Interviewer(s): Interviewer
Interviewee(s): Respondent

Interviewer: So today is the 12th of November 2019 and we are at Mbarara Regional Referral hospital, meeting one of the health workers. Morning sister.

Respondent: morning.

Interviewer: Thank you for giving us this time.

Respondent: You are welcome.

Interviewer: Um, this is participant ID WH008. So as I had told you, this study is to determine how to provide better care for RHD and there are right or wrong answers. Express yourself and we ask you to be frank and share your opinions. The data we gather here is totally confidential and we won’t link your identity in any of your comments in the reports that we produce.

Respondent: Okay.

Interviewer: So please tell me about yourself; your age. How old are you?

Respondent: I am a nurse working at Mbarara Regional Referral hospital. I have worked here since 1984 up to today.

Interviewer: Okay, tell me your age; how old are you?

Respondent: I am 59 years old.

Interviewer: Okay, and you said you are a nurse?

Respondent: Yes.

Interviewer: Where did you train from?

Respondent: Kabale Nursing (school)?

Interviewer: Okay, which year did you finish?

Respondent: In finished in 1982.

Interviewer: 1982, so how long have you been in practice?

Respondent: Its now 37 years.

Interviewer: Wow, and how long have you been working here at regional referral hospital?

Respondent: 36 years now.

Interviewer: 36 years now! Okay.

Respondent: But we worked, and then the university took us, and then we came back. Then we were brought back.

Interviewer: Okay. So the patients you see at this hospital, tell me about them; how old are they? Which age groups?

Respondent: Age groups, in fact those with RHD ...

Interviewer: Generally.

Respondent: Generally, mostly 6 to any age.

Interviewer: Okay, and are they mostly female or male?

Respondent: Mostly females.

Interviewer: And what are the common illnesses do you see in each of the age groups?

Respondent: The young ones usually present with fevers, loss of weight, sore throat and cough which is not productive, then they get ... Usually by the time they come here, they come when they have these complications of swelling of the stomach and swelling of the legs.

Interviewer: Okay. Here you are talking specifically about RHD?

Respondent: Yes.

Interviewer: How about other illnesses?

Respondent: Mostly we have malaria, typhoid, Brucella and we have HIV patients but usually they come when they don’t know what they are suffering from and then the diagnosis is made after they have come.

Interviewer: So tell me, are these people inpatients or outpatients? What are the common diseases you see in inpatients and outpatients?

Respondent: With these outpatients, it’s always these flu, cough, fevers and even accidents for those who get them every second. Then these of malaria are diagnosed sometimes and they come with these symptoms like fevers and headaches. They come in after checking their blood. If it’s RHD, they usually come with fever, coughs, and chest complications and so on. But the inpatients who usually come with severe anemia are usually admitted. Those with complicated malaria which has been treated for so long and is not healing and they need further investigations. Then there’s this typhoid; usually those with typhoid come when they have complications and are admitted. Diabetes complications are also admitted and those with RHD are of course admitted when they come even before they are diagnosed because they come with other complications at times, they are admitted and removed from complications.

Interviewer: Any other illnesses?

Respondent: Yes. There are these TB Patients and it is rampant these days because it comes as a complication of those people who don’t take their ARVs steadily, then they leave care. So the TB is now very common.

Interviewer: Okay.

Respondent: Although we don’t admit most of them, we have them as outpatients and they are many.

Interviewer: Okay. Now tell me a little bit about your training in RHD; did you receive any training during school about RHD?

Respondent: No, they just talked of it as the liver. But then I just got training when I joined this study.

Interviewer: Okay. That was after your graduation?

Respondent: Yeah.

Interviewer: So, when was that training?

Respondent: It was 2013.

Interviewer: Where did it take place?

Respondent: It was in Seeta, Mukono.

Interviewer: By who?

Respondent: By doctor, he said he was doctor ... um, I am forgetting the name of the doctor.

Interviewer: Do you remember how qualified he was?

Respondent: Um, yes. They were three doctors form URHD and there was Doctor ..., and then Doctor ...

Interviewer: You said that is 2013?

Respondent: Yes.

Interviewer: Okay. So now, how many patents of RHD do you see per day?

Respondent: Per day I can see about 2 and monthly we usually have a general clinic. We usually share the number of those patients into two so that some are seen this month and others the next month. And on a clinic day, I see about 35 to 40 patients.

Interviewer: That’s per month?

