At 80, This Former Nun Is Helping Sick Ugandans Die Painlessly

With medical care sorely lacking in the African nation, some are working to ease suffering.
A woman in the care of Hospice Africa Uganda receives a dose of oral morphine to ease the pain of advanced cervical cancer and AIDS. (Photo: Amy Fallon)
Feb 17, 2016· 3 MIN READ
Amy Fallon is a freelance journalist currently based in Uganda.

KAMPALA, Uganda—Lying in a bed at a run-down hostel, an emaciated woman ravaged by advanced cervical cancer and HIV/AIDS was awaiting her dose of morphine.

Dr. Steven Luboyera delivered a 16-ounce bottle, administered to control pain and stabilize the patient, to her full-time nurse. With doses every four hours, the amount will last her a week.

“When I take this, the pain improves,” the woman, who wished to remain unidentified but agreed to be photographed, told TakePart.

One in 500 Ugandans have cancer, but the country is severely lacking in specialists and resources to help them, with 80 percent dying because of late diagnosis, according to Uganda Cancer Institute.

That’s made tough work for doctors like Luboyera and Hospice Africa Uganda, considered the most successful palliative-care program in Africa and the developing world. Also known as end-of-life care, palliative care focuses on providing comfort and relief from pain for those with advanced serious illnesses.

As Luboyera put it in an interview with TakePart, his patient was “very weak, and what we have to do is make sure that her last days are as comfortable as possible.”

Getting this form of morphine, which is cheap to manufacture and easy to deliver, is only possible because “Dr. Anne has really done tremendous work toward the palliative-care movement in Africa,” Luboyera said, referring to Dr. Anne Merriman.

Dr. Anne Merriman. (Photo: Courtesy Hospice Africa Uganda)

For almost 25 years, Merriman and her hospice home-care teams have been bringing green, pink, and blue bottles of pain-relieving morphine to dying people in Uganda. They have also been bringing hope, reassurance, and friendship to seriously ill patients and their families.

“The reality is that oncology and other services won’t be available in Africa for generations,” Merriman, a 2014 Nobel Peace Prize nominee who founded Hospice Africa Uganda, told TakePart. This is why the former missionary nun from Liverpool, England, continues to do this work at age 80.

“When you see a patient who’s been bedridden for months, and within a couple of days you’ve relieved their pain and you see the joy, it’s remarkable,” Merriman said.

Uganda ranked No. 1 among low-income countries for overall quality of death, according to a recent study published by The Economist, which credits the availability of pain-killers.

Other developing countries are watching. Last week, Uganda’s top palliative-care official, Rose Kiwanuka, was invited to speak at a United Nations special session on drugs around the world. An estimated 43 percent of the time, deaths in Africa are painful because of a lack of access to opioids, Kiwanuka said in an interview with New Vision, a leading Ugandan newspaper.

It was that dire need that inspired Merriman’s work.

“Many people, in every country I’ve been to, thought I was introducing euthanasia,” said Merriman, adding that people were concerned about morphine addiction, but she stressed that this only occurs when injected strongly and intravenously.

With only one doctor for thousands of people, in 2004 Uganda became the world’s first to allow nurses to prescribe the drug. Today the morphine is made at Hospice Africa Uganda’s headquarters in the capital, Kampala, with a bottle costing just $2 to manufacture and funded by the government.

Merriman’s organization has a unique referral system, using trained volunteers as the “eyes and ears” of the community to trace ill, impoverished patients. They have treated 27,000 patients successfully, 25,000 of them with morphine. It also has two centers outside Kampala.

Merriman came to this work after being affected by seeing elderly people die in pain in her home city in the late 1970s. Inspired by British Dame Cicely Saunders, the modern hospice movement founder who believed that hospice is not a building but a philosophy of care, Merriman worked in the U.K. and then Nigeria.

In Singapore in 1986, working with a pharmacist, she developed an affordable oral liquid morphine—a feat “easier than making a cake in the kitchen sink”—for more effective pain control. It contained morphine, water, a dye, and a preservative.”

Merriman didn’t foresee going back to Africa but was invited to work at a Nairobi hospice in 1990.

“When I went for the interview, I saw patients in agony, and I said, ‘I can’t come unless you get morphine,’ ” said Merriman.

Six months later she was back, introducing the oral morphine and making a huge difference to people’s lives.

Hospice Africa Uganda was set up in 1993—the same year morphine was brought in—with a vision to provide palliative care to all in need. While the center was founded for cancer care, it took on AIDS patients because, Merriman said, vast numbers were HIV-positive at the time. “It was terrible. People were dying all over the place.”

The hospice she set up would come to be a model for other countries and an education center offering palliative-care degrees and diplomas.

“So rather than cure, we must concentrate on care and ensuring a pain-free and dignified end of life,” Merriman said.