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Irish Independent
06-07-2025
- Health
- Irish Independent
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.
Boston Globe
02-07-2025
- Health
- Boston Globe
Anne Merriman, ‘mother of palliative care' in Uganda, dies at 90
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.' Get Starting Point A guide through the most important stories of the morning, delivered Monday through Friday. Enter Email Sign Up Dr. Merriman died May 18 at her home in Kampala, Uganda. She was 90. The cause was respiratory failure, her cousin Chris Merriman said. Advertisement Although hospice centers already existed in Africa when Anne Merriman began working in Uganda in the early 1990s, she envisioned an affordable model of hospice that could be adapted to various developing countries. At the time, the AIDS crisis was at its peak. About 30% of the population of Uganda was HIV positive, and the cancer rate, as a result, was climbing. Average life expectancy was 38 years. The country had recently emerged from a violent dictatorship and a protracted guerrilla war. Advertisement But Dr. Merriman and Mbaraka Fazal, a Kenyan nurse she had met while working in Nairobi, had promising conversations with Uganda's health minister, James Makumbi, and were confident that it would be safe to make the country their home base -- and that they could convince the government of the importance of importing powdered morphine. So in 1992, Dr. Merriman founded Hospice Africa, with the idea of spreading palliative care across the continent. A year later, she started Hospice Africa Uganda, to introduce her model to the country. Initially, it was a shoestring operation. Working out of a small two-bedroom house in Kampala, Dr. Merriman and Fazal mixed morphine powder in buckets with water boiled on the kitchen stove. There was no office equipment, which made writing grants impossible. At one point, their total funding amounted to 19 Ugandan shillings -- less than two American pennies at the time. To make matters worse, local doctors were reluctant to refer their patients, out of fear of enabling opioid addiction or because they equated the analgesic with euthanasia. The first hospice patients -- most of them young women with cancer -- were referred late and often died within weeks. And the nurses who visited patients in remote locations were not able to administer morphine without a doctor's prescription, which meant longer waiting times. But Dr. Merriman pressed on. Driving a donated white Land Rover, she rumbled down bumpy roads to visit hospice patients. Cheerful and well turned out, she wore vibrant kitenge dresses, her hair done and her nails painted for meetings with donors. But while she had a gentle bedside manner, she could be steely, especially in meetings with doctors and government officials. Advertisement Early on, she wrote in a 2010 memoir, her relationship with the country's health ministry became 'as frosty as it can get in a tropical climate' because of the government's lack of support for her work. But eventually things began to improve. Patients in hospice care were no longer in pain, and word began to spread. Medical students that Dr. Merriman had trained became practicing doctors, and they helped shift attitudes. And in 2004, Dr. Merriman finally persuaded the health ministry to allow certain nurses to prescribe morphine. Within five years, Hospice Africa Uganda had three sites in the country. By 2000, Hospice Africa had expanded its training sessions to Tanzania. Today, through its Institute of Hospice and Palliative Care in Africa, Hospice Africa offers degrees in palliative care. Dr. Merriman, who became known as Uganda's 'mother of palliative care,' reflected on her early days in Uganda and the importance of persistence in an interview with The New York Times in 2017. 'You need someone to shout and scream and keep it going,' she said. Anne Merriman was born May 13, 1935, in Liverpool, England, one of four children of Thomas Merriman, the headmaster of a Catholic primary school, and Josephine (Dunne) Merriman, who ran the home and volunteered with Catholic charities. Along with various medical papers, Dr. Merriman published a handbook on geriatric medical practices in 1989 and two memoirs, 'Audacity to Love' (2010) and 'That's How the Light Got In' (2023), written with Autumn Fielding-Monson. Advertisement Dr. Merriman left no immediate survivors. Despite her accomplishments and awards -- she was appointed a Member of the Order of the British Empire in 2003 and received Ireland's Presidential Distinguished Service Award in 2013 -- Dr. Merriman remained loyal to her working-class background. She made a point of avoiding the funerals of famous Ugandans, and was critical of the way the rich were prioritized for medical treatment, not just in Uganda, but around the world. During her final days, she was as attentive to her appearance as ever, and she specified the outfit she wanted to wear to her own funeral: a purple kitenge dress with a bright yellow pattern. Stitched at the center was a map of Africa. This article originally appeared in
