2001
Anne Merriman, MBE, MB BCh, DCH, DTM&H, FRCP(I), FRCP(Edin), MCommH, FMCP(Nig), AM(Sing), FJMU.
Anne was born in 1935 in Liverpool, England. Daughter of a teacher and third in a family of four children, she remained in Liverpool until the age of 18 years. Her younger brother died at the age of 11 of cancer of the brain and as he was her closest friend (she was only 12) his life and death may have influenced her future choice of career.
Her Mother told that at the age of four, Anne said that she would like to go to Africa to look after the children, inspired by a Missionary journal that came regularly to the house. In 1953, she left Liverpool for Ireland, where she joined a Missionary religious order, the Medical Missionaries of Mary (MMMs), in Drogheda, Ireland. After Missionary training, she worked in the hospital medical laboratory for two years before joining medical school at University College Dublin in 1957. Graduating in 1963 she first went to Africa in 1964. She worked in Nigeria as Medical Officer to a busy acute hospital, followed by a small Mission hospital, where her responsibilities included everything from birth, through surgery and obstetrics and medicine and paediatrics, to death and post mortems! During this time she experienced the Biafran war and also qualified as a consultant physician. In 1973, she left the MMMs and returned to Liverpool to look after her ailing mother. There she joined Geriatric medicine as one of the initial pioneers of that speciality both in Liverpool and in UK. After a short training she became a consultant and Lecturer in the University Department at Liverpool University.
The next ten years were spent in Geriatric Medicine with a short spell in General Practice, both in Liverpool and the University of South Manchester. While restructuring the geriatric service in St Helen’s and Knowsley, she became interested in the needs of the dying. She was asked to teach pain and symptom control to the teams in surgical and medical wards, as palliative care had not yet reached Merseyside. In September 1981, shortly after Anne’s Mother had died, Dame Cicely Saunders accepted an invitation to come to St. Helen’s and Knowlsey, to take part in a day’s seminar in palliative care. At this time, Anne was preparing to return to developing countries. Dame Cicely then arranged for the first Macmillan Nurses for home care to be appointed and funded in Merseyside.
In 1982, Anne spent one year at Liverpool School of Tropical Medicine achieving a Master’s in International Community health, during which time she went to India for three months and wrote her dissertation on the Needs of the Elderly of India. This short time gave her a lot of insight into the Indian cultures and religions and their influence on the people and the development of the country.
In 1983, on the recommendation of the Dean of the Liverpool School of Tropical Medicine, she joined the Community medicine Department of Universiti Sans Malaysia as Associate Professor. She moved to Singapore 7 months later as her special interest was the elderly, who were quite a low proportion of the population in Malaysia whereas the elderly population in Singapore was growing rapidly due to the birth control policy over the previous 25 years (two children to a family). This had resulted in an inversion of the population pyramid with economic and social effects in the country. She spent 6 years as a Senior Teaching fellow in the Department of Community and Family Medicine. During that time she spearheaded research into the needs of the terminally ill and then formed a volunteer organisation to meet these needs. This was take up after 4 years, to be funded by the Community Chest, a social fund raising organisation. The last 7 months in Singapore involved setting up an organisation (the Hospice Care Association) from her flat, which took hold and today is one of the most successful Hospice organisations in the world, giving 60% coverage of all diagnosed cancer patients in the Island.
