throats to make sure you don’t get more injury. The next one is to treat heart failure in case people have heart failure or prevent changes, what we call remodeling of the heart, the heart may dilate or fail. Or those who are already in heart failure, you treat heart failure. But ultimately, they need surgery, those who are already severely sick they need surgery to correct the valve or replace it. You put a new valve.

[Assistant] Wonderful. Wow! So what is your understanding about the long term prognosis of RHD?


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

[User] Or you give some shots of Benzathine penicillin, they will come back and you repeat the ECHO, and interestingly, some of them regress. You find those changes have gone back in the very early stages.

[Assistant] Wow.

[User] But when you have an established disease, now that is a permanent diseases, a severe one because heart failure will need medicine for 3 things; the first one is to prevent recurrent sore throats to make sure you don’t get more injury. The next one is to treat heart failure in case people have heart failure or prevent changes, what we call remodeling of the heart, the heart may dilate or fail. Or those who are already in heart failure, you treat heart failure. But ultimately, they need surgery, those who are already severely sick they need surgery to correct the valve or replace it. You put a new valve.

[Assistant] Wonderful. Wow! So what is your understanding about the long term prognosis of RHD?

[User] If caught early, if the disease is diagnosed early the prognosis is good actually, I told you some may regress. But here in our experience, majority are discovered late, the prognosis unfortunately is not good; it is very bad. We have a lot of cases where you can’t do much and they can’t afford surgery or they’re too late for a new valve. You know even putting a new valve, when you are too late, you will not even be managed.

[Assistant] Why are they coming late?


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

[User] But when you have an established disease, now that is a permanent diseases, a severe one because heart failure will need medicine for 3 things; the first one is to prevent recurrent sore throats to make sure you don’t get more injury. The next one is to treat heart failure in case people have heart failure or prevent changes, what we call remodeling of the heart, the heart may dilate or fail. Or those who are already in heart failure, you treat heart failure. But ultimately, they need surgery, those who are already severely sick they need surgery to correct the valve or replace it. You put a new valve.

[Assistant] Wonderful. Wow! So what is your understanding about the long term prognosis of RHD?

[User] If caught early, if the disease is diagnosed early the prognosis is good actually, I told you some may regress. But here in our experience, majority are discovered late, the prognosis unfortunately is not good; it is very bad. We have a lot of cases where you can’t do much and they can’t afford surgery or they’re too late for a new valve. You know even putting a new valve, when you are too late, you will not even be managed.

[Assistant] Why are they coming late?

[User] It is because of challenges with diagnosis. As I told you, it is not easy to link this sore throat to the problem of the heart. Even majority won’t know that they had a sore throat. Imagine if you get a sore throat and you are 3 years old, or 5 or 10 years old and it goes a way, so now they come in with non- specific symptoms and they are in the village and there is not enough knowledge about it, so they are in heart failure, they’re having chest pain palpitations and they are lost. They are treated by many people because not everyone has ECHO to see what’s in the heart and the symptoms could be because of many things. So the diagnosis is usually delayed.

[Assistant] It is delayed!


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

[User] If caught early, if the disease is diagnosed early the prognosis is good actually, I told you some may regress. But here in our experience, majority are discovered late, the prognosis unfortunately is not good; it is very bad. We have a lot of cases where you can’t do much and they can’t afford surgery or they’re too late for a new valve. You know even putting a new valve, when you are too late, you will not even be managed.

[Assistant] Why are they coming late?

[User] It is because of challenges with diagnosis. As I told you, it is not easy to link this sore throat to the problem of the heart. Even majority won’t know that they had a sore throat. Imagine if you get a sore throat and you are 3 years old, or 5 or 10 years old and it goes a way, so now they come in with non- specific symptoms and they are in the village and there is not enough knowledge about it, so they are in heart failure, they’re having chest pain palpitations and they are lost. They are treated by many people because not everyone has ECHO to see what’s in the heart and the symptoms could be because of many things. So the diagnosis is usually delayed.

