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

[User] It is changed because, you choose what to cook that is why they are not cooking beans and they cook sardines instead

[Assistant] What else? What about the price

[User] T his has an impact because you don’t eat much because of that, if you don’t have enough funds you are supposed to buy flour which is not expensive. However, this time the flour is very expensive compared to rice. Hence people are not consuming much that.

[Assistant] mhh, what about food stereotyping, what food can lead to stereotype?

[User] Like alcohol,

[Assistant] What made Masai to eat pork meat, fish?


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

[User] T his has an impact because you don’t eat much because of that, if you don’t have enough funds you are supposed to buy flour which is not expensive. However, this time the flour is very expensive compared to rice. Hence people are not consuming much that.

[Assistant] mhh, what about food stereotyping, what food can lead to stereotype?

[User] Like alcohol,

[Assistant] What made Masai to eat pork meat, fish?

[User]
It is because of the few cow

Also, now Maasai are not eating meat now when they go to the village they eat vegetable with stiff porridge

[Assistant] What are the foods that were considered to be of high social status in the past?


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

[User] Like alcohol,

[Assistant] What made Masai to eat pork meat, fish?

[User]
It is because of the few cow

Also, now Maasai are not eating meat now when they go to the village they eat vegetable with stiff porridge

[Assistant] What are the foods that were considered to be of high social status in the past?

[User] Meat and the blood

[Assistant] What about now


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

[User]
It is because of the few cow

Also, now Maasai are not eating meat now when they go to the village they eat vegetable with stiff porridge

[Assistant] What are the foods that were considered to be of high social status in the past?

[User] Meat and the blood

[Assistant] What about now

[User] It is not very common.

[Assistant]
There are a lot of reasons that contribute to this change. We mentioned aridity, availability. Let’s now go back to food preparation before arranging these reasons.

What has cause the changes in preparation of food


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

[User] Meat and the blood

[Assistant] What about now

[User] It is not very common.

[Assistant]
There are a lot of reasons that contribute to this change. We mentioned aridity, availability. Let’s now go back to food preparation before arranging these reasons.

What has cause the changes in preparation of food

[User] We used to grill but now we are using coconut, tomatoes, curry and other spices

[Assistant] What made people to do that


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

[User] We used to grill but now we are using coconut, tomatoes, curry and other spices

[Assistant] What made people to do that

[User] It is because of the people who are coming from other places to Kibaya

[Assistant] Another reason

[User] It because of the industry like Bakhresa industries brings the cooked food, also milk and other food

[Assistant] How do you store the milk?


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

[User] It is because of the people who are coming from other places to Kibaya

[Assistant] Another reason

[User] It because of the industry like Bakhresa industries brings the cooked food, also milk and other food

[Assistant] How do you store the milk?

[User] We used the pot but now we use the plastic bucket

[Assistant] What about Wazigua?


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

[User] It because of the industry like Bakhresa industries brings the cooked food, also milk and other food

[Assistant] How do you store the milk?

[User] We used the pot but now we use the plastic bucket

[Assistant] What about Wazigua?

[User] To our side we used to boil

[Assistant] You have mentioned so many issues causing food change like aridity, interaction, school issues, also moving to other places, the industries, traditions, so among all these what contributed much to this change


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

[User] We used the pot but now we use the plastic bucket

[Assistant] What about Wazigua?

[User] To our side we used to boil

[Assistant] You have mentioned so many issues causing food change like aridity, interaction, school issues, also moving to other places, the industries, traditions, so among all these what contributed much to this change

[User] I t is aridity because this force people to move away,

[Assistant] Which one is the first between interaction and the aridity


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

[User] To our side we used to boil

[Assistant] You have mentioned so many issues causing food change like aridity, interaction, school issues, also moving to other places, the industries, traditions, so among all these what contributed much to this change

[User] I t is aridity because this force people to move away,

[Assistant] Which one is the first between interaction and the aridity

[User] The first one is the interaction

[Assistant] the second one, please which one is supposed to be the first between aridity and interaction?


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

[User] I t is aridity because this force people to move away,

[Assistant] Which one is the first between interaction and the aridity

[User] The first one is the interaction

[Assistant] the second one, please which one is supposed to be the first between aridity and interaction?

[User] It is aridity because it makes people to move away?

[Assistant] Do we agree


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

[User] The first one is the interaction

[Assistant] the second one, please which one is supposed to be the first between aridity and interaction?

[User] It is aridity because it makes people to move away?

[Assistant] Do we agree

[User] Y es

[Assistant] The second one?


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

[User] It is aridity because it makes people to move away?

[Assistant] Do we agree

[User] Y es

[Assistant] The second one?

[User] It is interaction

[Assistant] T he third one?


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

[User] Y es

[Assistant] The second one?

[User] It is interaction

[Assistant] T he third one?

[User] School because people interact, and they learn what is cooked in town

[Assistant] What about others, your colleague has said school


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

[User] It is interaction

[Assistant] T he third one?

[User] School because people interact, and they learn what is cooked in town

[Assistant] What about others, your colleague has said school

[User] I think the third one should be food availability, this contribute to food change

[Assistant] What has contributed less among these reasons you have mentioned


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

[User] School because people interact, and they learn what is cooked in town

[Assistant] What about others, your colleague has said school

[User] I think the third one should be food availability, this contribute to food change

[Assistant] What has contributed less among these reasons you have mentioned

[User] The market has contributed much not less as people come and sell their product

[Assistant] What contributed less?


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

[User] The market has contributed much not less as people come and sell their product

[Assistant] What contributed less?

[User] Tradition and customer

[Assistant] Why?

[User] I It is because there are things we used to do, Example we used to slaughter the goats and the intestines we used to wear it in the head but now we don’t do that because this is dirty.

[Assistant]
I have now put all these here what are most reasons contributing to the change?

Do you Masai used to eat vegetables?


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

[User] Tradition and customer

[Assistant] Why?

[User] I It is because there are things we used to do, Example we used to slaughter the goats and the intestines we used to wear it in the head but now we don’t do that because this is dirty.

[Assistant]
I have now put all these here what are most reasons contributing to the change?

Do you Masai used to eat vegetables?

[User] No

[Assistant] So between availability and interaction what is contributing most


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

[User] No

[Assistant] So between availability and interaction what is contributing most

[User] The first one is interaction

[Assistant] then

[User] the food availability

[Assistant] What is number four? Between school, income, agriculture development, industries and price


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

[User] The first one is interaction

[Assistant] then

[User] the food availability

[Assistant] What is number four? Between school, income, agriculture development, industries and price

[User] quite

[Assistant] who can lead the discussion


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

[User] quite

[Assistant] who can lead the discussion

[User] Number four is the increase of the income because we don’t have the same income.

[Assistant] mhh

[User] Number five is the being exposed to other communities because when you go to Arusha or Korogwe you learn new things

[Assistant] we are not yet to complete?


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

[User] Number four is the increase of the income because we don’t have the same income.

[Assistant] mhh

[User] Number five is the being exposed to other communities because when you go to Arusha or Korogwe you learn new things

[Assistant] we are not yet to complete?

[User] Number six is agriculture because even if you want to go to school you must eat first

[Assistant] We still have other reasons


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

[User] Number five is the being exposed to other communities because when you go to Arusha or Korogwe you learn new things

[Assistant] we are not yet to complete?

[User] Number six is agriculture because even if you want to go to school you must eat first

[Assistant] We still have other reasons

[User] Number seven, is school

[Assistant] M hh we still have other reasons


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

[User] Number six is agriculture because even if you want to go to school you must eat first

[Assistant] We still have other reasons

[User] Number seven, is school

[Assistant] M hh we still have other reasons

[User] I think number eight is industries because the price depends on food manufacturing in industries, the industries can lead to raise the price or decrease

[Assistant] Okay let’s continue


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

[User] I think number eight is industries because the price depends on food manufacturing in industries, the industries can lead to raise the price or decrease

[Assistant] Okay let’s continue

[User] Price Changes is number nine

[Assistant] mhh

[User]
Number ten is the roles that people have in society

The last one is customers and tradition, these have changed a lot in clothing the way people dress, the way they great and it is due to interaction with other tribes.

[Assistant] Now we have seen the reasons that you have arranged from one to ten, which are three reasons that contributed most and which have less contribution


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

[User] Price Changes is number nine

[Assistant] mhh

[User]
Number ten is the roles that people have in society

The last one is customers and tradition, these have changed a lot in clothing the way people dress, the way they great and it is due to interaction with other tribes.

[Assistant] Now we have seen the reasons that you have arranged from one to ten, which are three reasons that contributed most and which have less contribution

[User] The major one is aridity, interaction of societies and food availability

[Assistant] which has less contribution ?