In 1989, she was invited to Kenya to become the first Medical Director of the newly formed Nairobi Hospice. Nairobi Hospice was only the second Hospice in the then sub Saharan Africa (which excluded South Africa) and the first Hospice set up to meet the needs of the indigenous population. This was the first time that Anne had found a country were oral morphine was not available. She said that she could not come to do palliative care unless it was made available and the Hospice Board had the morphine available in the next 6 months. She joined Nairobi Hospice in June 1990. During the following 18 moths, the suffering and distress caused by cancer in African countries was brought home to her as she worked with the first home care team for cancer and set up the teaching programmes for health professionals. In 1991, she was invited to write an article for the Christian Journal Contact, which was publishing an edition on Hospice Care world wide with Dame Cicely as the editor. Following a short article on the work in Nairobi, Anne was approached by concerned people from different African countries asking her to bring palliative care to other African countries, now suffering from the HIV/AIDS epidemic. Uganda was one of these countries. As Nairobi Hospice was very much under the control of the Board of Trustees who did not wish to extend themselves as a model at that time, she left Nairobi Hospice in 1992. The next year was spent in raising support and funds for a new "model" Hospice that would act as a catalyst for other African countries to start a similar service. Following a feasibility study of three African countries in 1993, Hospice Africa (Uganda) commenced in the front room of a two bedroom house lent to Anne and Fazal Mbaraka, a Kenyan Nurse, who had pioneered the work with Anne from 1992. Those first months were difficult, including Fazal losing her Father who was murdered in Kenya, necessitating her need to leave and return to the family. The only capital was a second hand Land Rover donated by the British High Commission. There was just enough funding for three months, employing an Ugandan Nurse and a driver. However there was a lot of faith in the work and as soon as the patients and families began to experience the change in their care, we knew that this work would prosper.
Meanwhile Hospice Africa had been registered as a Charity in UK. Mrs Lesley Phipps spearheaded the group of friends that were supporting the work and her husband and other friends joined in. A Charity shop was opened, completely manned by old age pensioners, and started to raise a regular income. This shop and a second shop opened in Ainsdale are still the backbone and fall back for funding the project.
A Ugandan business man, Henry Mary Kateregga, lent his house in the industrial area of Kampala, and the service worked from there for a year. A Board of Advisors was formed with henry as the first Chairman until his death in 1995. We moved into the present house in Makindye in 1994. This was bought and renovated by Ireland Aid. This is still the site of Hospice Uganda but has expanded in the last two years. It now incorporate a residential facility for those coming to learn about Hospice in the African situation (Kateregga House), a home care service covering on average 250 patients in their own homes or hospitals, an education unit and a centre for the Distance Learning Diploma in Palliative Care for Africa. This is due to commence in April 2002 in conjunction with Makerere University in Kampala. Our training programmes are now reaching other African countries. This is with the assistance of Diana Princess of Wales Memorial Fund, who invited Hospice Uganda to be their technical experts in Africa in 2000. Thus the third objective of Hospice Africa is being realised reaching Tanzania and Malawi in 2001.
In 1998 two branches were opened in Uganda. Mobile Hospice Mbarara was founded to give teaching to Uganda’s second Medical School. It now covers Mbarara District and is extending to the surrounding Districts. Little Hospice Hoima was founded to serve the poorest in a rural District with very little means. This Hospice is only now expanding but has a model service which is about to reach out further, following the completion of recent research of the unmet needs of the poorest during end of life and critical illness in the home. 57% of people in the villages in Uganda do not reach medical care and in Hoima District, 1 in 4 are HIV positive. This District should be a model for other poorer districts in Africa.
This award recognises the unique appropriateness of palliative care and the Hospice spirit in Africa. The Ugandan team are now mainly palliative care nurse specialists, trained on the job. The MoH have now take up palliative care as an essential clinical service in the National Health Plan 2000-2005. Because of the shortage of doctors (1:50,000 in the villages) the law is being changed so that palliative care nurse specialists can prescribe morphine. Morphine is being given free of charge to patients in end of life care and critical illness in their homes. Hospice Uganda is working with MoH to train health professionals in the District in parallel with the introduction of oral morphine solution, which is affordable and is made available with the International guidelines in place. Uganda is setting the trends in Africa with this model.
Hospice Africa (Uganda) is almost a completely Ugandan NGO. With 50 in the team in Makindye, 14 in Mbarara and 6 in Hoima. Anne plans to pass over her role as Medical Director in 2003 to Dr. Lydia Mpanga and concentrate more on the training aspects until she can leave Hospice Uganda. At the age of 66 it is time to think about retirement but Hospice Africa will always be special. We thank God who has prepared her through life for this special assignment.
