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

[User] Let's leave that.

[Assistant] How about funding in health care, is it working for you as you are doing your work as a health worker?

[User] It's working for me on side but not much for the patients.

[Assistant] Okay. Explain more.

[User] Maybe we get funding but maybe we may not be knowing because I see we don’t get most of the things we need. You find that one who has a BP machine moves with it; it's personalized. That means it's his and the health center doesn't have any.

[Assistant] So when you request what happens?


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

[User] It's working for me on side but not much for the patients.

[Assistant] Okay. Explain more.

[User] Maybe we get funding but maybe we may not be knowing because I see we don’t get most of the things we need. You find that one who has a BP machine moves with it; it's personalized. That means it's his and the health center doesn't have any.

[Assistant] So when you request what happens?

[User] Of course they keep on promising we shall get.

[Assistant] So what do you do when you get a hypertensive patient or people whom you need to check with that machine? In such instances how do you handle?


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

[User] Maybe we get funding but maybe we may not be knowing because I see we don’t get most of the things we need. You find that one who has a BP machine moves with it; it's personalized. That means it's his and the health center doesn't have any.

[Assistant] So when you request what happens?

[User] Of course they keep on promising we shall get.

[Assistant] So what do you do when you get a hypertensive patient or people whom you need to check with that machine? In such instances how do you handle?

[User] But we always have our own equipments.

[Assistant] So you move with your own BP machine.


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

[User] Of course they keep on promising we shall get.

[Assistant] So what do you do when you get a hypertensive patient or people whom you need to check with that machine? In such instances how do you handle?

[User] But we always have our own equipments.

[Assistant] So you move with your own BP machine.

[User] [laughs] and when I am not around they won't take any blood pressure and I cannot leave it behind.

[Assistant] Umm, when you look at the number of health workers, how are they here? Are they working in number?


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

[User] But we always have our own equipments.

[Assistant] So you move with your own BP machine.

[User] [laughs] and when I am not around they won't take any blood pressure and I cannot leave it behind.

[Assistant] Umm, when you look at the number of health workers, how are they here? Are they working in number?

[User] We have a number of health care providers but I can say to an extent they are not enough. You know they may be enough but they don't want to provide services.

[Assistant] So how are the numbers of patients here?


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

[User] [laughs] and when I am not around they won't take any blood pressure and I cannot leave it behind.

[Assistant] Umm, when you look at the number of health workers, how are they here? Are they working in number?

[User] We have a number of health care providers but I can say to an extent they are not enough. You know they may be enough but they don't want to provide services.

[Assistant] So how are the numbers of patients here?

[User] For the patients they know the time when we get drugs and when they are out of stock. When they know we have drugs they come in big numbers. Like in this season, we have a big number of patients not like the previous months.

[Assistant] They get to know there are drugs?


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

[User] We have a number of health care providers but I can say to an extent they are not enough. You know they may be enough but they don't want to provide services.

[Assistant] So how are the numbers of patients here?

[User] For the patients they know the time when we get drugs and when they are out of stock. When they know we have drugs they come in big numbers. Like in this season, we have a big number of patients not like the previous months.

[Assistant] They get to know there are drugs?

[User] Yes, that's when they come.

[Assistant] And then if you look at the qualifications of the health workers here are they working for you or there are Cadres where you feel like they need to be boosted.


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

[User] For the patients they know the time when we get drugs and when they are out of stock. When they know we have drugs they come in big numbers. Like in this season, we have a big number of patients not like the previous months.

[Assistant] They get to know there are drugs?

[User] Yes, that's when they come.

[Assistant] And then if you look at the qualifications of the health workers here are they working for you or there are Cadres where you feel like they need to be boosted.

[User] So things of Cadres, as you have seen we have doctors, nursing officers, clinical officers but you find a doctor doesn't work and it's the nursing assistant who works meaning those cardiac patients have to be attended by a clinical officer or a doctor or nursing officer but when you find a nursing officer attending to cardiac patients, that means doctors and clinical officers don't know what they are supposed to be doing.

[Assistant] When you look at the medicine you said you usually have stock outs. You don’t have most of the medicine.


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

[User] Yes, that's when they come.

[Assistant] And then if you look at the qualifications of the health workers here are they working for you or there are Cadres where you feel like they need to be boosted.

[User] So things of Cadres, as you have seen we have doctors, nursing officers, clinical officers but you find a doctor doesn't work and it's the nursing assistant who works meaning those cardiac patients have to be attended by a clinical officer or a doctor or nursing officer but when you find a nursing officer attending to cardiac patients, that means doctors and clinical officers don't know what they are supposed to be doing.

[Assistant] When you look at the medicine you said you usually have stock outs. You don’t have most of the medicine.

[User] Yes.

[Assistant] And for the heart medicine you don't have any. Is that what you are saying? Okay let me mention some; do you have some of the heart failure drugs here in your health center? Have you seen any?


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

[User] So things of Cadres, as you have seen we have doctors, nursing officers, clinical officers but you find a doctor doesn't work and it's the nursing assistant who works meaning those cardiac patients have to be attended by a clinical officer or a doctor or nursing officer but when you find a nursing officer attending to cardiac patients, that means doctors and clinical officers don't know what they are supposed to be doing.

[Assistant] When you look at the medicine you said you usually have stock outs. You don’t have most of the medicine.

[User] Yes.

[Assistant] And for the heart medicine you don't have any. Is that what you are saying? Okay let me mention some; do you have some of the heart failure drugs here in your health center? Have you seen any?

[User] Am not sure.

[Assistant] How about the BPG?


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

[User] Yes.

[Assistant] And for the heart medicine you don't have any. Is that what you are saying? Okay let me mention some; do you have some of the heart failure drugs here in your health center? Have you seen any?

[User] Am not sure.

[Assistant] How about the BPG?

[User] Am not sure.

[Assistant] Do you have Anti coagulation drugs in stock here?


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

[User] Am not sure.

[Assistant] How about the BPG?

[User] Am not sure.

[Assistant] Do you have Anti coagulation drugs in stock here?

[User] May be.

[Assistant] Maybe? Have you seen any?


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

[User] Am not sure.

[Assistant] Do you have Anti coagulation drugs in stock here?

[User] May be.

[Assistant] Maybe? Have you seen any?

[User] But I can't tell because I haven't seen any.

[Assistant] Okay. And how about diagnostics, tell me about them. How are they in this Buwambo health center? Are they working for you?


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

[User] May be.

[Assistant] Maybe? Have you seen any?

[User] But I can't tell because I haven't seen any.

[Assistant] Okay. And how about diagnostics, tell me about them. How are they in this Buwambo health center? Are they working for you?

[User] The?

[Assistant] The diagnostics. For instance, do you have echo-cardiography here?


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

[User] But I can't tell because I haven't seen any.

[Assistant] Okay. And how about diagnostics, tell me about them. How are they in this Buwambo health center? Are they working for you?

[User] The?

[Assistant] The diagnostics. For instance, do you have echo-cardiography here?

[User] No we don't have.

[Assistant] And where is the nearest health center to get one?


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

[User] The?

[Assistant] The diagnostics. For instance, do you have echo-cardiography here?

[User] No we don't have.

[Assistant] And where is the nearest health center to get one?

[User] Maybe in town or Bombo.

[Assistant] Okay. So let's look at the record keeping system and the health information flow here. Is it working here?


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

[User] No we don't have.

[Assistant] And where is the nearest health center to get one?

[User] Maybe in town or Bombo.

[Assistant] Okay. So let's look at the record keeping system and the health information flow here. Is it working here?

[User]
As in what?

Let's look at how you keep records in case you need to look up a patient who has come in for follow up. Is it easy to access the file if you want to know who worked on that person?

On my side it's working very well in the HAART clinic but this side I don't think it’s flowing very well.

[Assistant] How can we improve the way information flows between you?


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

[User] Maybe in town or Bombo.

[Assistant] Okay. So let's look at the record keeping system and the health information flow here. Is it working here?

[User]
As in what?

Let's look at how you keep records in case you need to look up a patient who has come in for follow up. Is it easy to access the file if you want to know who worked on that person?

On my side it's working very well in the HAART clinic but this side I don't think it’s flowing very well.

[Assistant] How can we improve the way information flows between you?

[User] Maybe installing a system where we can track all those patients.

[Assistant] What kind of system?


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

[User]
As in what?

Let's look at how you keep records in case you need to look up a patient who has come in for follow up. Is it easy to access the file if you want to know who worked on that person?

On my side it's working very well in the HAART clinic but this side I don't think it’s flowing very well.

[Assistant] How can we improve the way information flows between you?

[User] Maybe installing a system where we can track all those patients.

[Assistant] What kind of system?

[User] It can computerized.

[Assistant] Have you had any RF patients? Patients who come with acute rheumatic failure?


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

[User] Maybe installing a system where we can track all those patients.

[Assistant] What kind of system?

[User] It can computerized.