[Assistant] It is delayed!

[User] That’s the main problem.

[Assistant] Wow. You have said they don’t have the knowledge, how can we step up the knowledge?


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

[User] That’s the main problem.

[Assistant] Wow. You have said they don’t have the knowledge, how can we step up the knowledge?

[User] There are efforts already which have been made; we have had schools’ programs for sensitizations and also a bit of checkups to see how many. There was a study which was run around here. So there is some knowledge around here in schools.

[Assistant] Okay.

[User] Then there has been some campaigns, a few ones on radios right now and there’s also an advert going on to screen for Rheumatic Fever. So giving such knowledge generally improves people to start thinking about the heart and what can go wrong.

[Assistant] Okay, that’s wonderful. So do you remember the last patient you worked on for RHD?


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

[User] There are efforts already which have been made; we have had schools’ programs for sensitizations and also a bit of checkups to see how many. There was a study which was run around here. So there is some knowledge around here in schools.

[Assistant] Okay.

[User] Then there has been some campaigns, a few ones on radios right now and there’s also an advert going on to screen for Rheumatic Fever. So giving such knowledge generally improves people to start thinking about the heart and what can go wrong.

[Assistant] Okay, that’s wonderful. So do you remember the last patient you worked on for RHD?

[User] I remember.

[Assistant] So how long has it been?


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

[User] Then there has been some campaigns, a few ones on radios right now and there’s also an advert going on to screen for Rheumatic Fever. So giving such knowledge generally improves people to start thinking about the heart and what can go wrong.

[Assistant] Okay, that’s wonderful. So do you remember the last patient you worked on for RHD?

[User] I remember.

[Assistant] So how long has it been?

[User] Yesterday.

[Assistant] [laughs] could you briefly tell us how that visit was? Who was it?


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

[User] Yesterday.

[Assistant] [laughs] could you briefly tell us how that visit was? Who was it?

[User] It was a follow up visit and it was a good news of RHD regression.

[Assistant] Wow.

[User] Which I don’t see many times, so this was mild Rheumatic Heart Disease with mild micro gurgitations. It was diagnosed this year in January, so I followed up after 6months so that was July there, the symptoms had reduced but we still maintained PEN-V penicillin. So the patient came back yesterday and we did another ECHO, and RHD changes on the heart had disappeared.

[Assistant] Wow. How old was this?


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

[User] It was a follow up visit and it was a good news of RHD regression.

[Assistant] Wow.

[User] Which I don’t see many times, so this was mild Rheumatic Heart Disease with mild micro gurgitations. It was diagnosed this year in January, so I followed up after 6months so that was July there, the symptoms had reduced but we still maintained PEN-V penicillin. So the patient came back yesterday and we did another ECHO, and RHD changes on the heart had disappeared.

[Assistant] Wow. How old was this?

[User] This was a 30 year old lady. It is one of those which am very proud of.

[Assistant] Wow, that’s wonderful. So do these patients know the link between sore throat, ARF and RHD, at all? Do they have a sense of, do they know that?


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

[User] This was a 30 year old lady. It is one of those which am very proud of.

[Assistant] Wow, that’s wonderful. So do these patients know the link between sore throat, ARF and RHD, at all? Do they have a sense of, do they know that?

[User] The ones who come to us are referred via ELT doctors here. The unit doctors explain to them that “you have recurrent sore throat so you could be having RHD, so go to physicians, cardiologist or whoever for further screening.” Those ones come knowing and they are the ones who usually comply to treatment very well. But the ones we diagnose usually who come in late, they don’t know actually.

[Assistant] They don’t!

[User] So the majority don’t know.

[Assistant] They don’t even know that.


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

[User] The ones who come to us are referred via ELT doctors here. The unit doctors explain to them that “you have recurrent sore throat so you could be having RHD, so go to physicians, cardiologist or whoever for further screening.” Those ones come knowing and they are the ones who usually comply to treatment very well. But the ones we diagnose usually who come in late, they don’t know actually.

