Dr Anne Merriman tells Rachel Beard about the origins of a revolution in hospice care
Rachel Beard
“I get more out of doing palliative care than anything else, and I’ve done nearly everything,” Nobel Peace Prize nominee and founder of Hospice Africa, Professor Dr Anne Merriman told The Irish Catholic. “The most fulfilling thing I’ve ever done is palliative care because these people have never had somebody take care of them before and people have never gone into their homes before we did.”
Although Dr Merriman was born in Liverpool, she has strong ties to Ireland. She joined the Medical Missionaries of Mary in Co. Louth when she was 18 and trained as a doctor at UCD.
“I was in geriatric medicine for eight years in the UK, and I saw people very uncomfortably being kept alive forever and the quality of life wasn’t reflected in the way they were being managed, living in long term wards,” Dr Merriman says.
Dr Merriman served with the order in Nigeria for nine years and left after 19 years but retained strong connections with the organisation as well as her enthusiasm for missionary work. Dr Merriman launched the Anne Merriman Hospice Africa Foundation (AMHAF) in Dublin on June 19 in order to support the two organisations she founded to provide palliative care to those in Africa: Hospice Africa (HA) and Hospice Africa Uganda (HAU).
Problems
“I’d been in Africa 10 years previously, in Niger, so I knew Africa had a terrible problem, and then when I realised that the problem in Nairobi was not just in Nairobi but the whole of Africa, I thought we have to start something that will move throughout Africa,” Dr Merriman says. “So that’s how we conceived of the idea of Hospice Africa, so I went to Liverpool, got my friends together, started a board and started Hospice Africa.”
When Dr Merriman first began introducing hospice care to Africa through HA and HAU, many of the locals were taken aback. “They’d never heard of palliative care before,” Dr Merriman says. “They didn’t know what it was. They thought we were bringing euthanasia to Uganda.”
The core of Dr Merriman’s work in Africa is the oral liquid morphine that she developed in the ‘80s. The drug, which costs only one dollar for 10 days, “could be used in the home by the patient themselves, so it was now affordable for Africa, and the patient could be taking charge of what was happening, and if they were too sick, the family would”.
Dr Merriman says her work in Africa can be “very distressing” but “the fact that you can relieve it and that you don’t have to disturb them by bringing them in to the hospital where they would be treated very badly, it’s just wonderful”. Since it was founded in 1993, HAU has cared for more than 27,000 patients and currently looks after around 1,800 patients every month.
But caring for the dying often means more than just ensuring they have a comfortable death. Dr Merriman calls Africa “a very spiritual continent,” and she takes that into account when she’s working with her patients.
“But the actual patients themselves, when they’re coming towards death, if they’ve murdered their grandmother or they’ve stolen from everybody or they’ve been terrible in their life, they still believe that God is merciful and they want to pray to God and all that, no matter what,” Dr Merriman says.
“So we try to train our teams. They will, each of them, need to be spiritual in some way, because whether we believe in religion or God, we all have spirits, and when the spirit leaves the body, we’re dead, and we don’t need a doctor anymore, we don’t need help anymore, but we need it when we’re alive.”
Part of palliative care, Dr Merriman says, is to try to address all the pain a patient is feeling – physical as well as spiritual.
“Now, when we look at pain, physical pain is what we think of,” Dr Merriman says. “But then there’s pain, from the holistic point of view, they have social issues, they have cultural issues, they have spiritual issues, they have family issues, they have so many different issues, psychological problems and they worry about death, ‘what’s going to happen to my children afterwards?’.”
Dr Merriman and her team have made a lot of progress in Africa through HA and HAU, but she still feels her programme has work to do.
“Now, 35 countries in Africa know about palliative care but only 20 have affordable morphine,” she says. “When we came, only three had affordable morphine.”
Introducing hospice care to African communities can be an uphill battle. Not only do the locals often view it with scepticism, but even other health workers outside of Africa don’t always see the need for it.
“Palliative care kind of comes at the bottom of the pile for the Ministry of Health,” Dr Merriman says. “They’ve been very good in Uganda, getting the policies, allowing our nurses to prescribe morphine because there’s only one doctor in 19,000 people here, so there’s not enough doctors to prescribe morphine for all the people in need.
“In Uganda, there’s something like 150,000 in need as I’m speaking to you now, and we’re only reaching 10% of those. And yet, Uganda is seen as the best in the whole of Africa when it was assessed by WHO and the World Hospice and Palliative Care Association, they found that Uganda was the only country that had comprehensive palliative care in Africa.”
For donations to AMHAF, cheques can be sent to Hospice Africa Ireland, c/o Our Lady’s Hospice & Care Services, Harold’s Cross, Dublin 6W. Supporters can also donate €2 by texting HAI to 50300.