IOL News
02-07-2025
- Health
- IOL News
Legacy of Uganda's end-of-life 'grandmother' lives on
Josephine Namwanjje (right), 28, prays while holding a Bible for her brother Jonathan Luzige, a colon cancer patient, at their home in Nabbingo. Hospice Africa Uganda, founded in 1993 by Dr Anne Merriman, brought holistic end-of-life care to Uganda at a time when it was offered in only three African countries Image: Badru Katumba / AFP In a small home in Uganda's capital, Jane Mwesige, a nurse with a hospice that has transformed African end-of-life care, breaks into a gospel song about surrendering to God, a favourite of her patient Jonathan Luzige. These home visits, combining affordable medical care and spiritual support, are part of Mwesige's routine with Hospice Africa Uganda. Founded in 1993 by Dr Anne Merriman, it brought holistic end-of-life care to Uganda at a time when it was offered in only three African countries. By the time Merriman died this May, aged 90, she had treated more than 40,000 Ugandans and her model had spread to 37 countries on the continent. In his worn-brick home, Luzige's colon cancer makes it difficult to move, but he eagerly joins in the singing. "I feel very happy, and it made me feel stronger knowing there are people who are able to care for me," said Luzige, 30. Jane Mwesige (Centre), a nurse at Hospice Africa Uganda, knocks the door of patient Jonathan Luzige's home while carrying morphine and other medicines for a home visit in Nabbingo. Image: Badru Katumba / AFP "Palliative care is all about taking care of patients," said Mwesige. "Every one of us, or one of our relatives, may need the service." Born in Britain to Irish parents, Merriman trained as a doctor and became a nun before leaving her order to help establish palliative care in Singapore. When she arrived in Uganda, it was in the grips of the HIV/AIDS epidemic and she had raised only enough charitable funding for three months of work and a skeleton crew. The famously persuasive Merriman convinced Uganda's government to allow the import of morphine powder, which she used to make an oral solution she had developed in Singapore. Simple enough to make in a bucket over her kitchen sink, it became invaluable to thousands. Hospice Africa Uganda, which now runs from a mix of NGO and charitable funding, distributes the solution in recycled plastic bottles for free to hospitals and clinicians. Mary Nakaliika, 24, an adopted daughter of Dr. Anne Merriman and nurse who treated her in her last days in Kampala. By the time Merriman died in May 2025, aged 90, she had treated more than 40 000 patients in Uganda and her model had spread to 37 African countries. Image: Badru Katumba / AFP
Times
17-06-2025
- Health
- Times
Dr Anne Merriman obituary: doctor known as ‘mother of palliative care in Africa'
Dr Anne Merriman revolutionised palliative and end-of-life care in Africa after developing a cheap form of oral morphine with a Singapore hospital pharmacist. Originally mixed in a kitchen sink, it included a pound of morphine, a preservative and colouring: lighter doses were green; stronger ones, pink and blue. A bottle cost about $2, a fraction of the cost of western formulations. Universally known as 'Dr Anne', she said: 'It's easier than baking a cake.' She developed the pain-controlling recipe after seeing terminally ill patients discharged from hospital because 'nothing more could be done for them'. Many died at home in severe and prolonged pain. 'A wild, undisciplined schoolgirl' who became a nun and a doctor, Merriman founded the pioneering Hospice Africa Uganda (HAU) in 1993 at the age of 57. Palliative care was largely unknown in Africa when she started her work in Uganda. HAU has treated more than 35,000 patients and trained more than 10,000 healthcare professionals from 37 African countries in the so-called Merriman model. Tough, stubborn and charismatic, she conceded that her 'brash and insensitive ways' had offended people, adding: 'I find it amazing that God has used this blemish as one of my greatest strengths.' It enabled her, she said, to be 'a forceful and obsessive' advocate for hospice care and to stand up to older male doctors who claimed that morphine prescribing would promote drug abuse. In her book Audacity to Love, published in 2010, she wrote: 'In Africa, in particular, some men are more dominant than in the rest of the world and don't take well to a female doctor bringing in a new speciality. 