[Assistant] They don’t!

[User] So the majority don’t know.

[Assistant] They don’t even know that.

[User] Yes.

[Assistant] Okay. What sort of symptoms do they usually describe to you when they come?


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

[User] So the majority don’t know.

[Assistant] They don’t even know that.

[User] Yes.

[Assistant] Okay. What sort of symptoms do they usually describe to you when they come?

[User] They come with easy fatigability, (they get tired).

[Assistant] Yeah, they get tired all the time.


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

[User] Yes.

[Assistant] Okay. What sort of symptoms do they usually describe to you when they come?

[User] They come with easy fatigability, (they get tired).

[Assistant] Yeah, they get tired all the time.

[User] Body swelling, they come with chest pain, they come with palpitations, so those are the four main symptoms. But there are those who come with a cough that is not going away; they have treated the cough and it is not going away but when you check the heart, you find the problem is from the valves.

[Assistant] Okay and are they good at follow up and adherence?


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

[User] Body swelling, they come with chest pain, they come with palpitations, so those are the four main symptoms. But there are those who come with a cough that is not going away; they have treated the cough and it is not going away but when you check the heart, you find the problem is from the valves.

[Assistant] Okay and are they good at follow up and adherence?

[User] Yes and no, and it varies from patient to patient. So I will categorize them.

[Assistant] Okay.

[User] I will say the ones who have support like social support, family support come back and the ones who are alone don’t come back. I have seen that case clearly.

[Assistant] So social support like what?


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

[User] Yes and no, and it varies from patient to patient. So I will categorize them.

[Assistant] Okay.

[User] I will say the ones who have support like social support, family support come back and the ones who are alone don’t come back. I have seen that case clearly.

[Assistant] So social support like what?

[User] Social support makes them comeback but without that, they go away and they get lost, and then we discover them on the ward in heart failure admitted.

[Assistant] Oh! They come back when ... ?


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

[User] I will say the ones who have support like social support, family support come back and the ones who are alone don’t come back. I have seen that case clearly.

[Assistant] So social support like what?

[User] Social support makes them comeback but without that, they go away and they get lost, and then we discover them on the ward in heart failure admitted.

[Assistant] Oh! They come back when ... ?

[User] Yes. When they are very sick and in heart failure. So you say “eh! This one was our patient of RHD. ”

[Assistant] So part form social support, what else makes some people comply with the drugs?


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

[User] Social support makes them comeback but without that, they go away and they get lost, and then we discover them on the ward in heart failure admitted.

[Assistant] Oh! They come back when ... ?

[User] Yes. When they are very sick and in heart failure. So you say “eh! This one was our patient of RHD. ”

[Assistant] So part form social support, what else makes some people comply with the drugs?

[User] Well, when they have pain, unfortunately, when they have pain they keep coming and complying for that period when they are in pain, with bad symptoms, but as they get better, they disappear then they come back when the symptoms come back. That is what I have seen.

[Assistant] Okay. And then um, so to then when they come back especially in heart failure, what excuses do they give for having not come back?


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

[User] Yes. When they are very sick and in heart failure. So you say “eh! This one was our patient of RHD. ”

[Assistant] So part form social support, what else makes some people comply with the drugs?

[User] Well, when they have pain, unfortunately, when they have pain they keep coming and complying for that period when they are in pain, with bad symptoms, but as they get better, they disappear then they come back when the symptoms come back. That is what I have seen.

[Assistant] Okay. And then um, so to then when they come back especially in heart failure, what excuses do they give for having not come back?

[User] The medicines. You see the medicines in the hospital, some are there and some are not there. Those who are not in the RHD program may not get and for me I also work in private sectors and other places, so there the medicine is expensive.

[Assistant] So it’s the medicine.