Respondent: Yes.

Interviewer: So that means per month you see 36 to 40 patients.

Respondent: Yes.

Interviewer: Okay. Are these inpatients or?

Respondent: Outpatients.

Interviewer: Okay, now I am interested in what you were taught during that training of RHD. So what do you understand about RHD?

Respondent: RHD is a condition where someone’s heart valves don’t work well; they are usually swollen and they are caused by a virus which causes sore throats and influenza which are not well treated. These bacterial diseases which are not well treated lead to the valves of the heart, the valves swell and you find that the opening is not okay, blood does not move freely to the chambers and that’s when you find water on top.

Interviewer: Okay, what do you have left there? Anything you can tell us about RHD?

Respondent: Um

Interviewer: The cause. We are on the cause now.

Respondent: The cause is usually a bacteria.

Interviewer: Do you know that bacteria?

Respondent: I don’t know, it is ...

Interviewer: So are you aware of a link between sore throat and RHD?

Respondent: A link?

Interviewer: Yes, are those 2 related?

Respondent: Yes.

Interviewer: How? How do you relate them?

Respondent: Like I said when someone gets a sore throat caused by bacteria and it is not well-treated, the bacteria remain there and cause some clots which come and make the valves sink in. when they sink in and don’t close, they really make someone’s breathing sort of cut off, then someone will start to talk of palpitations, tiredness, not feeling okay and not being able to move uphill.

Interviewer: Okay. What were you taught can be done to prevent RHD?

Respondent: What we were taught is to usually make sure we advocate that whoever gets a sore throat should go to a medical personnel or hospital and be treated thoroughly, and finish the treatment. The on and off fevers have to be treated with a full dose so that you don’t leave some of the organisms untreated. We should make sure that when a child complains of sore throat, don’t just go to someone and say “give me Penicillin so that I go and treat;” you have to take that person to a medical personnel or doctor so that they check and see. We are always telling them that when this child has a problem of breathing, don’t just treat it in the village or go to herbalists to give some herbs. No, you bring the child to hospital and whenever they tell you “go do these investigations” do it and go back to the doctor so that the child is treated well. And for the grownups, we always tell them “when you are feeling pain in swallowing, palpitations, you have problems when sleeping at night or fail to sleep without putting pillows, go to a medical personnel; go to the hospital. Go and they do an ECG ECHO to see if your heart is really okay.

Interviewer: Okay.

Respondent: and usually when you go to a health center, you have to inform them whatever you feel and when they give you treatment and not respond, you go back and tell them so that they can treat it very well. And whenever you get treatment and you feel you have not cleared, don’t just keep quiet and say “it will go.”

Interviewer: Okay. So, any other? Any ways you were taught can prevent RHD?

Respondent: Yes, we have to teach people where to go when they have problems, and maybe if someone has approached you with such a problem, you have to make sure that person is treated. He has to come back for checkups because if one goes and doesn’t get back, it means he is a lost case. RHD doesn’t go like that and in most cases it doesn’t cure; the patient has to remain in treatment. Usually we have to explain that. When a patient is found with RHD, we tell them “with this condition, you will be okay and live with it and do whatever you want to do, and there’s also a chance of being operated, when you have money. When you are on drugs you won’t have any complications” so that these patients know their condition and that they are supposed to stay on treatment, because some of them when they feel that they are okay, they leave the treatment and disappear. The first thing we do is tell them “please, this condition doesn’t go like that; you have to keep coming back. You have to come for you revise. Maybe this condition can be operated and then you will be okay, but still you will be on drugs until the physicians or doctors tell you to stop.

Interviewer: So now am interested in what you were taught are the treatment options for RHD.

Respondent: The treatment options; usually we tell them that get an injection every month for at least the rest of your life. If you are not to be operated or if it is to be stopped, there are some...

Interviewer: Which injection is this?

Respondent: Benzathine.

Interviewer: Okay.

Respondent: And we tell them that if we are to stop the treatment, that will be the doctors’ options. But there are some who can’t get the injections. There are some who react on penicillin, those can use erythromycin and there are some who can’t even use the injection. So they can use penicillin injection for 5 days. We give penicillin and erythromycin and others that I have not mentioned.

Interviewer: Any other treatment options for RHD? Besides antibiotics?

Respondent: They are operated and they put in a new valve.

Interviewer: So what’s your understanding of the long term prognosis of RHD? What is the prognosis of those patients?

