IN MY LONG LIFE AS A DOCTOR (55 years), I have worked in many specialties, surgery, obstetrics and gynaecology, paediatric medicine, internal medicine and many others. Initially with 10 years in Nigeria and Ireland behind me, it was only as I was past middle age that I came to geriatric medicine. There I recognised palliative care as an urgent and huge need for those dying initially in old age, then eventually at all ages.
In the 1980’s, I found myself (a clinician) in Community medicine departments in USM, Penang and then Singapore, I brought with me, my knowledge of ageing, the needs of that generation of elderly and palliative care, learned from my experience in UK and books by Dame Cicely and Robert Twycross, both of whom I had met and kept in touch with over the years and would influence my future in Africa. We commenced the home care service in Singapore now HCA and one of the most successful home care services in the world.
Over my 50 years in both specialties, I have learned that palliative care must be crosscutting in all specialties, for all who care, and most importantly for all who make decisions affecting the lives of the suffering and their families. Governments who care for their citizens need to make decisions, having knowledge of the suffering, and the heart to do something about it.
There is light coming through the tunnel from the dedicated people today working in palliative care and who I have witnessed in Ireland, UK, Malaysia, Singapore and throughout Africa. And especially those I met in Kuching in April 2018! There I was privileged to witness their palliative care, the effect it has had on the lives of those who are reaching the 23 Hospice care both in hospitals and at home, and I was greatly moved.
But sadly Uganda and Africa is missing the “oil” that is needed to move forward and bring this care to those who never reach a heath worker and lie in their village homes, or even under a tree, suffering from day to day with pain, sores and smells, keeping their loved ones at a distance.
Uganda, the model for African palliative care, was found to be the best countrywide service in Africa in 2014 and the second best place to die in Africa in 2015 . This year we celebrate 25 years of palliative care in Uganda and during that 25 years, we have introduced culturally acceptable and adaptable palliative care which is economically viable and sustainable. The cost per year for 10 patients in an in-patient unit in UK is £1M, but in Uganda we can care for 2,000 patients in their own homes or as outpatients, as well as teaching Africans dedicated Palliative care, from our Institute up to degree level, for the same cost. Yet this year we cannot make the Million needed and this coming year (commencing on 1 july) our budget is cut to £600K, our team is reduced and our patients also reduced as we try to find other caring services that might take them on. This is traumatic for both patients, families and our dedicated teams, who have been trained to degree level in this specialty.
What have I learned over these years in so many countries?1. Palliative care needs to be adaptable to the culture and economy of each country, and sometimes each tribe or locality within that country.2. The main elements of palliation are compassion that not only empathises, but takes action to support the suffering, so that they can face the end of their lives, making decisions for themselves and their families and coming to terms with forgiveness and peace with their families and their God. 3. Our ethos for PC will guide those working and have arisen from experience in many countries, where difficulties have arisen when one or more of the pillars are not adhered to.
1.Palliative care needs to be adaptable to the culture and economy of each country, and sometimes each tribe or locality within that country.
2. Economics Intelligence Unit, 2015 “The 2015 quality of Death Index Ranking palliative care across the world”
A report by the Economist Intelligence Unit; Available at www.eiuperspectives.economist.com/sites/default/ files/2015%20EIU%20Quality%20of%20Death%20 Index%20Oct%2029%20FINAL_0.pdf
3. http://uganda.hospiceafrica.or.ug/images/pdf/Hos- pice_Ethos_2014_latest_edition.pdfEthos2016
Born in Liverpool, in 2018 Prof Anne Merriman celebrates 55 years as a doctor, 37 years in Afric, 28 years since bringing affordable morphine to Africa. Education of health professionals and others is her priority. In 2014, she was nominated for the Nobel Prize for bringing a simple solution of oral morphine to Africa as an affordable form of pain control, coupling it with holistic palliative care service.