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

[User] The medicines. You see the medicines in the hospital, some are there and some are not there. Those who are not in the RHD program may not get and for me I also work in private sectors and other places, so there the medicine is expensive.

[Assistant] So it’s the medicine.

[User] The medicine is expensive! So they take. Then others get tired of medicine because it is daily, then the injection is painful. This Benzathine penicillin is terrible, you know it.

[Assistant] Yes.

[User] it’s like the one of syphilis if you have ever got it, and it is terrible, very terrible! And the technique of injecting, not every nurse knows it. So some nurses, sorry to say, inject it badly or poorly or they don’t put pain killers or Lignocaine there. So the patient says “ah, I am not going back for that painful injection”

[Assistant] Okay. And then um, now let’s look at the local health system barriers that you are facing. You are going to tell me which ones are working for you and you tell us why and those which ones are not working for you and you tell us why?


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

[User] The medicine is expensive! So they take. Then others get tired of medicine because it is daily, then the injection is painful. This Benzathine penicillin is terrible, you know it.

[Assistant] Yes.

[User] it’s like the one of syphilis if you have ever got it, and it is terrible, very terrible! And the technique of injecting, not every nurse knows it. So some nurses, sorry to say, inject it badly or poorly or they don’t put pain killers or Lignocaine there. So the patient says “ah, I am not going back for that painful injection”

[Assistant] Okay. And then um, now let’s look at the local health system barriers that you are facing. You are going to tell me which ones are working for you and you tell us why and those which ones are not working for you and you tell us why?

[User] Yes.

[Assistant] Let’s look at the administration and leadership in the district, is it helping you do your work with our patients?


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

[User] it’s like the one of syphilis if you have ever got it, and it is terrible, very terrible! And the technique of injecting, not every nurse knows it. So some nurses, sorry to say, inject it badly or poorly or they don’t put pain killers or Lignocaine there. So the patient says “ah, I am not going back for that painful injection”

[Assistant] Okay. And then um, now let’s look at the local health system barriers that you are facing. You are going to tell me which ones are working for you and you tell us why and those which ones are not working for you and you tell us why?

[User] Yes.

[Assistant] Let’s look at the administration and leadership in the district, is it helping you do your work with our patients?

[User] I don’t know much about the administration at the district.

[Assistant] You don’t know?


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

[User] Yes.

[Assistant] Let’s look at the administration and leadership in the district, is it helping you do your work with our patients?

[User] I don’t know much about the administration at the district.

[Assistant] You don’t know?

[User] Yeah, I only know the administration at the hospital. Because a regional referral hospital is semiautonomous; we are under the central government, Ministry Of Health more than the district. We seem to be above the district; the DHO I think doesn’t have a lot of say, so I don’t think ...

[Assistant] Okay. So let’s talk about the administration in the hospital.


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

[User] I don’t know much about the administration at the district.

[Assistant] You don’t know?

[User] Yeah, I only know the administration at the hospital. Because a regional referral hospital is semiautonomous; we are under the central government, Ministry Of Health more than the district. We seem to be above the district; the DHO I think doesn’t have a lot of say, so I don’t think ...

[Assistant] Okay. So let’s talk about the administration in the hospital.

[User] It is very good.

[Assistant] Is it supportive?


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

[User] Yeah, I only know the administration at the hospital. Because a regional referral hospital is semiautonomous; we are under the central government, Ministry Of Health more than the district. We seem to be above the district; the DHO I think doesn’t have a lot of say, so I don’t think ...

[Assistant] Okay. So let’s talk about the administration in the hospital.

[User] It is very good.

[Assistant] Is it supportive?

[User] Yes it is because working together with the heart institute, it is the one really responsible for the cardiology clinic together with the university. So heart institute, Mbarara University, MarieStopes and Ministry Of Health. So there’s coordination really; it is the same angle that we managed to the ECHO machine. It the ECHO which does a lot of diagnostics, you see that? Then there’s an RHD program. So our place is organized because we have a specific RHD clinic on Fridays and then we also a general cardiologist clinic in Tuesday. So if a patient comes when it’s not a Friday and they are sick, they can still be assisted. So the system is good.

