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Circular - December 2019: Evaluation of the work of Acheru
Dr Ray Allen recently stopped off in Uganda on his way back from work in Zambia to carry out an evaluation of our work at Acheru. He was accompanied by a civil engineer, Sam Phillips, who was able to look at our buildings and services. The following are some of Ray's observations, which have been shared with the Acheru staff and board:
Observations on visit to Acheru by Dr Ray Allen, October 2019:
Provision of medical services and duties of staff members.
37 beds, nearly 100% occupancy rate at all times.
Impression was of good pre-op and post-op care of orthopaedic patients, mainly children and infants.
Outreach clinics: 2 or 3 per week, organised by Harriet and Rose (social worker). Spent time (usually most of the day) assessing, reviewing, checking first-time referrals, counselling. Visited clinics in the surrounding community. Often accompanied by a student (physio, OT, medical). Students were both overseas and local. Overseas students mainly from USA (Uganda Christian University Uganda Studies Program), local students from Makerere University in Kampala. Attended 2-3 days/week over a 3 month internship period. They are much appreciated by Acheru, bringing new ideas, enthusiasm, hope for future. Programme operating since 2007.
Nursing care:
Carried out by Isaac and Betty. They provide all necessary post-op care for all the patients returning from CoRSU, where most of the surgery is carried out.
Impressed with type, variety and sophistication of surgery.
Nurses do dressings, wound care, check POPs, splints etc, also monitor general health of the children. Usually not a big problem but common conditions are malaria, chest infections, vomiting and diarrhoea. These illnesses are dealt with 'in house' but there is always the option of transferring out to an acute hospital, usually the Church of Uganda Hospital in Mukono though this is rare. Wound infections after surgery also rare. Acheru has a good working relationship with C of U hospital and the nearby Noah's Ark, which looks after abused and unwanted children. Acheru use their facilities if any patients are deemed to be malnourished, and would be referred to Noah's Ark before surgery is contemplated.
Acheru always has a nurse on duty (24 hours a day, 7 days a week). Also access to an on call orthopaedic surgeon (from CoRSU) at all times.
Orthotics Dept:
Run by Ronald (orthotist). Enthusiastic, competent, forward thinking, innovative. In charge of needs of patients regarding splints, plaster casts, and application of orthotic prostheses such as AFOs and KAFOs (ankle-foot & knee-ankle-foot orthoses).These have to be bought but Ronald would like to make them in house, requiring equipment and materials. Also looks after special (Ponsetti) boots for club feet children.
Community Based Rehabilitation Workshop:
Harriet is responsible for the CBR programme; the workshop, with help from Stephen, and Sam, a carpenter, produces crutches, cerebral palsy chairs, stools, standing frames. Good quality appliances! Could make spinal corsets if they had more tools. Currently able to meet most of the needs of post op children.
Physiotherapy:
Fundamental to good recovery, especially recovery of function after orthopaedic surgery. New physiotherapist recently appointed (Daphne), in post three months. Appeared dedicated, innovative, committed. Working regularly with all patients, putting them through their paces. Has some useful equipment - parallel bars, standing frame, large balls, wheelchairs. Would like more - static bicycle, building blocks, elastic therapy bands. Would love to have input from an occupational therapist as well as OT tools and toys. All these pieces of physio and OT equipment are available in Uganda, same for tools for workshop and orthotics.
Actual physio dept needed some attention: to work top, water supply, lighting. Daphne is working on improved record keeping.
CME/CEPD (continuing medical education, continuing educational and professional development):
Some (limited) in house training eg Ronald training/teaching nurses about orthoses. However, most staff not aware of short courses/seminars to help update knowledge and skills. Encouraged to identify such courses, attend CoRSU or C of U hospital to help update their own practice and skills. Maybe senior staff members could encourage staff to pursue CME, make allowances, time off etc.