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

[User]
Number ten is the roles that people have in society

The last one is customers and tradition, these have changed a lot in clothing the way people dress, the way they great and it is due to interaction with other tribes.

[Assistant] Now we have seen the reasons that you have arranged from one to ten, which are three reasons that contributed most and which have less contribution

[User] The major one is aridity, interaction of societies and food availability

[Assistant] which has less contribution ?

[User] The roles/responsibilities and food price

[Assistant] What is the importance of milk to you all


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

[User] The major one is aridity, interaction of societies and food availability

[Assistant] which has less contribution ?

[User] The roles/responsibilities and food price

[Assistant] What is the importance of milk to you all

[User] They make the body healthier it is not like the stiff porridge you can drink a milk for a day without feeling hungry

[Assistant] What is another reason for drink milk?


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

[User] They make the body healthier it is not like the stiff porridge you can drink a milk for a day without feeling hungry

[Assistant] What is another reason for drink milk?

[User] It is not if you have inhaled a lot of dust when you drink milk will contribute to reduce the among of dust in the body

[Assistant] mhh

[User]
It is good because it helps to detoxify the body if somebody is drunken

The fresh milk is good for the children, but the sour milk is not very good.

[Assistant] What about the importance of milk in the past and now days?


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

[User]
It is good because it helps to detoxify the body if somebody is drunken

The fresh milk is good for the children, but the sour milk is not very good.

[Assistant] What about the importance of milk in the past and now days?

[User] I n the past people were going to the forest and eat meat for a long time but when they come back to the village they drink sour milk, But now the Maasai don’t go to forest to eat the meat.

[Assistant] mhh

[User] The difference is that in the past people used to milk the cow but now after milking they mix with water.

[Assistant] what about its importance now


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

[User] The difference is that in the past people used to milk the cow but now after milking they mix with water.

[Assistant] what about its importance now

[User] It is less important than before because people are mixing with water

[Assistant] mhh

[User]
The business has contributed to this, because when you sell to food vendors they tend to mix with water

The milk now is not good because in the past the pasture was greener compared to now, also there were no diseases and also the cow were not drinking water contaminated with salt.

[Assistant] okay, I think you have not understood. I want you to tell me the importance of drinking milk and also the drinking trends is decreased or increased?


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

[User]
The business has contributed to this, because when you sell to food vendors they tend to mix with water

The milk now is not good because in the past the pasture was greener compared to now, also there were no diseases and also the cow were not drinking water contaminated with salt.

[Assistant] okay, I think you have not understood. I want you to tell me the importance of drinking milk and also the drinking trends is decreased or increased?

[User] It is still important, but the availability is a problem. You might find you have fifty cows but you can’t get even ten bucket.

[Assistant] mhh

[User] T he problems is that we don’t have money to buy milk

[Assistant] Okay, let talk about the cow blood use, how about its consumption?


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

[User] It is still important, but the availability is a problem. You might find you have fifty cows but you can’t get even ten bucket.

[Assistant] mhh

[User] T he problems is that we don’t have money to buy milk

[Assistant] Okay, let talk about the cow blood use, how about its consumption?

[User] We still eat, mostly the women who have given the birth, also men drinks when they are sick. We take it from the animal of hitting the cow with an arrow in the neck. Then we mix the blood with milk and drink,

[Assistant] What kind of cow


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

[User] We still eat, mostly the women who have given the birth, also men drinks when they are sick. We take it from the animal of hitting the cow with an arrow in the neck. Then we mix the blood with milk and drink,

[Assistant] What kind of cow

[User] The big cows except the BULL

[Assistant] Why that

[User] We don’t take from the bull because they are the ones who are used during farming activities, we learn this from our parents

[Assistant] Do you boil the blood


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

[User] The big cows except the BULL

[Assistant] Why that

[User] We don’t take from the bull because they are the ones who are used during farming activities, we learn this from our parents

[Assistant] Do you boil the blood

[User] Yes, in previous but not now because, Maasai were not selling the cow but now they sell frequently. So, there are no cows that they could use for that reason of taking the blood. If there are no cows at home, you can go to your neighbour. Also before taking blood you must make sure that the cow is healthier

[Assistant] How the diseases are affecting the human


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

[User] We don’t take from the bull because they are the ones who are used during farming activities, we learn this from our parents

[Assistant] Do you boil the blood

[User] Yes, in previous but not now because, Maasai were not selling the cow but now they sell frequently. So, there are no cows that they could use for that reason of taking the blood. If there are no cows at home, you can go to your neighbour. Also before taking blood you must make sure that the cow is healthier

[Assistant] How the diseases are affecting the human

[User] When you eat you get those diseases. To avoid that we boil the meat three times, also others are dried up

[Assistant] You have talked about food change, how the food changes in societies affecting the people. For example do Maasai eat the sardines or fish?


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

[User] Yes, in previous but not now because, Maasai were not selling the cow but now they sell frequently. So, there are no cows that they could use for that reason of taking the blood. If there are no cows at home, you can go to your neighbour. Also before taking blood you must make sure that the cow is healthier

[Assistant] How the diseases are affecting the human

[User] When you eat you get those diseases. To avoid that we boil the meat three times, also others are dried up

[Assistant] You have talked about food change, how the food changes in societies affecting the people. For example do Maasai eat the sardines or fish?

[User] It positively affects the community as the way we interact we get various food, for instance in the past Maasai were not eating the cow which is sick buy not if the cow is sick they slaughter it. So these are the development

[Assistant] Mhhh another one


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

[User] When you eat you get those diseases. To avoid that we boil the meat three times, also others are dried up

[Assistant] You have talked about food change, how the food changes in societies affecting the people. For example do Maasai eat the sardines or fish?

[User] It positively affects the community as the way we interact we get various food, for instance in the past Maasai were not eating the cow which is sick buy not if the cow is sick they slaughter it. So these are the development

[Assistant] Mhhh another one

[User] The interaction made the community to change by sharing the food, they eat in the hotel, and they eat chicken

[Assistant] You eat fish but you don’t take it home? why


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

[User] It positively affects the community as the way we interact we get various food, for instance in the past Maasai were not eating the cow which is sick buy not if the cow is sick they slaughter it. So these are the development

[Assistant] Mhhh another one

[User] The interaction made the community to change by sharing the food, they eat in the hotel, and they eat chicken

[Assistant] You eat fish but you don’t take it home? why

[User] We don’t do that

[Assistant] The last section is about food selection: What criteria which you are using to choose the food?


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

[User] We don’t do that

[Assistant] The last section is about food selection: What criteria which you are using to choose the food?

[User] Is just your desire, you eat what you want

[Assistant] mhh

[User] The income you are getting also contribute to what you have to eat. Example you can buy a soda but if you don’t have money you cannot buy it

[Assistant] What contribute you to eat fish?


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

[User] Is just your desire, you eat what you want

[Assistant] mhh

[User] The income you are getting also contribute to what you have to eat. Example you can buy a soda but if you don’t have money you cannot buy it

[Assistant] What contribute you to eat fish?

[User] The money you have and the imitation from others

[Assistant] What else? what about the test/flavour


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

[User] The income you are getting also contribute to what you have to eat. Example you can buy a soda but if you don’t have money you cannot buy it

[Assistant] What contribute you to eat fish?

[User] The money you have and the imitation from others

[Assistant] What else? what about the test/flavour

[User] Yes, it also contributes you to enjoy after eating

[Assistant] What about food availability?


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

[User] The money you have and the imitation from others

[Assistant] What else? what about the test/flavour

[User] Yes, it also contributes you to enjoy after eating

[Assistant] What about food availability?

[User] If you are hungry you have to eat

[Assistant] So, I just want us to arrange which first one between these reasons


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

[User] Yes, it also contributes you to enjoy after eating

[Assistant] What about food availability?

[User] If you are hungry you have to eat

[Assistant] So, I just want us to arrange which first one between these reasons

[User] Number one is hungry you can eat and pay later if you don’t have money

[Assistant] mhh the second one


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

[User] If you are hungry you have to eat

[Assistant] So, I just want us to arrange which first one between these reasons

[User] Number one is hungry you can eat and pay later if you don’t have money

[Assistant] mhh the second one

[User] The desire of eating certain food

[Assistant] (They are discussing and starting again to arrange)


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

[User] Number one is hungry you can eat and pay later if you don’t have money

[Assistant] mhh the second one

[User] The desire of eating certain food

[Assistant] (They are discussing and starting again to arrange)

[User] The second one is money and the third one what somebody needs/desire for a certain food

[Assistant] T The last section: I would like to know school is affecting the community activities


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

[User] The desire of eating certain food

[Assistant] (They are discussing and starting again to arrange)

[User] The second one is money and the third one what somebody needs/desire for a certain food

[Assistant] T The last section: I would like to know school is affecting the community activities

[User] T he educated Masai they never go back to engage with animal keeping

[Assistant] mhh, what about Zigua?


