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July 2013 Report - The problem Acheru now has
We have a problem. The Acheru staff now encounter more disabled children than we can deal with, despite being very selective about the conditions we treat.
We recently added a hostel at Acheru to accommodate more patients and relatives, significantly increasing our capacity with potential for 32 surgical inpatients. This means Acheru is much bigger than we originally envisaged. Any further expansion would, I think, be unwise and create too many problems for the future, not just financial but increasing the burden on staff and management and affecting the ‘family’ atmosphere of Acheru which is so important to us. And we can’t do everybody’s work for them. Where are the others who talk so much about treating disabled children?
We provided the additional beds at Acheru so that more children could be brought from the north. We started with a team from Acheru going to the clinic at Minakulu, south of Gulu, every two months and bringing back children needing surgery. The next step was recruiting and placing permanent staff there to conduct outpatient clinics and community work, referring surgical patients to Acheru or having simpler surgery carried out locally. We then saw the problems caused by the distances some people had to travel to get to Minakulu, so the next step was to start rural clinics in more remote areas – doing this in conjunction with government centres so that adequate preparations could be made in each area.
I’ve now received details of the first visit to two of these clinics in July. Our Minakulu staff, with Sam Mutumba and a number of visitors from other organisations, went first to Zambia Health Centre, south west of Gulu in Oyam District, the community having been told to expect them. Over 30 people were already waiting; osteomyelitis, club feet, post injection paralysis, burns contractures, cleft lips, and other deformities. 35 patients were registered, 10 of which needed surgery. Osteomyelitis is usually given priority, patients perhaps having bones sticking out. It wasn’t easy though; one girl in urgent need of help had been brought by her sister, but we need to find her parents to get their permission for surgery. Treatment of some club foot patients started right away with plaster of Paris, which can be changed on the next visit after further manipulation.
They went next day to Otwal health centre, seeing similar conditions there with some osteo cases requiring immediate surgery. They were sent by public transport to Kampala and on to Kabembe. Another 12 of those registered needed surgery, but we simply can’t take them at present.
The outcome of two days clinics was that only the most urgent cases went to Acheru; 20 had to be left, their conditions possibly worsening and causing further suffering. This in addition to other children seen at Minakulu which Acheru couldn’t take in. This is distressing for the staff who are praying for a solution. They have gone there to help children; their presence alone holds out hope to children and families, and they have to be told we’re unable to help, they will have to wait.
As a matter of urgency we are now discussing all possible options with the Acheru staff to see what we can do ourselves or in conjunction with others. It makes me think back to when we started Cherub, and were strongly advised by people there not to bother, as there was no need for our services. Even in areas with relatively well developed services we’ve encountered significant gaps, but in the north it’s so much worse. There are various hospitals and clinics, and we remain focused on only dealing with those children that they aren’t equipped to deal with.
So that’s our problem, and it’s urgent, so we’ve a lot to think about. Those clinics were our first steps into that wider area, and we don’t know if what we’ve seen is a backlog of neglected cases that can be cleared up in a few months or years, or if it’s the proverbial tip of the iceberg, and we will keep uncovering a bigger problem. If nothing else, we’ve already made others aware of the problem, so there may be potential to develop partnerships. But can we take any more children into Acheru? Find other hospitals who can carry out surgery? Provide an inpatient facility at Minakulu? We must also step up community work, not just to find disabled children, but to help prevent conditions like osteomyelitis.
Lots to think and pray about, but look back to what we started from such a short time ago and how many have already been helped.
Brian Dorman

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