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

Interviewer: Thank you, madam, for allowing to be part of this interview, let me just know but before we begin, just remember that there is no right or wrong answer, we just want your opinion.

Respondent: Its ok...you are also correct.

Interviewer: Yes, not even correct because what you tell me is what I will write.

Respondent: Like ourselves, I wanted to learn.

Interviewer: You wanted to learn?

Respondent: Yes, so that when you are interviewing, I will know how much I know

Interviewer: And then we ask you to be honest as possible and share your opinions, we shall not link your identity whatsoever and your comments to the reports we produce, so now for record purpose, this is the 16th of December 2018 and we are sitting at the nurse’s office at lira regional referral hospital. Ok just tell me a little about yourself

How old are you?

Respondent: I am 27 years

Interviewer: What are your qualifications?

Respondent: Nursing officer

Interviewer: Where did you train from?

Respondent: Nsambya

Interviewer: When was that?

Respondent: 2015 November, that’s when I completed

Interviewer: For how long have you been working here at lira regional referral hospital?

Respondent: I have been working for 11 months, I am going to make a year in January

Interviewer: Ever since you came around, when you look around at the demographics, what are the common ages you see of the patients? Respondent Because I’m working at emergency, I always see the young.

Between what ages?

Respondent: I have always seen between the young around 15-20 years here.

Interviewer: Which are the common illness that you treated?

Respondent: At emergencies?

Interviewer: Yes

Respondent: Apart from RHD?

Interviewer: Yes, apart from RHD...

Respondent: We are having those one which come with like sinuses, then malaria, T.B

Interviewer: Among children, which are the common one?

Respondent: Among children, we have malaria mostly, sickle cells, they come in as a crisis

Interviewer: Ok...have you encountered the RHD patients?

Respondent: Yes

Interviewer: Ok you see them, then the RHD, those who comes with the complication with RHD, like on average in a day, how many have you seen or in a month?

Respondent: I see like 5

Interviewer: And then, have you got any special training on RHD?

Respondent: No

Interviewer: During school days?

Respondent: No, they just taught us in school, they taught us as atopic

Interviewer: So, they taught you something?

Respondent: Yes, they taught us something

Interviewer: Ok and after, have you had any training on RHD?

Respondent: No

Interviewer: No and then, what do you remember about it, which area were they tackling when they were teaching you?

Respondent: They were tackling about the causes, the bacteria that causes it and how it comes about and because I remember they said it’s a complication mostly a patient who first develop a sore throat, then it becomes a complication

Interviewer: As a complication?

Respondent: Yes

Interviewer: Ok, did they mention about the management?

Respondent: Yes, they mentioned about it.

Interviewer: Yes, what do you remember?

Respondent: Like they told us like in case someone has developed sore throat, then you have to manage it early enough with antibiotics, then maybe when it comes in with complication of that kind, then they put that patient into nursing

Interviewer: Ok weekly or monthly

Respondent: Monthly

Interviewer: Ok thank you. Have you attended any CME on RHD?

Respondent: Yes, I have only attended once when I had just come here

Interviewer: Since you came here?

Respondent: Yes, so they are teaching us

Interviewer: So, they are teaching you? How many, so far have you attended?

Respondent: Just because I am always busy this side, I always miss

Interviewer: So, you have only attended only once?

Respondent: Only once

Interviewer: Once eh

Respondent: But I am always seeing on the notice board eh..., they always call people for the training on CME’S

Interviewer: CME’S

Respondent: But you find when you are a tutor and you can’t leave and go and attend and being an emergency unit

Interviewer: So, there are times when you are alone

Respondent: Not a times am always alone, there are only four of us and they put one on duty.

Interviewer: So, you work from what time up to what time when on your duty?

Respondent: when it’s your duty, you work from 8:00 -2:00

Interviewer: To 2:00

Respondent: Yes, then evening from 2:00 – 8:00

Interviewer: You have four shifts?

Respondent: Three shift, for night you come in and leave at 8:00 in the morning, like now I am leaving

Interviewer: So now like typically on a normal day, like how many cases can you get during your shift, how many emergency cases?

Respondent: like 10.

Interviewer: Since you said like in a month, you see like 5 RHD patients, when you look at those patients, are they usually inpatients, do they end up being inpatients?

Respondent: Yes, mostly like those who come when they are already badly off, so we admit them, then those who are not badly off, they go to OPD

Interviewer: They go to OPD?

