06-07-2025
Obituary: Dr Anne Merriman, nun and UCD-trained doctor who transformed end-of-life care in Africa
When she arrived in Kenya in 1990, it was one of only three countries in Africa — along with Zimbabwe and South Africa — that had any palliative care with meaningful pain control. For most Kenyans, however, codeine was prohibitively expensive. Even patients with cancer were being sent away with paracetamol.
Anne Merriman was anxious to introduce her cheap oral morphine, which she had developed in the 1980s in Singapore as founder of its first palliative care service. Her formula was, she said, 'as easy as making coffee, just four ingredients: morphine powder, a preservative, PH stabiliser and water'.
It had proved transformative in giving a modicum of peace and dignity to patients for whom nothing more could be done, and who would otherwise have been discharged from hospital to die in agony in their own flats.
In 1993, she founded Hospice Africa Uganda in Kampala — on the condition that the Ugandan health minister should also legalise powdered morphine and approve its importation.
She went on to oversee the care of more than 40,000 patients in Uganda and the training of thousands of healthcare workers across Africa. Her model, of nurse-led teams visiting patients in their homes, became the blueprint for palliative care on the continent.
In 2018, The Lancet reported that pain inequality was still 'a heinous injustice that has been largely ignored in global health… the 3.6 billion people residing in the poorest countries receive less than 1pc of the morphine distributed worldwide'.
Merriman, on the other hand, took the view that 'you are not going to change the world, but if you change the life of one person you will change their world'.
She told her mother: 'I'm going to Africa to care for the poorly children'
Anne Merriman was born on May 13, 1935, to Irish parents in she was four, inspired by the church magazine Echo from Africa, she announced to her mother: 'I'm going to Africa to care for the poorly children.'
Her medical calling was sharpened by the sudden death of her younger brother, Bernard, aged 11, of a brain tumour. 'There was no palliative care for him, and nothing to help us with bereavement afterwards,' she recalled. 'I remember feeling so sad on a bus full of people and thinking: they don't know what we've just been through.'
She entered the Medical Missionaries of Mary in Drogheda, Co Louth, and in 1963 graduated in medicine from University College Dublin. She was posted to a hospital in Nigeria.
Although the Nigerian hospital was well-equipped, she was shocked to discover that terminally-ill patients were simply sent home to fend for themselves. The same was true in Liverpool, where she returned nine years later — having left the order — to care for her own mother and run the geriatric unit at the Whiston Hospital.
After her mother's death in 1981, she moved to Malaysia, then Singapore, before returning to Africa in 1990. She was appointed MBE in 2003, and published two memoirs.
Dogged and focused, with a wicked sense of humour, she retained her Liverpudlian accent, but latterly favoured traditional African dress. She lived in Kampala in a house full of rescue cats and dogs, attended by three unmarried mothers and their children, whom she regarded as her family.
