Latest news with #Merriman
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
NBC News
24-06-2025
- Business
- NBC News
How a war-torn Myanmar plays a critical role in China's rare earth dominance
Beijing has been stepping up controls on rare earth exports, triggering global shortages and exposing industries' dependence on Chinese supply chains. However, over recent years, China itself has become reliant on rare earth supplies from an unexpected source: the relatively small and war-torn economy of Myanmar. While China is the world's top producer of rare earths, it still imports raw materials containing the coveted metals from abroad. Myanmar accounted for about 57% of China's total rare earth imports last year, Gracelin Baskaran, director of the Critical Minerals Security Program at the Center for Strategic and International Studies, told CNBC. According to Chinese Customs data, Myanmar's rare earth exports to China significantly picked up in 2018 and reached a peak of nearly 42,000 metric tons by 2023. Baskaran added that the imports from Myanmar are also particularly high in heavy rare earth element contents, which are generally less abundant in the earth's crust, elevating their value and scarcity. 'Myanmar's production has significantly strengthened China's dominant position, effectively giving Beijing a de facto monopoly over the global heavy rare earths supply chain — and much of the leverage it wields today.' The country has become a key source of two highly sought-after heavy rare earths, dysprosium and terbium, that play crucial roles in high-tech manufacturing, including in defense and the military, aerospace and renewables sectors. 'This dynamic has given rise to a supply chain in which extraction is concentrated in Myanmar, while downstream processing and value addition are predominantly carried out in China,' said Baskaran. Why Myanmar? Myanmar is home to deposits that tend to have higher heavy rare earth content, David Merriman, research director at Project Blue, told CNBC. These 'ionic adsorption clay,' or IAC, deposits are exploited through leaching methods that apply chemical reagents to the clay — and that comes with high environmental costs. According to Merriman, the vast majority of the world's IAC operations were in Southern China in the early to mid-2010s. But, as Beijing began implementing new environmental controls and standards in the rare earths industry, many of these projects began to close down. 'Myanmar, particularly the north of the country, was seen as a key region which had similar geology to many of the IAC deposit areas within China,' Merriman said. 'You started to see quite a rapid buildout of new IAC-type mines within Myanmar, essentially replacing the domestic Chinese production. There was a lot of Chinese business involvement in the development of these new IAC projects.' The rare earths extracted by these IAC miners in Myanmar are then shipped to China mostly in the form of 'rare earth oxides' for further processing and refining, Yue Wang, a senior consultant of rare earths at Wood Mackenzie, told CNBC. In 2024, a report from Global Witness, a nonprofit focused on environmental and human rights abuses, said that China had effectively outsourced much of its rare earth extraction to Myanmar 'at a terrible cost to the environment and local communities.' China's rare earth risks China's reliance on Myanmar for rare earths has also opened it up to supply chain risks, experts said. According to Global Witness's research, most of the heavy rare earths from Myanmar originate from the Northern Kachin State, which borders China. However, following Myanmar's violent military coup in 2021, the military junta has struggled to maintain control of the territory amid opposition from the public and armed groups. 'Myanmar is a risky jurisdiction to rely on, given the ongoing civil war. In 2024, the Kachin Independence Army (KIA), a group of armed rebels, seized sites responsible for half the world's heavy rare earths production,' said CSIS' Baskaran. Since the seizure, there have been reports of supply disruptions causing spikes in the prices of some heavy rare earths. According to a Reuters report, the KIA was seeking to use the resources as leverage against Beijing. Chinese customs data shows imports of rare earth oxides from Myanmar fell by over a third in the first five months of the year compared with the same period last year. 'If Myanmar were to cease all exports of rare earth feed stocks to China, China would struggle to meet its demand for heavy rare earths in the short term,' said Project Blue's Merriman. Not surprisingly, Beijing has been looking to diversify its sources of heavy rare earths. According to Merriman, there are IAC deposits in nearby countries, including Malaysia and Laos, where some projects have been set up with Chinese involvement. Still, he notes that environmental standards are expected to be higher in those countries, which will present challenges for rare earth miners. China's decision to cut back on its own extraction of heavy rare earth elements may serve as a warning to other countries about the costs of developing such projects. A report by Chinese media group Caixin in 2022 documented how former IAC operation sites in Southern China had left behind toxic water and contaminated soil, hurting local farmers' livelihoods.
