Circular - December 2020: The latest news from Acheru including improvements to premises and equipment, updates from a previous patient, and Angom's story, illustrating why we place so much emphasis on community work.
We are coming to the end of what has been a difficult year for most of us, with all our usual problems compounded by Covid here and in Uganda, and now increasing unrest around election campaigns in Uganda. It's also a year in which we lost two long standing and very experienced members of our Acheru board. Despite the setbacks there have been encouragements too and significant progress has been made, as evidenced by the number of successfully treated patients, and continuing improvements to the premises and equipment.
In Uganda, staff had to deal with the restrictions around Covid. At a time when some of our patients out in the villages needed our help more than ever, it became increasingly difficult to reach them. There was a period when travel became impossible but Acheru offered to provide transport for the district authorities to distribute food and this helped raise our profile.
The aim with Acheru is to treat children, have them return home, and move on to the next child. However, with some former patients it is necessary for us to help with ongoing care if the child's family can't cope; the longer the work goes on, the more of these responsibilities we incur. One recent example is a child with Spina Bifida who continues to need special dressings for pressure sores. We want the parents to help as much as they can but there's a cost to Acheru too. Such expenses can only be managed if there is strict control of other costs, and in the face of a number of difficulties over the last year, some changes were implemented at Acheru. Staff numbers were reduced and it says much about the capability of the remaining staff members that they're able to maintain the same level of service. Transport is a major expense, and it is costly using an Acheru vehicle to transport patients from the north. Unless there are enough to fill our ambulance it has proved more economical to pay bus fares for a relative to bring the child to Kampala, to be collected by the Acheru ambulance at the bus station. A significant additional cost during the year was charges for surgery which had previously been free. Acheru has been dealing with this by developing relationships with other surgeons willing to operate on our children. An additional benefit of this has been a significant reduction in the distances travelled to access surgery. Each difficulty has been overcome, the work has continued within budget, and there has even been growth. The most recent problem has been violence around election campaigns, with disruption to clinics. We are blessed with staff who seek out solutions to problems rather than just accepting limitations to their activities.
This time last year we circulated a report by Dr Ray Allen detailing his observations following a visit to Acheru. On the basis of this we had discussions with the Acheru staff and board and drew up a development plan, with priorities and costings. Our primary responsibility is to send the Acheru budget every month, so we could only consider any additional work if 'new' money was available. The timing wasn't ideal as we were then hit with Covid restrictions which affected us here and in Uganda, and we recognize the financial difficulties this has caused for many of our supporters.
Despite all the problems, people responded and good progress has been made. The first priority was a security fence round the five acre Acheru site. Work started on this, then was suspended during lockdown, but has now been completed. Next came solar powered backup lighting for the main buildings, all now installed and in use not only during power cuts but at other times too, reducing electricity costs. Then came AV equipment for use on community visits and rural outreaches for health education and promotion of Acheru. We've now been able to buy tools for the workshop to help with production of appliances. We didn't go ahead with the oven etc to produce orthotics as Joyce found another charitable organization able to supply these for less than it would cost to make our own.
The next priority is replacement of the ambulance. It was bought in 2014, like most vehicles in Uganda as a used Japanese import. Since then it has had constant use transporting children and servicing clinics, and it is now old and well worn. They've tried to keep it well maintained but it is wearing out and we are anxious to replace it before it becomes a liability.
Some of the help we received towards our development plan was specifically designated for community work including a 'community fund' to provide practical help for extreme cases. We regard this as a very important part of our work. As well as maintaining a witness in the community, running clinics, promoting health education, there's follow up on previous patients. Some time ago I wrote about a boy paralysed when he fell from a tree and left to die. Acheru's intervention and treatment brought reconciliation with his family and enabled him to return home, but life was tough for him. He was lying on the floor of the hut all day, with no company and no stimulus. Provision of a wheelchair enabled him to be wheeled around the village by his friends, and to return to school. A difficult issue for the boy and his family was double incontinence, but he has now improved sufficiently to be able to use a toilet. He feels much more positive about the future, when previously there was only despair.
I sometimes refer to the numbers of children treated by Acheru, with many thousands seen as inpatients and outpatients in addition to all who have benefitted through community work and education, but the children aren't just statistics, they are individuals each with particular needs and Acheru continues to change their lives. We sometimes wonder what life would have been like for them and for their families without Acheru, the work has an impact which seems out of all proportion to the number of people involved or the sums of money spent.

The new security fence, not just to protect us from crime but keeping our Acheru animals in and wild animals out

Installing solar panels to power backup lighting systems throughout the inpatient and outpatient units

These pictures should give you some idea of the living conditions of some of our patients, and why we have concerns for their welfare; much of their recovery has to continue at home.
Angom Sandra is 15 years old, the fourth born of six children from Oyam district in northern Uganda. She stays with an aunt following the death of her parents. In 2012 she developed a small itchy swelling in her right lower leg; this grew gradually, with an open wound and smelly discharges. She was taken to a number of clinics with no improvement, the various 'treatments' including medication for cattle, and was eventually taken to several different hospitals.
All other treatments having failed, the only option was amputation but her aunt, a widow struggling to support her own children as well as those of her late sister, couldn't afford this. Someone then advised her to bring Sandra to our Acheru unit at Minakulu. From there she was transferred to our main Kabembe unit and taken to CoRSU for Xrays and biopsy. She was diagnosed with Ulcerated Fumigating Tumour, and had a below knee amputation.
Post surgical treatment continued at Acheru with antibiotics, nursing care, therapeutic exercises, and psycho social support. She is now a happy girl, free of pain. She will be fitted with an artificial limb and should be able to fully participate in the activities of daily life. Her relatives are very thankful for the presence of Acheru in the north, and urge us to continue reaching out to people deep in the villages where many with physical and mental conditions may be losing hope.

Angom's story helps to show why we are placing so much emphasis on community work. We shouldn't be encountering cases like this - the problem could have been prevented or easily dealt with through early intervention. More widespread community work can reduce suffering and is very cost effective for us in reducing the need for costly surgical interventions.
Brian Dorman

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