[Assistant] Have you had any RF patients? Patients who come with acute rheumatic failure?

[User] I haven’t had any.

[Assistant] So you don't have any kind of registers for those kind of patients.


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

[User] It can computerized.

[Assistant] Have you had any RF patients? Patients who come with acute rheumatic failure?

[User] I haven’t had any.

[Assistant] So you don't have any kind of registers for those kind of patients.

[User] No. I know we don't have any registers.

[Assistant] Have you looked at any guidelines for RHD management?


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

[User] I haven’t had any.

[Assistant] So you don't have any kind of registers for those kind of patients.

[User] No. I know we don't have any registers.

[Assistant] Have you looked at any guidelines for RHD management?

[User] No.

[Assistant] Okay. Have you ever attended any CME on heart disease or RHD?


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

[User] No. I know we don't have any registers.

[Assistant] Have you looked at any guidelines for RHD management?

[User] No.

[Assistant] Okay. Have you ever attended any CME on heart disease or RHD?

[User] I have never attended any CME.

[Assistant] Do you hold CMEs here?


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

[User] No.

[Assistant] Okay. Have you ever attended any CME on heart disease or RHD?

[User] I have never attended any CME.

[Assistant] Do you hold CMEs here?

[User] We have.

[Assistant] How many? How often?


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

[User] I have never attended any CME.

[Assistant] Do you hold CMEs here?

[User] We have.

[Assistant] How many? How often?

[User] We always have. Of course for CMEs it always depends on staff cooperation; when you call someone to come and have a CME they say, "are you paying me? If you're not paying me, then I am not coming”. Because some people are not cooperative so we can’t have a CME of 2 or 3 people. With two people you can have it but of course it's better if you are more than 3.

[Assistant] Okay how often do you hold them?


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

[User] We have.

[Assistant] How many? How often?

[User] We always have. Of course for CMEs it always depends on staff cooperation; when you call someone to come and have a CME they say, "are you paying me? If you're not paying me, then I am not coming”. Because some people are not cooperative so we can’t have a CME of 2 or 3 people. With two people you can have it but of course it's better if you are more than 3.

[Assistant] Okay how often do you hold them?

[User] We always have CMEs twice a month.

[Assistant] And then could you be knowing a referral path for RHD patients; that this is where you take them. Do you know any of those facilities?


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

[User] We always have. Of course for CMEs it always depends on staff cooperation; when you call someone to come and have a CME they say, "are you paying me? If you're not paying me, then I am not coming”. Because some people are not cooperative so we can’t have a CME of 2 or 3 people. With two people you can have it but of course it's better if you are more than 3.

[Assistant] Okay how often do you hold them?

[User] We always have CMEs twice a month.

[Assistant] And then could you be knowing a referral path for RHD patients; that this is where you take them. Do you know any of those facilities?

[User] Am not very sure.

[Assistant] So among the things we've have mentioned administration, funding, health records system, guidelines what has worked for you? What has motivated you to do your work? What do you think is working for you in Buwambo?


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

[User] We always have CMEs twice a month.

[Assistant] And then could you be knowing a referral path for RHD patients; that this is where you take them. Do you know any of those facilities?

[User] Am not very sure.

[Assistant] So among the things we've have mentioned administration, funding, health records system, guidelines what has worked for you? What has motivated you to do your work? What do you think is working for you in Buwambo?

[User] Okay funding, administration, record keeping; actually everything is down.

[Assistant] Nothing has worked for you! Okay, and then let's look at the perception of patient outcome. Generally do you think these patients like the RHD patients get the care they need here?


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

[User] Am not very sure.

[Assistant] So among the things we've have mentioned administration, funding, health records system, guidelines what has worked for you? What has motivated you to do your work? What do you think is working for you in Buwambo?

[User] Okay funding, administration, record keeping; actually everything is down.

[Assistant] Nothing has worked for you! Okay, and then let's look at the perception of patient outcome. Generally do you think these patients like the RHD patients get the care they need here?

[User] For those who find positive health care providers, they get the care.

[Assistant] Okay. And can your health center handle surgeries for RHD patients?


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

[User] Okay funding, administration, record keeping; actually everything is down.

[Assistant] Nothing has worked for you! Okay, and then let's look at the perception of patient outcome. Generally do you think these patients like the RHD patients get the care they need here?

[User] For those who find positive health care providers, they get the care.

[Assistant] Okay. And can your health center handle surgeries for RHD patients?

[User] Maybe you ask the doctor.

[Assistant] Okay. Do you have anyone who can handle such cases?


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

[User] For those who find positive health care providers, they get the care.

[Assistant] Okay. And can your health center handle surgeries for RHD patients?

[User] Maybe you ask the doctor.

[Assistant] Okay. Do you have anyone who can handle such cases?

[User] I don't think.

[Assistant] You don't think?


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

[User] Maybe you ask the doctor.

[Assistant] Okay. Do you have anyone who can handle such cases?

[User] I don't think.

[Assistant] You don't think?

[User] Yes.

[Assistant] Okay. When you look at your patients and their safety; is it put into consideration when you are working on them here in Buwambo?


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

[User] I don't think.

[Assistant] You don't think?

[User] Yes.

[Assistant] Okay. When you look at your patients and their safety; is it put into consideration when you are working on them here in Buwambo?

[User] Safety?

[Assistant] Yes, for patients.


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

[User] Yes.

[Assistant] Okay. When you look at your patients and their safety; is it put into consideration when you are working on them here in Buwambo?

[User] Safety?

[Assistant] Yes, for patients.

[User] Usually that's the first thing but in Buwambo I don't think it's considered. Somewhere somehow it's not considered.

[Assistant] Why do you think so?


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

[User] Safety?

[Assistant] Yes, for patients.

[User] Usually that's the first thing but in Buwambo I don't think it's considered. Somewhere somehow it's not considered.

[Assistant] Why do you think so?

[User] This is a center where you find the VHTs prescribing in the absence of staffs. So you can never know that they might prescribe a dangerous drug. So anything can happen.

[Assistant] Why does it happen? What makes that happen?


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

[User] Usually that's the first thing but in Buwambo I don't think it's considered. Somewhere somehow it's not considered.

[Assistant] Why do you think so?

[User] This is a center where you find the VHTs prescribing in the absence of staffs. So you can never know that they might prescribe a dangerous drug. So anything can happen.

[Assistant] Why does it happen? What makes that happen?

[User] I can't say that we don't have qualified staff because we have qualified staff, but people don't know how to perform their roles or when to perform their duties.

[Assistant] When you look at the quality of care being given to your patients here how is it?


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

[User] This is a center where you find the VHTs prescribing in the absence of staffs. So you can never know that they might prescribe a dangerous drug. So anything can happen.

[Assistant] Why does it happen? What makes that happen?

[User] I can't say that we don't have qualified staff because we have qualified staff, but people don't know how to perform their roles or when to perform their duties.

[Assistant] When you look at the quality of care being given to your patients here how is it?

[User] I think it's at 50

[Assistant] What’s stopping it from being 100%? Where are the gaps?


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

[User] I can't say that we don't have qualified staff because we have qualified staff, but people don't know how to perform their roles or when to perform their duties.

[Assistant] When you look at the quality of care being given to your patients here how is it?

[User] I think it's at 50

[Assistant] What’s stopping it from being 100%? Where are the gaps?

[User] Those people will prescribe a drug, the patient goes to the register but doesn’t have drugs that means the chain is not complete. Some come to the laboratory but from there they are not seen by the medical staff.

[Assistant] Okay, anything else?


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

[User] I think it's at 50

[Assistant] What’s stopping it from being 100%? Where are the gaps?

[User] Those people will prescribe a drug, the patient goes to the register but doesn’t have drugs that means the chain is not complete. Some come to the laboratory but from there they are not seen by the medical staff.

[Assistant] Okay, anything else?

[User] no

[Assistant] Okay, have you seen any preventable death which occurred but wouldn't have occurred? You know there are those deaths that happen and you are like um no.


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

[User] no

[Assistant] Okay, have you seen any preventable death which occurred but wouldn't have occurred? You know there are those deaths that happen and you are like um no.

[User] It might have happened?

[Assistant] Yes.

[User] For The time I’ve been here I've seen only death that was at theater.

[Assistant] Where do you think went wrong?


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

[User] It might have happened?

[Assistant] Yes.

[User] For The time I’ve been here I've seen only death that was at theater.

[Assistant] Where do you think went wrong?

[User] There I wont go deep.

[Assistant] I had to do with what? You don't have to mention people's names but what could have happened to her?


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

[User] For The time I’ve been here I've seen only death that was at theater.

[Assistant] Where do you think went wrong?

[User] There I wont go deep.

[Assistant] I had to do with what? You don't have to mention people's names but what could have happened to her?

[User] Let's leave that.

[Assistant] We Leave that?


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

[User] There I wont go deep.

[Assistant] I had to do with what? You don't have to mention people's names but what could have happened to her?

