
Anne Merriman, ‘Mother of Palliative Care' in Uganda, Dies at 90
The cost of intravenous morphine was prohibitive for many of her patients. So she came up with an alterative: powdered morphine.
At her behest, a pharmacist at the National University of Singapore, where Dr. Merriman taught, developed a formula with just three ingredients: morphine powder, water and a preservative. The cost was a fraction of that of intravenous morphine. And the simplicity of the formula meant that, unlike medical cocktails containing sedatives and alcohol, it could be quickly adjusted and mixed for each patient to take home.
For Dr. Merriman, a former nun who would go on to expand palliative care in the developing world — introducing a replicable, culturally flexible model of hospice to Africa, treating nearly 40,000 patients and training some 10,000 medical professionals across 37 countries on the continent — that small innovation was, she later wrote, 'a game changer.'
Dr. Merriman died on May 18 at her home in Kampala, Uganda. She was 90. The cause was respiratory failure, her cousin Chris Merriman said.
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Snack (195 calories) 1 cup nonfat plain strained (Greek-style) yogurt ¾ cup raspberries 1 serving No-Sugar-Added Chia Seed Jam Lunch (458 calories) 1 serving One-Pot White Bean, Spinach & Sun-Dried Tomato Orzo with Lemon & Feta P.M. Snack (177 calories) 1 serving Pizza Pistachios Dinner (540 calories) 1 serving High-Protein Caprese Chickpea Salad Daily Totals: 1,780 calories, 86g fat, 93g protein, 174g carbohydrate, 46g fiber, 2,253mg sodium. Make it 1,500 calories: Omit A.M. snack and change P.M. snack to ¾ cup low-fat plain kefir. Make it 2,000 calories: Add 1 serving Cottage Cheese Snack Jar as an evening snack. Day 28 Breakfast (584 calories) 1 serving Shredded Wheat with Raisins & Walnuts A.M. Snack (62 calories) 1 medium orange Lunch (458 calories) 1 serving One-Pot White Bean, Spinach & Sun-Dried Tomato Orzo with Lemon & Feta P.M. Snack (101 calories) 1 serving Cottage Cheese Snack Jar with Tomatoes, Cucumbers & Bell Peppers Dinner (604 calories) 1 serving Sheet-Pan Chicken Thighs with Brussels Sprouts & Gnocchi Daily Totals: 1,809 calories, 69g fat, 94g protein, 224g carbohydrate, 36g fiber, 1,556mg sodium. Make it 1,500 calories: Change Breakfast to 1 serving Anti-Inflammatory Breakfast Smoothie and omit P.M. snack Make it 2,000 calories: Add ¼ cup unsalted dry-roasted almonds as an evening snack. Week 5 Day 29 Breakfast (407 calories) 1 serving Avocado Toast with Jammy Eggs A.M. Snack (195 calories) 1 cup nonfat plain strained (Greek-style) yogurt ¾ cup raspberries 1 serving No-Sugar-Added Chia Seed Jam Lunch (500 calories) 1 serving Black Bean-Quinoa Bowl P.M. Snack (122 calories) 1 serving White Bean-Stuffed Mini Bell Peppers Dinner (561 calories) 1 serving Pan-Seared Cod with Radish & Lentil Salad Daily Totals: 1,787 calories, 84g fat, 96g protein, 138g carbohydrate, 48g fiber, 2,033mg sodium. Make it 1,500 calories: Omit A.M. snack and change P.M. snack to 1 clementine. Make it 2,000 calories: Add 1 serving Cottage Cheese Snack Jar as an evening snack. Day 30 Breakfast (397 calories) 1 serving Chickpea & Kale Toast A.M. Snack (195 calories) 1 cup nonfat plain strained (Greek-style) yogurt ¾ cup raspberries 1 serving No-Sugar-Added Chia Seed Jam Lunch (430 calories) 1 serving Avocado & Chickpea Salad P.M. Snack (177 calories) 1 serving Pizza Pistachios Dinner (419 calories) 1 serving Tofu Tacos 1 serving Spicy Cabbage Slaw Evening Snack (170 calories) 1 serving Cottage Cheese-Berry Bowl Daily Totals: 1,788 calories, 82g fat, 100g protein, 177g carbohydrate, 50g fiber, 1,759mg sodium. Make it 1,500 calories: Change A.M. snack to 1 medium apple and omit evening snack. Make it 2,000 calories: Add 1 cup low-fat plain kefir to breakfast and add 2 Tbsp. chopped walnuts to A.M. snack. Frequently asked Questions Is it OK to mix and match meals if there is one I do not like? Yes, feel free to mix and match meals if there's one you don't like, or browse some of our other Mediterranean diet recipes for additional inspiration. We aimed for at least 90 grams of protein and 30 grams of fiber per day, while capping sodium at 2,300 mg per day in accordance with the Dietary Guidelines for Americans. Can I eat the same breakfast or lunch every day? You can eat the same breakfast and lunch every day if you prefer. Most options are similar in calories, so a simple swap should work for most people. If you're closely monitoring calories, protein, fiber or other nutrients, you may want to adjust a snack or two to meet your individual goals. Why is there not a modification for 1,200 calories? We no longer provide modifications for 1,200-calorie days in our meal plans. The 2020-2025 Dietary Guidelines for Americans suggests that limiting calories to 1,200 per day is too low for most people to meet their nutritional needs, plus it's unsustainable for long-term health and well-being. What is fiber? Fiber is a type of indigestible carbohydrate found in plants. High-fiber foods include whole grains, legumes and nuts as well as many fruits and vegetables. Health Benefits of This Mediterranean Diet Plan High in Fiber: Each day provides at least 30 grams of fiber, with most days coming in higher than that. Fiber is a type of indigestible carbohydrate found in plants. Good sources of fiber include legumes, whole grains, nuts, seeds and most fruits and vegetables. Eating enough fiber has many health benefits and yet just 7% of adults in the United States hit the recommended Daily Value of 28 grams per day. A high-fiber diet may improve gut health, promote longevity, reduce cholesterol, lower body weight and reduce the risk of developing type 2 diabetes. Prioritizes Protein: We include at least 90 grams of protein per day, spread