Respondent: Usually the prognosis is not all that good because some of them fail to take the treatment the way they are supposed to treat. Some of them come when they already have complications and they are taking a lot of tablets plus that injection. So you find a patient having a lot of drugs and it is somehow difficult to take, so that patient stops taking. So you find that in 2 – 3 months the patients are okay and responding but find that after a few months, they start to deteriorate and when you ask, some of them tell you “I don’t have money to buy those drugs” the captopril, Lasix ... so they get other complications. You also find drugs are many and expensive, so the patient can’t buy them. He says “I take them, when they are over, I wait.” Like now we have some injectors, they give them some drugs but at times don’t have them that makes them get poor prognosis because of irregular taking of their drugs.

Interviewer: So now you are going to tell me about your encounters with these patients; do you remember that last RHD patients you worked on? The very last one?

Respondent: The last one we registered or saw?

Interviewer: Any; it can be any. I don’t want their names, but I want you to recall their age, sex ... give me a brief summary of this person, how did they present?

Respondent: Okay. At first when he came, he was weak. He used to cough, get fevers and couldn’t move uphill. After getting treatment, he improved but that was after like 2 years. He gained weight and started working. Then there in the middle, I don’t what happened, but he told me that he had gone to the village so he couldn’t access the drugs, so he spent like 3 weeks without the drugs. When he came he had deteriorated, so I asked what happened and he said and told us “I was in the village and I couldn’t buy the drug; I had the money but couldn’t get the exact drugs.” So he came, got his drugs and became okay. Infant last Friday he was here; he is on his drugs and he can tell you that he can do anything. He can do his work and dig; he has no problem although he is waiting for surgery.

Interviewer: Is that the latest patient you saw?

Respondent: Yes.

Interviewer: That’s the 26th of last month?

Respondent: Yes. In fact this month I have not seen any.

Interviewer: How old was he?

Respondent: 43 years.

Interviewer: Is he working or not?

Respondent: He is self-employed.

Interviewer: okay. So these patients that you see, are they aware of the link between ARF, RHD and sore throat?

Respondent: Some are, but some are not, because at times, I told you some patient’s regularly tell you, “I didn’t have transport so I didn’t come” Usually the doctor tries to tell them that ... he gives them a lecture before. At least he tries every month to tell them, “if you have someone who is like this at home bring him because it can be RHD” Some pick and some don’t pick. Because you at times ask someone “have you ever had someone with this and that?” and he says “yes. ” And you ask “why didn’t you tell us and he says “me I didn’t even know that.”

Interviewer: So what sort of symptoms do they present with?

Respondent: They usually present with swelling of the body; they tell you they become tired as they walk, they lose appetite and you see someone looking small or under age.

Interviewer: And generally, do these patients come for follow up?

Respondent: Yes.

Interviewer: Do they adhere to the drugs? Tell us about the follow up chain and adherence to the drugs.

Respondent: These patients come these patients usually start when they are weak. When they are on their drugs, they come back. You find someone telling you “this time I have no problem; I can do all sorts of work, and I am at school studying. I can get what they are teaching, so I have no problem.” When someone has taken the drugs the way they are supposed to be taking it, they come back so that they check the heart and sometimes get drugs. When we have (drugs), they get and when we don’t have, they go and buy. But some of those who don’t have money, it’s a problem. You find that the adherence is poor. The drugs are here but when they get drugs and come back for review, they come back when he is okay. Then after they get the drugs, you find that there’s no food; she eats whatever she wants. So you find the patient deteriorating. In fact we have that group of the poor; their adherence is poor due to financial problems and drugs because even at times they fail to come for drugs or even buy drugs. We can also provide the drugs but we don’t have all of them. So at least those that have some money for up keep are at least okay.

Interviewer: So you have told me about the patients that don’t come back. Now I am interested in what they tell you are the reasons they don’t come back.

Respondent: The reasons are usually “we don’t have money for transport” and when they stay home, “we had no drugs so I was just there on God’s mercy.”

Interviewer: So personally, what do you think are the reasons? These are the ones they tell you, but as you, what do you think are the reasons why they don’t come back for follow up?

