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

Interviewer: Ok thank you for accepting to come for this interview, it’s nice to have you here.just for the purpose of recording, today is the 16th Dec 2018, we are seated at the nurses office. ok now just to remind you a little bit is that what you are going to tell me is going to be kept confidential, there are no right or wrong answers, what you say is what we want to hear and so we request you to be frank and honest in your opinion and then we are not going to link your identity to any comments that you make in the reports that we are going to produce, so before we begin, let me just know a little bit about you.

How old are you?

Respondent: I am 38 years old

Interviewer: And then what are your qualification?’

Respondent: I am a nursing officer

Interviewer: Ok, where did you complete from?

Respondent: From lira school of comprehensive nursing

Interviewer: How long ago where you, when did you qualify?

Respondent: 2009

Interviewer: 2009?

Respondent: Diploma, I qualified in 2013 December, Certificate I qualified in 2009, may

Interviewer: Ok

Respondent: Yes

Interviewer: Which health center are you working in?

Respondent: I am working in Alik health center II

Interviewer: Ok and how long have you been working there?

Respondent: Since 2015

Interviewer: 2015?

Respondent: Yes

Interviewer: And if you look at the demographics of your patients in your centre, which are the..., if you look at the ages that you see, which department are you working in now?

Respondent: First of all, am the in charge of that unit, so you know I come to almost across to all department

Interviewer: You cut across?

Respondent: Yes

Interviewer: So when you look at the demographics of your patients, which age groups do you see mainly?

Respondent: Between 4 years to 30 years

Interviewer: To 30 years?

Respondent: Yes

Interviewer: Do you mainly see adults or children?

Respondent: Yes

Interviewer: And then are they women or men

Respondent: Women are the majority group but with children below 4 years, male children again are the majority

Interviewer: Male children?

Respondent: Yes

Interviewer: Wow! What do you think explains that?

Respondent: With children, I can’t explain well but when you look at the number of male children that come to seek the health center, they are quite more than the female children, I always try to think that maybe males are weak some how

Interviewer: And then when it comes to adults, you said it’s mainly women, why?

Respondent: It’s the contrary laughs..., females are three times more than the males that come to the hospital

Interviewer: Why?

Respondent: So to me I think males have a poor health seeking behavior because even in the village, people who die most are the males, secondly, they always come to the hospital when the condition has worsened, when the man is not feeling really bad, this man does not really come but women, they have really good health seeking behavior, they fear sicknesses, when a woman feels anything to the extent that even some of them come to me when they are feeling ovulation laughs...,the monthly usual pains, somebody will come. You see musawo, I feel pain by my side, then when you like try to access, you will find this woman not sick because you go back and dig past history, she will say even last months it pained me, then you just know, sometimes you just have to counsel and assure but I don’t blame them, am happy with such kind of a person

Interviewer: Wow! And then what are the common illnesses that are treated at your health centers?

Respondent: The most common ones used to be malaria but now days with the issues of IRS, malaria has reduced although it has started shooting abit ehh...but not much but now the most common ones are the respiratory tract disease infections,yes,many of them come feeling cough, pain in the throat, chest pains, those things

Interviewer: So the sore throat cases, are they diagnosed?

Respondent: Sorry?

Interviewer: Sore throat cases, how are they, what are the burdens?

Respondent: Yes they are there, they always come with the issue of sore throat hmm

Interviewer: Ok, how about RHD, do you get some here?

Respondent: Acute rheumatic fevers?

Interviewer: RHD

Respondent: RHD, yes, I have seen, I have been referring people here and a good number of them were found positive

Interviewer: If you remember in the last one year, have you received any?

Respondent: Except I have not kept the records but they can reach even more than 10

Interviewer: And you refer them?

Respondent: Yes and I used to get the feedback and always when am referring them, I also tell them, please after there, you can also come back to me although some of them do not go but whether they go or not, the people who work there in the institute always when they visit, sometimes we always interact on phones, they tell me but for me always when am referring, I first call ahead to like avoid bouncing, I always don’t like my clients to bounce.