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

[User] The second one is money and the third one what somebody needs/desire for a certain food

[Assistant] T The last section: I would like to know school is affecting the community activities

[User] T he educated Masai they never go back to engage with animal keeping

[Assistant] mhh, what about Zigua?

[User] They don’t engage with keeping the animal, they consider that is the work of those people who are not educated, most of them they go to town looking for job in garage, they ride motorcycle,

[Assistant] What about the women


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

[User] T he educated Masai they never go back to engage with animal keeping

[Assistant] mhh, what about Zigua?

[User] They don’t engage with keeping the animal, they consider that is the work of those people who are not educated, most of them they go to town looking for job in garage, they ride motorcycle,

[Assistant] What about the women

[User] They do the same as washing dishes etc

[Assistant] Where do you learn about the nutrition?


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

[User] They don’t engage with keeping the animal, they consider that is the work of those people who are not educated, most of them they go to town looking for job in garage, they ride motorcycle,

[Assistant] What about the women

[User] They do the same as washing dishes etc

[Assistant] Where do you learn about the nutrition?

[User] From home

[Assistant] What about Masai


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

[User]
Our fathers teach us, we go to forest eat the meat and becomes healthier, these event is called OLBURU. this can comprise like 20 people who mostly are youth

Also in the groups,

[Assistant] mhh

[User] I n the hotel we order food that we want

[Assistant] mhh

[User] We learn from friends in the street

[Assistant] How is this information helping you to choose what kind of food you want


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

[User] I n the hotel we order food that we want

[Assistant] mhh

[User] We learn from friends in the street

[Assistant] How is this information helping you to choose what kind of food you want

[Assistant] Do you think information on nutrition is important, how can that help?


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

[User] We learn from friends in the street

[Assistant] How is this information helping you to choose what kind of food you want

[Assistant] Do you think information on nutrition is important, how can that help?

[User] It is important because people eats chips which is not helpful in the body at all

[Assistant] How can we teach/impart this knowledge to the youth?


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

[Assistant] Do you think information on nutrition is important, how can that help?

[User] It is important because people eats chips which is not helpful in the body at all

[Assistant] How can we teach/impart this knowledge to the youth?

[User] Education in the classes

[Assistant] How can we deliver this education


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

[User] ok

[Assistant] you can tell me about yourself, how old are you?

[User] I am an old man of 51 years now

[Assistant] 51?

[User] yeah

[Assistant] And what’s your qualification?


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

[User] I am an old man of 51 years now

[Assistant] 51?

[User] yeah

[Assistant] And what’s your qualification?

[User] I hold advanced diploma in medical education, am a health tutor by training. I also have a diploma in clinical medicine.

[Assistant]
ok

so, where did you qualify from, where was your training done?


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

[User] I hold advanced diploma in medical education, am a health tutor by training. I also have a diploma in clinical medicine.

[Assistant]
ok

so, where did you qualify from, where was your training done?

[User] the initial training was in Gulu for clinical medicine and then for medical education, being a tutor was in Mulago

[Assistant] Mulago?

[User] yes

[Assistant] ok how long ago were you qualified?


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

[User] yes

[Assistant] ok how long ago were you qualified?

[User] For Makerere University, that was around 2003

[Assistant] ok

[User] yes, that’s when I got my diploma in medical education

[Assistant] and for clinical medicine?


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

[User] For Makerere University, that was around 2003

[Assistant] ok

[User] yes, that’s when I got my diploma in medical education

[Assistant] and for clinical medicine?

[User] clinical medicine was way back in 1994, I think you were not yet born... laughs

[Assistant] no, I was already born, I guess I was around 4 years... laughs


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

[User] yes, that’s when I got my diploma in medical education

[Assistant] and for clinical medicine?

[User] clinical medicine was way back in 1994, I think you were not yet born... laughs

[Assistant] no, I was already born, I guess I was around 4 years... laughs

[User] that was when I qualified

[Assistant] and how long have you been working here in LRRH?


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

[User] clinical medicine was way back in 1994, I think you were not yet born... laughs

[Assistant] no, I was already born, I guess I was around 4 years... laughs

[User] that was when I qualified

[Assistant] and how long have you been working here in LRRH?

[User]
in lira regional referral hospital I was transferred to lira in 2004 January from Soroti hospital where I served for 10 years ? Laughs Ok meaning here you have been for more than...

like 14 years

[Assistant] 14 years? Ok quite a long time


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

[User] that was when I qualified

[Assistant] and how long have you been working here in LRRH?

[User]
in lira regional referral hospital I was transferred to lira in 2004 January from Soroti hospital where I served for 10 years ? Laughs Ok meaning here you have been for more than...

like 14 years

[Assistant] 14 years? Ok quite a long time

[User] yes iam actually among the oldest people around

[Assistant]
laughs... so which kind of patients do you usually see? Which are the commonest illnesses that you meet in your day today work? m... since iam not a specialist, we attend to all sorts of patients that we have around this region ranging from malaria, pneumonia and tuberculosis, diarrheal diseases, STIs, the rheumatic fever we are talking about, suspected cases and others, quite many, including injuries...

Accidents...


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[User]
in lira regional referral hospital I was transferred to lira in 2004 January from Soroti hospital where I served for 10 years ? Laughs Ok meaning here you have been for more than...

like 14 years

[Assistant] 14 years? Ok quite a long time

[User] yes iam actually among the oldest people around

[Assistant]
laughs... so which kind of patients do you usually see? Which are the commonest illnesses that you meet in your day today work? m... since iam not a specialist, we attend to all sorts of patients that we have around this region ranging from malaria, pneumonia and tuberculosis, diarrheal diseases, STIs, the rheumatic fever we are talking about, suspected cases and others, quite many, including injuries...

Accidents...

[User] accidents

[Assistant] so do you see like a specific age group or you cut across


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[User] accidents

[Assistant] so do you see like a specific age group or you cut across

[User] as I had said that iam not a specialist, we keep rotating

[Assistant] ok

[User] today you are attending to children, or this month you are attending to children, the other time you are attending to women, you can go to male, like that.

[Assistant] ok...so you kind of meet every group?


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[User] as I had said that iam not a specialist, we keep rotating

[Assistant] ok

[User] today you are attending to children, or this month you are attending to children, the other time you are attending to women, you can go to male, like that.

[Assistant] ok...so you kind of meet every group?

[User] you meet all sorts of patients

[Assistant] ok ...so during your school time, did you receive any specific training on rheumatic heart disease?


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[User] today you are attending to children, or this month you are attending to children, the other time you are attending to women, you can go to male, like that.

[Assistant] ok...so you kind of meet every group?

[User] you meet all sorts of patients

[Assistant] ok ...so during your school time, did you receive any specific training on rheumatic heart disease?

[User]
yes, within the training, you know the training is broad

and it’s supposed to cover everything, and of course rheumatic heart disease, ok let’s say rheumatic fever, start from rheumatic fever of course rheumatic heart disease will now come in as a complication of... streptococcal bacterial infection, so all those bacterial infections were covered

[Assistant] ok and then you are aware of the link between sore throat and rheumatic heart disease right


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[User] you meet all sorts of patients

[Assistant] ok ...so during your school time, did you receive any specific training on rheumatic heart disease?

[User]
yes, within the training, you know the training is broad

and it’s supposed to cover everything, and of course rheumatic heart disease, ok let’s say rheumatic fever, start from rheumatic fever of course rheumatic heart disease will now come in as a complication of... streptococcal bacterial infection, so all those bacterial infections were covered

[Assistant] ok and then you are aware of the link between sore throat and rheumatic heart disease right

[User] yes, yes yes

[Assistant] what do you know about it?


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[User] I know the sore throat is a step... a beta hemolytic streptococcal infection which is more common around the throat...although not only throat, even on the skin of the patient, it can affect any part of the body. But when it attacks the throat and the patient develops antibodies against the infections, and then the antibodies will clear the bacterial infection, but as time goes on the body will recognize the antibodies it had produced as foreign again it begins reacting to the antibodies it had produced against the beta hemolytic streptococcal infection so, it is the antigen antibody reaction then which becomes a problem not only in the heart it can be in the brain, can be in the heart, can be at the joints it can be in the kidneys, those target organs, and if it affects the heart then we have rheumatic heart disease, when it is the joints then we have rheumatic arthritis

[Assistant] ok

[User] yes,

[Assistant] wow

[User]
that’s what I still remember when it’s in the brain then many of our patients present with rheumatic fever disease, they present with symptoms related to rheumatic fevers

yes

[Assistant] ok, let’s move a bit aback, I mean slightly, other than the training you received from school, did you receive any other trainings on rheumatic heart disease since graduation?