[Assistant] Wow, that’s wonderful. Now when you look at the funding of health care, how is it? Is it working for you?


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

[User] Yes it is because working together with the heart institute, it is the one really responsible for the cardiology clinic together with the university. So heart institute, Mbarara University, MarieStopes and Ministry Of Health. So there’s coordination really; it is the same angle that we managed to the ECHO machine. It the ECHO which does a lot of diagnostics, you see that? Then there’s an RHD program. So our place is organized because we have a specific RHD clinic on Fridays and then we also a general cardiologist clinic in Tuesday. So if a patient comes when it’s not a Friday and they are sick, they can still be assisted. So the system is good.

[Assistant] Wow, that’s wonderful. Now when you look at the funding of health care, how is it? Is it working for you?

[User] I don’t know much about funding for health care but what I can say, salaries are paid on time.

[Assistant] That’s good!

[User] So I have no reason to say in that regard, well maybe the drugs; if some patients may not get the heart failure drugs, then that may be an issue.

[Assistant] Are they getting them?


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

[User] I don’t know much about funding for health care but what I can say, salaries are paid on time.

[Assistant] That’s good!

[User] So I have no reason to say in that regard, well maybe the drugs; if some patients may not get the heart failure drugs, then that may be an issue.

[Assistant] Are they getting them?

[User] They get some like Lasix and Captopril but if you want more, others you might not get them like the Losartan. But if you want Atenolol, captopril, Lasix you will get. So I could say it is 50/50.

[Assistant] 50/50. So for those they cannot get at the hospital, how much can they spend for a month?


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

[User] So I have no reason to say in that regard, well maybe the drugs; if some patients may not get the heart failure drugs, then that may be an issue.

[Assistant] Are they getting them?

[User] They get some like Lasix and Captopril but if you want more, others you might not get them like the Losartan. But if you want Atenolol, captopril, Lasix you will get. So I could say it is 50/50.

[Assistant] 50/50. So for those they cannot get at the hospital, how much can they spend for a month?

[User] Unfortunately, the drugs which are not available are the most expensive ones. So the ones that are on are what we call the essential drugs from the Ministry. They may not be very efficacious for these cases who are in heart failure, so you may want to bring back the injection fraction, blah. So if they have to buy, it is very expensive.

[Assistant] Like how much?


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

[User] They get some like Lasix and Captopril but if you want more, others you might not get them like the Losartan. But if you want Atenolol, captopril, Lasix you will get. So I could say it is 50/50.

[Assistant] 50/50. So for those they cannot get at the hospital, how much can they spend for a month?

[User] Unfortunately, the drugs which are not available are the most expensive ones. So the ones that are on are what we call the essential drugs from the Ministry. They may not be very efficacious for these cases who are in heart failure, so you may want to bring back the injection fraction, blah. So if they have to buy, it is very expensive.

[Assistant] Like how much?

[User] They can spend like 100,000shs a month if they are in heart failure. That’s a lot of money, 100,000shs seriously! It is a lot. It is actually more that 50% of their earnings because if you take the earning of people here, it is like 200,000sh-300,000shs.

[Assistant] Okay. So what do you have to say about the funding of RHD in general? In particular.


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

[User] Unfortunately, the drugs which are not available are the most expensive ones. So the ones that are on are what we call the essential drugs from the Ministry. They may not be very efficacious for these cases who are in heart failure, so you may want to bring back the injection fraction, blah. So if they have to buy, it is very expensive.

[Assistant] Like how much?

[User] They can spend like 100,000shs a month if they are in heart failure. That’s a lot of money, 100,000shs seriously! It is a lot. It is actually more that 50% of their earnings because if you take the earning of people here, it is like 200,000sh-300,000shs.