Interviewer: Ok, that is nice to hear, that means there is a way you communicate to these people

Respondent: Yes I do

Interviewer: Wow! Has it helped in the..., do you see the advantage in that when you make the follow up calls?

Respondent: Yes, I have found it really very important because out of the client I do send, they have helped me find out the other diseases like for instance there was a child I sent, I was very happy with that child, the..., he was..., the acute rheumatic fever was negative but they found the child had sickle cell disease and up to now am managing the child, the child has improved compared to the way he came to me

Interviewer: Wow! Let’s talk about your training on RHD, have you ever received any training on RHD during school days?

Respondent: During school days?

Interviewer: Yes, have they ever introduced a topic about RHD?

Respondent: In school?

Interviewer: Yes

Respondent: No,

Interviewer: They didn’t?

Respondent: No

Interviewer: How did you get the information that you know?

Respondent: I got the information through these people who are working in the acute rheumatic fever, I was called for a short training in lira hotel, then they briefed us, by the way I was working and I think I used to like make them pass a lot of them minus me realizing their conditions because you find someone every time having cough, we could but not having that in mind, after interacting with these people, I went back with the forms, started now accessing them, somebody comes, there is fever, joint pains, cough, what...that has not been treated, whether treated but with no improvement, so such are the cases I have been sending here

Interviewer: So before you got that message, what would you do with those patients who had those symptoms?

Respondent: what I would do with those patients, I used to treat them first at contact, when they come back again with no improvement, I would find them referrals and refer them

Interviewer: To where?

Respondent: To the exact place, the way I do it now days, those days I could just say, you go to lira regional hospital but you know, when they come, they go to OPD and even those days lira used to miss, the regional referral used to miss because they used to come to OPD and then the doctors may see the treatment I have given and also change to stronger anti biotic,.

Interviewer: Ok, so that is how it is?

Respondent: Yes

Interviewer: And then after graduation, these people of RHD who trained you about RHD?

Respondent: pardon

Interviewer: Since you graduated, is the project here?

Respondent: Yes

Interviewer: Who trained you?

Respondent: Sorry?

Interviewer: Have you had any CMEs on RHD management or prevention?

Respondent: From my unit?

Interviewer: Yes

Respondent: Yes, I always have CMEs with my staffs

Interviewer: But have you ever introduced a topic on RHD?

Respondent: Yes, now days even if am not in the facility, any staff give health education to the OPD about that

Interviewer: Have they all been trained?

Respondent: No, they have not all been trained but I have been hinting the information through CME

Interviewer: Ok, wonderful, now before you came to these guys, you didn’t have this kind of CMEs?

Respondent: No

Interviewer: Ok thank you, so you made a record at all times?

Respondent: Yes

Interviewer: In what times

Respondent: sorry?

Interviewer: In what period?

Respondent: Sometimes even in a day, I could transfer ,it depends on how they come like in a week, I could send 3-4 like that ,ok you said that you have asked only for the last one year but in total, those that I have sent here are more than 30 even

Interviewer: They are more than 30?

Respondent: Actually I interacted with her at one point and she told me that I am the one who has been sending the highest number

Interviewer: The highest number?

Respondent: I got even the motivation laughs...

Interviewer: Wow! Wow!

Respondent: I was motivated

Interviewer: Good to her that, so in a month, you can send how many?

Respondent: In a month, it depends, sometimes I even get 1 or 2 but sometimes they come even 5-6

Interviewer: And what are the age group?

Respondent: The age I have been sending is 4..., 5-18.

Interviewer: 5-18?

Respondent: I think below 5 is hard

Interviewer: Ok and the...then so, they come as outpatients in your place ehh and then you send them?

Respondent: They come in as outpatient, then I access them and I rule out other things and I send them

Interviewer: Ok, wonderful, now am interested in what you are taught about RHD, what do you think are the causes of RHD?