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[User] yes,

[Assistant] wow

[User]
that’s what I still remember when it’s in the brain then many of our patients present with rheumatic fever disease, they present with symptoms related to rheumatic fevers

yes

[Assistant] ok, let’s move a bit aback, I mean slightly, other than the training you received from school, did you receive any other trainings on rheumatic heart disease since graduation?

[User] no, I told you, iam a teacher, I am a health tutor by training, so being a health tutor by training, I teach, and because I am teaching medicine, I am a teacher of medicine, because iam teaching my students then I would say I am training, I am being trained time and again, all yearly, those we shall have to cover...

[Assistant] you keep yourself updated all the time


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[User]
that’s what I still remember when it’s in the brain then many of our patients present with rheumatic fever disease, they present with symptoms related to rheumatic fevers

yes

[Assistant] ok, let’s move a bit aback, I mean slightly, other than the training you received from school, did you receive any other trainings on rheumatic heart disease since graduation?

[User] no, I told you, iam a teacher, I am a health tutor by training, so being a health tutor by training, I teach, and because I am teaching medicine, I am a teacher of medicine, because iam teaching my students then I would say I am training, I am being trained time and again, all yearly, those we shall have to cover...

[Assistant] you keep yourself updated all the time

[User] yes, yes, we keep ourselves updated

[Assistant] ok... and then in the patients you see, how many patients of RHD do you see per day?


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[User] no, I told you, iam a teacher, I am a health tutor by training, so being a health tutor by training, I teach, and because I am teaching medicine, I am a teacher of medicine, because iam teaching my students then I would say I am training, I am being trained time and again, all yearly, those we shall have to cover...

[Assistant] you keep yourself updated all the time

[User] yes, yes, we keep ourselves updated

[Assistant] ok... and then in the patients you see, how many patients of RHD do you see per day?

[User] depending on the location, right now you have found me in family planning, when iam here in family planning, I may end up not attending to any of the patients of RHD, but if I am in the general out patient, yes, chances that I will see, especially in children, chances that I would attend to more than 3,

[Assistant] in a day?


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[User] yes, yes, we keep ourselves updated

[Assistant] ok... and then in the patients you see, how many patients of RHD do you see per day?

[User] depending on the location, right now you have found me in family planning, when iam here in family planning, I may end up not attending to any of the patients of RHD, but if I am in the general out patient, yes, chances that I will see, especially in children, chances that I would attend to more than 3,

[Assistant] in a day?

[User] suspected, suspected cases, not real ones, suspected cases of rheumatic heart disease are many, because it is almost, I would say it is common

[Assistant] ok alright... and then, the patients you meet, are they only out patients or you also see in patients?


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

[User] depending on the location, right now you have found me in family planning, when iam here in family planning, I may end up not attending to any of the patients of RHD, but if I am in the general out patient, yes, chances that I will see, especially in children, chances that I would attend to more than 3,

[Assistant] in a day?

[User] suspected, suspected cases, not real ones, suspected cases of rheumatic heart disease are many, because it is almost, I would say it is common

[Assistant] ok alright... and then, the patients you meet, are they only out patients or you also see in patients?

[User] out- patient patients

[Assistant] ok so we can go back now, you had actually... told me what causes Rheumatic heart disease...


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[User] suspected, suspected cases, not real ones, suspected cases of rheumatic heart disease are many, because it is almost, I would say it is common

[Assistant] ok alright... and then, the patients you meet, are they only out patients or you also see in patients?

[User] out- patient patients

[Assistant] ok so we can go back now, you had actually... told me what causes Rheumatic heart disease...

[User] yes, yes, I talked about beta hemolytic streptococcal infection as being the prime cause

[Assistant] ok... what were you told that can be done to prevent rheumatic heart disease?


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[User] out- patient patients

[Assistant] ok so we can go back now, you had actually... told me what causes Rheumatic heart disease...

[User] yes, yes, I talked about beta hemolytic streptococcal infection as being the prime cause

[Assistant] ok... what were you told that can be done to prevent rheumatic heart disease?

[User] I would think about health education, people should be well educated about rheumatic heart disease, but of course when they have the information they will not move around in the villages, this issue of I have been poisoned, and because I have been poisoned, then they go to those traditional healers and if they come to the health facility and we diagnose the infections in the throat, treat it early, then we will have prevented the production of the antibodies, we shall have prevented the production of antibodies which the body would react to in the later stage, so early diagnosis, early treatment, health education is paramount in the prevention of rheumatic heart disease

[Assistant]
then, which treatment options were you taught about for rheumatic heart disease? Respondent ... RHD is supposed to have long acting antibiotics especially the penicillins of course beta hemolytic streptococcus tend to respond better to penicillin. And ...when someone has already developed iris, in the process of developing rheumatic heart disease, one of the things that we need to prevent seriously is the subsequent attack of beta hemolytic streptococcal infection, therefore we give them long acting penicillins majorly things like benzathine which takes little longer in the body and some steroids where possible to neutralize the antigen antibody fights that I was talking about

ok... any other treatment options that you know of? Respondent ... apart from... apart from penicillins?

yes


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

[User] yes, yes, I talked about beta hemolytic streptococcal infection as being the prime cause

[Assistant] ok... what were you told that can be done to prevent rheumatic heart disease?

[User] I would think about health education, people should be well educated about rheumatic heart disease, but of course when they have the information they will not move around in the villages, this issue of I have been poisoned, and because I have been poisoned, then they go to those traditional healers and if they come to the health facility and we diagnose the infections in the throat, treat it early, then we will have prevented the production of the antibodies, we shall have prevented the production of antibodies which the body would react to in the later stage, so early diagnosis, early treatment, health education is paramount in the prevention of rheumatic heart disease

[Assistant]
then, which treatment options were you taught about for rheumatic heart disease? Respondent ... RHD is supposed to have long acting antibiotics especially the penicillins of course beta hemolytic streptococcus tend to respond better to penicillin. And ...when someone has already developed iris, in the process of developing rheumatic heart disease, one of the things that we need to prevent seriously is the subsequent attack of beta hemolytic streptococcal infection, therefore we give them long acting penicillins majorly things like benzathine which takes little longer in the body and some steroids where possible to neutralize the antigen antibody fights that I was talking about

ok... any other treatment options that you know of? Respondent ... apart from... apart from penicillins?

yes

[User] yes, surgical maneuver can come in in case of some pathology in the heart, although it is not performed in this facility, but maybe if referred to other places, yes, in case it has already destroyed the valves and then it would require valve replacement, which is fairly expensive

[Assistant] yeah and may not be available in the facility, or even in the country ok...and then what is your understanding of the long-term prognosis of rheumatic heart disease?


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[User] the prognosis depends on... the long-term prognosis now will depend on the magnitude of the damage, if the intervention got the patient when there was no serious damage, then there would be good prognosis.

[Assistant]
ok Respondent... but if there was destruction caused by the antigen antibody reaction, then the prognosis would be poor, the person would present with full blown ...destroyed say valves of the heart and might even go into heart failure

ok

[User] and we may even lose that such a patient as a result

[Assistant] true

[User] and we have lost many

[Assistant] ok... do you recall the last patient you saw with rheumatic heart disease?


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[User] and we may even lose that such a patient as a result

[Assistant] true

[User] and we have lost many

[Assistant] ok... do you recall the last patient you saw with rheumatic heart disease?

[User] actually, I am even expecting one today

[Assistant] ahhh... maybe you could tell me briefly about the person you were expecting, how they presented to you, maybe the first time...


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[User] aha...yes, possibly, possibly possibly the girls complain more easily than the boys but more girls are brought to the facility than the boys

[Assistant] so...this...

[User] about 7 years

[Assistant] 7years?

[User] yes

[Assistant] so, these ones who come, are they in school, do they report being in school or they are out of school, are they school drop outs?


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[User] about 7 years

[Assistant] 7years?

[User] yes

[Assistant] so, these ones who come, are they in school, do they report being in school or they are out of school, are they school drop outs?

[User] many of them are in schools, many of them are in schools

[Assistant] ok...and adults? Any adults who show up with RHD?


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[User] many of them are in schools, many of them are in schools

[Assistant] ok...and adults? Any adults who show up with RHD?

[User] adults rarely report, when you see an adult coming, then that person is already in late stage

[Assistant] ok...with complications

[User] With serious complications but as I said, when you go backwards, you will realize that this person was not well managed at the initial stages of the infection.

[Assistant] ok. So, when you try to talk to them, are they really aware of the link between sore throat, rheumatic fever and RHD?


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[User] With serious complications but as I said, when you go backwards, you will realize that this person was not well managed at the initial stages of the infection.