CNBC
24-06-2025
- Business
- CNBC
How a war-torn Myanmar plays a critical role in China's rare earth dominance
Beijing has been stepping up controls on rare earth exports, triggering global shortages and exposing industries' dependence on Chinese supply chains. However, over recent years, China itself has become reliant on rare earth supplies from an unexpected source: the relatively small and war-torn economy of Myanmar. While China is the world's top producer of rare earths, it still imports raw materials containing the coveted metals from abroad. Myanmar accounted for about 57% of China's total rare earth imports last year, Gracelin Baskaran, director of the Critical Minerals Security Program at the Center for Strategic and International Studies, told CNBC. According to Chinese Customs data, Myanmar's rare earth exports to China significantly picked up in 2018 and reached a peak of nearly 42,000 metric tons by 2023. Baskaran added that the imports from Myanmar are also particularly high in heavy rare earth element contents, which are generally less abundant in the earth's crust, elevating their value and scarcity. "Myanmar's production has significantly strengthened China's dominant position, effectively giving Beijing a de facto monopoly over the global heavy rare earths supply chain — and much of the leverage it wields today." The country has become a key source of two highly sought-after heavy rare earths, dysprosium and terbium, that play crucial roles in high-tech manufacturing, including in defense and military, aerospace and renewables sector. "This dynamic has given rise to a supply chain in which extraction is concentrated in Myanmar, while downstream processing and value addition are predominantly carried out in China," said Baskaran. Myanmar is home to deposits that tend to have higher heavy rare earth content, David Merriman, research director at Project Blue, told CNBC. These "ionic adsorption clay" or IAC deposits are exploited through leaching methods that apply chemical reagents to the clay — and that comes with high environmental costs. According to Merriman, the vast majority of the world's IAC operations were in Southern China in the early to mid-2010s. But, as Beijing began implementing new environmental controls and standards in the rare earths industry, a lot of these projects began to close down. "Myanmar, particularly the North of the country, was seen as a key region which had similar geology to many of the IAC deposit areas within China," Merriman said. "You started to see quite a rapid build out of new IAC type mines within Myanmar, essentially replacing the domestic Chinese production. There was a lot of Chinese business involvement in the development of these new IAC projects." The rare earths extracted by these IAC miners in Myanmar are then shipped to China mostly in the form of "rare earth oxides" for further processing and refining, Yue Wang, a senior consultant of rare earths at Wood Mackenzie, told CNBC. In 2024, a report from Global Witness, a nonprofit focused on environmental and human rights abuses, said that China had effectively outsourced much of its rare earth extraction to Myanmar "at a terrible cost to the environment and local communities." China's reliance on Myanmar for rare earths has also opened it up to supply chain risks, experts said. According to Global Witness's research, most of the heavy rare earths from Myanmar originate from the Northern Kachin State, which borders China. However, following Myanmar's violent military coup in 2021, the military junta has struggled to maintain control of the territory amid opposition from the public and armed groups. "Myanmar is a risky jurisdiction to rely on, given the ongoing Civil War. In 2024, the Kachin Independence Army (KIA), a group of armed rebels, seized sites responsible for half the world's heavy rare earths production," said CSIS' Baskaran. Since the seizure, there have been reports of supply disruptions causing spikes in the prices of some heavy rare earths. According a Reuters report, the KIA was seeking to use the resources as leverage against Beijing. Chinese customs data shows, imports of rare earth oxides from Myanmar fell by over a third in the first five months of the year compared to the same period last year. "If Myanmar were to cease all exports of rare earth feed stocks to China, China would struggle to meet its demand for heavy rare earths in the short term," said Project Blue's Merriman. Not surprisingly, Beijing has been looking to diversify its sources of heavy rare earths. According to Merriman, there are IAC deposits in nearby countries, including Malaysia and Laos, where some projects have been set up with Chinese involvement. Still, he notes that environmental standards are expected to be higher in those countries, which will present challenges for rare earth miners. China's decision to cut back on its own extraction of heavy rare earth elements may serve as a warning to other countries about the costs of developing such projects. A report by Chinese media group Caixin in 2022 documented how former IAC operation sites in Southern China had left behind toxic water and contaminated soil, hurting local farmers' livelihoods.