[User] Let's leave that.

[Assistant] We Leave that?

[User] yes.

[Assistant] . Do you think patients are dying in the community without presenting to hospital for care?


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

[User] yes.

[Assistant] . Do you think patients are dying in the community without presenting to hospital for care?

[User] Of course.

[Assistant] Why?

[User] There are far away from the basic health care settings or they don't know what they are supposed to be doing.

[Assistant] They don't know what they are supposed to be doing, in what ways?


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

[User] Of course.

[Assistant] Why?

[User] There are far away from the basic health care settings or they don't know what they are supposed to be doing.

[Assistant] They don't know what they are supposed to be doing, in what ways?

[User] In that when you are sick you have to go to the hospital where you can get help.

[Assistant] Which other reason? Why are they dying? Apart from distance and not knowing.


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

[User] There are far away from the basic health care settings or they don't know what they are supposed to be doing.

[Assistant] They don't know what they are supposed to be doing, in what ways?

[User] In that when you are sick you have to go to the hospital where you can get help.

[Assistant] Which other reason? Why are they dying? Apart from distance and not knowing.

[User] (silence)

[Assistant] Okay. So in your opinion which are the two most important things Ministry of health should do to improve patient outcomes? Let's begin from general patients then we will narrow it down to RHD patients.


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

[User] In that when you are sick you have to go to the hospital where you can get help.

[Assistant] Which other reason? Why are they dying? Apart from distance and not knowing.

[User] (silence)

[Assistant] Okay. So in your opinion which are the two most important things Ministry of health should do to improve patient outcomes? Let's begin from general patients then we will narrow it down to RHD patients.

[User] Ministry of health! What I know they are funding but they don't follow the accountability for their funds. That's what they are supposed to do so that such a health care unit cannot lack even a thermometer and yet we are getting a lot of funds.

[Assistant] So accountability needs to be improved.


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

[User] (silence)

[Assistant] Okay. So in your opinion which are the two most important things Ministry of health should do to improve patient outcomes? Let's begin from general patients then we will narrow it down to RHD patients.

[User] Ministry of health! What I know they are funding but they don't follow the accountability for their funds. That's what they are supposed to do so that such a health care unit cannot lack even a thermometer and yet we are getting a lot of funds.

[Assistant] So accountability needs to be improved.

[User] Yes.

[Assistant] Okay anything else?


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

[User] Ministry of health! What I know they are funding but they don't follow the accountability for their funds. That's what they are supposed to do so that such a health care unit cannot lack even a thermometer and yet we are getting a lot of funds.

[Assistant] So accountability needs to be improved.

[User] Yes.

[Assistant] Okay anything else?

[User] And regional supervision for health workers.

[Assistant] What can be done for our RHD patients?


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

[User] Yes.

[Assistant] Okay anything else?

[User] And regional supervision for health workers.

[Assistant] What can be done for our RHD patients?

[User] Firstly by recruiting qualified staffs for future conditions.

[Assistant] Okay. Anything else before we finish? Okay. Thank you so much for your time and contribution towards this study, we shall your ideas to provide better services to RHD patients.


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

[User] I am 38 years old

[Assistant] okay, what are your qualifications and where did you train

[User] I trained in school of clinical officers, I came out in 2005, I have been working in hospital based care, mainly hospital based care, clinical work, along the way of course, I did another diploma in health administration, I did another one in HIV management, added on a bachelors, added on another bachelors in HIV management and a bachelors with Mild May recently but that is not clinical, project planning and management, certificates along the way, quite a number of them, in administrative law, health administration and other areas, during that time, that is about 14years, of hospital based clinical care, I have been seeing, inpatients and out patients cases, quite a number of them, out patients cases being between 30-60 patients a day, on the wards of course those are inpatients care, that is following up the management of patients that have been admitted in more severe cases or diseases and discharged as they improve, this has been mainly facility based care, but rolling out also to outreach programs where we have been seeing, following up cases, case identification, supervision of policy implementation and various activities, and as well of course also subscribed to me by my superiors

[Assistant] okay, so how long have you been working at the regional referral here?

[User] I have been here since 2010

[Assistant] okay, so those are nine years?


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

[User] I trained in school of clinical officers, I came out in 2005, I have been working in hospital based care, mainly hospital based care, clinical work, along the way of course, I did another diploma in health administration, I did another one in HIV management, added on a bachelors, added on another bachelors in HIV management and a bachelors with Mild May recently but that is not clinical, project planning and management, certificates along the way, quite a number of them, in administrative law, health administration and other areas, during that time, that is about 14years, of hospital based clinical care, I have been seeing, inpatients and out patients cases, quite a number of them, out patients cases being between 30-60 patients a day, on the wards of course those are inpatients care, that is following up the management of patients that have been admitted in more severe cases or diseases and discharged as they improve, this has been mainly facility based care, but rolling out also to outreach programs where we have been seeing, following up cases, case identification, supervision of policy implementation and various activities, and as well of course also subscribed to me by my superiors

[Assistant] okay, so how long have you been working at the regional referral here?

[User] I have been here since 2010

[Assistant] okay, so those are nine years?

[User] yah nine years.

[Assistant] okay, so you talked about the patients you see, you talked about the numbers you see 30 to 60 patients, how about their age, which age do you see specifically and what are the common illnesses you see in these patients?


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

[User] yah, aah repeat that, I am really not so sure

[Assistant] are you aware of the link between a sore throat and rheumatic heart disease?

[User] I believe a sore throat is one of the main signs of someone having a streptococcal B infection and of course one of the signs of streptococcal B infection is sore throat, but from the sore throat, it’s also one of the clinical diagnostic manifestations we use to know that this person could be having acute rheumatic fever or not.

[Assistant] and what were you taught can be done to prevent RHD

[User] RHD, of course for starters, prevention is better than cure, the first thing would be prompt treatment of any cough, or sore throat with penicillin, basically that is it. Prompt treatment but even then increasing the awareness of the communities on diseases like rheumatic heart disease and rheumatic fever.

[Assistant] so what were you taught are the treatment options of rheumatic heart disease?


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[User] No, he had been in school the previous term but this term, he had studied for a week or two and came down with an attack on this febrile illness.

[Assistant] okay, kindly summarise for me signs and the symptoms he had, you had talked of the sore throat, how did he present when you received him?

[User] actually he presented as a case of recurrent joint pains and tonsillar hypertrophy and as I took my history I noted from the parents that he had recurrent episodes of oral pharyngitis manifesting as a sore throat, pain on swallowing and hyper salivation, these episodes were associated with fevers, being a child it had been difficult for him to talk about the joint pains, so the mother, when she found out the joint pains she was being keen and another time she really found out when she was telling him to walk and run faster and he was saying he had some pains which she could not allocate at that time, so it was basically presentation of recurrent tonsillitis.

[Assistant] so are these our patients generally aware of the link between sore throat, rheumatic fever and rheumatic heart disease?

[User] definitely not, at that time when they come in the diagnosis sense of; because when the patient is brought, usually a child is brought by the mother, the awareness is on the connection of co-currency, either co-currency or precision, a mother will tell you that this child first developed a fever, had sore throat around the same time and cough with flue and later got joint pains, but sometimes between this time and a few months later when they manifest with a heart symptoms, the mother might not easily correlate, so the correlation a mother or patient says is just by a fact of how some symptoms follow each other or how some symptoms are related to each other but not as part of the diagnosis that this fever, is rheumatic heart fever or rheumatic heart disease in that sense.

[Assistant] okay, so do you think these patients are good at follow up and adherence, you have talked about giving them penicillin for this disease, so what do you comment about the follow up visits and adherence to the drugs?


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[User] in relation to...

[Assistant] to providing care

[User] yes, yes it does

[Assistant] okay, explain for me because we are looking at the local health system barriers so we are starting with the administration at the hospital, is this piece working for you, you said yes, how is it enabling you to give the care that you are giving or how is it a barrier to the care that you are giving patients at the hospital?

[User] it is two forward because I would say yes and no, administration leadership it is a yes because one, we as staffs in this institution we are working and some of the things that we need are provided, we have furniture, we have lighting, we have a reporting mechanism, we have a good referral system internally, our lab is up but there are some system challenges especially one regarding the responsiveness of the administration or the leadership to certain gaps when they are reported so it would be a yes and no, administration and leadership with in the hospital has provided facility and the instruments that we need, the challenge is that this is not consistent when it comes to the drug side and the lab side

[Assistant] okay, so how about the funding for health care in general and rheumatic heart disease in particular, is the funding working for you?