[Assistant] ok. So, when you try to talk to them, are they really aware of the link between sore throat, rheumatic fever and RHD?

[User] no, they are no aware, they are not aware,

[Assistant] ok...

[User] ... actually, they are surprised, especially the adults, they are surprised, when you begin telling them of the sore throat, of course, they will not benefit much from your education, because already by the time they are coming to the facility, they will be having the complications, but they would be surprised and when you talk about if this was handled earlier, well, you will not have gone into this, then they will regret, say if I had known then I would have acted

[Assistant]
meaning they have knowledge gap Respondent ... there is an issue of knowledge about it

so, when they present to you, what sorts of symptoms do they describe?


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[User] ... actually, they are surprised, especially the adults, they are surprised, when you begin telling them of the sore throat, of course, they will not benefit much from your education, because already by the time they are coming to the facility, they will be having the complications, but they would be surprised and when you talk about if this was handled earlier, well, you will not have gone into this, then they will regret, say if I had known then I would have acted

[Assistant]
meaning they have knowledge gap Respondent ... there is an issue of knowledge about it

so, when they present to you, what sorts of symptoms do they describe?

[User] of course, palpitations, easy fatigability, difficulty in lying on the left side

[Assistant] ok

[User] and...even lying flat sometimes is their problem, most of them will be seated... but of course as I had said most of them would be the late cases reporting to the facility... phone rings...hmmm so...yes

[Assistant] do any of them ever tell you about other symptoms like joint pains?


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[User] and...even lying flat sometimes is their problem, most of them will be seated... but of course as I had said most of them would be the late cases reporting to the facility... phone rings...hmmm so...yes

[Assistant] do any of them ever tell you about other symptoms like joint pains?

[User] ... joint pains yes...joint pains, joint pains is there especially in adults, especially in adults...ok, joint pain and swelling and partial loss of function is more in adults

[Assistant] ok

[User] yes...is more in adults

[Assistant] and not in children?


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[User] ... joint pains yes...joint pains, joint pains is there especially in adults, especially in adults...ok, joint pain and swelling and partial loss of function is more in adults

[Assistant] ok

[User] yes...is more in adults

[Assistant] and not in children?

[User] no, it’s fairly rare in children you know when people tend to associate ... When they come with joint pain, severe joint pain is more common among Sickler’s so, you find people moving them more to investigating sickle cell, of course sickle cell is also more common so sometimes sickle cell and rheumatic heart disease is mimic

[Assistant] do you think we are missing out children with rheumatic fever being directed to sickle cell clinic?


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[User] no, it’s fairly rare in children you know when people tend to associate ... When they come with joint pain, severe joint pain is more common among Sickler’s so, you find people moving them more to investigating sickle cell, of course sickle cell is also more common so sometimes sickle cell and rheumatic heart disease is mimic

[Assistant] do you think we are missing out children with rheumatic fever being directed to sickle cell clinic?

[User] yes ... that’s what I think. That is another thing I think of course, those children, those ones with sickle cell disease have low immunity, and have higher chances of even developing rheumatic heart disease...

[Assistant] ok

[User] and in such situations, sickle cell will be blamed for causing the problem when actually the problem is rheumatic heart disease

[Assistant] have you met anyone with both


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[User] and in such situations, sickle cell will be blamed for causing the problem when actually the problem is rheumatic heart disease

[Assistant] have you met anyone with both

[User] yes, they are many

[Assistant] many?

[User] yes, I wish you could check through the sickle cell children? In the sickle cell clinic, you will discover that oh, our patients are here...ok, many of them are there... phone rings again and requests to answer it ok...

[Assistant] so generally, what’s good about the follow up? Is the follow up really good? And what about the adherence?


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

[User] yes, I wish you could check through the sickle cell children? In the sickle cell clinic, you will discover that oh, our patients are here...ok, many of them are there... phone rings again and requests to answer it ok...

[Assistant] so generally, what’s good about the follow up? Is the follow up really good? And what about the adherence?

[User] follow up is not good, why? I said rheumatic fever is more among children, more common among children

[Assistant] ok

[User] and people tend to neglect children, if you tell a parent that you would want to see this child after 2 weeks, they will come when the child is badly off, they are never considered in most of the families so, follow up is ... is not very easy of course, the follow up in a hospital in many cases you would want the patient to come to the hospital but not the health workers following the patients to their homes so, may be one day if the strategy of follow up is changed, where people follow these people to their villages...then possibly, they would be attended to, but they would wait until when there is another serious attack has come, then they come to the facility so, they never follow their appointment dates the appointment dates are never followed

[Assistant] ok... is it because they are feeling well...


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

[User] follow up is not good, why? I said rheumatic fever is more among children, more common among children

[Assistant] ok

[User] and people tend to neglect children, if you tell a parent that you would want to see this child after 2 weeks, they will come when the child is badly off, they are never considered in most of the families so, follow up is ... is not very easy of course, the follow up in a hospital in many cases you would want the patient to come to the hospital but not the health workers following the patients to their homes so, may be one day if the strategy of follow up is changed, where people follow these people to their villages...then possibly, they would be attended to, but they would wait until when there is another serious attack has come, then they come to the facility so, they never follow their appointment dates the appointment dates are never followed

[Assistant] ok... is it because they are feeling well...

[User] of course, yes, if the child is still playing about, or if someone is still doing well, they tend to forget, they think the whole thing is cleared.

[Assistant] ok. What of adherence, do they follow their prescribed medication? I was like, the treatment would prevent, preventive treatment where you would think of those long acting penicillins...


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

[User] and people tend to neglect children, if you tell a parent that you would want to see this child after 2 weeks, they will come when the child is badly off, they are never considered in most of the families so, follow up is ... is not very easy of course, the follow up in a hospital in many cases you would want the patient to come to the hospital but not the health workers following the patients to their homes so, may be one day if the strategy of follow up is changed, where people follow these people to their villages...then possibly, they would be attended to, but they would wait until when there is another serious attack has come, then they come to the facility so, they never follow their appointment dates the appointment dates are never followed

[Assistant] ok... is it because they are feeling well...

[User] of course, yes, if the child is still playing about, or if someone is still doing well, they tend to forget, they think the whole thing is cleared.

[Assistant] ok. What of adherence, do they follow their prescribed medication? I was like, the treatment would prevent, preventive treatment where you would think of those long acting penicillins...

[User] ...yes, if it is too long, then they may not, they may not adhere to

[Assistant]
ok. Then what sorts of barriers do they commonly state to you in getting the care they need...challenges they face? Respondent ... In the first-place lack of information because they lack the information, they will not go to the health facility or to a trained health worker to make the correct diagnosis and treatment that is one, then two, sometimes distance assuming somebody is in Aromo, and is not interested in going to aromo health center because people are saying there are no drugs in aromo health center, because our people believe in drugs that when they go to the health center, they must get drugs

ok


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[User] they don’t believe in this information, the prescription that we make but they would want to get the drugs in the health facility, and if there are no drugs they will go to the private facility because there are drugs there. Unfortunately, many of the private places are not managed by professionals you will find a facility well stocked with drugs but managed by a nursing assistant see that? ... So, the nursing assistant may not be in the capacity of making the correct diagnosis and prescription, the correct prescription

[Assistant] ok

[User] so, that could be an issue, distance coupled with lack of information that they have poverty coming in, coz they don’t have money to travel that distance from aromo possibly to lira hospital or if those areas of my village in oyam, otwal, is far away moving from that place to maybe atapara it requires resources so, it’s sometimes difficult for them

[Assistant] ok

[User] they wait until there are serious complications and actually, when they are going to the hospital, they go for admission

[Assistant] laughs... So, they wait when they are badly off


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[User] so, that could be an issue, distance coupled with lack of information that they have poverty coming in, coz they don’t have money to travel that distance from aromo possibly to lira hospital or if those areas of my village in oyam, otwal, is far away moving from that place to maybe atapara it requires resources so, it’s sometimes difficult for them

[Assistant] ok

[User] they wait until there are serious complications and actually, when they are going to the hospital, they go for admission

[Assistant] laughs... So, they wait when they are badly off

[User] when they are badly off

[Assistant] what about you, which barriers do you face?


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[User] one I talked about ah... ok let me start with personnel,

[Assistant] yes

[User] that we have very few well trained clinicians or experienced clinicians... the outpatient, our outpatient right now I think should be having like 3 clinical officers

[Assistant] ok

[User] and if one is possibly sick and maybe another one is on leave, then you would see that there is only one person left at the station meaning that the care that our patient may not be adequate

[Assistant] ok... quality of care...