'Even today in Uganda, considered to have the best palliative care in Africa, there are consultants who refuse to allow patients' pain to be treated with oral morphine, even though sometimes these patients are their own colleagues.' Calling herself a 'true Scouser', she was born in Liverpool in 1935, the third of four children of Thomas ('Toddy'), a primary school headmaster, and Josephine Merriman (née Dunne). A bright, questioning child, she wanted to become a Catholic priest like her older brother Joseph and later wrote: 'I could not understand such discrimination and I still feel the same way.' The catalyst for her passion for palliative care emerged in childhood when her 11-year-old brother Bernard died from a brain tumour. She later spoke passionately about the absence of palliative care for him. There were other signposts signalling a spectacular future in caring. At the age of four, after seeing pictures of sick African children in a magazine, she declared: 'I'm going to Africa to look after the poorly children.' Nine years later she saw a film showing the Irish head of the Medical Missionaries of Mary (MMM) riding around the Nigerian village of Anua on a bicycle. She told her mother and a nun at school that she wanted to join the order and did so at the age of 18 after leaving Broughton Hall Catholic High School in West Derby, Liverpool. Recognising a rich potential in the wayward, recalcitrant novice with disappointing exam results, MMM enrolled her in a three-year internship at the International Missionary Training Hospital in Drogheda, Ireland. She spent a further year in a medical laboratory before going to medical school at University College Dublin. As a young doctor Merriman worked in MMM hospitals in Nigeria and in Drogheda, Edinburgh and Dublin. After 20 years as a religious sister and missionary, she returned to secular life in Liverpool to look after her sick mother and to specialise for eight years in geriatric medicine. Increasingly concerned by patients dying 'without pain and symptom control', she followed the teaching of Dame Cicely Saunders (obituary, July 15, 2005), the founder of the modern hospice movement. Saunders created a new kind of hospice, St Christopher's in Sydenham, southeast London, combining compassionate care with medical care. But Merriman's vision of a hospice was not restricted to a physical building. Hospice care, she said, could be given in the most appropriate place, including the patient's home. It included emotional, social and spiritual support as well as pain control. This made pragmatic sense in Uganda where 90 per cent of the population are reported to live in rural areas where doctors are scarce. Uganda became the first African country to permit nurses and trained clinical officers (physician assistants) to prescribe morphine; and the first African country to make palliative care part of its health service. After her mother's death in 1981, Merriman worked in Calcutta with Mother Teresa whose order included a hospice; in Penang in Malaysia as an associate professor; and in Singapore as a senior teaching fellow. In 1990 she accepted an invitation to become the first medical director of the Nairobi Hospice, only to leave quickly because of 'bureaucratic interference'. A case history she published in Contact, a World Council of Churches journal, secured her future in Africa. Describing a terminally ill patient who had a pain-free, peaceful death, it attracted invitations from several African countries who wanted to develop palliative care services. She chose Uganda as it was emerging from 25 years of war and reeling under the HIV crisis. Archbishop Emeritus Desmond Tutu (obituary, December 27, 2021) said in 2018: 'Anne has created a uniquely African template of love, dignity, care and compassion for people.' Nominated for the Nobel peace prize in 2014 and appointed MBE, Merriman protested that 'caring for the dying is the lowest priority in healthcare because doctors are trying to cure, not to care'. She lived in a large house overlooking Lake Victoria with her 'family', including three housekeepers and 15 dogs, once led by Adam and Eve. When Eve died she declared that Adam was grieving and found him a new partner. A warm, welcoming hostess, she was renowned locally for her Tuesday night dinners where 12 or more guests would include local dignitaries, visiting specialists and overnighting donors and volunteers. But she could also, as she put it, create a frosty atmosphere in a tropical climate. In one notable case, she highlighted the tragedy of Robert, a terminally ill 12-year-old boy with a huge cancer, a Burkitt's lymphoma, on his face. Robert slept under a counter in his aunt's shop and Merriman regularly took him to the hospice for a change of scene. He grimaced in pain as they drove across the many potholes along the way. Merriman said: 'After his [Robert's] death, the President of the USA, Bill Clinton, visited Uganda … They levelled the road so he wouldn't get a bump on the bum. The Roberts of this world do not count. But Presidents do. How sick is that?' Anne Merriman, doctor, was born on May 13, 1935. She died from respiratory failure on May 18, 2025, aged 90