Daphne (physio) was able to keep in touch with university colleagues (graduates) and discusses cases with them on social media platforms. She is a member of Uganda Assoc. of Physios. Perhaps others could follow her example.
School:
Teacher (Juliet) enthusiastic, energetic, committed. Helped by Margaret. All the children have an opportunity to attend class at some time during the day (on a rota system). Special room set up as a classroom (rather small) which contained basic teaching equipment but could definitely be improved. (Appropriate material available in Uganda). Often it's the first time for some of the Acheru children to attend any sort of schooling (a reflection on Ugandan society's attitude to handicapped children - not worth spending time/money sending to school). Often when child went home, they agitated to continue with school. Very encouraging.
Funding:
All patients fed by Acheru, a unique feature in Uganda. Joseph is main cook during the week, helped by children's carers (esp at weekends). Patients all well nourished. Food supplies bought in by Acheru and supplemented by produce from Acheru garden. Also have own chickens, providing eggs and meat, and a cow (with calf) providing milk.
Funding is an ongoing issue. Patients make a small one-off payment towards costs of stay (often waived/reduced as some can't afford to pay). Cost of surgery is covered by CoRSU but all other costs for CoRSU referrals are met by Acheru, consequently stays at CoRSU are kept to a minimum. Funding is a limiting factor for the development of Acheru services.
Accountant:
Brenda, in post since 2013. Committed, conscientious. Would like new computer package to run accounts. Showed us recent figures - over 90% of annual income from Africare. Very dependent! Didn't back up regular work. Depts all need to be encouraged to do so, need external drives.
Social worker:
Rose has been providing excellent services for years. Does a lot of outreach clinics and carries out checks on children's background. Does a commendable job co-ordinating cases, resources, and other supporting bodies.
Transport:
Two Toyota pickups (for CBR and general 'workhorse'), both mechanically sound at present. A Toyota minibus doubles up as an ambulance, and is used regularly to transport patients to and from CoRSU, clinic runs etc. Giving more and more trouble, with obvious transmission problems.
Security:
The wire fence around the periphery of the property was not secure, allowing stray dogs to come and go - a threat to chickens and goats on the site, and possibly to the children. Visitors and staff entered through a main gate. Always a guard on duty (two appointed directly by Acheru and one by a local security firm). Thankfully no history of burglary. All individuals had to sign in and out.
Christian witness:
Obvious that Joyce and Harriet have strong, overt Christian testimony. Devotions held with staff on Monday and Friday mornings. Wednesday and Sunday evenings see a local pastor come in to take meetings for children and carers. Witnessed this personally - full, happy participation by all the children. Staff all have church connections. Also, Christian values mentioned specifically on Mission Statement.
Community relations:
Police Chief, Town Mayor, Regional Commissioner, Chairman of local Community Association, have all shown interest in Acheru's work, have been shown round, are keen to see Acheru prosper and develop.

Ray's evaluation has given us a lot to think about, and we await Sam Phillips' comments on buildings, power, and water. We're encouraged by Ray's comments on the quality and effectiveness of the work and will be looking very closely at any areas for improvement he has highlighted. It is our intention to try to address all the issues raised. This will take time - and money. Some matters can be addressed quickly, others will need to be considered at more length, such as the provision for education, physiotherapy, and occupational therapy, and I will have news of what we plan in future reports. We have however been able to make an immediate start to some things. We've increased the Acheru budget which I hope will cover overdue salary increases and facilitate other work, and we have identified some supplies they have difficulty getting locally, some already sent out by air with more to follow.
We're obliged to Ray and Sam for the work they put in on our behalf, it's valuable to have the views of experienced professionals to help us maintain standards and prepare for the future. Most of our money is committed to the budget, so we will need help if we're to develop, although I think we are in agreement with the Acheru management that 37 beds is as much as they can cope with, so the emphasis is on improved services. We will be working on detailed plans and estimates so please get in touch if you've an interest in any particular area of the work.
Brian Dorman

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