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.
Want all of The Times? Subscribe.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Yahoo
6 hours ago
- Yahoo
Lung damage, poor brain development, addiction: What vaping does to the body
SINGAPORE - Vapes, e-cigarettes, dab pens, pod-mods, and vaporisers – whatever they are called, an increasing number of younger people think they are cool, easy to use undetected, and safer than cigarettes. But experts warn that vaping is a silent killer, its seemingly less harsh candy, dessert and fruit flavours hiding its ability to cause harm without immediate, obvious symptoms. In fact, the vaping device, which looks like a pen or a lighter, is more harmful than cigarettes, said Dr Puah Ser Hon, who heads the Department of Respiratory and Critical Care Medicine at Tan Tock Seng Hospital. 'The vape device is more harmful than a stick of cigarette. There is an end point with a cigarette when it burns out. The device is run on battery, allowing the user to continuously vape until the battery runs out,' said Dr Puah, who is also the chair of the Smoking Cessation Workgroup at NHG Health. He told The Straits Times that the liquid in the e-cigarette device has various chemicals that are not restricted or checked at all. Vape devices were previously marketed as a safer alternative to smoking, driving people to vape and exposing them to various harmful chemicals that lead to lung damage, nicotine addiction, and other health problems. The United States Centres for Disease Control and Prevention (CDC) says that apart from nicotine - which is highly addictive and particularly dangerous to youth because their brains are still developing - aerosol from e-cigarettes can contain harmful substances including cancer-causing chemicals and tiny particles that can be inhaled deep into lungs. According to the American Lung Association, the dangerous chemicals produced include acetaldehyde, acrolein, and formaldehyde, which can cause lung and heart disease; and acrolein, a herbicide used to kill weeds, which can cause acute lung injury and Chronic Obstructive Pulmonary Disease, and may cause asthma and lung cancer. In addition, experts have warned about the risks of inhaling secondhand e-cigarette emissions, because bystanders may breathe in substances such as nicotine and toxic chemicals within the vapour. To make things worse, the use of vapes and e-cigarettes is a brewing global crisis – crime syndicates are packing potent and addictive substances into the devices, such as etomidate, an anaesthetic, and more youth are getting hooked on drugs. In Singapore, where vaping is illegal, there has been a rise in related offences – there were roughly 8,000 cases of e-cigarette use in 2023, a 43 per cent jump from the 5,600 similar offences recorded in 2022. The Government has announced it was enhancing current enforcement laws, following a spike in seizures of drug-laced e-vaporisers. Dr Puah said some people have reported an asthma-like attack shortly after vaping, where the airways get constricted and they feel breathless. In some instances, users suffered E-cigarette or Vaping product Use-associated Lung Injury (Evali). 'They can come in with severe respiratory failure where the oxygen levels are super low and they need to go into the intensive care unit. (As) they need help with breathing... we have to attach them to a mechanical (ventilator) that pumps oxygen and help them breathe,' Dr Puah said. 'There are people who do not survive this. Some who survived may live on with scars in the lungs and they end up having permanent symptoms like cough and breathlessness,' he added. Washing out popcorn lungs Another health problem related to vaping is pulmonary alveolar proteinosis, or popcorn lungs, a rare disease in which protein and fatty material build up in the air sacs of the lungs, making breathing difficult. Renovation site supervisor Muhammad Dandiar Rosli, 34, who suffered from the condition had to undergo lung washing, not once but twice – in 2020 and then again in 2021. The procedure, called whole lung lavage, is the primary treatment for popcorn lungs. Singapore General Hospital (SGH) is the only hospital in Singapore that performs it. Carried out in the operating theatre, and performed on one lung at a time while the patient is under anaesthesia, whole lung washing uses warm sterile saline to wash away abnormal build-up of protein from the lung. The patient has a double lumen tube inserted through the mouth and into the windpipe to isolate the left and right lungs from each other. A large volume of saline is infused sequentially into one lung while the patient is ventilated through the other, and the saline is drained out through a bronchoscope until the liquid extracted turns from milky to almost clear. The whole process takes three to four hours, after which the patient is returned to the intensive care unit and the procedure is repeated for the other lung after one to two weeks. Because vaping is still very new, so there is still a lot to learn about the long term health effects. Add drugs into the chemical cocktail, and the health risks increase exponentially. Teens who vape more likely to have poor mental health On Feb 26, Health Minister Ong Ye Kung said in a written parliamentary reply that there were 2,000 cases of students, including those from institutes of higher learning, reported for possessing or using e-vaporisers in 2024. This is up from 800 cases in 2022, and 900 cases in 2023. The problem is exacerbated by easy access to a vaping fix – vapes are cheaper than cigarettes and can be found on messaging groups, according to users and parents in previous ST reports. Many users would scan through a series of Telegram groups to pick a seller based on price and a 'delivery man' would be meet them with an e-vaporiser laced with etomidate within two hours. Some youth turn to vaping as a coping mechanism for stress and other negative emotions, perhaps unaware that it could be harm them more than it harms adults. Exposure to potent psychoactive substances such as etomidate or ketamine through vaping hampers the adolescent brain from developing normally, said Dr Elaine Chew Chu Shan, head of the Adolescent Medicine Service at the KK Women's and Children's Hospital. 'The adolescent brain is still undergoing critical development, particularly in areas like the prefrontal cortex that governs impulse control, decision-making, and emotional regulation, and is particularly vulnerable to the exposure to drugs,' she said, adding that it can have 'long-term changes in brain structure and function'. Another doctor explained that 'youths also metabolise drugs differently than adults, which may lead to unpredictable side effects'. 