[Assistant] Okay. So what do you have to say about the funding of RHD in general? In particular.

[User] Funding of RHD it is lacking, I am sorry to say. Because, we should look at it in a holistic way, now there’s RHD clinic, we won’t go into the details, but what if the RHD research clinic closes? Because like any other project, it has a timeline, it has to close, what will happen? These patients will fall back to the general cardiology all of them and the medicine which we are getting for RHD, the follow up and sometimes the phone calls to bring them back , I don’t know about transport refunds but I know about phones calls and follow up will be lost. So the funding should be sustainable, what I see is there right now it might not be sustainable. So funding is not enough.

[Assistant] Okay. And let’s look at the health worker force, how are the numbers and qualifications that you have?


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

[User] They can spend like 100,000shs a month if they are in heart failure. That’s a lot of money, 100,000shs seriously! It is a lot. It is actually more that 50% of their earnings because if you take the earning of people here, it is like 200,000sh-300,000shs.

[Assistant] Okay. So what do you have to say about the funding of RHD in general? In particular.

[User] Funding of RHD it is lacking, I am sorry to say. Because, we should look at it in a holistic way, now there’s RHD clinic, we won’t go into the details, but what if the RHD research clinic closes? Because like any other project, it has a timeline, it has to close, what will happen? These patients will fall back to the general cardiology all of them and the medicine which we are getting for RHD, the follow up and sometimes the phone calls to bring them back , I don’t know about transport refunds but I know about phones calls and follow up will be lost. So the funding should be sustainable, what I see is there right now it might not be sustainable. So funding is not enough.

[Assistant] Okay. And let’s look at the health worker force, how are the numbers and qualifications that you have?

[User] The numbers now and qualifications, we have 2 physicians with some cardiology training with one in the cardiac patients’ clinics. It’s fair for now because when you are 2, one can even afford to be off today, this week and the other works or you work together one on the ECHO machine and the other treating the patients. For now, it is okay but it also because of the help of RHD (study), the second clinic will close as soon as the RHD clinic study stops. Then in terms of other cadres, we also have senior health officers, doctors who are trying to specialize in internal medicine, they help us. Because we have taught them so they help us. Because this is a teaching hospital, I think the workforce is good for the doctors.

[Assistant] Waiting time for our patients?


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

[User] Funding of RHD it is lacking, I am sorry to say. Because, we should look at it in a holistic way, now there’s RHD clinic, we won’t go into the details, but what if the RHD research clinic closes? Because like any other project, it has a timeline, it has to close, what will happen? These patients will fall back to the general cardiology all of them and the medicine which we are getting for RHD, the follow up and sometimes the phone calls to bring them back , I don’t know about transport refunds but I know about phones calls and follow up will be lost. So the funding should be sustainable, what I see is there right now it might not be sustainable. So funding is not enough.

[Assistant] Okay. And let’s look at the health worker force, how are the numbers and qualifications that you have?

[User] The numbers now and qualifications, we have 2 physicians with some cardiology training with one in the cardiac patients’ clinics. It’s fair for now because when you are 2, one can even afford to be off today, this week and the other works or you work together one on the ECHO machine and the other treating the patients. For now, it is okay but it also because of the help of RHD (study), the second clinic will close as soon as the RHD clinic study stops. Then in terms of other cadres, we also have senior health officers, doctors who are trying to specialize in internal medicine, they help us. Because we have taught them so they help us. Because this is a teaching hospital, I think the workforce is good for the doctors.

[Assistant] Waiting time for our patients?

[User] Waiting time for our patients varies; if we have many patients in the line we prioritize those ones who are very sick. So whether you have RHD or not, if you are very sick you will be seen. So waiting time will be on average about an hour. Unfortunately, if are dealing with an RHD case, it takes a lot of time on the ECHO machine; it is a tedious exam but if I am dealing with hypertension, 10 minutes and I’m through.

[Assistant] You are done!


