Hospice Africa - the Uganda story

“Patients with advanced disease, severe pain and gross disfigurement were sent home from hospital to die, with nothing stronger than a few paracetamol.  I could not stand by and let this happen when we have the means to control pain,” said Dr Anne Merriman referring to her visit to Nairobi Hospice in 1989. 

In 1993 she started with three staff and enough medicine for just three months.  Now the project has 135 staff and is a model for the rest of Africa in hospice care. 

The scheme has pioneered the use of pure morphine and outpatient care, both of which suit the African culture and are less expensive.  Most morphine is mixed in a sort of cocktail with sedatives or alcohol but Dr Merriman uses pure morphine mixed to the correct dosage at the local hospital dispensary. 

“It wasn’t pure morphine, it didn’t keep them alert or allow them to go back to work,” she explained to ciNews.  “What we use is pure powder morphine made up into a liquid.  We don’t have any inpatients, they are all at home because that is where they want to die, they can’t afford inpatient care anyhow.  If they do need initial hospitalisation, we get them home as quickly as possible.  Then we can talk to them about the other problems that face them as they die - financial problems and so on, so they can die at peace with God and their families.”

On Sunday her book,  Audacity to Love, the Story of Hospice Africa was launched and  Dr Merriman, 75, a former nun with the Irish Medical Missionaries of Mary (MMMs), spoke of how she has devoted the last seventeen years to establishing Hospice Africa.  Audacity to Love, a part memoir, gives insight into Dr Merriman’s life and relentless pursuit of her vision to bring affordable pain relief to millions of Africans suffering painful deaths from cancer and AIDS. 

Movingly personal at times, the book outlines how Dr Merriman felt her calling to help the sick in Africa from as early as age four.  Back then, her mother used to get a magazine called Echoes from Africa.  “When I saw the pictures inside I said I want to help those sick children,” she told ciNews.

At eighteen she joined the MMMs, studied medicine at UCD and became a missionary doctor in Nigeria for ten years.  Later she initiated hospice care in Singapore before moving back to Africa, first to Kenya, and then in 1993 to Uganda where she still works. 

It was in Uganda that the model, Hospice for Hospice Africa, began and has cared for more than 160,000 patients.  More than 7,000 personnel from Uganda and other sub-Saharan countries have also been trained, allowing hospice care to spread to wider regions in Africa.

Dr Merriman explained that in the countries with no palliative care, people were dying in agony.  A third of African countries have no access to chemotherapy or radiotherapy for cancer patients and in Uganda 57 per cent of patients never reach a health worker.

Mr Eugene Murray, CEO of the Irish Hospice Foundation, said at the launch, “The remarkable achievements of Dr Anne Merriman and the teams in Hospice Africa Uganda have enabled so many people to spend their last days and weeks free of pain.  They have created a model that works so well that it is being adopted right across Africa.”
 
The book is published by the Irish Hospice Foundation and available in Eason bookstores nationwide and at www.eason.ie.  All proceeds will go directly to Hospice Africa.

by Ann Marie Foley