Respondent: And we don’t capture those ones

Interviewer: Ok those ones you don’t get to see?

Respondent: Yes

Interviewer: Ok, so you told me about your little understanding of RHD?

Respondent: Yes

Interviewer: So, you said it’s a result of untreated sore throat

Respondent: Yes

Interviewer: So just to get more details, how does it come up according to you?

Respondent: The bacteria itself?

Interviewer: The sore throat

Respondent: I have forgotten it

Interviewer: So, what happens if anyone has that?

Respondent: What I know, it walks within the blood stream and as it ends up reaching the heart, it spoils the blood valves

Interviewer: That’s what you know?

Respondent: Yes

Interviewer: So then, are you aware of the link between sore throat and RHD? Do you know the association?

Respondent: I am not certain

Interviewer: Are they related in anyway? Sore throat, getting sore throat and RHD?

Respondent: The relationship I know is that the causes are the same, the bacteria which causes it when it has been more or when it reaches the blood stream, it spoils the valves that is what I know.

Interviewer: Ok, what were you told can be done to treat RHD, what did they teach you at school?

Respondent: Early treatment of or when someone develops the sore throat, you have to treat it early enough before the bacteria moves to other parts of the body like the heart.

Interviewer: So, what were you told were the treatment options for RHD? What are the different treatment option of RHD you were taught?

Respondent: What I know and what were taught and what I am always seeing because like this people are always treating them from our place there, these people, the vevida, they always give vaccine protection

Interviewer: then the other treatment option?

Respondent: I am not sure off

Interviewer: You are not sure off?

Respondent: Yes

Interviewer: And then, what are your understanding about the long-term prognosis of RHD?

Respondent: The prognosis

Interviewer: Yes

Respondent: What I always see, it’s not always good, it’s poor

Interviewer: It’s poor?

Respondent: Mostly patients come in when they are not heathy, maybe for those ones who always pass this side of the tent but these ones who always come in, they are really sick and they don’t know about this program, it is always poor

Interviewer: It’s always poor?

Respondent: Yes, because we always lost them

Interviewer: You have lost them!

Respondent: Yes

Interviewer: And then, so tell me about your encounter with patients with RHD eh...do you recall the last patient you saw who had RHD, when was that?

Respondent: Recording them?

Interviewer: Do you remember you last saw a patient with RHD, how did they go?

Respondent: Remembering the time I encountered that patient...

Interviewer: The last patient.

Respondent: Yes, it was last month.

Interviewer: Last month

Respondent: Yes

Interviewer: So briefly tell me how it was with that patient.

Respondent: Yes, given on that and she was brought here at night, when she was anaemic and she had become oedematous all over the whole body and the face was puffy and she was anaemic at that time, so we had to rush for blood transfusion

Interviewer: Yes, but did you know straight away that she had oedemic injury?

Respondent: Because she had never come here

Interviewer: Ok and you straight away admitted her?

Respondent: Yes, I worked on her on that night, then the following day she was brought here because we don’t always take long with them at the emergency, we always give them the first treatment, when they stabilise abit, we transfer them to the various wards according to their conditions and because when she was brought here, I didn’t follow her.

Interviewer: When you look at your RHD patients, what is the average age you see for RHD patients?

Respondent: The average age, like that girl was 14, hmm..., was 14 and another one was 15, around 15 hmm... Another one was 20nyears old

Interviewer: Another one?

Respondent: But that one passed on, that one of passed away from here,

Interviewer: That one of 20 years?

Respondent: But those two I didn’t I didn’t follow up after they had been transferred here

Interviewer: So, the ages you see is between 14-20?

Respondent: Yes

Interviewer: And then if you follow, were they in school or out?

Respondent: They were in school

Interviewer: And then, any children you saw between the ages of 5-10 years that are sick?

Respondent: No, I didn’t see

Interviewer: You didn’t see any young children?

Respondent: Yes

Interviewer: When you see these patients are they generally aware of the link between sore throat and Acute Rheumatic Fevers and RHD?

Respondent: No, they are not aware

Interviewer: They are not? And what symptoms do they describe to you when they come?

Respondent: The symptoms they always talk

Interviewer: Present with or they

Respondent: They always talk of pain of the heart, then the chest, they talk of the pain always

Interviewer: So, it’s always the chest pain?