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

[User] The numbers now and qualifications, we have 2 physicians with some cardiology training with one in the cardiac patients’ clinics. It’s fair for now because when you are 2, one can even afford to be off today, this week and the other works or you work together one on the ECHO machine and the other treating the patients. For now, it is okay but it also because of the help of RHD (study), the second clinic will close as soon as the RHD clinic study stops. Then in terms of other cadres, we also have senior health officers, doctors who are trying to specialize in internal medicine, they help us. Because we have taught them so they help us. Because this is a teaching hospital, I think the workforce is good for the doctors.

[Assistant] Waiting time for our patients?

[User] Waiting time for our patients varies; if we have many patients in the line we prioritize those ones who are very sick. So whether you have RHD or not, if you are very sick you will be seen. So waiting time will be on average about an hour. Unfortunately, if are dealing with an RHD case, it takes a lot of time on the ECHO machine; it is a tedious exam but if I am dealing with hypertension, 10 minutes and I’m through.

[Assistant] You are done!

[User] Yeah, but to study a valve in an academic way because we are in a teaching institution, it will you take a lot of time.

[Assistant] It takes a while!


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

[User] Waiting time for our patients varies; if we have many patients in the line we prioritize those ones who are very sick. So whether you have RHD or not, if you are very sick you will be seen. So waiting time will be on average about an hour. Unfortunately, if are dealing with an RHD case, it takes a lot of time on the ECHO machine; it is a tedious exam but if I am dealing with hypertension, 10 minutes and I’m through.

[Assistant] You are done!

[User] Yeah, but to study a valve in an academic way because we are in a teaching institution, it will you take a lot of time.

[Assistant] It takes a while!

[User] So the next patient to come after one rhd patient, it will be about minimum of 30 minutes and maximum 1 hour.

[Assistant]
Okay, thank you. And then when you look at the quality of care that you are giving to these patients, how is it?

On average, it's above average. Reason being this being a teaching hospital, I think we tend to follow protocols so it's above average. We may lack some few things but it's above average here.

It's above but it's not yet there at 100.


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

[User] So the next patient to come after one rhd patient, it will be about minimum of 30 minutes and maximum 1 hour.

[Assistant]
Okay, thank you. And then when you look at the quality of care that you are giving to these patients, how is it?

On average, it's above average. Reason being this being a teaching hospital, I think we tend to follow protocols so it's above average. We may lack some few things but it's above average here.

It's above but it's not yet there at 100.

[User] It is not at 100 because of patient numbers.

[Assistant] Okay.

[User] So sometimes you have to wash through and finish the line, so there you don’t do what’s the ideal. You just do the basic that you can and that will be above average.

[Assistant] So what is that that you can't do especially on busy days when you are working?


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

[User] On busy days you may not do a full ECHO.

[Assistant] Okay.

[User] You may do just a basic ECHO and that one affects quality. Let's say if you are studying micro valves, you want to see in details how much RHD has done to eat from the base to the valves themselves to the tips and surrounding areas and you score, you do what is like a weekly score. But when you are in a hurry, you just say severe Mitroscenosis and you put micro valvular ending.

[Assistant] Without scoring!

[User] but you do not score; you be like, “I want to finish” because it takes a lot of time. You may not calculate the Pulmonary Pressure because it takes a lot of time but you must see severely, this rheumatic and it is schiznosed. We diagnose and you just go. So that is slightly average above average and not ideal. The other thing which might be lacking is patient education; so we shall do diagnosis and send to the nurse to treat or to dispense the treatment. But if we had few patients, we would sit with the patients and say “look, we found this and is because of this." So if a patient hears it from the doctor and they may believe it better. And I don't know why, but they tend to believe it better when they hear it from the doctor than a nurse or a second person that simply says, “The doctor said ABCD.”

[Assistant] Okay, wonderful. Let's look at the medications; how are the stocks?