Respondent: I think is the ..., I could say it is congenital, some people are born with it but some due to the exposure of other things like sometimes for instance, those who come with too much cough which maybe sometimes its poorly or untreated respiratory tract disease, so that is what I think and also sometimes I also think maybe some poisoning due to chemicals and others

Interviewer: Ok and the are you aware of the link between the sore throat and RHD

Respondent: Yes

Interviewer: Are the two of them associated or related in anyway, sore throat and RHD?

Respondent: Yes

Interviewer: How are they related?

Respondent: I can’t explain much but to me I know there is some relation between the two

Interviewer: They are related?

Respondent: Yes

Interviewer: what were you taught that can prevent RHD, how can people prevent it?

Respondent: I think first of all to prevent this RHD does not start from now but it starts even when the mother is preparing for conception, how the mother is fed and how the mother takes medications like the folic acid and also these pregnant mothers are not supposed to take any drugs anyhow minus medical consent and then finally how the child is kept from birth.

Interviewer: Ok and then what were you taught are the treatment option for RHD? How is it treated?

Respondent: I may not know all but I know of PPF given once in a month and the time duration depends, it will be given but with a review, but for some people can take like 6 months, and some can go like a year or others even 2 years

Interviewer: when they are...?

Respondent: When they are still getting their treatment

Interviewer: OK

Respondent: Yes

Interviewer: so do they ever stop?

Respondent: I have not yet known someone whom they have stopped the treatment because the program has not yet taken long here but for me I think they stop, that is my thinking, when the fault is corrected

Interviewer: Does it cure. The RHD?

Respondent: Yes to me

Interviewer: To you?

Respondent: Yes

Interviewer: And then, what do you understand by the long term prognosis of having RHD?

Respondent: The long term prognosis of RHD depends, for those who have realized and taken care of, the prognosis may not be very bad but for those ones that go unrealized, they end up with a poor prognosis

Interviewer: Ok, now tell me about your encounter with patients who have RHD, when did you last see one?

Respondent: I last saw one this year

Interviewer: This year?

Respondent: I think around September

Interviewer: September? Tell me, when that person came, how old is that person?

Respondent: This girl is 12 -13 years there

Interviewer: What symptoms did she have?

Respondent: She was having cough with chest pain and then I told the mother to bring her here, she was brought and when tested, she was found to be having it, the RHD and she was put on treatment, she normally comes back monthly

Interviewer: ok so you have told me you see many, you have not seen kids below 5 years, you only see those...

Respondent: I think they are there, of course they are there maybe how they explain themselves is not easy but I have seen from 5 and above

Interviewer: Above to?

Respondent: Up to 18 mostly, last year or early this year, most of them I was finding people of around 16 to 17 years most common

Interviewer: Where they in school children?

Respondent: Yes they were school children

Interviewer: Ok and then do you think these patients, do they know the link or relationship between sore throat, acute rheumatic fevers and then RHD? Do they know the association?

Respondent: For them they do not know

Interviewer: So when they come to you, what do they say, what do they think is the problem?

Respondent: And the worst thing in the village, once someone has the sore throat, this person will go to the old woman, who will open the throat and do anything, yes, so to them they think the throat is having either the pus or its growing the oedemal and there is that local tonsillectomy they do in the village but we are trying to health educate them, others are understanding but others still go for it up to now. Like last week ah...,somebody was just about to take the child for that local tonsillectomy, then I told her, you don’t have to take ,what you do, you first use these antibiotics, I gave, I gave metronidazole and Amoxicillin plus the pain killers and after two days, she came back to me and said the child took the medicine for two days and vomited pus and there was already improvement, I told her, did you take to the other woman, she said no, I didn’t, so that child improved on that medication but its most common in the villages that by the time they are bringing a child to you, sometimes for me always when they come at times they hide it but the moment the mother talks about coughs and maybe ear and pain in the throat, I always ask have you done anything in the throat, and in most cases they would have done it

Interviewer: why do they always prefer going to that old woman, why do you think they go there. Why don’t they believe they can be treated in the health center?