'Sedatives such as etomidate can potentially affect memory, cognition or emotional regulation,' said Dr Clare Anne Fong, a consultant with the Division of Respiratory and Critical Care Medicine in the Department of Medicine at National University Hospital (NUH) and Alexandra Hospital. Dr Chee Tji Tjian, a senior consultant with NUH's Department of Psychological Medicine, explains how two chemicals in vaping liquids impact users. 'Nicotine mimics natural neurotransmitters and alters neuron communication, particularly in the prefrontal cortex, which governs decision-making and self-control,' he said. Etomidate poses additional risks by suppressing brain activity, and 'potentially causing long-term neurotoxic effects, including increased vulnerability to emotional dysregulation, anxiety, and depression, though research remains limited', Dr Chee added. With both substances disrupting the dopamine system, which is a network of nerve cells in the brain that use dopamine to communicate, they raise the risk of addiction and persistent behavioural problems. Dr Chee said while some ill effects of vaping may improve with early cessation, changes to brain function, especially with repeated exposure, can persist into adulthood, raising the possibility of long-term neurodevelopmental harm. Psychiatrist Adrian Wang, who runs his own clinic at Gleneagles Medical Centre, said it is hard to predict who may be vulnerable to such side effects. 'Teenagers with a history of anxiety, depression or past trauma are vulnerable and those with low self-esteem, or impulsive behaviour are also at risk. They may succumb to peer pressure and try these devices out of curiosity, wrongly assuming that they are safe,' he said. '(Drugs such as) etomidate, ketamine and fentanyl can cause loss of consciousness, hallucinations and seizures. Intoxication can be rapid and lead to abnormal behaviour in users before they realise what is happening. It gets them into 'zombie-like' states,' Dr Wang added. Source: The Straits Times © SPH Media Limited. Permission required for reproduction Discover how to enjoy other premium articles here
Yahoo
6 hours ago
- Yahoo
Experts issue warning over slow-moving 'catastrophe' threatening food and water systems: 'The worst I've ever seen'
Experts issue warning over slow-moving 'catastrophe' threatening food and water systems: 'The worst I've ever seen' A new report warns that drought is fueling a global hunger crisis, with more than 90 million people in Africa on the brink of starvation and key food supplies disrupted worldwide. Experts say this slow-moving disaster, worsened by a warming world, threatens water, food, and energy systems across continents. What's happening? The dire report issued by the National Drought Mitigation Center and the United Nations Convention to Combat Desertification says that the world has experienced some of the largest and most destructive droughts ever recorded since 2023. "Drought Hotspots Around the World 2023-2025" was produced with support from the International Drought Resilience Alliance. It outlines how droughts exacerbate poverty, hunger, energy insecurity, and the breakdown of ecosystems. "Over 90 million people across Eastern and Southern Africa face acute hunger," according to a news release about the report. "Some areas have been enduring their worst ever recorded drought." The report notes that drought-ravaged southern Africa saw a staggering 68 million people, or roughly one-sixth of its population, in need of food assistance in August 2024. "This is not a dry spell," said Mark Svoboda, the founding director of the NDMC and co-author of the report, per The Guardian. "This is a slow-moving global catastrophe, the worst I've ever seen." Why is this report on drought around the world important? "Drought is a silent killer," said UNCCD Executive Secretary Ibrahim Thiaw in a summary of the report. "It creeps in, drains resources, and devastates lives in slow motion. Its scars run deep." Per the news release, the report says that "women, children, the elderly, pastoralists, subsistence farmers, and people with chronic illness" are most vulnerable to the health risks raised by drought, which include "cholera outbreaks, acute malnutrition, dehydration, and exposure to polluted water." "Drought is no longer a distant threat," added Thiaw. "It is here, escalating, and demands urgent global cooperation. When energy, food, and water all go at once, societies start to unravel. That's the new normal we need to be ready for." Our overheating planet is supercharging many forms of extreme weather. The United States Geological Survey warns that our warming world is making droughts more frequent, longer, and more intense. Do you worry about the quality of the air inside your home? Yes — often Yes — but only sometimes Only when it's bad outside No — I never do Click your choice to see results and speak your mind. What's being done about severe droughts? The NDMC and UNCCD report recommends urgent investment in stronger early warning systems, nature-based solutions, resilient infrastructure, gender-responsive adaptation, and global cooperation as ways to mitigate the devastation caused by droughts. It cautions that drought disproportionately impacts people who have the fewest resources to deal with it. Advances in technology provide hope for finding ways to help people hit hardest by drought. U.S. researchers have developed a solar-powered device that can produce clean drinking water from saltwater day and night, even after sunset. Rwandan farmers are increasingly relying on solar-powered irrigation for their small-scale farms, leading to better harvests and lower expenses across the drought-prone country. Talking to friends and family members about climate issues and donating to organizations focused on our climate can help. Supporting pro-climate politicians who are fighting for the future of our planet is another way to make a difference. Join our free newsletter for good news and useful tips, and don't miss this cool list of easy ways to help yourself while helping the planet. Solve the daily Crossword
Bloomberg
7 hours ago
- Bloomberg
Deadly Child Malnutrition Surges in Nigeria as Aid Cuts Bite
Deadly child malnutrition is soaring in northern Nigeria amid rampant inflation, simmering conflict and sharp cuts to foreign aid. Children suffering from the most severe and fatal types of malnutrition more than doubled in the six months through June compared with the same period in 2024, according to Geneva-based Doctors Without Borders.
