Innovations in End-of-Life Care
an international journal of leaders in end-of-life care

Dr. Anne Merriman first went to Africa in 1964, following graduation from medical school at University College, Dublin (1963) and earlier training in Ireland as a medical missionary. In Africa, she worked in Nigeria as a medical officer in an acute care hospital and a small Mission hospital where she had wide-ranging responsibilities. After returning in 1973 to the United Kingdom, where she got some additional training, she became a pioneer in the specialty of geriatric medicine, as a consultant and lecturer in the University Department of Geriatric Medicine at Liverpool University. Over the next 10 years, Dr. Merriman worked in geriatric medicine and general practice in Liverpool and the University of South Manchester. While restructuring the geriatric service in St. Helen's and Knowsley hospital in Merseyside, she became interested in the needs of the dying, and taught pain and symptom control on the surgical and medical wards.

After earning a Master's in International Community Health in 1982, Dr. Merriman went to Malaysia, and then to Singapore, where the elderly population was increasing rapidly. As a Senior Teaching fellow in the Department of Community and Family Medicine in Singapore, she spearheaded research into the needs of the terminally ill and set up a Hospice Care Association, which today provides 60% of care to all diagnosed cancer patients in that country.

In 1990, she returned to Africa to be the first Medical Director of the newly formed Nairobi Hospice in Kenya, the first hospice in sub-Saharan Africa set up to meet the needs of the indigenous African population. She agreed to accept the appointment only after the hospice's Board of Trustees ensured that morphine would be available to treat patients' pain. During the next 18 months, she worked with the first home care team for cancer and set up teaching programs for health professionals. Based on an article she wrote about her work in the Christian journal Contact, people in several African countries most affected by the HIV epidemic approached Dr. Merriman to set up a hospice in their countries. In 1992, she left Nairobi Hospice to raise funds and support for a new "model" hospice and training program to be opened in Uganda, which would serve as a catalyst for other African nations interested in starting a similar program. The following year, Hospice Africa, a charitable organization founded to provide support for the project, was registered in the United Kingdom, and Dr. Merriman opened a model program, Hospice Uganda in Kampala, to serve people dying of AIDS and cancer and to train Ugandan health care professionals in palliative care. In 1998, she opened two branches of this hospice, one in Mbarara, to provide a site for education of students in the medical school there, and the other in Hoima, to model providing care to very poor people in a rural setting. Dr. Merriman's enormous influence on palliative care in Uganda is evident in the National Health Plan (2000-2005), which includes a commitment to providing palliative care, and in government policy changes to make morphine widely available to treat pain.

In 2001, Dr. Merriman received the annual Individual Recognition award from the International Association for Hospice and Palliative Care. In the New Year's Honour List from the Queen, 2002, she received the MBE in recognition of her contribution to health care in Uganda.