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[User] but the pressure there, sometimes you would find some few history written and then somebody would move straight to prescription, which is not the order which is not how things should be done

[Assistant] ok

[User] but... that is one, two. As I mentioned, I think I mentioned it yesterday, that we have, sometimes we get volunteers but a volunteer, someone who is not paid for the activities they are doing can also have his or her special interests of being within the facility. One he is difficult to supervise two, because of the other interest, that hidden interest, it is difficult, so those are some of the things. And then two, drugs...

[Assistant] ok

[User] that in many occasions...

[Assistant] so, should I say lack of motivation for the volunteers?


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[User] but... that is one, two. As I mentioned, I think I mentioned it yesterday, that we have, sometimes we get volunteers but a volunteer, someone who is not paid for the activities they are doing can also have his or her special interests of being within the facility. One he is difficult to supervise two, because of the other interest, that hidden interest, it is difficult, so those are some of the things. And then two, drugs...

[Assistant] ok

[User] that in many occasions...

[Assistant] so, should I say lack of motivation for the volunteers?

[User] yes, yes, lack of motivation...

[Assistant] or for the health workers?


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

[User] that in many occasions...

[Assistant] so, should I say lack of motivation for the volunteers?

[User] yes, yes, lack of motivation...

[Assistant] or for the health workers?

[User] the health workers are getting their salary but the volunteers are there for nothing

[Assistant] they are not paid anything?


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

[User] yes, yes, lack of motivation...

[Assistant] or for the health workers?

[User] the health workers are getting their salary but the volunteers are there for nothing

[Assistant] they are not paid anything?

[User] 100% they are there, they are not getting anything completely,

[Assistant] they are not getting anything? I thought the hospital is supposed to provide something?


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[User] to supervise them and to monitor some of their, ok their hidden interest is difficult then I was talking of shortage of drugs, you may wish to prescribe a drug or you can prescribe a drug and the drug is not supplied by the pharmacy, that we have.. Why, because there is a stock out, so that one interferes with adherence

[Assistant] ok

[User] and then the quality of care that you are offering to the patient, therefore, meaning that, meaning that your patient will come back with serious complications and investigations, investigations... the results of the investigations tend to take long

[Assistant] ok

[User] if you order for an investigation, you are thinking about rheumatic heart disease...and you would want investigations done, so that you maybe refer the patient to the respective places that they can get adequate care, two things, you may receive your patient back or you may not see your patient anymore

[Assistant] do they get lost on the way?


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

[User] and then the quality of care that you are offering to the patient, therefore, meaning that, meaning that your patient will come back with serious complications and investigations, investigations... the results of the investigations tend to take long

[Assistant] ok

[User] if you order for an investigation, you are thinking about rheumatic heart disease...and you would want investigations done, so that you maybe refer the patient to the respective places that they can get adequate care, two things, you may receive your patient back or you may not see your patient anymore

[Assistant] do they get lost on the way?

[User] they get lost on the way

[Assistant] due to the long waiting hours at the investigation point...?


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

[User] they get lost on the way

[Assistant] due to the long waiting hours at the investigation point...?

[User] that one I have not discovered yet, that one I have not discovered yet, but sometimes they also get lost on the way

[Assistant] ok

[User] then... if you have referred or you have admitted the patient Respondent sometimes we don’t get any information about our patient

[Assistant] so, lack of feedback


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[User] that one I have not discovered yet, that one I have not discovered yet, but sometimes they also get lost on the way

[Assistant] ok

[User] then... if you have referred or you have admitted the patient Respondent sometimes we don’t get any information about our patient

[Assistant] so, lack of feedback

[User] feedback about your patient

[Assistant] ok what else...?


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

[User] then... if you have referred or you have admitted the patient Respondent sometimes we don’t get any information about our patient

[Assistant] so, lack of feedback

[User] feedback about your patient

[Assistant] ok what else...?

[User] I think basically those are the ones

[Assistant] And then, ok now this is in your perspective, what sorts of barriers do you perceive that the patients face in the care that they need?


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

[User] I think basically those are the ones

[Assistant] And then, ok now this is in your perspective, what sorts of barriers do you perceive that the patients face in the care that they need?

[User] one major problem that me as a person think of is health education

[Assistant] ok

[User] in the community. Health education is a major problem, we are going back, actually most of our patients are going back in the times of Albert Cook where when they fall sick, they do their things in the villages, they are going into those days of, someone has developed, because those days in the past in lango, in the past, if there was someone with a sore throat, they would pour water on an axe, then they would scoop it, the other one pouring on the other side the axe would be handled like this ... (demonstrates) then somebody pours water there and this patient must have to, must take this one which is dropping from the sharp edge of the axe and they say it would clear, it would treat very well

[Assistant] would it really work?


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

[User] they would just play about with your mind so that you assume you are treated. so, our people are almost going back to those ancient methods of treatment, that’s why you are seeing others coming, ok... am seeing almost 30% of our patients have lost their uvula so, there should be proper health education about sore throat

[Assistant] ok

[User] in case there is any sore throat, let us not have any body tampering with the mouth

[Assistant] laughs

[User] they should go to the health facility so that they are adequately treated, so that there is proper diagnosis and proper treatment, otherwise we shall continue receiving them at a late hour in the hospital or in the health facility so, to start with, I would think there must be adequate health education offered to the people

[Assistant] ok which other barriers do you think they face?


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

[User] in case there is any sore throat, let us not have any body tampering with the mouth

[Assistant] laughs

[User] they should go to the health facility so that they are adequately treated, so that there is proper diagnosis and proper treatment, otherwise we shall continue receiving them at a late hour in the hospital or in the health facility so, to start with, I would think there must be adequate health education offered to the people

[Assistant] ok which other barriers do you think they face?

[User] I mentioned ... the distance...

[Assistant] this is in your view, what you think they go through


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

[User] they should go to the health facility so that they are adequately treated, so that there is proper diagnosis and proper treatment, otherwise we shall continue receiving them at a late hour in the hospital or in the health facility so, to start with, I would think there must be adequate health education offered to the people

[Assistant] ok which other barriers do you think they face?

[User] I mentioned ... the distance...

[Assistant] this is in your view, what you think they go through

[User] another thing could be our attitude, some of us are not friendly to our clients, some of us are not friendly to our clients, we tend to ignore them and indeed, if someone comes to the hospital and I have not given him the proper attention he expects, sincerely, he will lose interest in getting services from the facility, goes back to the village and have it the other way, the traditional

[Assistant] that’s why I was told mothers prefer traditional birth attendants


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

[User] I mentioned ... the distance...

[Assistant] this is in your view, what you think they go through

[User] another thing could be our attitude, some of us are not friendly to our clients, some of us are not friendly to our clients, we tend to ignore them and indeed, if someone comes to the hospital and I have not given him the proper attention he expects, sincerely, he will lose interest in getting services from the facility, goes back to the village and have it the other way, the traditional

[Assistant] that’s why I was told mothers prefer traditional birth attendants

[User] yes, yes

[Assistant] because they are treated nicely


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

[User] yes, yes

[Assistant] because they are treated nicely

[User] yes, majorly it’s our attitude towards our clients and patients, so maybe health workers must develop that customer care attitude they should recognize that they are our customers, they are the reason why we are here...

[Assistant] yeah

[User] and then treat them fairly because they are not the same, others are coming to the health facility for the first time, they have been in the villages so crossing to lira they would have a lot of fear and if they are mishandled then automatically, they would lose interest in getting care from the health facility so, attitude is another big challenge another big barrier

[Assistant] ok. Anything else?


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

[User] yes, majorly it’s our attitude towards our clients and patients, so maybe health workers must develop that customer care attitude they should recognize that they are our customers, they are the reason why we are here...

[Assistant] yeah

[User] and then treat them fairly because they are not the same, others are coming to the health facility for the first time, they have been in the villages so crossing to lira they would have a lot of fear and if they are mishandled then automatically, they would lose interest in getting care from the health facility so, attitude is another big challenge another big barrier

[Assistant] ok. Anything else?

[User] basically, I think I would mention that

[Assistant] ok. So, let’s talk about the administration and leadership in the district, what do you think they have done well for you?


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

[User] yes

[Assistant] ok

[User] so, people should be looking at how to retain the services so that it is always there. Then, I wish they could think of continuously training health workers, if they could continuously train health workers have in plan, that the health workers even in the health facility, in the hospital here and other places are trained and then supervised on the management of rheumatic heart disease, it would be so good

[Assistant] ok. That is with the administration?

[User] yes

[Assistant] so, they are not doing that?


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

[User] so, people should be looking at how to retain the services so that it is always there. Then, I wish they could think of continuously training health workers, if they could continuously train health workers have in plan, that the health workers even in the health facility, in the hospital here and other places are trained and then supervised on the management of rheumatic heart disease, it would be so good

[Assistant] ok. That is with the administration?

