A light led hospice founder to east Africa

WHEN Dr Anne Merriman arrived in Uganda almost 20 years ago, the first thing that stood out for her was the number of coffin makers who had set up along the roadsides – the business of death in a country then dealing with the tragedy of an AIDS epidemic.

Working in hospitals where facilities were often limited, she realised patients were constantly sent home with the words, “there is nothing more we can do”. The ill could only return to their families who would often “put them in an outhouse because the howling of pain was too much”.

Since then, the 75-year- old doctor and former nun has pioneered the concept of hospice and end-of life care in Africa. And yesterday she was celebrating the opening of an Irish-funded Centre of Excellence in Uganda to develop and educate to build a palliative care system across Africa.

“This will train people for palliative care for the whole of Africa. It really is a dream come true,” she said at the celebration of the yesterday’s opening of the new building by Minister for Foreign Affairs Micheál Martin. They were joined by representatives from the Irish Hospice Foundation and a number of Irish medical volunteers who help care for around 1,400 patients at three centres.

Dr Merriman said she “followed a light” to get to where she was yesterday. Born to an Irish family in Liverpool, she moved to Ireland as a teenager where she lived for 20 years and joined the Medical Missionaries of Mary. Aged 40, she returned to secular life and studied tropical medicine.

Not only has she brought a hospice philosophy and care to Africa, she also developed a form of morphine medication that is cheaper, accessible and more acceptable for many African people.

“You use morphine powder, water, cake dye so you can tell the different strengths, and preservatives, that’s’ all that goes into it. And for the price of a loaf of bread it controls pain for 10 weeks,” she said.

The formula does not have to be injected, which people in Uganda are reluctant to do “because there is a terrible fear that they are going to become addicted”.

“In the countries we go into with no palliative care, people are just dying in agony,” said Dr Merriman.

In many African countries, HIV is on the increase but prevalence is dropping in some, including Uganda, where it has been reduced from 20% in the 1990s to 6.4%. Cancer is rapidly increasing and is expected to account for at least 10% of deaths in Africa by 2020.

Despite this, Dr Merriman says “just a third of African countries have access to chemotherapy or radiotherapy for cancer patients and 57% of patients never see a health worker”.

Many of patients are children. “They are quite disfigured because the tumours might effect their face. They are stigmatised, they feel lonely and they can’t go out to play,” said Dr Ita Harnett from Limerick, who spent18 months as clinical director in the hospice outside Kampala.

With just one radiotherapy unit in Uganda, the children have little or no access to any cure and so the focus is on alleviating pain.

The three hospices run by Dr Merriman and the Hospice Africa in Uganda have treated 16,000 people and trained 7,000 health professionals with the help of €1 million from Ireland .

“The Irish have hearts that the rest of the world don’t have,” Dr Merriman said.