Respondent: Ok, they always come and complain of the sore throat, they always come with complications

Interviewer: And then are they good about follow up and that of treatment? When you look at those issues

Respondent: Yes, for those ones that come here because for us we always link them when we get patients with RHD, I mean, patients of that kind, I think they always link them up with those people, this project.so when they are coming back, they always come back together but they always come back to us

Interviewer: Yes...but do you see that they adhere to the treatment?

Respondent: Yes, but others do not

Interviewer: They don’t, what could be the reason?

Respondent: For what I know, they have it in mind that it’s incurable, it’s the things that makes them not to come back, that’s it’s a wastage of time

Interviewer: What else do you think always makes them not to come back?

Respondent: Other maybe coming from far deep in the village and they may be lacking transport

Interviewer: Transport?

Respondent: To bring them

Interviewer: Any other reasons, those are two, any other reasons?

Respondent: Maybe fearing injections because others complain of the injection being so painful

Interviewer: Being so painful.

Respondent: Because there is one of recent, there is a daughter of one of the staff here, she is at campus, Lira University, she told me she used to have a sore throat but they used to take it as a mere cough and not sore throat. Then of recent it’s when they discovered that the heart has got some complications, they brought her here so of recent she was telling me that she was given the medicine and they have told her that she should be injected for some good times until she makes 25 years and she said it’s so painful and I am going to start dodging. I think it’s the painful injection that makes them not to come

Interviewer: Ok any other reasons maybe they have shared with you?

Respondent: No, I only had a conversation about it with her, those others have never had the conversation.

Interviewer: You have not had any other conversation, then if you look at those who come, why do you think they come. What motivates them to come?

Respondent: Just because they have seen there is some improvement and maybe they have been convinced enough that there is hope of getting cured

Interviewer: Who do you think could be convincing them?

Respondent: Mostly its people who are doing it, these people of the RHD because we are also utilizing them because once we get clients who are not aware of it, we always connect them to them at once, and they are always there for them.

Interviewer: Hope of getting cured!

Respondent: When they are getting better

Interviewer: What else because we need to learn, we need to know what motivates them, what other reasons?

Respondent: Other reasons maybe, I think this people, they are always telling them that they are there for them and now they know that there is treatment for it not like those days and if they come, they find when there are no drugs but now days the drugs are there

Interviewer: So, the drugs are now available?

Respondent: The ones that I always see them are being injected like I told you that they are always treated from our place here at emergencies,

Interviewer: So basically, the project has brought in the medicine which was not there before?

Respondent: Yes, you know for government, drugs always be there but when they are not enough, they might come in when they are there but like they may come in for the review when the drugs are there then next time they tell them to come back for the review, they find when the drugs are out of stock, so that one demotivates them from coming back, but this time around whenever they come, they find the drugs there

Interviewer: Ok...thank you for those points, so that is the reasons you think some of them are coming, any other reasons?

Respondent: None

Interviewer: None

Respondent: Yes

Interviewer: Ok...Thank you for that, you as a health worker are there any barriers you face when treating the RHD patient

Respondent: The barriers we face

Interviewer: The problems or the difficulties

Respondent: like when they come in when they are really sick before they get to this side of the project, the barriers is because when we don’t have this other drugs, For them apart from the delay, sometimes they come when they have heart failure, the drugs I always write for them to buy and you know buying, they may have come from the village and the only have transport for bringing them here, mostly those drugs, they don’t be with them and you find when they are missing their drugs and they are not taking the rightful treatment like expected per years

Interviewer: What other barriers are you facing?

Respondent: Maybe also the beds

Interviewer: The beds?

Respondent: The beds, to position them when they come with that extent of heart failure, you find that they don’t have enough beds, more especially when you find that the patient is already there, hmm, like for us, we have like one cardiac bed, so you find that inpatients like I told you that one those ones with cystic River Cirrhosis (CRC).You find when the beds are not enough it becomes a challenge to us who are nursing them

Interviewer: How do you always improvise in such a situation?

Respondent: We always improvise, we always tell them to put like if they have come with clothes, they make those clothes like a pillow to raise it up but not always enough

Interviewer: Okay other challenge you are getting?

Respondent: No

Interviewer: Let’s talk about the training you have in RHD management, how is it, how do you look at it, do you feel like it’s adequate

Respondent: Yes, it is, its adequate like I told you, I always don’t find time for the CME’S like I always don’t find time for it, am even busy, I reached when they have already reached the middle part of it, I didn’t attend it fully but I always miss it out because am busy

Interviewer: But do you always feel comfortable treating an RHD patient when you feel luck some knowledge about it?