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

[User] You may do just a basic ECHO and that one affects quality. Let's say if you are studying micro valves, you want to see in details how much RHD has done to eat from the base to the valves themselves to the tips and surrounding areas and you score, you do what is like a weekly score. But when you are in a hurry, you just say severe Mitroscenosis and you put micro valvular ending.

[Assistant] Without scoring!

[User] but you do not score; you be like, “I want to finish” because it takes a lot of time. You may not calculate the Pulmonary Pressure because it takes a lot of time but you must see severely, this rheumatic and it is schiznosed. We diagnose and you just go. So that is slightly average above average and not ideal. The other thing which might be lacking is patient education; so we shall do diagnosis and send to the nurse to treat or to dispense the treatment. But if we had few patients, we would sit with the patients and say “look, we found this and is because of this." So if a patient hears it from the doctor and they may believe it better. And I don't know why, but they tend to believe it better when they hear it from the doctor than a nurse or a second person that simply says, “The doctor said ABCD.”

[Assistant] Okay, wonderful. Let's look at the medications; how are the stocks?

[User] I really don't know about the stocks.

[Assistant] Anti coagulation, the heart failure drugs?


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

[User] I really don't know about the stocks.

[Assistant] Anti coagulation, the heart failure drugs?

[User] I want to tell you that I don't know about the stocks.

[Assistant] Yes.

[User] We write and you go get or don't get. So we don't know.

[Assistant] Eh, So you don't know much about that.


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

[User] I want to tell you that I don't know about the stocks.

[Assistant] Yes.

[User] We write and you go get or don't get. So we don't know.

[Assistant] Eh, So you don't know much about that.

[User] Yes.

[Assistant] But for the diagnostics you said have said you have that.


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

[User] We write and you go get or don't get. So we don't know.

[Assistant] Eh, So you don't know much about that.

[User] Yes.

[Assistant] But for the diagnostics you said have said you have that.

[User] We are doing well; we have ECHO which can do a detailed study of what you want.

[Assistant] Are they paying for the services?


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

[User] Yes.

[Assistant] But for the diagnostics you said have said you have that.

[User] We are doing well; we have ECHO which can do a detailed study of what you want.

[Assistant] Are they paying for the services?

[User] If they come among the general patients they pay. If they come among the RHD study they don't.

[Assistant] So for the general, how much do they pay?


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

[User] If they come among the general patients they pay. If they come among the RHD study they don't.

[Assistant] So for the general, how much do they pay?

[User] For the ECHO?

[Assistant] Yes.

[User] They pay 70,000shs

[Assistant] Okay. Can many afford that and what do they do when they can't?


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

[User] For the ECHO?

[Assistant] Yes.

[User] They pay 70,000shs

[Assistant] Okay. Can many afford that and what do they do when they can't?

[User] Well they complain but if they are really poor, there’s a waiver that comes out of bureaucracy to the hospital to waive. So they can't afford in general because 70,000shs, and I told you already 100,000sh is a much. So 70,000sh is close to 100,000shs. It is not really affordable but they struggle.

[Assistant] Let's look at the health information system you have and the medical records systems, how are they?


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

[User] Well they complain but if they are really poor, there’s a waiver that comes out of bureaucracy to the hospital to waive. So they can't afford in general because 70,000shs, and I told you already 100,000sh is a much. So 70,000sh is close to 100,000shs. It is not really affordable but they struggle.

[Assistant] Let's look at the health information system you have and the medical records systems, how are they?

[User] Well again I say that for those who are in study, the information is good.

[Assistant] Why?

[User] Because they have the papers that are already pre-signed to get the information that you want and there’s a channel of information to even consult work to get and follow. That one among the study, they are good. Those ones who are not in the study, the general cardiologists, we keep in our book. We have two registers one if you are going to do the echo we register you, second in the Computer we put results then actually there’s a 3rd one for the general clinic for the nurse to keep track. But it may not go to the details of the hospital, I don't know how often it goes because it stays in.

[Assistant] It stays in your place!