Respondent: Some of them are genuine reasons; they don’t have money. Some of them are just stubborn; they feel that maybe this one has been bewitched. They be like, “we should go to a witch doctor” because the patients can’t stay on the drugs throughout. Then outside you hear them telling stories, like, “You know there is this child who had a disease like this and they went to a witch doctor who cured that person.” But then you also hear another person saying “no, even if you go there. Me I have moved all around and I have not been cured, that’s why I came here.” So with such people you find that they are taking drugs and also going the other side and by the time she feels like, “ah, let me go for herbs!” that person goes and disappears and sometimes they come when they are not in good state, and then they tell you “I had no money to come” or “I had no money to buy drugs” but you know he is deceiving you. But there are people who say, “I don’t have money” and you see that really they don’t have money!

Interviewer: Okay.

Respondent: There was a certain woman who had failed to come now she has picked up, now she comes back and she’s okay.

Interviewer: So we are going to talk about health system barriers, you will tell me which pieces are working for you and which ones are not and you tell me why. So let’s look at the administration here at the hospital and at the district, does it work for you?

Respondent: No. They don’t help us because when they bring the Benzathine, they give it to us with the syringes and water for injection. But the other drugs like Lasix, lauzatone, Spirilactone, we usually don’t get. They tell the patients to go to the window and when they go there, you see our patients are weak. There’s a queue which is for sometimes an hour. So they give up and when its lunch time, they close and go. So you find the patient saying “I failed to get the drugs, I can’t go back (to the hospital).” You find that the administration helps us when the drugs are there but when they are not there, in regards to RHD patients, there’s step that is taken.

Interviewer: So how about the funding for health care in general, is it working for you?

Respondent: No. Which funding is that?

Interviewer: In terms of money for buying drugs, supplies, everything that you use generally at the hospital.

Respondent: That one I don’t know.

Interviewer: How about for RHD, does it work for you?

Respondent: No. They have never funded us; it’s the other studies that used to fund.

Interviewer: And how about the health care workers, in terms of numbers and qualifications, is that working for you?

Respondent: No. in general or for the RHD?

Interviewer: Yes.

Respondent: I am there with Doctor ...

Interviewer: Are the numbers working for you?

Respondent: No, I wish we are having someone else, but the study said it will get. As per now we are just volunteering for those patients we had and we are registering new ones. We said, “Let’s work for this year, maybe when we fail to get something that can keep the patients, then we close and they go to the general cardiac clinic.”

Interviewer: So in the general cardiac clinic, are the numbers working for you?

Respondent: I am not aware.

Interviewer: How about the waiting time for these patients, how is it?

Respondent: The waiting time is also a bit prolonged because I am alone taking vitals and everything, then sending to the doctor. The doctor is one of course. If they are forty, we take a day.

Interviewer: How long do you think it takes a patient from the time they arrive to the time they meet the doctor?

Respondent: More than 2 hours.

Interviewer: How about the quality of care the patients receive, is it working for you?

Respondent: Not really because that’s what I would be expecting or they would be expecting from us. I would expect that when they come, they are given treatment and they go, because they are weak patients. But when they come, they have to wait; I have to take the vitals, they have to see that doctor and at times if we have some drugs, they have to wait and then I would give them the drugs when we are finished. Because you can’t say am weighing this one, am giving this one medicine, am measuring pressure then giving drugs too, you find it confuses everything.

Interviewer: Okay. And how about the medication; BPG, anti- coagulants and anti-failure drugs. Are they working for you? Are they enough?

Respondent: No, they are not enough. As per now, we just give the patients the ... but for all the patients, I give Benzathine and the others they but for themselves or the get at the pharmacy.

Interviewer: How about the diagnostics; the ECHO cardiography, what do you say about it?

Respondent: At times it’s working and at times it is not working.

Interviewer: What do you mean?

Respondent: That would be okay but you find the machine is working today and tomorrow it is not working. If a patient had an appointment to do an ECHO, it is not done. When you give him another day, the patient comes back and the machine is not working. You find that it takes 6 months without doing that ECHO. Like the other time, the ECHO took like 4 months when it is not working.

Interviewer: Do these patient get this service for free?

Respondent: Yes, when it is working. When it is okay, they get treatment.

Interviewer: How about the health information system; the medical records For RHD patients are they working for you?

Respondent: Actually, it has been working because we record them. We give them appointments and they are recorded. Those who are nice patients, they come and they go back. It is recorded; I don’t think I have any problem with it.

Interviewer: Is there a link between the registers you have here for RHD, outpatient and in patients?

Respondent: No, because I have never seen them come here for these registers to see if they can compare so they can admit. But usually they have their Rheumatic Heart Disease numbers and when they admit them, they write the number down. I think that’s the link because they use that number.