Respondent: I think its ignorance and how people started, they see that it helps but to me it doesn’t because at times when that local tonsillectomy is done from home, at times it goes to some serious cases of septicemia and sometimes even the way it is cut, anemia sets in and even it claims the lives of very many children

Interviewer: They are dying?

Respondent: Yes

Interviewer: Is there anything done maybe to educate those old ladies, have you had the interaction with the old ladies where they do that?

Respondent: The problem maybe we can just communicate to them maybe when there is a radio program but those ladies, the traditional healers, they are not really very much close with the health centers and hospitals and you know with the nature of our work and the schedules, we are always busy, there is no way we can find them but anyway, we give the information to the clients who come, just as I can just say we give, there are those who take and there are those who don’t take the information we give them

Interviewer: Ok and then basically, the symptoms you said they describe is chest pain, fever...

Respondent: Yes fevers, joint pains and sometimes cough which has taken long and throat

Interviewer: And then if you look at them, are they good at follow up and adherence, the RHD patients, in your opinion.

Respondent: They do

Interviewer: They do.?

Respondent: Yes

Interviewer: If you tell them to come for the injections, do you think they come?

Respondent: They do

Interviewer: What makes them to come?

Respondent: It’s the way they are counselled, they well know of what taking place is and what may happen if they don’t follow the treatment, they do come

Interviewer: What else apart from the counselling, what makes some people to come?

Respondent: Sometimes even from there I always tell them when they come ,transport is met like where I work as I told you, it’s like 17 kms and the boda is 6000shs, so when you come and go, that is 10,000shs plus minus eating something but always when they come, they are refunded their transport, so it makes them come because sometimes when you are referring, they tell you, you see musawo,there is no money, there is no what...but when I tell them, you go ,the money you are going to use for transport, they are going to refund it.you know in the village, you can pick a boda and waits for you to take you back, so that is how they are like trying to like meet ...Yeah, so the motivation is one, if you give them transport, two when you give them counselling

Interviewer: What else?

Respondent: Three is that, those ones who come to the hospital are those ones who care for their lives, so they take whatever advice you give

Interviewer: Any other, so how about those, do you think that there are those who don’t come or who miss their drugs

Respondent: Yes it is possible

Interviewer: Why do you think some people miss their drugs?

Respondent: Some of them just take things for granted like that you are told to go back and you don’t mostly when the disease starts, it looks very serious on the beginning of treatment, someone feels there is improvement and when they feel there is improvement, they think that they are healed then they will now miss to come and sometimes they forget the dates of appointments and others on realizing that they have passed laughs...they refuse to come

Interviewer: Why would they fear to come when they skip the dates of appointment?

Respondent: You know by the common saying, they say that for us the medics we are harsh because you are reaching here, the first thing I am not saying it has happened in the RHD but its common within health, not because the health workers are very bad but they know the implications of missing ,so of course definitely when you have passed by 3-4 weeks or even you have passed by 4-5 days, they will ask you why didn’t you come on the exact date because even the reasons they give do not impress the health workers like somebody will say I had gone to visit, such things, you find visit is not more important than health

Interviewer: Another thing just to take you back, have you encountered patients who go to those traditional, those elders in the villages who lied to you, when you asked them have you gone there and lied but you later discovered that surely ...

Respondent: Yes they are there, they lie, most especially with the middle age, they lie

Interviewer: They lie?

Respondent: Yes

Interviewer: Why?

Respondent: Of course they go there even when they are doing wrong things, they are guilty, they know it’s not right and definitely they will not, it’s not easy to start from there and because you are defeated from there and now you come to the health center

Interviewer: Ok, some of them lie?

Respondent: Yes, some of them lie but mostly mothers of very young children, they don’t lie because they know when you don’t tell the truth, it will not be well.

Interviewer: Ok, now then, how about those who miss their drugs when you give them a 30 days treatment, why do some of them not adhering to the drugs?

Respondent: At first I said, sometimes its ignorance, at times they forget the drugs, at times they have started feeling fairer than before

Interviewer: ok and then ah...what are some of the barriers or problems that you face when you’re taking care of these patients, what do you think are the difficulties you get in caring for them?

