Try to imagine living with a family of seven in a house built from mud-brick walls, with a tin roof and a bare earth floor — or, if you are fortunate, one made of concrete. There is no running water and no electricity. Add an equatorial climate of high humidity, increasingly unpredictable droughts and torrential downpours, and you could be in many rural communities across sub-Saharan Africa.
There may be no means of transport other than your feet or a rickety bicycle to reach a well, school or health facility. Income may come almost entirely from subsistence farming. Unless you have lived or travelled somewhere like this, it is hard to appreciate how relentless daily life can be. Even as a visitor, you cannot fully understand the reality of living this way for a lifetime.I spent most of my medical career as a GP in a deprived area of Swansea, where I saw the health outcomes and social consequences faced by successive generations living with disadvantage. But none of that prepared me for my first visit to Uganda in 2014 with Friends of Lowero (FLOW).
How Wales found a lasting link with Lowero
FLOW is the health division of Care for Uganda, a small to medium-sized charity founded in 2001 by Andy Pilcher, a former Baptist minister in Briton Ferry. The town is now twinned with Bbowa in Lowero, Uganda, where the charity has its permanent headquarters and employs local staff.
Andy saw great need and, with tremendous perseverance, established links with the Buganda Kingdom, one of the ancient kingdoms that existed before colonial rule and the creation of modern Uganda. It remains the largest and most influential of them, with continuing significance at national level.
Care for Uganda runs child sponsorship programmes to improve access to education, alongside community development projects that provide safe hand-washing facilities, latrines, mosquito nets and solar lamps. More recently, its current chief executive, Jennifer Fletcher, has successfully established a women’s empowerment project with support from a Welsh Government grant.
FLOW was set up in 2012 by Dr Gordon Lewis, Dr Hilary Lewis and Dr Chris John, all GPs in Carmarthen, together with Jo Henderson, a Carmarthen-based midwife. They had been impressed by PONT, another Welsh organisation already working in Mbale in eastern Uganda, under the leadership of Dr Geoff Lloyd.
The volunteers bringing care closer to home
Its two main aims are simple: widening access to healthcare and improving outcomes in rural communities.
The first strand of its work is support for Village Health Teams (VHTs). These teams are widespread throughout East Africa, and Uganda in particular. In each rural community, local leaders and elders select prospective volunteers, who then receive training based on a Ugandan Government curriculum.
The charity has formed strong links with the Lowero District Health Office and its leader, Dr Innocent Nkonwa. He identifies where help is most needed, allowing resources to be targeted effectively. VHTs assist their villages with health promotion advice, signposting to healthcare facilities, and the delivery of a World Health Organisation-approved programme to reduce deaths among children under five by treating diarrhoea, malaria and pneumonia through an agreed protocol.
District trainers deliver the training package. Experience has shown, however, that initial training alone is not enough. In other areas, VHTs have disbanded or become ineffective. That is understandable: all members are volunteers and have other commitments. Most are subsistence farmers with no other external income, and the responsibility of providing for their families must come first.
When muddy roads stand between families and care
The second strand is the provision and maintenance of motorcycle ambulances. This includes training local mechanics, funding fuel and repairs, helping with permits and supporting driver training. Because much of Lowero District is served by mud-track roads, travelling conditions are extremely challenging for conventional vehicles.
There are now 15 motorcycle ambulances in Lowero, seven of which FLOW directly supports. The original vehicles were specialised eRanger motorcycles with sidecars, while more recent additions include tuk-tuk-style ambulances. In 2025, Cymdeithas Feddygol supplied a tuk-tuk ambulance built by the PONT team in Mbale.
Most ambulance journeys to or between healthcare facilities are for women in labour, children under five with acute illness, and other people facing medical emergencies. The District Health Officer has told us that the vehicles have been instrumental in reducing maternal and infant mortality in Lowero.
The team also collects data on ambulance activity and supports a monthly meeting of drivers with Mulumba Mathias; the Care for Uganda projects co-ordinator and Lowero District Health Office Public Health Officer.
A partnership built on listening
The Welsh team visits Uganda every year to monitor the VHT and motorcycle ambulance programmes and to consult with the District Health Office. The relationship has endured because it is based on listening, practical help and local leadership.
The organisation is determined to avoid the kind of well-intentioned donations that can be seen elsewhere: equipment that arrives from NGOs but is left unused, unsupported or impossible to maintain. Instead, the aim is to provide resources that are wanted, usable and sustainable.
All members of the team have benefited from the link, forming friendships with Ugandan colleagues and learning from them about the issues they face. Two of FLOW’s closest Ugandan colleagues have visited Wales, staying in team members’ homes and giving talks to a range of groups, including at the Global Health Partnerships Cymru conference in Cardiff.
Team members have also given presentations to Welsh community groups, both to publicise the projects and in the spirit of the Well-being of Future Generations Act’s ambition for a globally responsible Wales.
What small teams can achieve when communities lead
The work is organised by volunteers who self-fund their visits to Uganda. Money is raised through community activities in Wales, as well as grants from bodies such as the Wales and Africa Grant Scheme, the Royal College of General Practitioners International Travel Scholarship and the Tropical Health and Education Trust (THET), now part of Global Health Partnerships.
Unfortunately, the current political climate in the UK and elsewhere has drastically reduced these funding routes, making community support more important than ever.
It is a good example of what can be achieved through principles that also apply in Wales: a small team, rooted in community and common purpose, can deliver meaningful change with limited financial resources when it works in genuine partnership with strong communities elsewhere.
In Lowero, that partnership is not abstract. It means practical help for village health volunteers, ambulances that can reach people on difficult roads, and a continuing Welsh commitment to improving lives.
To support FLOW or learn more, visit careforuganda.co.uk or contact Owen Powell at o.powell@btinternet.com
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