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[User] and we need to be specific, I wish I had the Uganda clinical guideline here because it’s the one I used, but if I have my UCG or my table and I met a patient who I thought had a rheumatic heart disease or acute rheumatic fever and I read through those guidelines on my table, I believe they would help me a lot in helping my patient, two after the decision is taken to help these patients according to the Uganda clinical guidelines, I would start to meet challenges, one when I order for a test let’s say an aso titer , a CBC and Echo or any other of these tests and the patient cannot afford to pay for either of the tests, at a later stage, the patient might not be able to afford the treatment if we don’t have that treatment available at a tertially stage the patient might not be able to come back for follow up on a day that was subscribe either to see a specialist or referral or to be reviewed, so the system challenges begin to come up at a practical side but not from the theoretical side of the protocol and guidelines.

[Assistant] so in other wards you are saying that the guidelines are working for you but the diagnostics are not working for you

[User] but the diagnostics are not working

[Assistant] okay, the health information system and the records you said they are 50, 50.

[User] I cannot say 50, 50. I know these are things where it’s a black or white position, if data is meant to be useful, it should be full data, complete data consistently generated, consistently assimilated and analysed for it to be of any use, so I cannot say 50, 50. I would say our data is not complete, our data is porous, our data is not well assimilated and analysed, and our data is not collected on time so data is not working for me

[Assistant] so it’s not working for you, and for medications, BPG anti-coagulation drugs, anti failure drugs, you said they are working for you?


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[User] but the diagnostics are not working

[Assistant] okay, the health information system and the records you said they are 50, 50.

[User] I cannot say 50, 50. I know these are things where it’s a black or white position, if data is meant to be useful, it should be full data, complete data consistently generated, consistently assimilated and analysed for it to be of any use, so I cannot say 50, 50. I would say our data is not complete, our data is porous, our data is not well assimilated and analysed, and our data is not collected on time so data is not working for me

[Assistant] so it’s not working for you, and for medications, BPG anti-coagulation drugs, anti failure drugs, you said they are working for you?

[User] some

[Assistant] you would give it 50?


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

[User] I cannot say 50, 50. I know these are things where it’s a black or white position, if data is meant to be useful, it should be full data, complete data consistently generated, consistently assimilated and analysed for it to be of any use, so I cannot say 50, 50. I would say our data is not complete, our data is porous, our data is not well assimilated and analysed, and our data is not collected on time so data is not working for me

[Assistant] so it’s not working for you, and for medications, BPG anti-coagulation drugs, anti failure drugs, you said they are working for you?

[User] some

[Assistant] you would give it 50?

[User] that question is relative on whether I am comfortable with the drugs as prescribed in theory, that one I am but availability no

[Assistant] so it’s working for you


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

[User] some

[Assistant] you would give it 50?

[User] that question is relative on whether I am comfortable with the drugs as prescribed in theory, that one I am but availability no

[Assistant] so it’s working for you

[User] some are working for me, some of the drugs are working for me but the challenge is I don’t have consistent refresher on the category of drugs that are written there, what we call the anti-coagulants.

[Assistant] and the funding in general of the health care system, it is working or it’s not working?


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

[User] that question is relative on whether I am comfortable with the drugs as prescribed in theory, that one I am but availability no

[Assistant] so it’s working for you

[User] some are working for me, some of the drugs are working for me but the challenge is I don’t have consistent refresher on the category of drugs that are written there, what we call the anti-coagulants.

[Assistant] and the funding in general of the health care system, it is working or it’s not working?

[User] it works at a basic level, at a basic level where provision of basic services are provided, at a higher level, that falls short

[Assistant] so you give it a yes or no?


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

[User] some are working for me, some of the drugs are working for me but the challenge is I don’t have consistent refresher on the category of drugs that are written there, what we call the anti-coagulants.

[Assistant] and the funding in general of the health care system, it is working or it’s not working?

[User] it works at a basic level, at a basic level where provision of basic services are provided, at a higher level, that falls short

[Assistant] so you give it a yes or no?

[User] I cannot give it a yes or a no because I have told you at a basic level, provision of health care at a basic level, the staffing but when you begin to go into specialized care the health service delivery falls short

[Assistant] and the administration you said that one is working


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

[User] it works at a basic level, at a basic level where provision of basic services are provided, at a higher level, that falls short

[Assistant] so you give it a yes or no?

[User] I cannot give it a yes or a no because I have told you at a basic level, provision of health care at a basic level, the staffing but when you begin to go into specialized care the health service delivery falls short

[Assistant] and the administration you said that one is working

[User] the administration is too forward, the administration is working but there are also some leadership challenges but I would still say the administration and leadership within the hospital is okay

[Assistant] so let us go to the last batch of the questions, the perception of patient outcome generally do you think these patients get the care they need, clearly we are talking about RHD patients, especially surgery, and do you think they get the care they need?


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

[User] I cannot give it a yes or a no because I have told you at a basic level, provision of health care at a basic level, the staffing but when you begin to go into specialized care the health service delivery falls short

[Assistant] and the administration you said that one is working

[User] the administration is too forward, the administration is working but there are also some leadership challenges but I would still say the administration and leadership within the hospital is okay

[Assistant] so let us go to the last batch of the questions, the perception of patient outcome generally do you think these patients get the care they need, clearly we are talking about RHD patients, especially surgery, and do you think they get the care they need?

[User] our patients get the initial treatment, but when it comes to surgery, our patients do not get the care totally but a very small percentage, I can’t quote anything but in subjectively I can say under five percent can afford the surgery in this area, can afford the surgery required for management of rheumatic heart disease.

[Assistant] and let us look at the patient’s safety, do you think there are any patient’s safety and quality of care concerns for example have you heard preventable deaths in the hospital, have you seen a death occurring and you are like for sure this shouldn’t have happened?


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

[User] our patients get the initial treatment, but when it comes to surgery, our patients do not get the care totally but a very small percentage, I can’t quote anything but in subjectively I can say under five percent can afford the surgery in this area, can afford the surgery required for management of rheumatic heart disease.

[Assistant] and let us look at the patient’s safety, do you think there are any patient’s safety and quality of care concerns for example have you heard preventable deaths in the hospital, have you seen a death occurring and you are like for sure this shouldn’t have happened?

[User] okay, in relation to rheumatic heart disease or in general?

[Assistant] in general

[User] no, I saw one maybe, I saw one, the patient had severe hypoglycaemia in diabetes and well these are factors that are out of the hospitals control because this is a person who gave themselves an injection with insulin, forgot to eat and taken some alcohol, slept thought they would wake up, they did not and by the time they found out that the person was unconscious they were in the village, the first primary health care worker did not respond to the diagnosis that this could be hypoglycaemia, managed different things and added the quinine and referred the patient here, by the time the patient came, they were very comatose and I thought that this was a problem with diagnosis, it was a preventable death. That one, there are also others that have happened but I have not been there, neither at the emergency section or down on the wards, I cannot speculate to say something which I have not been there present, that one is one case that I saw.

[Assistant] but do you think there are many patients dying in the community without actually presenting to the hospital for care?


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

[User] no, I saw one maybe, I saw one, the patient had severe hypoglycaemia in diabetes and well these are factors that are out of the hospitals control because this is a person who gave themselves an injection with insulin, forgot to eat and taken some alcohol, slept thought they would wake up, they did not and by the time they found out that the person was unconscious they were in the village, the first primary health care worker did not respond to the diagnosis that this could be hypoglycaemia, managed different things and added the quinine and referred the patient here, by the time the patient came, they were very comatose and I thought that this was a problem with diagnosis, it was a preventable death. That one, there are also others that have happened but I have not been there, neither at the emergency section or down on the wards, I cannot speculate to say something which I have not been there present, that one is one case that I saw.

[Assistant] but do you think there are many patients dying in the community without actually presenting to the hospital for care?

[User] in regard to rheumatic heart disease or in general?

[Assistant] generally

[User] definitely yes

[Assistant] why do you think so?


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

[User] in regard to rheumatic heart disease or in general?

[Assistant] generally

[User] definitely yes

[Assistant] why do you think so?

[User] it has always been a barrier of ignorance, lack of knowledge, poor access to health care, poor health seeking behaviour, and financial incapacity, if we become more specific and go to either obstetric care, paediatric care, then that's where I will be more specific

[Assistant] okay, so as we wind up now, in your own opinion, are there one or two most important things you think ministry of health can do to actually improve the outcomes of our patients?


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

[User] it has always been a barrier of ignorance, lack of knowledge, poor access to health care, poor health seeking behaviour, and financial incapacity, if we become more specific and go to either obstetric care, paediatric care, then that's where I will be more specific

[Assistant] okay, so as we wind up now, in your own opinion, are there one or two most important things you think ministry of health can do to actually improve the outcomes of our patients?

[User] if it is regarding rheumatic heart disease, I think the ministry of health needs to secure funding internally, but it will secure funding after prioritizing and ruling out a basic treatment care package for rheumatic heart disease nationwide, this care package should include, one, an Aso titer, the ability to have echo to probably attaching a CBC test and then ensuring that basic treatment for rheumatic heart disease is available. If this is going to be very expensive, some facilities have these on a private basis, it will become easier for the ministry of health to ensure that all facilities have prioritized RHD by creating a department for management of rheumatic heart disease or acute rheumatic fever in their institutions. Having a department also increases the ability for sensitization and awareness job creation among the communities, rolling out other facility based and community based facilities, I think that is the one biggest thing, prioritizing through policy formulation by the ministry, prioritizing the need to create a rheumatic heart disease department within the ministry and then following all the system tyre downwards and it is then these departments that will prioritize how and when tests can be done and then health workers will be trained and refresher courses done how and when patients can be sensitized and referred through a system that would help patients get managed better and faster.