Interviewer: For example, if you had a patient here and was admitted. If that patient came back after 4 years and you wanted to look for that patient’s records, can you get them?

Respondent: Yes, on the ward.

Interviewer: How easy is it?

Respondent: It is not easy, but you have to dig out and get it because it is in the register and the number is there. Here you have a date when the number was written and when you go down, you check the day the patients was admitted.

Interviewer: Do you have registers for Acute Rheumatic Fever?

Respondent: No.

Interviewer: You don’t have specific register?

Respondent: No.

Interviewer: How about the guidelines and protocols for Rheumatic Heart Disease and care? Are they working for you? Do you have any?

Respondent: We have them.

Interviewer: How about the referral path way for these patients, what do you say about it? The referral RHD patients.

Respondent: From outside to here?

Interviewer: Yes. How do they get into the system?

Respondent: The ones we have got are from Mulago Hospital; they are just making them get services from a place nearer to their homes, and these days we are getting them from Nyamitanga or Innocent (medical center) but in the hospital setting, I think it is from Kabale hospital. I think we have got about two patients referred here. But in other hospitals, they usually send them to be diagnosed; they don’t say it is RHD. They say “go confirm if it is RHD. Go for confirmation and proper treatment.”

Interviewer: So we are going to go through these pieces. You said administration don’t work for you?

Respondent: It is fair.

Interviewer: And the funding for health care and RHD specifically? Is it working?

Respondent: It is not.

Interviewer: It’s not working also. And the health care worker numbers and qualifications, are they working for you?

Respondent: Not really.

Interviewer: And the medication; BPG, anti-coagulation drugs, heart failure drugs and injections. Is it working for you?

Respondent: It could be working for the patients and at first, it were all the patients, but now since the other study is over, now we are just there. We give some of the drugs and some we don’t have. I think it is not working.

Interviewer: Okay.

Respondent: Because if give some drugs and not give other drugs, it is not working.

Interviewer: Okay. And the medical records system is working for you?

Respondent: It is working.

Interviewer: Okay. The guidelines and protocols for RHD care?

Respondent: No.

Interviewer: Do you think it is good to have them? Do you need them?

Respondent: Yes.

Interviewer: So now, the last set of questions, here we are going to look at the perception of patient outcomes. Generally, do you think these patients get the care they need and why?

Respondent: They get not exactly what they need but they get some here. Why I am saying that is that when you write treatment, and maybe take the vitals and give the Benzathine but you have not given other drugs and you have not even monitored, how is that patient going to take those drugs? You can’t say it is good because these are outpatients. I usually give the Benzathine myself but these treatments, the other drugs, you don’t know if the patient took them. Usually you give them the right dose but the patient may mess up and take it another way because they don’t take time here that you will monitor and see how they are supposed to take. You would monitor how they take the drugs for 3 to 4 days and when you are observing, you’ll know that they are taking it the right way. They come, we treat and they go away; they at times can buy a drug of 50mg when they were given 25mg and they don’t tell them “take half” so you find that the patient took it all.

Interviewer: So you think you are not actually ...

Respondent: Yes.

Interviewer: How about the surgeries; do these patients get surgeries?

Respondent: Yes, we have some who have go it and some are promising to go.

Interviewer: How easy is it?

Respondent: It is not easy because the patients have to pay. And you know when it comes to money that is a problem. They usually contribute for their tickets and other things; we put in something. It is not that easy.

Interviewer: Where are these operations done?

Respondent: In Sudan, now it is done in Mulago because we have one who was operated from there and she is okay. She has just delivered.

Interviewer: That’s great. Do you have any patient safety concerns? For example, preventable deaths in the hospital where you look at the patient and you say “for sure this person wouldn’t have died”

Respondent: Yes.

Interviewer: What was the problem?

