Play Therapy That Helps Refugee Children Heal with Lulu Emannuel Ederia (Uganda)

A child refuses food, sits alone while others play, and wakes up terrified by memories that will not leave. When you work in a refugee settlement, those signs can be mistaken for ordinary illness, but they can also be PTSD. We sit down with Lulu Emmanuel Ederia, a Ugandan nurse and clinic officer with years in humanitarian health, to explain what “healing beyond medicine” looks like when the goal is not only survival, but recovery. 

We talk through Children’s Accelerated Trauma Therapy (CAT) in practical terms: how communities are sensitised, how children are identified, and how screening and follow-up scoring guide care. Lulu shares what he looks for most, especially intrusion and avoidance, and why these patterns matter when symptoms overlap with medical conditions. He also walks us through the heart of the model: a structured play approach using physical figurines, where children tell their story forwards and backwards to reprocess memory, reduce anxiety, and move through the hardest hotspots safely. 

The episode becomes deeply human through three real examples, including a 13-year-old girl struggling after losing her father, a 10-year-old boy with severe PTSD after losing both parents, and a 7-year-old boy living in conditions that would break most adults. You will also hear the part people avoid discussing: therapy can work, but hunger, tuition fees, and missing school materials can still block a child’s future, and volunteers cannot carry that burden alone. We end with secondary trauma and self-care for helpers who absorb painful stories every day. 

If this conversation helps you see refugee mental health differently, please subscribe, share the episode with someone who cares about child wellbeing, and leave us a review. What is one change you think would make the biggest difference for traumatised children after therapy?

Music, lyrics, guitar and singing by Dr Ariel Rosita King

Teach me to live one day at a time
with courage love and a sense of pride.
Giving me the ability to love and accept myself
so I can go and give it to someone else.
Teach me to live one day at a time.....

Transcript

Welcome And Today’s Guest

Dr Ariel R King 0:41

Hello and welcome to another episode of The Business of Life with Dr. King. Today we have a very special guest, Sir Lulu Emmanuel Ederia from Uganda. Welcome, sir.

SPEAKER_00 0:54

Thank you so much. My name is Lula Emanuel. I am currently in Arua, Uganda, and uh I am a trained nurse here in Uganda and also a clinic officer. I had a back I have a background in uh psycho mental mental health and psychosocial support and also health education in refugee setting, generally in humanitarian setting, both in Uganda and in South Sudan. Thank you so much.

Dr Ariel R King 1:21

Oh my goodness, this is so interesting. Would you please tell our audience the topic for today?

SPEAKER_00 1:26

The topic that I have chosen for today is healing beyond medicine in refugee setting where I have been operating currently.

Dr Ariel R King 1:36

I love that. I love that. Healing beyond medicine. Let's start. Let's talk about that.

SPEAKER_00 1:43

Yeah. Thank you so much. Healing beyond medicine. Here I mean because basically I have been doing a primary health care services, which is curative in the health in the clinical setting, but I've come to realize I can still do beyond that by integrating it into the into the community

What Healing Beyond Medicine Means

SPEAKER_00 2:04

through community health interventions, like health education, and also beyond that, in mental health and psychosocial support, specifically in children who have had post-domastic stress disorders by treating them using an intervention. We call it children's accelerated trauma therapy. And I've been doing this in the last seven years, and it has really shown a great impact to the children that have been in my under my care. Thank you so much.

Dr Ariel R King 2:36

That sounds so interesting. Could you please tell us more about this trauma therapy and what are the steps of this trauma therapy for children who have post-traumatic stress disorder?

SPEAKER_00 2:47

Oh, thank you. What we normally do is uh we first sensitize the community about post-traumatic stress disorder, and then after that, we identify those children who have who are who have the symptoms of uh post-traumatic stress disorders. Then we we screen them using our screening tool, we call it CRESSAIDSCO. Those ones who qualify for the therapy, we administer for them the CAT therapy. It is a it is it's a growth, it's a gradual therapy which is done in sections, and you find this first section will be difficult always for the child, but as the child you continue uh having the section with the child, you find the child continues to improve slowly, slowly, and eventually the child becomes uh detraumatized. And after that, we we we not only stop there because these traumatized children they have unmet needs, we try to provide for them the needs like scholastic materials, others demand for tuition fee, we we can refer, or what we can do, we just do it. That's basically what we do in that intervention. Thank you so much.