Respondent: Ok we don’t, actually in a health center where we work, we don’t care for them from here because the drug is always taken there, we always refer them to come and get treatment from here, so to me I think we don’t face the difficulties, the only challenge is that they don’t come willingly to be accessed and referred by us, we talk a lot, health educate them and then they will start coming

Interviewer: Why do they resist coming here?

Respondent: Sorry

Interviewer: Why do they resist coming here, why don’t they come willingly?

Respondent: No, they come willingly but sometimes they are not aware of the problems, in the most cases, they are not aware

Interviewer: Ok

Respondent: They are not

Interviewer: And then for other illnesses that you face, what are some of the barriers you get in treating these patients?

Respondent: One is lack of adherence, you like give treatment ,somebody goes to take it for two days, when there is improvement, she keeps it in the house, the next time another child is sick, she will start with the balance of the remaining drugs of another child unless the child starts feeling fair, it is stopped, two weeks later, the disease is back and the biggest challenge we have in the health setting is that the drugs that are provided by the national medical stores are not enough, they bring it like now and it has to serve for two months and at the end of one month’s sometimes the drugs is even over, the remaining one month, they come when there is no what...,when there is no drugs in the health center and always patients when they come and go back empty handed, they will not come back until they hear rumors that the vehicle has passed laughed...,then...

Interviewer: The vehicle?

Respondent: The national medical medicine vehicle, then they will know maybe drugs are brought, let me go and check

Interviewer: So even they know the vehicle?

Respondent: Yes they know very well, that is why when drugs is brought, the population in the health center is too much, when drugs are not there, they will even relax, they become very few because they say even if you go, they will not give you anything, so that is the time they go to any drug shop and buy anything

Interviewer: So you told me usually when maybe those who miss appointments they come late, when they come to you, they say maybe we went for burials forgot, which other excuses do they give?

Respondent: Even I went for the visit

Interviewer: she went for the visit?

Respondent: Yes, those ones

Interviewer: What else, what else do they tell you

Respondent: Sometimes I had a burial but those ones are guinuine,at times I went for a visit, at times I forgot, at times I thought I had gotten healed, there was no more pain and what have you

Interviewer: Those are the excuses they give?

Respondent: Yes

Interviewer: Any other?

Respondent: Those are the few I can remember

Interviewer: And so, according to you, why do you think they don’t come back apart from you said when they feel better, they relax, why, what else makes them not to come when they feel better? Your opinion now, what they tell you.

Respondent: To me?

Interviewer: You said when they feel better, they give up

Respondent: When they feel better they relax

Interviewer: what else, what other barriers are they facing in coming for the treatment?

Respondent: Maybe at times is distance

Interviewer: The distance?

Respondent: Yes, the distance, the weather, the climate condition

Interviewer: Which weather

Respondent: Usually when it’s raining, like if it rains during day time, every activity is at stand still because in the village settings, they have ..., so you can’t start moving in the rain that you are coming for your appointment.

Interviewer: So the weather condition, the weather, the distance and when they feel better, they don’t come, any other that we have not talked about?

Respondent: No

Interviewer: Now let’s look at the some of the local health barriers and we want to know which pieces are working for you and why and which ones are not working for you, when you look at the district administration and leadership, is it working for you, is it enabling you to do your work well when treating patients?

Respondent: Yes

Interviewer: How, why do you feel like it’s working for you

Respondent: The district administration?

Interviewer: And the leadership, is it working for you, does it make your work easy while you are working?

Respondent: Yes, they do, like in lira district, me I can’t blame any department because like in my health center, I always work hand in hand with them, I inform them of the challenges we have in hand in the health center and they always respond

Interviewer: They respond?

Respondent: Yes, like for instance in my unit, there was a lot of gaps but they helped me, the last one they had taken survey, there was no clean source of water but I know soon or later, it is going to be better and even my health center is heading to upgrading, actually they had even sent money but I think they diverted the money from up not from the district, they told us to wait for the next financial year, me I have no problems with the authorities, because first of all when it comes to lack of drugs in the unit, it’s not them, no

Interviewer: So ...what are the challenges you face in your administration, you know many cases come to your office, we don’t have this, we don’t have this, and how do you manage?