[Assistant] any other?

[User] that's the main one, because once this one is there, then the political need will come up. Of course it will secure secondary funding and the other but it still starts with prioritization

[Assistant] do you think you have any other thing you want to comment about before we close?


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

[User] Yea. MM and so a group of residents including John Gloster and Virginia Major, those are the two people who are still around, uh and a number of others got together and decided that there had to be…that something had to be done so that there would be, so that there would be somewhere in War 8 where people could buy fresh fruits and vegetables.

[Assistant] Yea

[User] So they created the market and initially they couldn’t get any farmers to come and so they would go to the Wholesale produce market on Florida Avenue and they would buy a bunch of stuff and they would just set up tables and volunteers would run it.

[Assistant] Yea

[User] Um. I mean after a couple years after doing that they started getting farmers…within a hundred miles, and that’s still the policy. Everything has to be produced within one hundred miles.

[Assistant] Are you guys, are you producer only, what do your regular farmers…what regular farmers does the market take? Do you do like value-added products?


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

[User] Um. I mean after a couple years after doing that they started getting farmers…within a hundred miles, and that’s still the policy. Everything has to be produced within one hundred miles.

[Assistant] Are you guys, are you producer only, what do your regular farmers…what regular farmers does the market take? Do you do like value-added products?

[User] Yea, it’s pretty open. Traditionally it’s just been fruits, vegetables, sometimes meat, sometimes eggs if we can get it. And then prepared food, sometimes barbeque, sometimes a fish fry. Um, things like that. This year we had a woman that did like organic, vegetarian, snacks.

[Assistant] Yea, sweet.

[User] And then in the past we’ve had people who’ve sold plants. Uh… we’ve had people selling soaps and cosmetics and stuff like that. And then crafts that are locally made.

[Assistant] Sweet, that’s great.


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[User] Um. To the market kind of grew slowly over the years, starting in 2005 or six they had enough funding for a paid market manager.

[Assistant] Okay

[User] At least part time, seasonally. But, because it was part time and season and the funding was always year to year it was hard to uh attract and retain really good people for that position.

[Assistant] Of course

[User] And mostly, mostly it remained a volunteer driven organization.

[Assistant] And is it still that way now?


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[User] Yea, yea,. So I was out of a job last winter, and I ended up writing some grants and we ended up getting one from the DC Department of small and local business development – uh the healthy food retail program. And that created a uh thirty hour a week position from March until September of 2016. And I resigned from the Board and they hired me to uh… rather I applied for the position, and then I resigned from the board so that I could accept it. And as part of that funding we also initialed a school garden program

[Assistant] Cool

[User] At Martin Luther King Elementary. The market has moved a few times, the new, new, location is at Martin Luther King Elementary School.

[Assistant] Okay

[User] So we partnered with them. For the first like ten years of the market, from 1998-2008 it was in the Old Congress Heights School. And then when they started to renovate… I mean that building was vacant from the ’70s until about 2009, when they finally got around to renovating that building the market had to move. At first it moved to Greater South East Hospital, and then it moved to the THEARC for three years…on Mississippi.

[Assistant] I do (laughs)


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

[User] At Martin Luther King Elementary. The market has moved a few times, the new, new, location is at Martin Luther King Elementary School.

[Assistant] Okay

[User] So we partnered with them. For the first like ten years of the market, from 1998-2008 it was in the Old Congress Heights School. And then when they started to renovate… I mean that building was vacant from the ’70s until about 2009, when they finally got around to renovating that building the market had to move. At first it moved to Greater South East Hospital, and then it moved to the THEARC for three years…on Mississippi.

[Assistant] I do (laughs)

[User] Good

[Assistant] THEARC I especially know, yea.


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

[User] So we partnered with them. For the first like ten years of the market, from 1998-2008 it was in the Old Congress Heights School. And then when they started to renovate… I mean that building was vacant from the ’70s until about 2009, when they finally got around to renovating that building the market had to move. At first it moved to Greater South East Hospital, and then it moved to the THEARC for three years…on Mississippi.

[Assistant] I do (laughs)

[User] Good

[Assistant] THEARC I especially know, yea.

[User] Uh and then we got kicked out of THEARC because they were expanding that building. Also they…they had had for a while a youth garden there – Urban Farm – but around the same time they were starting to build a new building they decided they wanted to have their own farm stand CSA. And so they kicked us out and we were in 2015, in 2015 we were in Saint Elizabeth’s gateway pavilion. And now we’re at the school.

[Assistant] Well it’s good that you continue to find space. That can be a challenge.


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

[User] Good

[Assistant] THEARC I especially know, yea.

[User] Uh and then we got kicked out of THEARC because they were expanding that building. Also they…they had had for a while a youth garden there – Urban Farm – but around the same time they were starting to build a new building they decided they wanted to have their own farm stand CSA. And so they kicked us out and we were in 2015, in 2015 we were in Saint Elizabeth’s gateway pavilion. And now we’re at the school.

[Assistant] Well it’s good that you continue to find space. That can be a challenge.

[User] And we realized that we had a problem. With THEARC where those facilities are very nice um but they…a lot of people that visit them are not from the community and people who live here perceive those facilities as like existing for other people. And so they don’t, there were basically all these people living from across the street from THEARC and we were always leafletting those apartments and stuff but very few of those people came to the market.

[Assistant] Yea, because those were institutions like for the…


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

[User] And we realized that we had a problem. With THEARC where those facilities are very nice um but they…a lot of people that visit them are not from the community and people who live here perceive those facilities as like existing for other people. And so they don’t, there were basically all these people living from across the street from THEARC and we were always leafletting those apartments and stuff but very few of those people came to the market.

[Assistant] Yea, because those were institutions like for the…

[User] Yea, they, we. People told us when we asked them, “we don’t really feel like that’s for us.”

[Assistant] Yea

[User] So we hope to overcome that by being at the school in a place that’s totally accessible, there’s no fence, there’s no security, there’s no gate. People pass through there all the time.

[Assistant] And people’s kids go there probably.


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

[User] Yea, they, we. People told us when we asked them, “we don’t really feel like that’s for us.”

[Assistant] Yea

[User] So we hope to overcome that by being at the school in a place that’s totally accessible, there’s no fence, there’s no security, there’s no gate. People pass through there all the time.

[Assistant] And people’s kids go there probably.

[User] Mhm.

[Assistant] Makes sense. Okay, cool, so can I ask you some of these questions I have?


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

[User] So we hope to overcome that by being at the school in a place that’s totally accessible, there’s no fence, there’s no security, there’s no gate. People pass through there all the time.

[Assistant] And people’s kids go there probably.

[User] Mhm.

[Assistant] Makes sense. Okay, cool, so can I ask you some of these questions I have?

[User] Sure

[Assistant] You kinda hit on some of this so uh I’ll try my best not to be repetitive but, if you had to pair down on the mission of Ward 8 Farmers Market what would you say?


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

[User] Mhm.

[Assistant] Makes sense. Okay, cool, so can I ask you some of these questions I have?

[User] Sure

[Assistant] You kinda hit on some of this so uh I’ll try my best not to be repetitive but, if you had to pair down on the mission of Ward 8 Farmers Market what would you say?

[User] Sorry I missed that, can you repeat it?

[Assistant] Yea. If you had to pair down the mission of Ward 8 Farmers Market?


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

[User] And we do that by making local… locally grown, sustainable food accessible and affordable. And we also promote healthy living and community and environmental sustainability mainly through popular education.

[Assistant] Cool.

[User] On topics of nutrition, cooking, gardening

[Assistant] Yea

[User] Environmental sustainability

[Assistant] Sweet. So um do you have, I guess you’ve talked a little bit about your personal role and history with these topics. Does this mission like specifically resonate with you for a reason? Is there a specific tie you have to this mission? … [pause] Or like what does that mean to you? How do you carry that out?


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

[User] and uh yea I’ve always been really concerned about social and racial justice and really like… when I decided to move over here a lot of people kind of warned me that it wouldn’t be safe, and also because … and this part is true … there’s a lack of amenities. And this part’s true. If I want to go to… if there’s an emergency I have to go across town to go to a reputable hospital.

[Assistant] Yea

[User] I can go to the one here but you wait for hours and you still might not see anyone. This has happened to me. And to my friends.

[Assistant] Sure.

[User] Um. And you know we don’t have bars, we don’t have restaurants, we don’t have many places even to buy uh… good food. So that, that’s the mission.