Dr Ariel R King 3:55

That's amazing. So, my question is what are the symptoms of trauma for children, for children who are refugees? What are the symptoms that you are educating the community about? Could you tell us about those symptoms?

SPEAKER_00 4:08

Yeah, thank you. Uh, one of the symptoms that you can see is refusal to eat. This child will refuse to eat or will have no appetite for food. This child stays in isolation. When the friends are playing, this child stays aside. You find, and also nightmares. This child dreams about the past traumatic events. You find the child gets fear, you know, fear anything, any any sound, the child is afraid, is frightened because of the past experience. So there are many symptoms really. And you find the the most the knowledge of trauma helped me in my clinical uh setting because sometimes the symptoms also mimic uh medical conditions. Yeah.

Dr Ariel R King 4:52

Oh, that's that's amazing. And are there other symptoms that parents look out for when you're trying to assess whether or not this child has had trauma in order to be in the program that you have for children with trauma?

SPEAKER_00 5:06

Yeah, basically, the symptoms that we look for to we look for avoidance. You find this child tries to avoid places,

How CAT Therapy Is Delivered

SPEAKER_00 5:17

people, and uh related to the past traumatic experience. And also we we look for what we call intrusion, those thoughts that the two symptoms that we we look for, but the others like hypervigilance and so on, those ones we we we we don't look for. But what in our Christ age school, we basically focus on intrusion and avoidance. Thank you so much.

Dr Ariel R King 5:45

Oh my goodness. And may I ask, how old are these children using? What's the age range that you you personally work with with children who have post-traumatic stress disorder?

SPEAKER_00 5:54

Uh basically, we we work with children who are six years to 18. Yeah.

Dr Ariel R King 6:01

And and just we're going to talk about those that you work with, but for those who are five years and younger who've had trauma, do you help the parents to figure out how to help these children, or are they helped by another another health officer?

SPEAKER_00 6:18

Or basically it depends. If this child is able to understand well and follow instructions, we can still lower ourselves down to help those ones. But before we do that, we have to get both the consent and the answer of both the parents and the and and the child. We don't just do it anyhow.

Dr Ariel R King 6:37

So then you also ask the child once you find a child, you know the symptoms, both of them say yes. And of course, you as a health officer are helping. What's the next step to allowing that child to free themselves from this post-traumatic stress?

SPEAKER_00 6:56

Let me get that question again.

Dr Ariel R King 6:57

What's once you've identified the child, and the child and the parent has given consent, they've said yes, you want help. What's the next step after that? What do you do with them?

SPEAKER_00 7:09

Okay, just like I said initially, the CAD therapy has tall protocols, and we follow the tall protocols. Like the first protocol is the comfortable setting for the child. You have to make sure the child is really comfortable before you start your therapy. And you go step by

PTSD Signs And Screening Children

SPEAKER_00 7:32

academic work. It involves it, it's it's really a series of you know steps that we follow. Okay. Before we we reach to the we reach to the to the play. The cut is a unique play that we normally do. It's it's really a lovely thing that it's a unique thing, and uh I we we are few in the country who are who are trained to do that by Action for Child Trauma International UK. Yeah.

Dr Ariel R King 7:58

That's really fantastic. Okay. So have you can you give us some examples? We don't need to know where these children are or their names, but could you give us some examples of at least three different children of three different ages and genders that were helped with what you've been able to do with them after they after you've identified they've had trauma?

SPEAKER_00 8:21

Okay, thank you so much. The first I can give you is an example of a young lady, 13 years old, in Rhino Camp Zone 8. I personally helped that child myself, lost the father in Sudan, and the the travels a long journey, and she's been taken care of by a single mother. And I was after my clinical work in the settlement, I was moving across the settlement. So I met the little the girl, and it's time for school, but the girl was unable to go to school because the parents had no tuition fee. And the tuition fee in is

Three Stories Of Recovery

SPEAKER_00 8:57

not really a big amount of money. It's like 14, uh, it's like four US dollars if I am to convert. And the the girl remained home. So I as I was moving, I asked, What's happening? She told me my father, my my father is not there, and my mother cannot afford to pay this money. So that's why I'm at home. And you could really see tears coming from the eyes, and so I I had to to to arrange uh for my cut intervention for with her, and then I moved with her sexon by sex one. Now, when she came, she became okay. I had to take her personal myself to the school, and then I had to really sacrifice to pay that that tuition fee for this for the case.