Respondent: The biggest challenge I face is lack of drugs and other utilities, but how do I manage, I have to just convince the clients to buy from outside because you cannot tell them and sit to wait for the drugs to be brought

Interviewer: How about the work force, the number you have in the unit

Respondent: The number is less but still it’s from the ministry not from the district because the policy was passed long time, here is away they outline that in this level of health center, these are supposed to be the number of people working, although at the district setting, we still lack because we find some people whose names are there but they have gone back to school

Interviewer: So how do you manage patients with such challenges?

Respondent: We balance ourselves with the few who are there using the duty roster so that all the days are cover with work meanwhile while some people also have their rest because you cannot capture human beings and tell him or her to work from January to 31st December

Interviewer: Ok, and then if you look at the funding for health care in general, is it working for you?

Respondent: It’s not ,it’s not working for us ,for instance am going to give you an example like in my health center, the knowledge is there to treat also other diseases but the drugs is not brought like these days, the most common conditions I told you is the respiratory tract infections, some can go with the advice and counselling and then you treat it as automatic depending on the cause maybe when its viral but some need to be treated with antibiotics and we don’t have it, even the few actually right now, the anti-biotic they bring for us is Amoxicillin, cipro an doxycycline and cipro they will bring like 500 and doxycycline also 500 to serve like for two months, then Amoxicillin they bring like 8000 and you know a tin of Amoxicillin on a serious busy day can get finished so that is like, its gets finished very fast actually me I suffer a lot because I always take pity on the patients, you find a very poor mother comes to the hospital sick and needs care but this is a mother who comes and find no drugs, you want to refer her, she does not have transport, she goes back and the sickness intensifies, sometimes it’s even death ah...,like for pregnant mothers, my health center is in Amach subcounty,we have only 2 health center in our sub-county, from this small health center to the bigger health units, it’s around 15 kms, you refer a pregnant mother, this mother will not go, somebody is pregnant, do not have even a bicycle and cannot walk for this 14kms and she goes back and delivers from home

Interviewer: So those are problems that you encounter

Respondent: Yes

Interviewer: Ok, when you look at the time these patients wait before they are worked on, what do you have to say about it?

Respondent: The waiting time is long, right .it’s just due to few staffs in place because the staffs are few but they will want to see everybody and definitely the waiting time at times becomes long

Interviewer: Long?

Respondent: Yes

Interviewer: And then when you look at the quality of services which patients get, are you satisfied?

Respondent: Not quite although we try but in situation where you are alone in the consultation room and you have 80 patients out, sometimes you tend to like hurry in order to serve everybody but in hurrying, you will not give quality services to the client because sometimes some of them need your time, you need to talk to them, you need to access them, you need to counsel them but if you do that, then you will not serve the rest and the rest will go back very annoyed, now in order not to annoy them, you hurry, but you know medically when you hurry, you do not give quality service.

Interviewer: And when you look at the qualification of the health workers you have, are they adequate?

Respondent: Yes they are above, there are those that are adequate and those that are not adequate, but the challenge is, as I told you, the policy we are using now was passed long time when the population was not like now, so you find now because of the few staffs, due to the staffing levels which is not from here, at times even the cadre that is not supposed to do something goes ahead to do it hence leading to poor quality service like for instance maybe clinician is alone doing now some procedures, nursing assistant sits in the consultations, now nursing assistant cannot really access, diagnose and treat well

Interviewer: Ok, the medication you told me, definitely the drugs are not enough, and how about the diagnosis like in your health center, do you have like echo cardiography?

Respondent: The what?

Interviewer: Echo cardiography

Respondent: No

Interviewer: You don’t have it

Respondent: No, actually echo cardiography in the whole of lira, maybe it’s in two places, here and that one is it joint medical clinic, I don’t know if there is any but I used to know only two.