[Assistant] I think it’s incredibly cool that you uh. Live in the community you’re working in. I think that’s extremely important.


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

[User] Um. And you know we don’t have bars, we don’t have restaurants, we don’t have many places even to buy uh… good food. So that, that’s the mission.

[Assistant] I think it’s incredibly cool that you uh. Live in the community you’re working in. I think that’s extremely important.

[User] Yea. And also the fact that it’s not something that I started it was started a long time before I got here. And when I got here it was still going but it needed…

[Assistant] A person?

[User] They were kind of tired

[Assistant] Sure, burnout happens


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

[User] Yea. And also the fact that it’s not something that I started it was started a long time before I got here. And when I got here it was still going but it needed…

[Assistant] A person?

[User] They were kind of tired

[Assistant] Sure, burnout happens

[User] Uh and so.. right… it needed new people and new energy.

[Assistant] I’m glad you’re bringing that. So how do you think the market effects the specific financial security of the farmers in that 100 mile radius you have?


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

[User] Yea. Um. We um…last year we brought on board a new farm, which we’re never proud of. It’s Licking Creek Bend Farm.

[Assistant] Yea, I know them

[User] Uh yea a lot of people know them because they were one of the founders of the Adam’s Morgan farmers market in the ‘70s. You know, they’ve been doing this long before it was trendy or fashionable. They’ve, and, throughout that time they’ve had a specific commitment to bringing their food to underserved community. Adams Morgan is not underserved so much anymore, and so they, you know they decided that it was time to be east of the river.

[Assistant] Cool

[User] Um. You know and they’re awesome because of their experience and their track record and because they’re certified naturally grown, they are really good at communicating. You know every week before market they would send a list of exactly what they would be offering with explanations for some of them.

[Assistant] That’s so rare; that’s great


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

[User] Uh yea a lot of people know them because they were one of the founders of the Adam’s Morgan farmers market in the ‘70s. You know, they’ve been doing this long before it was trendy or fashionable. They’ve, and, throughout that time they’ve had a specific commitment to bringing their food to underserved community. Adams Morgan is not underserved so much anymore, and so they, you know they decided that it was time to be east of the river.

[Assistant] Cool

[User] Um. You know and they’re awesome because of their experience and their track record and because they’re certified naturally grown, they are really good at communicating. You know every week before market they would send a list of exactly what they would be offering with explanations for some of them.

[Assistant] That’s so rare; that’s great

[User] And they’re like we’re gonna have these different varieties of heirloom apples which has notes of whatever. And then in May they have a community day where they invite, you know, community members and customers and vendors. And a couple of us went that last year.

[Assistant] So this isn’t a relationship just at like the market itself it transcends beyond that. It seems to be a true partnership where you’re, ya know, involved beyond


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

[User] Um. You know and they’re awesome because of their experience and their track record and because they’re certified naturally grown, they are really good at communicating. You know every week before market they would send a list of exactly what they would be offering with explanations for some of them.

[Assistant] That’s so rare; that’s great

[User] And they’re like we’re gonna have these different varieties of heirloom apples which has notes of whatever. And then in May they have a community day where they invite, you know, community members and customers and vendors. And a couple of us went that last year.

[Assistant] So this isn’t a relationship just at like the market itself it transcends beyond that. It seems to be a true partnership where you’re, ya know, involved beyond

[User] And we had another farmer who signed on with us in April. But then, it’s just a small family operation in Virginia – northern neck – so when things happened, they didn’t really explain to us what it was, when June came around they didn’t have any vegetables that were ready to sell and they dropped out.

[Assistant] That’s very hard


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

[User] And they’re like we’re gonna have these different varieties of heirloom apples which has notes of whatever. And then in May they have a community day where they invite, you know, community members and customers and vendors. And a couple of us went that last year.

[Assistant] So this isn’t a relationship just at like the market itself it transcends beyond that. It seems to be a true partnership where you’re, ya know, involved beyond

[User] And we had another farmer who signed on with us in April. But then, it’s just a small family operation in Virginia – northern neck – so when things happened, they didn’t really explain to us what it was, when June came around they didn’t have any vegetables that were ready to sell and they dropped out.

[Assistant] That’s very hard

[User] Yes it was very different for us

[Assistant] Because you’re relying on that. Um, okay, yea, cool.


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

[User] And we had another farmer who signed on with us in April. But then, it’s just a small family operation in Virginia – northern neck – so when things happened, they didn’t really explain to us what it was, when June came around they didn’t have any vegetables that were ready to sell and they dropped out.

[Assistant] That’s very hard

[User] Yes it was very different for us

[Assistant] Because you’re relying on that. Um, okay, yea, cool.

[User] So we ended up basically with one farmer, um, we had a bunch of others that were interested in vending with us. A bunch of them had the same problem, which was that they only had one truck – and the one person to drive the truck from Virginia to DC – you know and it wouldn’t be hard for me to find a Ward 8 resident who would man your stand for you. But that wasn’t actually the problem.

[Assistant] But if they had to take the time to drive the truck.


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

[User] Yes it was very different for us

[Assistant] Because you’re relying on that. Um, okay, yea, cool.

[User] So we ended up basically with one farmer, um, we had a bunch of others that were interested in vending with us. A bunch of them had the same problem, which was that they only had one truck – and the one person to drive the truck from Virginia to DC – you know and it wouldn’t be hard for me to find a Ward 8 resident who would man your stand for you. But that wasn’t actually the problem.

[Assistant] But if they had to take the time to drive the truck.

[User] And that basically has to be someone that lives on the farm. I’m not in the position to find someone and they apparently couldn’t find anyone either. Um. So. Yea.

[Assistant] Um okay so one of the focuses of my thesis is matching program like Produce Plus. So you do distribute produce plus right? Do you match too or no?


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

[User] So we ended up basically with one farmer, um, we had a bunch of others that were interested in vending with us. A bunch of them had the same problem, which was that they only had one truck – and the one person to drive the truck from Virginia to DC – you know and it wouldn’t be hard for me to find a Ward 8 resident who would man your stand for you. But that wasn’t actually the problem.

[Assistant] But if they had to take the time to drive the truck.

[User] And that basically has to be someone that lives on the farm. I’m not in the position to find someone and they apparently couldn’t find anyone either. Um. So. Yea.

[Assistant] Um okay so one of the focuses of my thesis is matching program like Produce Plus. So you do distribute produce plus right? Do you match too or no?

[User] Last year we did. In years past we have but this year we didn’t have funding for it

[Assistant] Yea, sure. So how do perceive that implementing produce plus expecially in a low income community affects – do you think it affects the outcomes of the farmers, like the amount that theyre able to sell, um, what do you see there?


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

[User] And that basically has to be someone that lives on the farm. I’m not in the position to find someone and they apparently couldn’t find anyone either. Um. So. Yea.

[Assistant] Um okay so one of the focuses of my thesis is matching program like Produce Plus. So you do distribute produce plus right? Do you match too or no?

[User] Last year we did. In years past we have but this year we didn’t have funding for it

[Assistant] Yea, sure. So how do perceive that implementing produce plus expecially in a low income community affects – do you think it affects the outcomes of the farmers, like the amount that theyre able to sell, um, what do you see there?

[User] I wasn’t really… I wasn’t too involved in the years before produce plus. I can tell you that in 2016 Produce Plus accounted for about 55 or 60 percent of our sales. So yea it’s huge. Without it we probably wouldn’t have had a market. Which is interesting because of course in past years we didn’t have it and we didn’t have a market. So I wonder a little bit about that… and you know Produce Plus ended at the end of, what, um

[Assistant] Late November right?


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

[User] I wasn’t really… I wasn’t too involved in the years before produce plus. I can tell you that in 2016 Produce Plus accounted for about 55 or 60 percent of our sales. So yea it’s huge. Without it we probably wouldn’t have had a market. Which is interesting because of course in past years we didn’t have it and we didn’t have a market. So I wonder a little bit about that… and you know Produce Plus ended at the end of, what, um

[Assistant] Late November right?

[User] No we stopped receiving them at the end of August

[Assistant] Oh really?

[User] Yea and we, and we stopped being able to distribute them after that and our sales tanked. And I think they tanked at a lot of markets. And so…obviously it increases what people are able to get, what they can afford, but I wonder if it doesn’t inadvertently make people less likely to spend their SNAP and their cash.

[Assistant] I wonder too.


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

[User] No we stopped receiving them at the end of August

[Assistant] Oh really?

[User] Yea and we, and we stopped being able to distribute them after that and our sales tanked. And I think they tanked at a lot of markets. And so…obviously it increases what people are able to get, what they can afford, but I wonder if it doesn’t inadvertently make people less likely to spend their SNAP and their cash.

[Assistant] I wonder too.

[User] I think people are like “I don’t need to use my SNAP and WIC I can use Produce Plus” but then, it’s ten dollars you know, and then do they spend more than ten dollars? Do they just keep it to that?