Respondent: Yes, I do feel that because I lack some management knowledge

Interviewer: So which area would you want to be trained on RHD treatment?

Respondent: How to nurse them, also the management, however much the doctors are there to write the medicine, still they might come in when there are no doctor and also how to prevent it so that you can also sensitise the people.

Interviewer: Ok... and then when you look at the administration, let’s start at the district, the leadership at the district, do you work, how is it? Is it working to treat the patient?

Respondent: They do but not that much,

Interviewer: What is lacking?

Respondent: Like we are understaffed like I told you before, you find that you leave the duty when you are so tired, we tried to complain about it to the administration but no action has been taken yet.

Interviewer: So, you tried to talk to the administration, what did they say?

Respondent: They promised like when the volunteers come in, we shall sign in the volunteers, but you know if someone is not earning, you can’t work well.

Interviewer: Motivation

Respondent: Still it comes back to us, like now I have just left now and yet I was supposed to leave at 8:00 because there was a volunteer who was supposed to come in but she came in at her own time and you know of course you can’t be on her neck that you come early because you know tomorrow she might not come back

Interviewer: Those are some of the challenges that you have?

Respondent: Yes

Interviewer: And when you look at... so in case you need things to use to treat the patients ah... and you approach the administration, what happens? How is everything?

Respondent: For any patient?

Interviewer: Yes, the things you need to do your work

Respondent: Like when we need which things

Interviewer: Like maybe things like the sundries

Respondent: They always provide when they are there, yeah, like of recent ,I think I just saw the vehicle coming in ,I think they have brought the drugs but we have not been having drugs

Interviewer: Like drugs for which diseases?

Respondent: Like for all the emergencies that comes in

Interviewer: You didn’t have drugs?

Respondent: Yes, like the ceftriaxone, like these other drugs, we didn’t have them

Interviewer: And for how long has that been?

Respondent: It’s now like two weeks

Interviewer: Two weeks!

Respondent: Yes

Interviewer: Ok, like in such an incidence where the drugs are not available, how does the administration handle the situation? So how do you survive?

Respondent: Anyway, for that case I think it’s always the in charge who goes to the administration but what I know, we always go the pharmacy and if the pharmacy is not having the drugs, they tell you that they are not there, we shall take that

Interviewer: So, what do you do to the patients?

Respondent: When they come in, we always write for them to go and buy what the doctors have written eh...

Interviewer: Those who can’t afford, how do they survive?

Respondent: But they always struggle, laughs...

Interviewer: They always struggle and buy?

Respondent: But sometimes like at night , there are times when they come at night and there is no where you can send them to go and buy and you really see these patients needs the drugs and we always look from the different wards to see which wards have and they always help

Interviewer: They always help?

Respondent: Yes

Interviewer: Have you ever encountered a situation where you failed to get the drugs?

Respondent: Yes

Interviewer: And the patients could not afford?

Respondent: Yes

Interviewer: How do you...

Respondent: Like I told you at night when the pharmacies are locked, we always just keep the patients there until morning

Interviewer: Until morning?

Respondent: Yes

Interviewer: Pharmacies only work during day?

Respondent: Yes, pharmacies I’m talking of is the outside one

Interviewer: The outside one? But yours only work in

Respondent: During the day and we always collect drugs in the day time

Interviewer: When you look at the waiting time, the time the patients waits before they are worked on, what do you have to comment on this? How is it?

Respondent: But in emergencies, what I was saying they trained the staffs though I was not there, that time they trained them on how to handle the emergencies, they don’t stay for long to be treated even when the doctors are not available, at least the nurses try their best to treat them

Interviewer: They try their best and then, what happens to the other wards? How are the wards there?

Respondent: There am not certain because ever since I came here, I have been on the emergency.

Interviewer: You have only been at the emergency?

Respondent: Yes

Interviewer: Ok and then...

Respondent: Because at emergency, we always work on them very fast

Interviewer: In your department at emergency, are there a times when you don’t really have the doctors around

Respondent: Yes, there are times when we don’t have doctors

Interviewer: Typically, what time?

Respondent: Mostly when these intern doctors are leaving because we have only few doctors, you find when those ones are also committed in those other wards, the interns are the ones who mostly help us.