Interviewer: Those are the two that you know?

Respondent: Yes and when you get out, you know its money

Interviewer: So in your center, do you have like any drugs like for heart failure drugs, drugs for BPG and anticoagulation drugs, do you have those drugs?

Respondent: No

Interviewer: No?

Respondent: Yes.

Interviewer: so patients from your area...

Respondent: laughs..., really far,

Interviewer: So they have to come here.

Respondent: They have to come

Interviewer: And when you look at the guidelines and protocols for RHD care, do you have any here?

Respondent: The guidelines?

Interviewer: Yes.

Respondent: No

Interviewer: And how about, do you have the referral paths they have to refer the RHD patients

Respondent: We have the referral forms which have even the numbers, the telephone numbers and you can call ahead of time

Interviewer: Are they forms for the ministry or forms for the project

Respondent: They are for the project, I don’t know if the forms is provided by the ministry but we received it through the project

Interviewer: Through the project?

Respondent: Yes

Interviewer: When you look at the medical records system and the way health information flows, are you happy with it, is it working for you in your health center?

Respondent: Yes, it is

Interviewer: Are the registries ok or is there any gap?

Respondent: No

Interviewer: Just in case someone wants to look at your records like for a year, is it easy for one to access the register or if I wanted to know like how many suspected RHD patients...

Respondent: Except that, ok I hear that it’s a new HMIS tool, maybe its include that one but the old one we were using do not have the provision for that have the provision for that

Interviewer: And then if someone wants to track the suspected RHD patients or acute rheumatic fever that you had, would it be easy to get that?

Respondent: It will not be easy to get that because in the beginning even me I was not keeping the records, I could just fill the forms and I refer like that, now one time when they were asking how many are absent, I realized I was not keeping it, yeah and in the HMIS, once they find and whatever the provision for RHD is not there

Interviewer: Do you think it is very important to come up with the guidelines?

Respondent: It is very important because the ministry knows what happens in the villages through the reporting system but now since it’s not there, we don’t report it directly

Interviewer: And then what has worked for you in your health center, what are some of those local system health enablers factors that have helped you do your work well, administration, has it worked for you?

Respondent: Yes

Interviewer: Funding

Respondent: Funding no

Interviewer: Laughs..., health workers, numbers and qualifications?

Respondent: That one even no, what has worked for me is the attitude at work, the few members, the few staffs, they have attitude

Interviewer: Ok, what else has motivated you to keep working?

Respondent: The project always give some little token also although not regularly but that once in a while shows somebody is in care

Interviewer: Ok, let’s look at the perception of patient’s outcome, generally do you think the patients get the care that they need when they come to you?

Respondent: Yes, they do unless if the care that they need is not provided there that is when they don’t get because you know when you come like when I come to you whole heartedly that you are going to help me then you tell me you see, your condition, I cannot work on it, you go to Mulago, now I will start things like how will I reach Mulago, even if it’s the ambulance to take me, they will ask for transport, I mean the fuel, so it’s not easy but services that they can get, they get

Interviewer: Ok, do you think that surgeries can be offered to RHD patients

Respondent: Yes

Interviewer: Do you do it around here?

Respondent: No, I have not known about it because I had a friend who had a daughter with the heart condition, the man even lost a land because I referred them here but the condition, no I think even the project had not yet come so they were taken to the health center cardio echo was done but from the private clinic and they were referred to Mulago heart institute and there, they asked them some good millions of money which he had to come back and sell of his land even his business has collapsed but thank God, the child is well

Interviewer: Wow! That is wonderful, and the patient’s safety and the quality of care do you have any concerns? Are the patients managed in a safe way?

Respondent: Yes

Interviewer: why?

Respondent: sorry!

Interviewer: What are the reasons, why do you feel the quality of care they get and their safety is ok?

Respondent: Because I see they are happy and they recover

Interviewer: And then have you witnessed, do you think that there are some of the preventable deaths which are occurring in the health center, preventable that the person shouldn’t have died but simply maybe there was some hindrance in the process?