[User] yes

[Assistant] so, they are not doing that?

[User] no

[Assistant] those are the things you feel they are not doing? Maybe you can just mention briefly what you the administration is not doing right and the leadership of the district, what you feel hasn’t been done


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

[User] yes

[Assistant] so, they are not doing that?

[User] no

[Assistant] those are the things you feel they are not doing? Maybe you can just mention briefly what you the administration is not doing right and the leadership of the district, what you feel hasn’t been done

[User] What has been done I think I mentioned it I talked about it

[Assistant] yes, what has been done, now we are looking at what you think should have been done and is not being done.


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

[User] What has been done I think I mentioned it I talked about it

[Assistant] yes, what has been done, now we are looking at what you think should have been done and is not being done.

[User] the element of, the element of support of follow up

[Assistant] ok

[User]
because if these patients are supposed to come back for review...

and they are coming, there must be a mechanism of tracing the defaulter, which is not there, I guess is not in place, so there should be a mechanism of tracing the defaulters...

[Assistant]
ok Respondent... so that they are comprehensively treated and they get cured. I think that is what I would talk about

ok. Are you happy about the funding of healthcare in general?


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

[User] the element of, the element of support of follow up

[Assistant] ok

[User]
because if these patients are supposed to come back for review...

and they are coming, there must be a mechanism of tracing the defaulter, which is not there, I guess is not in place, so there should be a mechanism of tracing the defaulters...

[Assistant]
ok Respondent... so that they are comprehensively treated and they get cured. I think that is what I would talk about

ok. Are you happy about the funding of healthcare in general?

[User] no

[Assistant] laughs... what of RHD?


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

[User] no

[Assistant] laughs... what of RHD?

[User] I don’t know the funding of... I don’t know, I don’t know, I don’t know what the implementers are experiencing, the implementers of this program, I don’t know what they are experiencing, but may be if I can see from your body then I would think that you people are doing well

[Assistant] laughs...

[User] laughs...however generally ...

[Assistant] what of generally funding for health care?


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

[User] I don’t know the funding of... I don’t know, I don’t know, I don’t know what the implementers are experiencing, the implementers of this program, I don’t know what they are experiencing, but may be if I can see from your body then I would think that you people are doing well

[Assistant] laughs...

[User] laughs...however generally ...

[Assistant] what of generally funding for health care?

[User] generally funding for health care is not adequate if it was adequate, we would be having specialized machines like a CT scan in general in regional referral hospitals we could be having MRIs in general in the hospitals, but now where do we get them? In private places in Kampala very expensive, and they would help in the diagnosis of some of those cases easily see that? So, the funding, look we are talking about motivation we are talking about staffing, if there was proper funding then we would be having enough staff in the health facility, but usually what do they say? The wage bill cannot allow, and if the wage bill cannot allow, what does it mean, there is no money! So there should be, to me there should be enough funding so that the staffing level is raised...

[Assistant] so, meaning the staff level is low?


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

[User] laughs...however generally ...

[Assistant] what of generally funding for health care?

[User] generally funding for health care is not adequate if it was adequate, we would be having specialized machines like a CT scan in general in regional referral hospitals we could be having MRIs in general in the hospitals, but now where do we get them? In private places in Kampala very expensive, and they would help in the diagnosis of some of those cases easily see that? So, the funding, look we are talking about motivation we are talking about staffing, if there was proper funding then we would be having enough staff in the health facility, but usually what do they say? The wage bill cannot allow, and if the wage bill cannot allow, what does it mean, there is no money! So there should be, to me there should be enough funding so that the staffing level is raised...

[Assistant] so, meaning the staff level is low?

[User] very low... yes, very low

[Assistant] ok. They are low but you have the right qualification


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

[User] generally funding for health care is not adequate if it was adequate, we would be having specialized machines like a CT scan in general in regional referral hospitals we could be having MRIs in general in the hospitals, but now where do we get them? In private places in Kampala very expensive, and they would help in the diagnosis of some of those cases easily see that? So, the funding, look we are talking about motivation we are talking about staffing, if there was proper funding then we would be having enough staff in the health facility, but usually what do they say? The wage bill cannot allow, and if the wage bill cannot allow, what does it mean, there is no money! So there should be, to me there should be enough funding so that the staffing level is raised...

[Assistant] so, meaning the staff level is low?

[User] very low... yes, very low

[Assistant] ok. They are low but you have the right qualification

[User] yes... we have the right qualification, but as I had mentioned, that now we are getting...ok the right qualification, yes we are getting volunteers who are not motivated, and the facility cannot motivate them why? Because there is no money, and there is no plan for them.

[Assistant] so how is the quality of care offered?


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

[User] very low... yes, very low

[Assistant] ok. They are low but you have the right qualification

[User] yes... we have the right qualification, but as I had mentioned, that now we are getting...ok the right qualification, yes we are getting volunteers who are not motivated, and the facility cannot motivate them why? Because there is no money, and there is no plan for them.

[Assistant] so how is the quality of care offered?

[User] ahh... I had mentioned that the quality of care is compromised

[Assistant] because of the few staff?


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

[User] yes... we have the right qualification, but as I had mentioned, that now we are getting...ok the right qualification, yes we are getting volunteers who are not motivated, and the facility cannot motivate them why? Because there is no money, and there is no plan for them.

[Assistant] so how is the quality of care offered?

[User] ahh... I had mentioned that the quality of care is compromised

[Assistant] because of the few staff?

[User] because of the few staff

[Assistant] how would you talk of the waiting time?


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

[User] ahh... I had mentioned that the quality of care is compromised

[Assistant] because of the few staff?

[User] because of the few staff

[Assistant] how would you talk of the waiting time?

[User] prolonged

[Assistant] ok. On average, how many hours would a patient have to wait?


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

[User] because of the few staff

[Assistant] how would you talk of the waiting time?

[User] prolonged

[Assistant] ok. On average, how many hours would a patient have to wait?

[User] sometimes even more than 2 hours

[Assistant] more than 2 hours? Ok. So as a health worker, what motivates you?


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

[User] sometimes even more than 2 hours

[Assistant] more than 2 hours? Ok. So as a health worker, what motivates you?

[User] first of all, being a health worker is my motivation, I’m not a health worker by chance I’m a health worker by choice...

[Assistant] ok

[User] and I love to be what I am. And if I have treated you, when you are badly off and tomorrow, I see you cured, I get motivated

[Assistant] other than that, what makes you carry on?


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

[User] first of all, being a health worker is my motivation, I’m not a health worker by chance I’m a health worker by choice...

[Assistant] ok

[User] and I love to be what I am. And if I have treated you, when you are badly off and tomorrow, I see you cured, I get motivated

[Assistant] other than that, what makes you carry on?

[User] ahh...the finances we talk about is just a source or a means to motivation, because I would want to come to the hospital, I’m a health worker I live, my home is about 5km away I would want to a place where I do offer my services and I feel happy about it, but coming from my home to the health facility requires resources, requires money therefore, the money should be given to me by the facility, but what do we receive? What we receive is not sufficient, although you have been hearing that there is some increment. But the increment of salaries that usually occur also has challenges, because by the time salaries were increased, even the prices of everything shot up so, everything is balanced again, you see that? Everything is balanced again if fuel was at 2500, by the time they are increasing the salary, it has now gone to 4000 actually 4300 now if I was using a fuel from my home to this place, I would put in fuel of like 10000 and 10000 or 15000 would take me for like 3 days but now I’m using 30 see that? So, it has balanced everything

[Assistant] so, there is actually no increment...


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

[User] ahh...the finances we talk about is just a source or a means to motivation, because I would want to come to the hospital, I’m a health worker I live, my home is about 5km away I would want to a place where I do offer my services and I feel happy about it, but coming from my home to the health facility requires resources, requires money therefore, the money should be given to me by the facility, but what do we receive? What we receive is not sufficient, although you have been hearing that there is some increment. But the increment of salaries that usually occur also has challenges, because by the time salaries were increased, even the prices of everything shot up so, everything is balanced again, you see that? Everything is balanced again if fuel was at 2500, by the time they are increasing the salary, it has now gone to 4000 actually 4300 now if I was using a fuel from my home to this place, I would put in fuel of like 10000 and 10000 or 15000 would take me for like 3 days but now I’m using 30 see that? So, it has balanced everything

[Assistant] so, there is actually no increment...

[User] there is no increment, there is no increment that is how iam looking at it there is no increment. Meat by then, meat was 8000, by the time salaries increased, now it is 10 and 12

[Assistant] laughs,

[User] its 10 and 12

[Assistant] laughs... did they decide to increase their prices because your salaries were raised?


