Circular - September 2025: Latest news from Acheru, and plans to develop work with Cerebral Palsy Napak Our first venture into work in northern Uganda was at Minakulu where we had use of a small government building to accommodate two staff and several children. Acheru ran clinics over a wide area and many children were sent to Acheru for treatment or dealt with locally as outpatients. We weren't working in isolation. We were close to other clinics and when they became familiar with the cases we could deal with there was good cooperation. It was never our intention to remain there long term, we wanted to develop a local network through which children could be referred to us, or who could help arrange community work and clinics. When it came time for us to consider winding up our base there the community weren't happy and we faced difficult decisions, but then the local council claimed back the building we had been using making it much easier for us to withdraw. We continue to work closely with the local clinics and ministry of health and referrals are still made to Acheru. An Acheru team still goes to the area to run community outreaches. We count Minakulu a success in terms of fulfilling our aims, and we wanted to use our experience to move to another area. Our aim is always to try to locate children who have been missed out by other developments in health care. We started to look closely at Napak in Karamoja, a very needy area where some development was beginning to take place, but nothing like our work had ever been seen there. Meetings were held with local government and other agencies in the area - Christian, educational, medical - to see how we might fit in. We always want to work with partners rather than try to do everything ourselves. Relationships were good from the start, everyone realized the benefits of working together. Following community outreaches and rural clinics children were brought to Acheru for treatment but before starting to build anything we needed a much better understanding of the area. I was already looking at the way local partners could make referrals to us, causing me to question the need to place our own workers there, so what could we do to best help in the area? Harriet and Rose on a home visit I was then very much challenged when I got a report on a Christmas party we arranged as part of our work in building good community relations. The party was a way of getting a large number of people together, and details of disabilities were recorded. When I saw that 90% of children attending had cerebral palsy I assumed it was a mistake but when I checked with Joyce she confirmed the figure was correct. It seemed a remarkable figure so we investigated the causes. CP is usually the result of the brain being starved of oxygen or otherwise damaged at birth. Napak covers a wide area and people have difficulty accessing maternity services, made worse by Karamajong women delivering from a crouched position with the babies falling on their heads. This was a 'light bulb' moment, we now saw where the emphasis of our work should be. Much of our community work is taken up with Cerebral Palsy children, and you can see some of the pictures of Harriet, Rose, and some of those they visit. While we do all we can to help, and Harriet, Rose, and Timothy, our physio, have a great deal of experience, we can't cure these children. We can certainly help, sometimes with dramatic results, but how much more effective it would be if we could prevent the condition in the first place. We think much can be achieved by working with our partners on a programme of community education to ensure people make full use of maternity services, and are made fully aware of problems which can arise at the birth of a child. Other factors resulting in CP have been identified too. There's a very high number of teenage pregnancies; many young girls from Napak have gone to Kampala to work as 'street' girls, coming back to Napak when they become pregnant. Acheru is working with another partner there to try to address this. So many lives are being blighted by Cerebral Palsy, not just the children affected but their families. It's not just a question of caring for the child, it often results in the family breaking up, a husband leaving, a mother being blamed. It's an immense problem and we believe a coordinated approach with our partners can make a big difference. Last years CP day at Acheru As well as prevention, we also consider what can be done to treat children with CP. We can't cure them, but there's still a lot we can do and our staff have a lot of experience. We can start by trying to convince the family that a child who has been ignored or rejected does in fact have potential if given the right help and stimulus. We have seen dramatic results when a child formerly left sitting in a corner and ignored has been enabled to stand upright and look people in the eye; they then have an opportunity to develop. Families can be instructed in exercises for the child, they can be provided with mobility aids, linked to other families who can encourage each other. At Acheru, we want to make significant improvements to our physiotherapy room to enable our staff to provide the best service possible, encouraging more families to bring children there on a regular basis and perhaps broadening the service we can provide. Building repairs Extreme heat and extreme rainfall take a toll on the Acheru buildings, but they try to keep up with repairs and are currently working on some of the staff accommodation, including making some improvements such as indoor toilets now that we have a much better water supply. The picture below is from a recent two day medical camp arranged by Buganda Kingdom, where the work of Acheru was promoted. These events greatly increase awareness of the services we can provide. You can see the posters about club foot; so much easier for us to treat in a very young child, yet still we see so many cases which have been neglected for years so there's still work to be done in raising awareness and encouraging people to bring children forward for treatment. I am delighted to report that Acheru's link to Salaama school for the blind continues to work effectively. Although Salaama is a government school, Acheru has responsibility for maintaining a Christian witness there, and groups from Acheru go there to lead fellowship. The school has really flourished from the time of our first involvement,, but inevitably there are always problems to be addressed. Their funding is limited and Joyce heard that they were struggling to feed the children properly. When an Acheru team visits they usually bring snacks and drinks for the children, but on their most recent visit, when they ministered to 65 children, they also brought 100kg of maize, 50 kg of beans, and 5 litres of cooking oil. I have been encouraged and comforted by so many messages following Hazel's death. I really appreciated what was done at Acheru when they arranged a live streamed thanksgiving service the day before her funeral, with a number of people paying tribute to Hazel. They recognized the huge contribution Hazel had made to the work through her years of painstaking work on finance and administration, but they highlighted the personal relationship too, the times Hazel had visited and got to know them, and the times she used her craft skills to make personal gifts for them. Hazel wanted no recognition, but I now think it appropriate that something should be done in her memory. At Acheru, we are planning improvements to our physiotherapy facilities as part of our drive to provide a better service for Cerebral Palsy patients, but we are now also discussing a day centre for Cerebral Palsy children and families, I am assured that there are enough affected children in the immediate area to make this worthwhile. It could give respite to carers as well as providing instruction in care of the children or arranging treatment as appropriate. We've thought about this before, but now seems to be the right time as we specialize more in CP. Following Hazel's funeral, a number of people asked if there is anything they could contribute to, and I think this would be very fitting given Hazel's affinity with the children. Sarah One of the first children we brought from Napak has now been able to return home. Sarah, a 15 year old, had a deformed left foot. She was born with normal feet but developed paralysis in the left leg which caused the foot to twist and making walking difficult since she had to bear weight on the side of the foot. Upon admission, serial manipulation was done to correct the foot which was followed up with a number of casts. The casting was later followed by Triple Arthrodesis and Capsulectomy in Naguru Hospital to fully correct the foot, after which she received post-operative treatment from ACHERU. Sarah was then reviewed for fitting of an Ankle Foot Orthosis (AFO) to maintain the foot position as she walks. Sarah was discharged back to Napak able to walk with both feet and pain free. 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