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