[Assistant] Yea, have you noticed, if someone is coming to market and is using like a Produce Plus voucher to pay do they also do a SNAP transaction?


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

[User] Yea and we, and we stopped being able to distribute them after that and our sales tanked. And I think they tanked at a lot of markets. And so…obviously it increases what people are able to get, what they can afford, but I wonder if it doesn’t inadvertently make people less likely to spend their SNAP and their cash.

[Assistant] I wonder too.

[User] I think people are like “I don’t need to use my SNAP and WIC I can use Produce Plus” but then, it’s ten dollars you know, and then do they spend more than ten dollars? Do they just keep it to that?

[Assistant] Yea, have you noticed, if someone is coming to market and is using like a Produce Plus voucher to pay do they also do a SNAP transaction?

[User] Um I would say our SNAP sales for the season seemed very low. Um we had more WIC than SNAP. And..

[Assistant] Do you think that’s a reaction?


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

[User] I think people are like “I don’t need to use my SNAP and WIC I can use Produce Plus” but then, it’s ten dollars you know, and then do they spend more than ten dollars? Do they just keep it to that?

[Assistant] Yea, have you noticed, if someone is coming to market and is using like a Produce Plus voucher to pay do they also do a SNAP transaction?

[User] Um I would say our SNAP sales for the season seemed very low. Um we had more WIC than SNAP. And..

[Assistant] Do you think that’s a reaction?

[User] I’m sure some economist has studied the psychology of if something is free versus if you have to pay for it. Under certain circumstances maybe you are less willing to pay. And you know we had some vendors that were not selling produce, we had someone selling aloe vera juice, we had people selling fragrances…they cant accept produce plus. And they didn’t see a huge impact. So ideally. The ten dollars of free produce would bring people in and they would spend their SNAP too if they have other money.

[Assistant] Okay. Sorry some of this you’ve already hit on. Um. Are there any specific challenges you’ve noticed for those vendors who can accept the vouchers? The administrative aspect of it?


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

[User] Um I would say our SNAP sales for the season seemed very low. Um we had more WIC than SNAP. And..

[Assistant] Do you think that’s a reaction?

[User] I’m sure some economist has studied the psychology of if something is free versus if you have to pay for it. Under certain circumstances maybe you are less willing to pay. And you know we had some vendors that were not selling produce, we had someone selling aloe vera juice, we had people selling fragrances…they cant accept produce plus. And they didn’t see a huge impact. So ideally. The ten dollars of free produce would bring people in and they would spend their SNAP too if they have other money.

[Assistant] Okay. Sorry some of this you’ve already hit on. Um. Are there any specific challenges you’ve noticed for those vendors who can accept the vouchers? The administrative aspect of it?

[User] I mean I think Licking Bend was really good at that. The problem we had this past year was that everything had to be done on the tablet and there was only one tablet so I don’t know I’m hoping that next year they provide a second tablet. There were times when we had enough volunteers and we could have had, you know, two people running tablets and two people writing checks. So I’m hoping…that for those markets that are distributing a lot, like ours, that they will provide more. Or else find some way to kind of streamline the steps you have to go through. Because it was really slow.

[Assistant] And for licking creek, do you think the lack of challenges they faced is drawing on that expertise you were speaking to working with these programs for so long?


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

[User] I’m sure some economist has studied the psychology of if something is free versus if you have to pay for it. Under certain circumstances maybe you are less willing to pay. And you know we had some vendors that were not selling produce, we had someone selling aloe vera juice, we had people selling fragrances…they cant accept produce plus. And they didn’t see a huge impact. So ideally. The ten dollars of free produce would bring people in and they would spend their SNAP too if they have other money.

[Assistant] Okay. Sorry some of this you’ve already hit on. Um. Are there any specific challenges you’ve noticed for those vendors who can accept the vouchers? The administrative aspect of it?

[User] I mean I think Licking Bend was really good at that. The problem we had this past year was that everything had to be done on the tablet and there was only one tablet so I don’t know I’m hoping that next year they provide a second tablet. There were times when we had enough volunteers and we could have had, you know, two people running tablets and two people writing checks. So I’m hoping…that for those markets that are distributing a lot, like ours, that they will provide more. Or else find some way to kind of streamline the steps you have to go through. Because it was really slow.

[Assistant] And for licking creek, do you think the lack of challenges they faced is drawing on that expertise you were speaking to working with these programs for so long?

[User] Yea, we… I think one of the things that scared off some of the other farmers we were trying to work with is that some of them hadn’t vended in DC before so Produce Plus was news to them and I was like “you’re getting free money,” but they were intimidated by it

[Assistant] That’s fair. So I want to shift a little bit from talking about farmers to talking about the people who are actually using these programs. So how do think Produce Plus at Ward 8’s farmers’ markets effects the food security of customers participating in the program?


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

[User] I mean I think Licking Bend was really good at that. The problem we had this past year was that everything had to be done on the tablet and there was only one tablet so I don’t know I’m hoping that next year they provide a second tablet. There were times when we had enough volunteers and we could have had, you know, two people running tablets and two people writing checks. So I’m hoping…that for those markets that are distributing a lot, like ours, that they will provide more. Or else find some way to kind of streamline the steps you have to go through. Because it was really slow.

[Assistant] And for licking creek, do you think the lack of challenges they faced is drawing on that expertise you were speaking to working with these programs for so long?

[User] Yea, we… I think one of the things that scared off some of the other farmers we were trying to work with is that some of them hadn’t vended in DC before so Produce Plus was news to them and I was like “you’re getting free money,” but they were intimidated by it

[Assistant] That’s fair. So I want to shift a little bit from talking about farmers to talking about the people who are actually using these programs. So how do think Produce Plus at Ward 8’s farmers’ markets effects the food security of customers participating in the program?

[User] Uh I don’t really have the hard data to back it up

[Assistant] Sure, I’m not asking for it


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

[User] Yea, we… I think one of the things that scared off some of the other farmers we were trying to work with is that some of them hadn’t vended in DC before so Produce Plus was news to them and I was like “you’re getting free money,” but they were intimidated by it

[Assistant] That’s fair. So I want to shift a little bit from talking about farmers to talking about the people who are actually using these programs. So how do think Produce Plus at Ward 8’s farmers’ markets effects the food security of customers participating in the program?

[User] Uh I don’t really have the hard data to back it up

[Assistant] Sure, I’m not asking for it

[User] I know, you know, certainly we have a lot of customers who come every single week. Most of them are women, many of them are seniors, people on the nord side of 50, and you know, anecdotally there are specific people I know of who are…who come to the market every week, and when the market’s not open they go to the store and eat stuff that’s not as good.

[Assistant] Um and what about that effect as it specifically relates to your location here in Ward 8? Let me think about this… I think that is probably true everywhere. When markets are out of season people will go to grocery stores instead, where the food isn’t great. Why is it especially important that you’re doing this work here?


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

[User] Uh I don’t really have the hard data to back it up

[Assistant] Sure, I’m not asking for it

[User] I know, you know, certainly we have a lot of customers who come every single week. Most of them are women, many of them are seniors, people on the nord side of 50, and you know, anecdotally there are specific people I know of who are…who come to the market every week, and when the market’s not open they go to the store and eat stuff that’s not as good.

[Assistant] Um and what about that effect as it specifically relates to your location here in Ward 8? Let me think about this… I think that is probably true everywhere. When markets are out of season people will go to grocery stores instead, where the food isn’t great. Why is it especially important that you’re doing this work here?

[User] I think our customers are more price sensitive. And this actually sometimes presents a challenge because we have to make the case to people that the produce we have is better than what’s in the grocery store and worth paying a little bit more for. Sometimes, it’s not always more, but sometimes. Um. You know, I think in more affluent areas local or organic produce is sort of a lifestyle choice, and for people here it’s much more a practical concern. It’s “do you have it, do you not have it, and how much is it going to cost?” You know and then there are obviously things that people are used to eating and know how to cook and then there are things people are not familiar with.

[Assistant] Like okra. Um do you have, similarly to how we talked about Licking Creek, a specific memory with a customer expressing the impact of the market to you for them? Or with a customer in relation to these incentives and the impact that’s had on them? [long pause]


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

[User] I know, you know, certainly we have a lot of customers who come every single week. Most of them are women, many of them are seniors, people on the nord side of 50, and you know, anecdotally there are specific people I know of who are…who come to the market every week, and when the market’s not open they go to the store and eat stuff that’s not as good.

[Assistant] Um and what about that effect as it specifically relates to your location here in Ward 8? Let me think about this… I think that is probably true everywhere. When markets are out of season people will go to grocery stores instead, where the food isn’t great. Why is it especially important that you’re doing this work here?

[User] I think our customers are more price sensitive. And this actually sometimes presents a challenge because we have to make the case to people that the produce we have is better than what’s in the grocery store and worth paying a little bit more for. Sometimes, it’s not always more, but sometimes. Um. You know, I think in more affluent areas local or organic produce is sort of a lifestyle choice, and for people here it’s much more a practical concern. It’s “do you have it, do you not have it, and how much is it going to cost?” You know and then there are obviously things that people are used to eating and know how to cook and then there are things people are not familiar with.