Interviewer: So, when they are not around, how do you handle it when they are done?

Respondent: Because we always wait for the doctor to come around

Interviewer: And do you get doctors at night?

Respondent: At night?

Interviewer: Yes

Respondent: The interns are always there, they are allocated for night duty

Interviewer: So, what you are trying to say is that you only have two doctors for the wards, two who are not doctors, only two are specialist?

Respondent: I am not sure of the number they are few that’s what I know

Interviewer: So, when you can’t access the interns, when you can’t access the doctors, who manages the patients for those who would have needed the attention of the doctor?

Respondent: We always call

Interviewer: You call, and then, do they respond to the call

Respondent: They respond.

Interviewer: Ok, when you look at the quality of the care the patients get, how is it?

Respondent: The?

Interviewer: Quality of care the patients get

Respondent: It’s always good

Interviewer: Are you satisfied with it or you find when there is something lacking?

Respondent: Yes, I am

Interviewer: Any room for improvement, any areas where you feel they should improve on or assist you to improve where they are treating the patients?

Respondent: The areas they should improve on like I told you understaffing, at least they should increase on the number of staffs because this also effects on the performance if at all we are not there and you find they need quick attention, we find that working on them at ago when you are alone is hard

Interviewer: So, have you seen/experienced any death which could have been prevented?

Respondent: You know there are a times when you see what happened could have not occurred but simply because of some or maybe something that didn’t work out well caused it to occur... that we call those prevented ones that Surely wouldn’t have been the case to occur,

Interviewer: But maybe because of some reasons?

Respondent: I have not witnessed

Interviewer: You have not ehh...and then you talked about medication and you said that sometimes you don’t have the heart failure drugs, how about BPG drugs and then anti- coagulation drugs? Do you get them, do you have it?

Respondent: I remember those days there is a time I found when I had just come, in our ‘’ka’’ store, I found some heparin, these days I have never seen it.

Interviewer: You never saw it? And how much is a doze for those guys when they send them outside, how much, typically, on average, how much do they pay?

Respondent: A doze

Interviewer: Yes

Respondent: Ah..., that one I am not sure

Interviewer: You are not sure?

Respondent: Because we don’t always send them but

Interviewer: You don’t know how much they spend?

Respondent: Yes

Interviewer: And then, when you look at the diagnostic, how are the stock? Are you happy with them, are they working for you, like if you got a patient with RHD and they need to do maybe echo-cardiography, can they access those services?

Respondent: Yes, they do

Interviewer: Do you have the access?

Respondent: Yes, we don’t but we utilize these people

Interviewer: You use the

Respondent: We always send them to the tent

Interviewer: To the tent but are the hospital safe?

Respondent: It is

Interviewer: And then let’s look at

Respondent: I’m not sure about the hospital but always I send them there

Interviewer: You send them there

Respondent: Yes

Interviewer: When you look at the health information system and medical record system, what do you have to say? Is it working for you people?

Respondent: Yes, it’s working

Interviewer: It’s working?

Respondent: Yes

Interviewer: Any gaps that needs to be improved?

Respondent: Yes

Interviewer: Like just in case you want to access some file of a patient who came in maybe a year ago, is it easy to get that file for treatment?

Respondent: Like for us here, we have our register where we enter all the patients we receive, just that we don’t always specify like maybe let this be for this group of people that is the only gap I see.

Interviewer: Ok and then how do you look at the integration between facilities, let’s look at, first let’s talk about the in patients, out patients and the register, how do you look at them? Do you have the register for RHD patients?

Respondent: Here for emergency, we don’t have

Interviewer: You don’t have?

Respondent: Yes

Interviewer: And then is there an integration and linkages between facilities, like in the hospital, do you have a teaching hospital

Respondent: No, it’s a university hospital

Interviewer: A university hospital? You don’t have a university hospital for lira?

Respondent: just heard that they are trying to open it

Interviewer: Ok, other facilities, is there any linkages between these hospitals here and then those health centres are there

Respondent: On RHD or on all conditions?

Interviewer: For all conditions

Respondent: There is because they always send in their patients

Interviewer: They send their patients? And the information flows well between the facilities?

Respondent: Yes

Interviewer: Like you get a referrals, do you have the details on the referral letters and then how about RHD’S specifically, is there any integration linkage between the two

Respondent: I am not sure

Interviewer: You are not sure about that and how about registers for acute rheumatic fever, do you have them here?