Dr Ariel R King 9:42

Pardon me, but can I ask that that was very fast? So you met her, she talked about her father dying, she is in she was in tears. What kind of so were you able to see she had trauma? What were her symptoms? And then how long did it take? Because it was like I bet her, I then took it to we went through, I took it to the school, but it was longer than that. Yes. So can you give us more of an understanding of the process? Um, how did you realize that she had trauma?

SPEAKER_00 10:09

Yes, so that's I was just trying to summarize that. I try I had to arrange with the section with her. So the first thing I had to do was to talk to talk to the mother, and the mother had to tell me more information about the girl because she was unable to open up. You all you could see was just tears in the eyes. So I had to talk to the mother. The mother had to tell me this girl sometimes doesn't want to eat, just go and sit very far from others. So that alone was already enough. It's an isolation. So when I had the interaction with her, she said she said sometimes she had she she had because of the love the father gave her, she could dream at night and you know, shout anyhow at night and so on. So I had to bring my Christ aid score to to screen her to see whether she really fits for the cat therapy or not. Then when I did the Christ aid score, the score was 36. So 36 out of 40. And normally when the score is from 17 to 40, that one implies that this child has post-traumatic stress disorder. So I had to arrange with her five sections for for her to be detraumatized. And after that, I had to do what I can to make sure some of her unmet needs like books, school, the tuition fee, clothes, I had to provide myself to her. Yeah, that is.

Dr Ariel R King 11:49

So you are in the field, so for you, you don't even think about it, it comes natural. But for people like me that are so curious about what you do and how you do it, can you explain for this young lady? Did you go five different times, or how did that work?

SPEAKER_00 12:02

No, what we what we arranged with her was on a weekly basis. That's what she chose was good for her. So we could arrange today, then next week she chose uh a day. Also, I come, we sit together, and then we do, and also the other week, that's how we have been doing with her together.

Dr Ariel R King 12:19

Okay, thank you. Yeah, wow, wow. So after six weeks after this, and I guess she started to feel comfortable to open up to you, and also you were able to move through these um stages of helping the child with trauma. How do you know that it's it's worked? I know that sounds strange, but when when you finish the stages, how do you know that your child no longer has the trauma that they started with?

SPEAKER_00 12:42

Well, when you you met during the follow-up, you will be repeating the Christ aid score. You find from 36 it will continue to reduce until when it is say zero out of 40 or 2 or 1 out of 40. That's when you really know that the therapy works. For so for her case, it was one out of 40. That that was now when I left her to say that she is now okay.

Dr Ariel R King 13:09

Yeah, wow, yeah, that's fabulous. Thank you. Could you give us an example of a second child, perhaps a boy child, and another age?

SPEAKER_00 13:18

Yeah, the second child is uh uh is a boy, also that was uh in the refugee settlement, and he is 10 years old. And this, you know, the the this one it came from Congo, Congo DRS, and also this lost both parents in the in the insurgency in Congo. So just brought by grand the grandmother and they are staying together with the grandmother. So I had to do the same intervention to see and for for for for for his case, uh the score was really 40 out of 40. That means it's a severe PTSD.

Dr Ariel R King 14:00

Wow.

SPEAKER_00 14:00

So I also had to intervene, and for with him, I had to arrange about six sections weekly to make sure that he is really okay. And at the end of our section, his press aid score reduced to three out of 40. So that one also tells me that he has really what he has improved.

Dr Ariel R King 14:27

And he case oh, sorry. Can I ask my apology? I'm so curious about what you're saying. So when you're doing every week, do you do art therapy? Are you doing music? Are you just doing talking? Can you tell us more about that? I find it absolutely fascinating.

SPEAKER_00 14:41

Thank you so much for that. And what the question you're asking me is in the protocol, it is protocol eight and nine. So it's uh it's a play, it's a unique play. You allow the child to tell you the story while moving the characters with the with the with some materials.

Dr Ariel R King 15:01

Oh, so you card me. So you do play therapy with actual physical figurines.

SPEAKER_00 15:06

Exactly. So thank you.

Dr Ariel R King 15:08

Okay, thank you.

SPEAKER_00 15:08

So as the uh as the child, as the child narrates for you the story, you first make the child to arrange, you tell the story of the traumatic event, and then represent the people who are there, or things that were there with the characters, and then you tell the child to to to start moving the the the the characters as he tells you the stories. So you find it's really a very it's a very interesting thing to to which I cannot really explain within this sort of time, but it's you have explained it.