Respondent: Yes, they are there

Interviewer: Any incidence that you recall?

Respondent: Last year around this time in December, the child was brought, the relative told me that they had a child who was not well, a child of 14 years, this child was taken to a certain private clinic, this child moving and he was shot from the chest with a ball and this was the child who was living with the grandmother, the child came back and did not tell the grandmother, after sometime he started feeling severe chest pain, they started treating the child everywhere with no improvement, the time I learnt of the child, he was in a private clinic on oxygen, they referred the child to lira hospital, then I called the acute rheumatic fever, they told us to bring the child, the child was accessed but from here and they found out that the heart was normal but rather the problem was with the lungs and it had grown advanced, the child passed on from here

Interviewer: So do you think there are some patients who are dying in the communities without presenting to the hospital

Respondent: Yes, they are very many

Interviewer: Why? Why do you think so?

Respondent: I said earlier on that ignorance and poor health seeking behavior as some people in the village, by the way when you live in town, you don’t know what happens in the village, drunkardness is rampant in the village and any father who drinks doesn’t mind what happens in the environment, whether the wife is happy, the children are healthy, it’s not his, for him, he is there, they are very many.

Interviewer: What do we do?

Respondent: We need to sensitize them using better channels maybe we can reach them over the radios, churches and whatever but they need serious sensitization

Interviewer: In your opinion, what are the two most common thing ministry of health should do to improve the patient’s outcome?

Respondent: I beg your pardon

Interviewer: What are two most important things you think ministry of health could do to improve the outcome of our patients?

Respondent: First of all let the ministry prioritize health and put much funding on health, let them motivate even, I know it’s a call, this medical profession is a vocations but even if it’s a vocation, medics have families that must actually be seen after them and if the salary is little and you find somebody’s child has to study but the monthly salary cannot even pay his school fees for one term, for you to pay the fees, you first have to keep on saving every months and yet in the family, you have to save, you have to build, you need to ...,those many things, maybe I would then in addition to others, let health professionals be motivated and cared for, by doing that, it will help them care for others, for example, I am going to give you an example, I know of a doctor who is my friend, this doctor was first a clinical office, he went back to school and did medicine, when he came back, he resumed work as a clinical officer, I think money was not enough for him, you could see him even rushing to part time in kitgum,sometimes he goes where but the moment, they gave him a position as the medical officer in lira district, he settled

Interviewer: laughs...

Respondent: Yes, he settled, to me I think by that time he had started getting something that help him and the family minus running running,so he is settled at work, so I would think of first let the ministry look at the health workers with eye of mercy and secondly let them look at the community with the eye of mercy, they put things in life, the preventive measures and also the curative measures like for instance when the IPV was brought, somebody came from the ministry and he was bitter whenever he sees the number of children getting DPT3 more than those getting IPV,he was harsh on them but do you know what happened, when he went back immediately IPV is out of stock, so they want us to do things but they are not providing us with what to use, just of recent, the Rota virus was not there and yet they are telling you every day to give ,now what do you expect?, nothing good

Interviewer: Ok thank you so much, anything in particular for RHD that ministry of health can do?

Respondent: Yes, first of all, let them sensitize the community by using whatever means but the means that make the information reach every community wherever they are and secondly, let the medication be provided at least to avoid the issues of coming from the village to get treatment and find when the drugs is not there and definitely when the drugs is not there, they don’t go and buy not because they don’t want but at times because they don’t have money and even if they go and buy, you can’t just trust where they buy it from, in a drug shop where drugs are kept, somebody flaws somewhere, you may take even the right drugs but when the drugs has expired and it will not work out, so let them at least and let them sensitize and provide it

Interviewer: anything else before we stop here

Respondent: I am just grateful to the project and I am happy with the steps you have taken, I know with all these words we have spoken here you will not take it for granted, I know you will take it where it should go and the steps will be taken.

Interviewer: Ok, thank you for your time and your wonderful views, we shall definitely use them to make sure that better programs come up to prevent RHD and control it Date 15th December 2018