Respondent: Like I told you in our emergency, we don’t have them

Interviewer: Do other departments have them?

Respondent: I am not sure about the other department

Interviewer: Let’s look at the guidelines and protocols for RHD, care you have them here?

Respondent: We don’t

Interviewer: Or could you be knowing how referrals are made for RHD patient

Respondent: No, I don’t

Interviewer: You don’t? Do you think it’s important to have the guidelines and protocols?

Respondent: Yes, it is

Interviewer: How would you utilize it?

Respondent: At least they guide you on how to take care of the patients and also how, like where to send them

Interviewer: Ok and then, so you said when they come to the emergencies, how do you refer them for care after emergency or could you be knowing where they refer them too

Respondent: Yes, what I have always seen doctors that they do, they always call these people, when these patients have been brought, they always call them to come in at least I have always seen her come for them.

Interviewer: Let’s look at the health system enablers, ah...so looking at the administration, is that working for you

Respondent: The?

Interviewer: The administration

Respondent: What?

Interviewer: Is it helping you to do your work well, has it enabled you to do your work well?

Respondent: Yes

Interviewer: Any gaps where they need to improve?

Respondent: Like I told you, improving on staffing

Interviewer: Improving on staffing ehh..., when you look at funding how about that in general to the health services and health care?

Respondent: The funding

Interviewer: Is it working for you?

Respondent: With funds I don’t know

Interviewer: Are you getting enough funds to do your work to treat the patients better?

Respondent: The funds what I know is the salary I get

Interviewer: Are you happy with it?

Respondent: No, I am not all that happy with it

Interviewer: Ok, looking at the funding for RHD patients, are you happy with it? Is it working for you?

Respondent: I don’t know

Interviewer: You don’t know, and then when you look at administration, funding health care workers, medicine and health information and medical record system and their guidelines, what have worked for you here? What do you think is working well among those things I have mentioned; administration, leadership at the district, funding, health care workers, the numbers?

Respondent: for all conditions?

Interviewer: Yes

Respondent: What I can give maybe tell about the experience I tell was in august, there was a patient who was brought in and was just transferred from Amolatar, he was bleeding, he had all the signs of ebola and that time, I was the one on duty, so we hear one of the leader was informed when they were setting off from those ends and then he directed them not to come here. They needed to be taken oba to which hospital hmm...there is a hospital where they always take them to

Interviewer: Yes

Respondent: And this patient insisted on coming here when I was on duty

Interviewer: On duty? Laughs...,

Respondent: When they brought them here, me myself I was called by the in charge where I was that I go and see the patient but I told him that emergencies are always handled very fast laughs...so I ran there and she told me she was bleeding and that time, that was when the ministry of health was talking about the ebola

Interviewer: Ebola...!

Respondent: So, I ran in and double gloved but I didn’t touch the patient, when the in charge followed, she told me she was standing at the door way, for me I was inside, Laughs

Interviewer: laughs...

Respondent: You screen! You screen!

Interviewer: She was ordering you?

Respondent: No, she was not, that time, you screen that patient

Interviewer: Oh my God!

Respondent: For me I don’t have a patient

Interviewer: Oh my God!

Respondent: Inside of the eyelid was out, eyeballs were out bleeding, the nose bleeding, blood was coming out of the ears

Interviewer: You suspected?

Respondent: Then I suspected, I would not touch him even if I had double gloved, then I came out of that room, so I was like this man is going to die without us doing any interventions, I wanted to access him but still I was worried to touch him, then they informed the people of administration, yes it happened, by the way we didn’t expect but not all that like I expected because us, though we didn’t touch the patient but at least we were in close contact with the patient ,they called the district, those ones didn’t even act to come in very fast, that is it the deceased or the survivor’s photo fast services came in late and for us ourselves decided to stay back and not go home but they were telling us that evening because the body even stayed, the man passed on, they were telling us to just call home and they bring us clothes, we bathe with JIK and then go back home, it’s us ourselves who insisted and stayed that night and then in the morning ,they still insisted that we go back home. Before they confirmed it, they came for it, it is, even the in charge who called the ministry, they sent that person, the driver or the driver I don’t know who came and picked the sample. They came at around 10:00 p.m. being it was a Saturday, it happened on Friday then the sample was taken on that very Friday late at around 10:00 p.m. but reached that side very late, now they were telling us we have to inform their people to stay back and they are supposed to work on the things, we got the result at around 10:00 on Saturday the following day because it happened on Friday, but the world service people didn’t act, they didn’t help us because they were saying the ministry of health has said ,just to go back home even getting the results so it’s us ourselves who decided to stay here

Interviewer: That was bad!