Dr Ariel R King 15:42

That's fabulous. I understand. And is it the same each week? Uh does the child does the child leave off from the story? Does it is the child able to tell the story again and again, or any way that the child wants to tell the story?

SPEAKER_00 15:56

The child tells the story like forward and backward. This is very important because it helps the child to re process the memory and also to allay the anxiety. But when you find that the first section, this child will have always a problem in moving the characters, and you find it reaches where the child can freeze, and you see hot spot, the tears will be coming out, and so on. And that is where you the hotspot will always come where the pain is too much, and that is when you realize that really this is where the problem is, and you you have to be encouraging her uh or him, that's that's how we we really do it. So I have about uh 20 cut cut counselors that are widely spread in the refugee settlement, and they are they are also there doing the work, and together we do it with them. Thank you.

Dr Ariel R King 16:50

And I'm so sorry that I interrupted. So, the 10-year-old boy, I'm just amazed that he had the highest score through this type of play therapy with figurines, and most importantly, you going each time and being there for him and listening to him and uh being with him helped him to work through the trauma. And after that, did was the child able to uh go to school, or what what was the 10-year-old boy able to do after that? I'm sure was he able to concentrate better? What what what was he able to do different?

SPEAKER_00 17:21

He was able to go to to to school, but now the the the challenge came like um the tuition fee wasn't there, and it and you know, because of the current situation, really things are different.

Dr Ariel R King 17:34

That's for a lot that I know that's for a lot of kids uh in in places where you have to pay tuition. That's understood. So, what happened to this wonderful young boy after you were able to help him with his trauma?

SPEAKER_00 17:46

The young boy that used not to sleep at night could really sleep up to morning hours without having the night terrors or the nightmares, and also able to bathe and eat, you know. He used not to mind about so much about his health, but now he can even you know socialize and go and play with the young ones, football and so on. So that is how we see that there's really a positive uh change in these children.

Dr Ariel R King 18:13

That's a big change, isn't it? Even to be able to go and play with other children makes all the difference. That's amazing. Would you tell us about one other story that that you think is so important that or one that really touched your heart of a child you worked with with trauma?

SPEAKER_00 18:29

The the the last child that I worked were with was seven years old, and that that was in in Rhino Cam Zone 8. And this one was a bit really so so so touching to me because uh when I met the child, I also met him unable to go to school. Same issue, nutrition fee, single mother, and the child told me that he really wanted to become a medical doctor, and it it puzzled me. Nothing, even eating, no food, you you just enter inside the where they sleep. You can't believe human beings can sleep inside there. So, what the mother just told me is um this this child at night, he can just wake up and sout on top of the voice. And when you ask what is happening, he says there's nothing. In the morning, he wakes up, goes, you could not know where he has gone. He comes at his own time, he prefers to do his things the way he wants. You can't see him combing the hair, he's just had to for him to bathe and all that. And so the situation was terrible. And now he was referred to me by the community health workers, and I had to go to visit the home. And when I ritually went to the home, you can you could visibly see that there's a problem in the in this in this in this family. First of all, the the structures are not really good for human beings to stay in. And I asked the mother what could what's the problem. Unfortunately, the mother started crying to for me also, and I that alone was too deep in my heart. So I told the mother, okay, I am I I introduced myself, what I do with children, and I gave also my ex seven-year experience of working with traumatized children. So she was able to welcome me, and they were able to I was able to start my sections with them. And the the score for that child was 38 out of 40, also. So that I had to start my same intervention, and I I moved with the with him five five sections every week until also he was able to catch up. But the most difficult challenge that I've got is after the therapy, you find you are supposed to meet the unmet needs of these children, which is now the hardest part because you cannot know what to do. The child needs clothes, the child needs clustered material,

Unmet Needs After Therapy

SPEAKER_00 21:12

the child needs tuition fee. So you are you are uh you are alone, you can't really do that. And that's that has been the biggest issue with me.

Dr Ariel R King 21:20

So, do I understand that this program is fantastic? With you have materials, you have training, you've also trained others, but the one thing this program doesn't have is the funds to actually meet the needs of the children in terms of going to school and or as you said, school materials or quote unquote tuition fee. So the program has everything except the way to move these children through to the to the next level. Is that correct?

SPEAKER_00 21:49

Yeah, that that's that's correct. And you find uh also because of the food ratio cards and so on in the settlement, you find these children mostly. So when you start the section with them, they become you know hungry and you have to what pause the section and wait for another one. So that is that is really the biggest issue. But also the the the the counselors, the cat counselors that we're working with, they are just volunteers, they are community trained people, and we we don't have the funds to really support them to do more because the the the settlement is too wide and they are just volunteering because these are your people, you cannot allow them to to Yeah.