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

[User] that’s when, that’s when the element of volunteers taking over office, you see a volunteer, the real person supposed to do the work requests the volunteer , please am still moving out, handle my patients, then the volunteer will do the reverse of what is expected. You see that?

[Assistant] yeah

[User] but if what was given to the civil servant was fairly good, they could cover the basics of the civil servant, then people would have more time at their places of work and then offer their services.

[Assistant] true

[User] you are lucky you are not in civil service...laughs

[Assistant] laughs... but I will soon join


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

[User] you are lucky you are not in civil service...laughs

[Assistant] laughs... but I will soon join

[User] please come... there is advert

[Assistant] ok

[User] they posted yesterday

[Assistant] ok. What about medication, do you think we have enough medication like benzathine, heart failure drugs and diagnostics in the hospital?


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

[User] they posted yesterday

[Assistant] ok. What about medication, do you think we have enough medication like benzathine, heart failure drugs and diagnostics in the hospital?

[User] many times, they are out of stock, many times they are out of stock

[Assistant] ok

[User] they will say very little was brought

[Assistant] so most of the time they are out of stock?


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

[User] many times, they are out of stock, many times they are out of stock

[Assistant] ok

[User] they will say very little was brought

[Assistant] so most of the time they are out of stock?

[User] most times they are out of stock

[Assistant] ok. Then why is it so, why is it always out of stock? Is it because the budget is small?


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

[User] I think the pharmacist would answer some of those,

[Assistant] ok

[User] I may not be in position, but sometimes when you ask them, others will say, you know, we order for the drugs but what is brought is not our order, we had ordered for this, look at the order book, we ordered for this but what is brought was this, so we go by what has been brought

[Assistant] ok

[User] I think they know the reason why some of those happen the way it is happening

[Assistant] what of the records system, do you think it is doing well?


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

[User] I think they know the reason why some of those happen the way it is happening

[Assistant] what of the records system, do you think it is doing well?

[User] hmm... records, yes, record have greatly improved, they have greatly improved, both out patient records and in-patient records

[Assistant] ok

[User] HMIS has greatly improved

[Assistant] ok so, what have they done well?


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

[User] HMIS has greatly improved

[Assistant] ok so, what have they done well?

[User] in the first place, record officers are many, they are many, and because they are so many, their quality of service is improved

[Assistant] ok

[User] they do their work with little stress, and because they do their work with little stress, they offer quality services

[Assistant] ok. That’s nice. Then what do you think they haven’t done well?


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

[User] what they haven’t done well, the records officers? The record people?

[Assistant] yes

[User]
maybe weekend coverage is an issue, weekend coverage is a big issue

because sometimes you would find the stores, I mean the records non-functional over the weekends, if they could only improve on that it would be so fine,

[Assistant] ok

[User] and many times, shortages of forms can also deter their activities, ok it is not their making it could be institutional

[Assistant] ok. If I went to their offices, would I get like registers for acute rheumatic fever or RHD patients?


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

[User] and many times, shortages of forms can also deter their activities, ok it is not their making it could be institutional

[Assistant] ok. If I went to their offices, would I get like registers for acute rheumatic fever or RHD patients?

[User] that is not their problem that is not their problem that is the same thing iam complaining about sexual gender-based violence ah... some diseases are grouped under others. I have not checked the register yet, but there are many diseases that are grouped under others and then you know others are never specific so, you may want to see a specific disease and they say ...ah... that one is under others, and the others will be so many I was giving an example of sexual gender-based violence, they would just call it domestic violence but we have rape, we have defilement, physical injuries, so we would want those categories spelt out. So, the same way, maybe, I said I haven’t checked the register yet,

[Assistant] ok

[User] maybe you will find rheumatic heart disease also put under others

[Assistant] under others... so actually you won’t be able to quantify the total number of patients seen here with rheumatic heart disease


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

[User] that is not their problem that is not their problem that is the same thing iam complaining about sexual gender-based violence ah... some diseases are grouped under others. I have not checked the register yet, but there are many diseases that are grouped under others and then you know others are never specific so, you may want to see a specific disease and they say ...ah... that one is under others, and the others will be so many I was giving an example of sexual gender-based violence, they would just call it domestic violence but we have rape, we have defilement, physical injuries, so we would want those categories spelt out. So, the same way, maybe, I said I haven’t checked the register yet,

[Assistant] ok

[User] maybe you will find rheumatic heart disease also put under others

[Assistant] under others... so actually you won’t be able to quantify the total number of patients seen here with rheumatic heart disease

[User] yes

[Assistant] ok. What about guidelines and protocols on rheumatic heart disease, do they exist in the hospital?


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

[User] maybe you will find rheumatic heart disease also put under others

[Assistant] under others... so actually you won’t be able to quantify the total number of patients seen here with rheumatic heart disease

[User] yes

[Assistant] ok. What about guidelines and protocols on rheumatic heart disease, do they exist in the hospital?

[User] I haven’t seen any

[Assistant] you haven’t seen any? Wow. We have had so much about local systems and health systems and all that. But now let’s look at perception of patient outcomes. Generally, do you think that these RHD patients are getting the care that they need? Especially surgery?


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

[User] yes

[Assistant] ok. What about guidelines and protocols on rheumatic heart disease, do they exist in the hospital?

[User] I haven’t seen any

[Assistant] you haven’t seen any? Wow. We have had so much about local systems and health systems and all that. But now let’s look at perception of patient outcomes. Generally, do you think that these RHD patients are getting the care that they need? Especially surgery?

[User] no

[Assistant] why do you think so?


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

[User] no

[Assistant] why do you think so?

[User] of course, when there is surgery you would think of referral to Mulago, heart institute and referral to Mulago heart institute has so many things attached, one, you would need maybe transport...

[Assistant] ok

[User] and transport from the hospital may require fuel which may not be available then 2, the upkeep on the other side will also require money, so in many cases if a patient is having a serious heart disease, RHD, and you think the patient may benefit from services outside a place like lira hospital they go back home, they condemn the patient, the patient is supposed to go to Mulago, we don’t have the resources, what do we do? Back home

[Assistant] that is really sad. Are you aware of any patient safety and quality of care concerns?


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

[User] of course, when there is surgery you would think of referral to Mulago, heart institute and referral to Mulago heart institute has so many things attached, one, you would need maybe transport...

[Assistant] ok

[User] and transport from the hospital may require fuel which may not be available then 2, the upkeep on the other side will also require money, so in many cases if a patient is having a serious heart disease, RHD, and you think the patient may benefit from services outside a place like lira hospital they go back home, they condemn the patient, the patient is supposed to go to Mulago, we don’t have the resources, what do we do? Back home

[Assistant] that is really sad. Are you aware of any patient safety and quality of care concerns?

[User] pardon

[Assistant] patient safety and quality of care concerns?


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

[User] and transport from the hospital may require fuel which may not be available then 2, the upkeep on the other side will also require money, so in many cases if a patient is having a serious heart disease, RHD, and you think the patient may benefit from services outside a place like lira hospital they go back home, they condemn the patient, the patient is supposed to go to Mulago, we don’t have the resources, what do we do? Back home

[Assistant] that is really sad. Are you aware of any patient safety and quality of care concerns?

[User] pardon

[Assistant] patient safety and quality of care concerns?

[User] yes, yes, I’m aware

[Assistant] ... like which ones?


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

[User] one they have right to information, we must give them correct information, they have right to correct treatment and we are supposed to offer the proper treatment that they are supposed to, that they demand and it is our responsibility ...

[Assistant] ok

[User] ...when we are in this health facility to fulfill all those and others, there are a number of things entailing the rights of patients

[Assistant] ok

[User] which is documented in the patient charter, I think we have it in this hospital, patient charters are there

[Assistant] ok, so, do you think we are following them?


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

[User] which is documented in the patient charter, I think we have it in this hospital, patient charters are there

[Assistant] ok, so, do you think we are following them?

[User] I ... yes, some areas, yes, some areas has challenges

[Assistant] ok

[User] and the challenges, others are man-made, others institutional, others national issues see that?

[Assistant] ok. Do you think we have preventable deaths occurring in the hospital?


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

[User] I ... yes, some areas, yes, some areas has challenges

[Assistant] ok

[User] and the challenges, others are man-made, others institutional, others national issues see that?

[Assistant] ok. Do you think we have preventable deaths occurring in the hospital?

[User] yes

[Assistant] like which ones?


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

[User] and the challenges, others are man-made, others institutional, others national issues see that?

[Assistant] ok. Do you think we have preventable deaths occurring in the hospital?

[User] yes

[Assistant] like which ones?

[User] maternal death

[Assistant] aha what do you think would be causing such?


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

[User] yes

[Assistant] like which ones?

[User] maternal death

[Assistant] aha what do you think would be causing such?

[User] late reporting

[Assistant] by the staff?