Respondent: So, there we were like in case any other disease of any kind, we should not always act, and we should always also be taking off because the administration and the district people don’t always mind about the health of their health workers

Interviewer: So, what has motivated you to continue working with these patients who come around?

Respondent: What has motivated me? Just because I was recruited and I am getting my salary, that is one because for me, I came, like I didn’t tell you, I came here in January, I was posted here, I came from Mbale, I am just renting and houses, accommodation here is not enough but there is a time, there is some staffs who were transferred, they advertised the houses that were left, we applied but they took since April up to now

Interviewer: Up to now?

Respondent: But the houses are still there, only one thing that made me get angry, it was in which month, it’s like am in emergency unit, that time I worked night and I worked six nights, it was almost coming to the end of the month, and this land lord of mine came and told me to leave and it was only remaining three days to the

Interviewer: Getting off the...!

Respondent: He was requesting that he wanted to renovate his house, you have to move and get another place, so I came here because it was now hard for me that time, I was on night duty, I didn’t have time and you know with emergency you leave when you are so tired. I didn’t have time to move looking for another house, I came and told the person who is responsible, I first went to the ‘’highest bin’’, that time she was still new, I told her about the things at least they helped me to give me one of the houses as if the houses are just there empty, I put my things for a short time as I look for where to go.

Interviewer: They don’t allow you to occupy them before ministry of health?

Respondent: The ministry of health is a committee

Interviewer: You can’t be there before the committee sits?

Respondent: That’s what I was told but there is a person who keeps the things. I see that is hard for me, I failed to get where to go, I just bring the things and I keep my things with him as I look for where to get a house, that is also the challenges faced at time, I was now wondering where to go

Interviewer: Generally, do you think the patients are getting the care they need here?

Respondent: They do get, they do get the care

Interviewer: How about the RHD patients in particular?

Respondent: They also get but not so much, I remember there is a boy whom they brought here but he was referred to Mulago heart institute

Interviewer: Why?

Respondent: Meaning that we don’t have the adequate care

Interviewer: Can they access a surgery here? The RHD?

Respondent: No...

Interviewer: Why?

Respondent: Maybe because we don’t have the specialists

Interviewer: You don’t have the specialist? If you look at the patient’s safety, is it there? Any concern you have under quality care they give them

Respondent: The safety?

Interviewer: Patient’s safety!

Respondent: I have not understood the question

Interviewer: Patient’s safety, when you look at the patient’s safety and the quality of care they get, are they safe, are they getting the quality of care that they should be getting

Respondent: Yes, they do get but what I hear, we don’t have enough medical doctors that is it

Interviewer: Do you feel like generally they are worked on time?

Respondent: Yes, because always when you call a doctor who is responsible for what he is supposed to do, like if the patient has cleaned up, they always rush in very fast when you call them

Interviewer: Do you feel like they are being given adequate time to ask questions?

Respondent: Yes, they are!

Interviewer: They are given?

Respondent: Yes

Interviewer: And do you think the health workers are giving them enough information about their illness?

Respondent: They do but not all because of the overwhelming work

Interviewer: So some of the health workers are overwhelmed with work?

Respondent: Yes, because of the understaffing

Interviewer: Do you think there are some RHD patients who are dying in the communities without coming to the hospital?

Respondent: I think

Interviewer: Why?

Respondent: They are not sensitised, that’s what I know

Interviewer: They are not aware of the disease?

Respondent: And others also I think they take it like be-witching, someone sees maybe a child is swelling, they take it like maybe he has been poisoned

Interviewer: In your opinion, what are the two most important things ministry of health could do to improve patient’s outcome?

Respondent: Maybe they should also come up with trainings to train health workers and also down in the village, they can also sensitize the population about the diseases

Interviewer: Any other thing that they can do, ministry of health?

Respondent: They should always provide the drugs

Interviewer: Which is enough for them? Anything else before we come to the end?

Respondent: No

Interviewer: Ok, thank you for your time and the ideas that you have given to us, we surely are going to use it to improve RHD prevention and management in our country, thank you very much

Respondent: Thank you too for coming