Dr Ariel R King 22:37

And so do I understand that many of these settlement camps are informal settlement camps rather than formal settlement camps? So you don't have running water, you don't have showers, you don't have the basic necessities. So are these informal settlements?

SPEAKER_00 22:54

These settlements are formal, and but you see, because of the the situations, you know, most of the angels.

Dr Ariel R King 23:04

Wait, wait, my apology. Let's we let's talk about the people in the in that that belong in the country or people the refugees seek refuge. The government says, okay, you can be in this camp. You say the camp is a formal camp, but do I understand that the camp doesn't have education? The camp doesn't have food, the camp doesn't have, for example, ways to plant food. I I don't understand. If it's formal, where's all the formal parts of life that children usually have? Food, uh, friends, play, and so on and so forth, if it's a formal settlement.

SPEAKER_00 23:35

Okay, what I can say is initially, initially, before the funding cuts and so on, everything was really okay. And schools, even currently, schools are there, structures are there, but the this the specific settlement I'm talking uh where the first lady, the one I helped, was staying. It's a new settlement. And you know, when the settlement is still new, there are things that are really, yeah, it's a process.

Dr Ariel R King 24:07

So I know sorry, I don't mean to interrupt. So may I ask? I mean, you're such an amazing gentleman. You're working with people, you work with children, you're working with the families. I'd like to know understand more about you. How does it affect you when you are helping the children with trauma? You see that they're getting over trauma, but you're not able to help them to meet their basic needs, which are safety, housing, whatever that is, to be housed in a structure that that allows for some type of humanity, water, food, learning, and play. How how does that affect you as a gentleman that is so caring about these young people?

SPEAKER_00 24:45

Yeah, uh, I have slowly developed what we call the secondary trauma, a trauma you get because of hearing somebody's story and seeing also what's happening on the ground. But uh, because I have been trained well to see how I can, you know, control or I can take safety of myself. So my my my entire life I've been working in the humanitarian setting. So I am, you know, well versed, and I know my limits where I can I can stop. And yeah, I also have to mind about my health

Secondary Trauma And Self Care

SPEAKER_00 25:22

and all that, yeah.

Dr Ariel R King 25:23

So then my question is how do you take my apology, how do you take care of you? There's so many of our listeners that do what you do, they work in NGLs, they do a lot of volunteering, they see things that they can't change, they change the things that they can change, like yourself, yes? But how do you take care of you while you also give in to others? What do you do for yourself to help yourself with this secondary trauma and to be able to get up the day and you know feel good about what you do?

SPEAKER_00 25:50

Personally, me, I really do not have uh much. I can say I am as because I have grown in the refugee life, so I I believe in in sare in the little that I can when I have. So most times if I have, I can search and if I don't have, I can also stay. And then I if there are other partners that I know they can help such children, I send them to them. Others go, they get help, others don't get help. So it's just it's a faith-based, it's done out of faith, and I have strong, you know, faith and pray together with the children. Yeah, that's how I've been, yeah.

Dr Ariel R King 26:31

That's how you cope. You're an amazing gentleman. Believe it or not, our time is right now. Could you please tell people how to get in touch with you and how to learn more about what you're doing? How can people get in contact with you?

SPEAKER_00 26:44

People can get in contact with me, one through my official email address, which I believe you have.

Dr Ariel R King 26:52

Right. And how about LinkedIn? Are you on LinkedIn, sir?

SPEAKER_00 26:55

Yeah, I'm on LinkedIn,

How To Contact Lulu Emmanuel

SPEAKER_00 26:57

yes.

Dr Ariel R King 26:59

And what's your LinkedIn name, please? What's your LinkedIn name?

SPEAKER_00 27:02

Lulu Emmanuel.

Dr Ariel R King 27:04

Wonderful. I want to thank you so much for being with us. And I think we're gonna have to have a second interview because that was outstanding to our audience. Remember, if I am not for myself, who will be for me? If I am only for myself, when am I? If not now, then when? That was by the great philosopher Hillel. And I've added, if not me, then who? Just like our guest. Thank you so much for joining us.

SPEAKER_00 27:29

Thank you so much, and thank you for hosting me. It's my first time, and I really enjoyed it, and thank you for the host.

Dr Ariel R King 27:36

Thank you.