throughout the day's meals and snacks. While the Mediterranean diet doesn't necessarily emphasize protein, it's possible to get plenty of protein following this healthy eating style. To do this, we include a wide variety of protein sources, such as fish, legumes, nuts, whole grains, poultry and low-fat dairy. Because protein is the building block of our cells, it plays a role in every function of our body. Adequate protein intake is particularly important for cell growth and repair, as well as maintaining a well-functioning immune system. Follows the Mediterranean Diet: This 30-day plan follows the principles of the Mediterranean diet by prioritizing vegetables, whole grains, healthy fats and a wide variety of proteins, including fish and legumes. The Mediterranean diet is perhaps one of the most researched and well-regarded eating patterns. Research shows that people who follow the Mediterranean diet tend to live longer and have lower rates of obesity, heart disease, type 2 diabetes and cognitive decline. Read the original article on EATINGWELL
Yahoo
11 hours ago
- Yahoo
Zimbabwe steps up the fight against dramatic rise in drug abuse
Zimbabwe is in the grip of a growing crisis as substance abuse rips through communities, with young people in the eye of the storm. "The current situation is that we have 57 percent of all mental health institutions admissions being attributed to drug use," says Wilson Box, head of the Zimbabwe Civil Liberties and Drug Network – an organisation working in eight of the country's 10 provinces to raise awareness about the dangers of drug abuse. "In our communities you find that for every four houses, in one house there is drug peddling. Among these we also have new sedative substances in the form of illicit brews that are very potent and nobody really knows the content of these illicit brews.' Box adds that the problem shows no sign of slowing down. 'Smoking to survive': How Sierra Leone's youth got hooked on kush Personal struggles Many young people in the country say they turn to drugs because of personal difficulties, including unemployment and poverty. Tawanda Murepa, who leads the Young People Mental Health Trust in Harare, says that stigma remains a major issue, as it prevents young people from speaking openly about their problems and seeking help. He believes the best approach is to show them the dangers of drug use, but with care and understanding "Turning away once you have started will differ from person to person depending on a number of factors, such as the resilience of the person as based on their mindset, their genetics, the period of usage of the drug," he said. Despite major strides, Zimbabwe faces battle to end HIV for all "The amount and quality and quantity of drug as well as the damage caused and so on, all determine the level of dependency. So we say it is not good to start on drugs at all. We should just talk about how people should not start on drugs whatever problems they have in life." Tawanda also says that rehabilitation should be the final option for treatment. Once a person reaches that stage, the process can go either way – they may succeed or suffer a relapse. A journey to recovery However, there are success stories. Givas Chirinda is 26. He started using drugs in 2011 but has not used any substances for the past three years. Today, he helps other young people in Harare understand the risks of drug abuse. He encourages those already involved to stop, because, as he says, he knows it is possible. "You do not need to use threats or frightening language," he said. "Approach those who are using drugs by acknowledging the problem. If one used 10 stars [a drug measure] for example, talk to them and say OK, why not try and reduce to nine and lets see what happens and go down to. say, six and see what happens..." He believes the root cause behind drug use must also be addressed to prevent relapse. 'Most young people get into drugs due to idleness and unemployment," he said. "So if at all possible it is a good idea that young people are assisted to become engaged in self-help projects such as chicken rearing and goat keeping and so on... This would go a long way [towards] keeping them away from drugs, and give them a sense of purpose." Detox and aftercare Sister Hendrina Chitsama is a medical professional working in drug rehabilitation. She explains that many drug users try to quit on their own, without going through detox or proper treatment. "Detoxification is incredibly important and it's more than just a medical procedure – it is a psychological and emotional reset," she said. "After someone turns away from drugs, their body still carries an imprint of addiction. Detoxification helps cleanse the system but more crucially it opens the door to real healing. You cannot build a new foundation on a toxic residue. That is why detoxification is the starting line, not the finish line." Government roadmap With the drug problem worsening, Zimbabwean President Emmerson Mnangagwa this month launched a campaign to raise more than USD $77 million to fight drug and substance abuse. This follows the creation of a committee of officials to lead the response. The plan also includes identifying more than 60 centres across the country to support rehabilitation efforts. Zimbabwe abolishes death penalty two decades after last execution Stakeholders believe this campaign could make a real difference – if implemented well. They have stressed the need in Zimbabwe to strengthen law enforcement in order to break drug supply chains. Other measures being called for are improved rehab facilities – and to stop the practice of treating drug users alongside mental health patients – as well as tackling the stigma around addiction, training more health professionals in addiction management and the provision of detoxification medication.