Out of Africa: The contribution of Dr Anne Merriman

To mark International Women’s Day tomorrow (8 March), Prof Sheila Payne, President of the European Association for Palliative Care, talks to Dr Anne Merriman, Founder and Director of International Programmes, Hospice Africa Uganda

Sheila Payne: Hospice Africa Uganda, which you founded in 1993, is recognised internationally for its clinical and educational work in palliative care and you have recently been nominated for a Nobel Peace Prize. What inspired you to devote so much of your life to palliative care?

Dr Anne Merriman speaking at the graduation ceremony at Hospice Africa Uganda on 21 February 2014

Dr Anne Merriman speaking at the graduation ceremony at Hospice Africa Uganda on 21 February 2014

Anne Merriman: I worked in Nigeria from 1964 to 1973. I was one of the doctors who had to tell patients there was nothing more to do when they were in terrible pain from cancer. But it was when I was in geriatric medicine in Liverpool and Manchester (UK) from1974 to1981 that I realised the terrible suffering of the elderly in long-term care, particularly cancer patients. This, combined with completing a Masters in International Community Health in 1982, led me to Penang, and then Singapore where I introduced palliative care and geriatric medicine while working as a senior teaching fellow in community medicine. Taken up by Drs Cynthia Goh and Rosalie Shaw, palliative care has progressed in Singapore in a big way and now offers one of the most successful examples of home and hospice care in Southeast Asia.

Perhaps the inspiration also came from my brother, whose death from a brain tumour at 11 years old devastated our family. He had terrible headaches and projectile vomiting and was in a darkened room for two weeks before the doctor realised it was more than ’flu. I was only 12. 

Sheila Payne: Tell me about the start of Hospice Africa Uganda

Anne Merriman: We began with enough money for three team members for three months – but a lot of faith. Our nurses had to be ‘everything in one’ and we trained them in all aspects of holistic care. We insisted on teaching alongside clinical care. Undergraduate training of doctors and nurses began in 1993 and all doctors qualifying since 1994 now know of palliative care. Our first research was carried out in 1994; using the same methods for pain control as for cancer we found we were able to control pain in AIDS. 

Celebrating success: Sylvia Dive (centre) was one of 34 students who graduated with a Diploma in Clinical Palliative Care from the Institute of Hospice and Palliative Care in Africa. Sylvia leads the international palliative care programme for Francophone Africa

Celebrating success: Sylvia Dive (centre) was one of 34 students who graduated with a Diploma in Clinical Palliative Care from the Institute of Hospice and Palliative Care in Africa. Sylvia leads the international palliative care programme for Francophone Africa

Sheila Payne: What tips would you give to someone who is setting up a new palliative care service?

Anne Merriman:

  • Internalise the ethos and encourage the team;
  • Patients and family are at the centre of all we do;
  • Care for and support each other within your team;
  • Recognise and respect your networking organisations so that you can provide the best care possible… many needs have to be met with the help of each other.

Sheila Payne: What has been your biggest achievement in palliative care?

Anne Merriman: Bringing an affordable solution of oral morphine to Africa for severe physical pain. This opened the door to holistic care and peace, for those in severe pain (which is the majority), the training of others and building on African spirituality to support the needs of our patients.

Sheila Payne: What are the main challenges facing palliative care in Uganda today?

Anne Merriman: A shortage of funding for patient care and for training at all levels, particularly for degree students from all over Africa; maintaining the spirit in the face of the bureaucracy in the health systems, and occasional rivalry between different organisations. 

Sheila Payne: What lessons have you learnt from your patients?

Anne Merriman:

  • Always listen to them. They know their body better than we do and we must not presume to know best. They have so much to teach, even the longest- serving of us.
  • Every person is different and has different needs. Their life history and experiences often determine their suffering as death approaches and many need reassurance.
  • You can never get too involved with your patient.
  • We need to always be prepared to learn, and not just to teach, by listening. This is particularly true in Africa where every country is so different and culture changes with tribes.

Sheila Payne: Which three women have most inspired you?

Anne MerrimanMy mother, whose spirituality and values were so right for a changing world; Mother Mary Martin, founder of the Medical Missionaries of Mary, who started a Missionary Congregation which supported medical service on three continents and Dame Cicely Saunders, a strong and forthright woman with deep spiritual values. 

To find out more…
Audacity to Love’  (Irish Hospice Foundation, 2010) is Anne Merriman’s story of how affordable pain relief became available to dying patients in the poorest countries of Africa. Click here for more information.

You can read more about Dr Anne Merriman and the work in Uganda in ehospice.

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This entry was posted in Advocacy, EAPC Board Members, Interviews and Tributes, National and international events and tagged , . Bookmark the permalink.

6 Responses to Out of Africa: The contribution of Dr Anne Merriman

  1. Pingback: Out of Africa: The contribution of Dr Anne Merriman | EAPC Blog | All Things Palliative - Article Feed

  2. nahlagafer says:

    I add my voice to all other voices that nominate Dr Anne Merriman for the Noble Prize. For all what was mentioned and also on her influence on a number of African countries: introducing PC through advocacy visits, training and mentoring .

  3. nahlagafer says:

    I add my voice to the thousands who felt the influence of Dr Anne Merriman in their countries. Dr Anne introduced PC in several African countries through advocacy visits, training and mentoring.

  4. Lillian Ogen - IHPCA says:

    Dr. Anne, you are quite a wonderful woman with great vision. Your story about the start of Hospice Africa challenges my brain as a woman and inspires me each day I read about you and I ask my self

    2. What have I done so far for the needy?
    3. How many people in need have I reached so far ?
    4. What can I do now?
    4. what legacy will I leave behind ?

  5. She influenced and helped me to initiate and implement Hospice Jinja and Hospice Tororo. I am proud of her contribution to palliative care in Africa
    Chaplain Daniel

  6. I think that Dr Ann Merriman is a most wonderful compassionate and practical person who is totally dedicated to her patients and the relief of pain as well as quality of life as the patients near the end of their lives. She is also very holistic and looks to the needs of the family who most certainly have needs of one kind or another.
    Sister Nuala Horgan mMM

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