The seeds of Hospice Africa were sown when our founder, Dr Anne Merriman, was shown pictures by her mother of sick children in Africa in a journal called “Echo from Africa”. Dr Anne was only four years of age. She told her mother that when she was grown up, she would become a nurse and go to Africa to help these sick children.
Ten years later, when she was 14, Dr Anne saw the film about the Medical Missionaries of Mary, (MMMs), “Visitation”, in which the founder, Mother Mary Martin, was bringing health care as a nurse to the sick in Nigeria. From that day she resolved to join the MMMs and work in Africa to improve the lives of the poorest of the poor.
It took several decades, but after more than 30 years of clinical experience working across continents as a Consultant and Associate Professor in multiple medical disciplines including Public Health, Clinical Geriatric and Palliative care, Dr Anne founded Hospice Africa Uganda with the vision: Palliative care for all those in need in Africa.
After carrying out feasibility studies in four African countries, it became clear that Uganda was the best country in which to establish a centre of excellence in palliative care, and the work of Hospice Africa commenced in September 1993 with just enough funding for a few months, and with Dr Anne and Nurse Mbaraka Fazal the first members of the team.
In order to support the HAU vision, Dr Anne devised a model of hospice care that respected the culture and economy.
In 1993 Uganda’s cancer rate was on the increase. Kaposi Sarcoma, a marker for AIDS, was the most common form of cancer and treatments such as antibiotics or anti-fungal agents were scarce and only available for the rich. The pain for those with infections was huge, and there was little hope for most.
At the time the population of Uganda was 23 million and 57% of the rural population never saw a health worker. As a result, life expectancy was a mere 38 years, and HIV prevalence was considered to be 30%. In those first few years, the HAU team saw a lot of very sad cases. A generation of parents was wiped out, leaving children as orphans or being cared for by elderly grandparents.
One of the most significant steps in the life of HAU was the introduction of oral liquid morphine as an affordable painkiller. In 1993, the Minister of Health, Dr James Makumbi, agreed that powdered morphine could be imported, despite the concerns around addiction and criminalisation.
This allowed HAU to start manufacturing affordable pure oral morphine, without additives, using a formula which had been devised by Dr Anne with pharmacists when she worked in Singapore.
The next challenge was to allow nurses and clinical officers to prescribe morphine to patients. In most countries, the only prescribers for Class A drugs are doctors, veterinarians, or dentists and with a severe shortage of doctors in Uganda, there was a real access issue.
After a lot of persistence and persuasion from the Hospice team, in 2003 the government finally sanctioned nurses and clinical officers who had received training from Hospice Africa Uganda to prescribe morphine to patients. This breakthrough meant the work of HAU could be accelerated at a significant rate, resulting in pain relief for hundreds of new patients.
Today, morphine is manufactured at a very low cost at the HAU site in Kampala through a public-private partnership with the Ugandan government. The morphine is key to allowing patients to ‘live until they die’.
HAU
Once establish it soon became apparent to the HAU team that there was a huge need to support patients in more rural settings. In 1995, the team was invited to Mbarara in western Uganda to teach palliative care to medical students at the Mbarara University of Science and Technology (MUST), and momentum began to build to establish a service there. The team was kindly donated a Land Rover, driver, and medical supplies, enough to get things started.
With support of a large grant the service developed with a refurbished clinic and doctors and nurses on the staff. It later set up outreach and roadside clinics, crucial in more rural areas.
The second clinical branch of Hospice Africa was opened in 1998 in Hoima, a rural and sadly neglected war-torn part of the country where very little medicine was available to patients suffering from HIV and cancer.
The clinic started from very small premises but eventually received the funding and support it needed to build a larger centre. Today Hoima offers a full palliative care service.
To achieve the goal of developing a palliative care network across Africa, the Institute of Hospice and Palliative Care in Africa (IHPCA) was established on the HAU site in Makindye in Kampala, offering diploma and degree level programmes in palliative care to health care workers and students across Africa. The first Masters in Palliative Care class, in Africa, graduated in 2023.
In addition, an International Programmes Team based in Uganda was established to connect with, and visit, partner organisations in other African countries to train healthcare professionals in palliative care practices, meet with government officials, and advocate the work of Hospice Africa across the continent.
A sign of the success and impact of the IHPCA is the fact that palliative care was only in three countries in Africa when HAU was established in 1993. Today it is available in 37 countries.
More than 30 years after its founding we are proud that over the last three decades HAU has changed end-of-life for around 40,000 critical ill patients in Uganda.