Respondent: It was a young patient, 15 years old; she was admitted through emergency and from there, they took her to the cardiology ward. That patient was there for 3 and half weeks but would miss treatment; it was not given at the right time. There are times when she couldn’t get treatment because the treatment was over and she didn’t have money to buy, and it was just Lasix. They couldn’t buy because the aunt had spent all the money. When you are admitted here, you have to eat and drink. They were from Ntungamo and they had to buy drugs, so you find things are not easy. That child would have survived if maybe we could help buy some drugs and maybe facilitate the aunt to eat and drink, maybe she would been there. However, there was a time she reached a point and she said “I am taking this girl” and I said “don’t leave.” Now she was asking me, “what if she dies here, what would I do? How will I take the body?” So I said, “God will provide” but God can’t come from heaven and provide, so that girl was there. After something like 13 days, she died and she had stayed for like 4 days without treatment. There was also this other woman; she didn’t have money, was on treatment for 3 days and then the treatment got over. She couldn’t buy the drugs and had nothing to eat. The attendant who came after 3 days was an old woman of about 80 years; we could ask her for this and that but she would say, “I don’t have money.” They stayed in the medical ward, they contributed for some time for about 3, 4 days, but that woman had to die. When they are not there, the drugs are expensive but those drugs ...

Interviewer: Those drugs are not provided by the hospital?

Respondent: They are not enough. That’s why I told you that from 3 days, you find a patient couldn’t get drugs when they get finished. At times they give a certain amount at the ward and when they are over before their time is due, they (care providers) say, “we gave you drugs for this period!” but they (patients) will say, “Now where can we get more?”

Interviewer: Do you think there are patients dying without presenting to the hospital for care?

Respondent: Yes, they are there. Because when you go deep in the village, they have patients, and they will tell you, “we have no money to take the patient to the hospital and even if we take the patient, he needs an attendant and yet both the patient and the attendant have to eat and drink. When you go the hospital, they tell you to go for an x-ray but you don’t have money, or they tell you to go for blood tests and you don’t have money.” Everything needs money. So they end up leaving the patient; they say, “How can we take this patient?” They end up leaving the patient to die, and this is not just for RHD but also for other diseases.

Interviewer: Is there another thing that stops them from coming to the hospital for care apart from money?

Respondent: Some people are careless; you will see someone with money but they fail to facilitate someone to go to school. Some are careless; some mothers say, “I am going to the garden, now imagine carrying this child to the hospital! Besides, she is a big woman. Let me go and cultivate for my kids.”

Interviewer: So as we are concluding, what are the two most important things Ministry of Health should put in place to improve the outcome of our patients?

Respondent: Ministry of Health should at least recruit more medical personnel in different departments so that the services can go neat, because now everywhere you go, there’s a shortage. You find one nurse with 50 patients! Can that nurse perform or give quality service? Then underpaying medical personnel demoralizes us; you feel like “ah, even if I work the whole day or week, what am I going to gain? At the end of the day I am not going to pay my child’s school fees.” So when you work when you are not motivated you feel like “let me work for some time” and at times you just work to be on duty and not actually offering services. Then the other thing is to at least provide drugs in hospitals, enough drugs especially the ones that are expensive. They bring the cheap ones! And for the expensive drugs, the patients are told to buy. The Hyperstensives and these diabetic patients are in trouble; they care for themselves. People can’t afford but at least I wish they can increase the amount of drugs according to the needs of the patients. Because at least here it is referral, we have many patients but you find that they bring drugs that can last for 2 months and yet they are supposed to be 3 months! They usually bring at 3 months yet the drugs get done at one and half or two months, so the remaining one and a half months you find patients have to buy for themselves. Even if you are a nurse, doctor or medical personnel who wants to offer services, you also wonder how you go and tell an old woman of 80 years, “You go and buy your drugs!” First of all these patients don’t know those drugs; they just go to the pharmacy and they give any drug and they have that thing of saying the wrong drugs to the patients. They say, “It will work as this” because this one is cheap and the other is expensive. So a patient brings drugs you didn’t send them for and they tell you, “They told me it works like the other one because I had no money to buy the other one.” So to me, they bring drugs which are enough. Maybe the nurses and doctors can get paid but when the drugs are there, they will give the best services.

Interviewer: Thank you so much. Do you have any other thing you want to add before we close? Because we have finished?

Respondent: If at least the government could sensitize these people about diseases at least in a massive way in the village and not in towns or hospitals, but in villages where these patients need help. Because if they are to sensitize, someone will listen in their language and at least get to be like, “Oh, I have a child or mother who has these signs and symptoms.” Then they will bring him and we see. But usually, things are done here in the hospital or towns, so you find when you go Kinoni town or a health center II, you find some 30 – 40 people but in the villages like at the parish level, that is where you meet these patients. Some of these people don’t even have radios, so you find that they can’t even hear our advertisement “come to Mbarara Hospital in the white tent ...”

Interviewer: Okay thank you so much for your time.