[Assistant] Like okra. Um do you have, similarly to how we talked about Licking Creek, a specific memory with a customer expressing the impact of the market to you for them? Or with a customer in relation to these incentives and the impact that’s had on them? [long pause]

[User] I don’t know, I’m drawing a blank right now.

[Assistant] Yea I mean it’s okay to say no if you don’t have one


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

[User] I think our customers are more price sensitive. And this actually sometimes presents a challenge because we have to make the case to people that the produce we have is better than what’s in the grocery store and worth paying a little bit more for. Sometimes, it’s not always more, but sometimes. Um. You know, I think in more affluent areas local or organic produce is sort of a lifestyle choice, and for people here it’s much more a practical concern. It’s “do you have it, do you not have it, and how much is it going to cost?” You know and then there are obviously things that people are used to eating and know how to cook and then there are things people are not familiar with.

[Assistant] Like okra. Um do you have, similarly to how we talked about Licking Creek, a specific memory with a customer expressing the impact of the market to you for them? Or with a customer in relation to these incentives and the impact that’s had on them? [long pause]

[User] I don’t know, I’m drawing a blank right now.

[Assistant] Yea I mean it’s okay to say no if you don’t have one

[User] I do I just cant remember right now.

[Assistant] Okay, well if you think of anything later in relation to any of these questions you can email me and I’ll make sure they’re included. On just like a regular day at market what do interactions with customers receiving vouchers look like?


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

[User] I don’t know, I’m drawing a blank right now.

[Assistant] Yea I mean it’s okay to say no if you don’t have one

[User] I do I just cant remember right now.

[Assistant] Okay, well if you think of anything later in relation to any of these questions you can email me and I’ll make sure they’re included. On just like a regular day at market what do interactions with customers receiving vouchers look like?

[User] Well there’s a line. And when you get to the front of the line you usually hand your ID to one person and your card to another, and the person you give your card to will scan the card on the tablet and go through all of that and the other person would take the name from the ID and copy the name onto the checks. Um. And then uh we give them their checks and sometimes we give them their ID and remind them they have to sign it before they give it to the vendor, we thank them for coming, and tell them to enjoy their vegetables

[Assistant] So it sounds a little bit like, like a business transaction, right?


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

[User] I do I just cant remember right now.

[Assistant] Okay, well if you think of anything later in relation to any of these questions you can email me and I’ll make sure they’re included. On just like a regular day at market what do interactions with customers receiving vouchers look like?

[User] Well there’s a line. And when you get to the front of the line you usually hand your ID to one person and your card to another, and the person you give your card to will scan the card on the tablet and go through all of that and the other person would take the name from the ID and copy the name onto the checks. Um. And then uh we give them their checks and sometimes we give them their ID and remind them they have to sign it before they give it to the vendor, we thank them for coming, and tell them to enjoy their vegetables

[Assistant] So it sounds a little bit like, like a business transaction, right?

[User] Yea

[Assistant] And I wonder if that’s because of the nature of being in a low income community, the line being long, and instead of being able to spend ten minutes talking with someone because they’re the only one there for the program that it manifests that way.


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

[User] Yea

[Assistant] And I wonder if that’s because of the nature of being in a low income community, the line being long, and instead of being able to spend ten minutes talking with someone because they’re the only one there for the program that it manifests that way.

[User] Yea, there’s definitely like the quality of customer service declines in relation to the volume of business.

[Assistant] Yea. Okay

[User] But we need the volume, so we’re not complaining

[Assistant] Yea, and people need food to eat. So that’s important too. Okay. I’m gonna skip pst some of these. Have you noticed any specific challenges related to incentives like Produce Plus um that customers have anticipated or expressed? Either constraints of the program that don’t work for them or challenges with how thye use them at market


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

[User] Yea, there’s definitely like the quality of customer service declines in relation to the volume of business.

[Assistant] Yea. Okay

[User] But we need the volume, so we’re not complaining

[Assistant] Yea, and people need food to eat. So that’s important too. Okay. I’m gonna skip pst some of these. Have you noticed any specific challenges related to incentives like Produce Plus um that customers have anticipated or expressed? Either constraints of the program that don’t work for them or challenges with how thye use them at market

[User] I know that at some point they put a restraint on how many markets you could go to in a week. And, um, before that we hadn’t realized it but after that we realized that a certain percentage of our people were going to multiple markets. I mean more than two. And they had to stop doing that. But I think people understood, nobody was too angry about it. You can understand why people would want to go to three or four markets, because ten dollars is not enough to feed your family for a week but forty dollars might be. If you go to four different markets. People found the whole procedure for proxy’s to be very confusing.

[Assistant] Can you explain that to me?


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

[User] But we need the volume, so we’re not complaining

[Assistant] Yea, and people need food to eat. So that’s important too. Okay. I’m gonna skip pst some of these. Have you noticed any specific challenges related to incentives like Produce Plus um that customers have anticipated or expressed? Either constraints of the program that don’t work for them or challenges with how thye use them at market

[User] I know that at some point they put a restraint on how many markets you could go to in a week. And, um, before that we hadn’t realized it but after that we realized that a certain percentage of our people were going to multiple markets. I mean more than two. And they had to stop doing that. But I think people understood, nobody was too angry about it. You can understand why people would want to go to three or four markets, because ten dollars is not enough to feed your family for a week but forty dollars might be. If you go to four different markets. People found the whole procedure for proxy’s to be very confusing.

[Assistant] Can you explain that to me?

[User] No, because its confusing. [laughs] but basically if you – you were allowed to pick up checks for someone who was not physically able to be there. You were in other words allowed to serve as their proxy. But in order to do that you had to first come to the market with them the first time. And you had to show your ID and they had to show their ID and there was something in the app where you had to indicate that that person was the proxy. And we ended up doing it not the way it was supposed to be done because the way it was supposed to be done was confusing. And you know some people would come with three cards, and “one of these is mine, one of these is my daughter, and one of them is my husband” but they wouldn’t know which one was which. So we would scan them but we would mix up the check numbers with the names, things like that.

[Assistant] And it sounds like you had a pretty good base of volunteers to help you do that?


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

[User] No, because its confusing. [laughs] but basically if you – you were allowed to pick up checks for someone who was not physically able to be there. You were in other words allowed to serve as their proxy. But in order to do that you had to first come to the market with them the first time. And you had to show your ID and they had to show their ID and there was something in the app where you had to indicate that that person was the proxy. And we ended up doing it not the way it was supposed to be done because the way it was supposed to be done was confusing. And you know some people would come with three cards, and “one of these is mine, one of these is my daughter, and one of them is my husband” but they wouldn’t know which one was which. So we would scan them but we would mix up the check numbers with the names, things like that.

[Assistant] And it sounds like you had a pretty good base of volunteers to help you do that?

[User] Yea. Yea I mean I was there, we had a market assistant who was always there and then we usually had at least one other person who was from the Farmers’ Market Brigade, and a couple of other random volunteers that I had recruited.

[Assistant] Cool

[User] So yea it wasn’t really a problem of man-power as it was of the intricacies of the program

[Assistant] Yea the administrative


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

[User] Yea. Yea I mean I was there, we had a market assistant who was always there and then we usually had at least one other person who was from the Farmers’ Market Brigade, and a couple of other random volunteers that I had recruited.

[Assistant] Cool

[User] So yea it wasn’t really a problem of man-power as it was of the intricacies of the program

[Assistant] Yea the administrative

[User] I mean we also had, our hotspot never really worked properly so we were always trying to use the wifi from the school. Which was fine 90% of the time but them it would go down without explanation.

[Assistant] And that obviously affects the program


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

[User] So yea it wasn’t really a problem of man-power as it was of the intricacies of the program

[Assistant] Yea the administrative

[User] I mean we also had, our hotspot never really worked properly so we were always trying to use the wifi from the school. Which was fine 90% of the time but them it would go down without explanation.

[Assistant] And that obviously affects the program

[User] Yea [laughs]

[Assistant] So I guess I kind of starting noting this but as it relates to the resources you have in terms of man power, do you feel like you had the tools and the resources you needed to implement the program?


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

[User] I mean we also had, our hotspot never really worked properly so we were always trying to use the wifi from the school. Which was fine 90% of the time but them it would go down without explanation.

[Assistant] And that obviously affects the program

[User] Yea [laughs]

[Assistant] So I guess I kind of starting noting this but as it relates to the resources you have in terms of man power, do you feel like you had the tools and the resources you needed to implement the program?

[User] Yea, for the most part

[Assistant] Cool. Are there ones that would be helpful to you next time around, now that you’ve done it once? Like “This is something that I want to use more next year or invest more time in” or that was kind of a best practice that I want to keep doing