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Dr Anne Merriman obituary: doctor known as ‘mother of palliative care in Africa'
Dr Anne Merriman revolutionised palliative and end-of-life care in Africa after developing a cheap form of oral morphine with a Singapore hospital pharmacist. Originally mixed in a kitchen sink, it included a pound of morphine, a preservative and colouring: lighter doses were green; stronger ones, pink and blue. A bottle cost about $2, a fraction of the cost of western formulations.
Universally known as 'Dr Anne', she said: 'It's easier than baking a cake.' She developed the pain-controlling recipe after seeing terminally ill patients discharged from hospital because 'nothing more could be done for them'. Many died at home in severe and prolonged pain.
'A wild, undisciplined schoolgirl' who became a nun and a doctor, Merriman founded the pioneering Hospice Africa Uganda (HAU) in 1993 at the age of 57. Palliative care was largely unknown in Africa when she started her work in Uganda. HAU has treated more than 35,000 patients and trained more than 10,000 healthcare professionals from 37 African countries in the so-called Merriman model.
Tough, stubborn and charismatic, she conceded that her 'brash and insensitive ways' had offended people, adding: 'I find it amazing that God has used this blemish as one of my greatest strengths.'
It enabled her, she said, to be 'a forceful and obsessive' advocate for hospice care and to stand up to older male doctors who claimed that morphine prescribing would promote drug abuse.
In her book Audacity to Love, published in 2010, she wrote: 'In Africa, in particular, some men are more dominant than in the rest of the world and don't take well to a female doctor bringing in a new speciality.
'Even today in Uganda, considered to have the best palliative care in Africa, there are consultants who refuse to allow patients' pain to be treated with oral morphine, even though sometimes these patients are their own colleagues.'
Calling herself a 'true Scouser', she was born in Liverpool in 1935, the third of four children of Thomas ('Toddy'), a primary school headmaster, and Josephine Merriman (née Dunne). A bright, questioning child, she wanted to become a Catholic priest like her older brother Joseph and later wrote: 'I could not understand such discrimination and I still feel the same way.'
The catalyst for her passion for palliative care emerged in childhood when her 11-year-old brother Bernard died from a brain tumour. She later spoke passionately about the absence of palliative care for him.
There were other signposts signalling a spectacular future in caring. At the age of four, after seeing pictures of sick African children in a magazine, she declared: 'I'm going to Africa to look after the poorly children.'
Nine years later she saw a film showing the Irish head of the Medical Missionaries of Mary (MMM) riding around the Nigerian village of Anua on a bicycle. She told her mother and a nun at school that she wanted to join the order and did so at the age of 18 after leaving Broughton Hall Catholic High School in West Derby, Liverpool.
Recognising a rich potential in the wayward, recalcitrant novice with disappointing exam results, MMM enrolled her in a three-year internship at the International Missionary Training Hospital in Drogheda, Ireland. She spent a further year in a medical laboratory before going to medical school at University College Dublin.
As a young doctor Merriman worked in MMM hospitals in Nigeria and in Drogheda, Edinburgh and Dublin. After 20 years as a religious sister and missionary, she returned to secular life in Liverpool to look after her sick mother and to specialise for eight years in geriatric medicine. Increasingly concerned by patients dying 'without pain and symptom control', she followed the teaching of Dame Cicely Saunders (obituary, July 15, 2005), the founder of the modern hospice movement.
Saunders created a new kind of hospice, St Christopher's in Sydenham, southeast London, combining compassionate care with medical care. But Merriman's vision of a hospice was not restricted to a physical building. Hospice care, she said, could be given in the most appropriate place, including the patient's home. It included emotional, social and spiritual support as well as pain control.
This made pragmatic sense in Uganda where 90 per cent of the population are reported to live in rural areas where doctors are scarce. Uganda became the first African country to permit nurses and trained clinical officers (physician assistants) to prescribe morphine; and the first African country to make palliative care part of its health service.
After her mother's death in 1981, Merriman worked in Calcutta with Mother Teresa whose order included a hospice; in Penang in Malaysia as an associate professor; and in Singapore as a senior teaching fellow.
In 1990 she accepted an invitation to become the first medical director of the Nairobi Hospice, only to leave quickly because of 'bureaucratic interference'.
A case history she published in Contact, a World Council of Churches journal, secured her future in Africa. Describing a terminally ill patient who had a pain-free, peaceful death, it attracted invitations from several African countries who wanted to develop palliative care services. She chose Uganda as it was emerging from 25 years of war and reeling under the HIV crisis.
Archbishop Emeritus Desmond Tutu (obituary, December 27, 2021) said in 2018: 'Anne has created a uniquely African template of love, dignity, care and compassion for people.'
Nominated for the Nobel peace prize in 2014 and appointed MBE, Merriman protested that 'caring for the dying is the lowest priority in healthcare because doctors are trying to cure, not to care'.
She lived in a large house overlooking Lake Victoria with her 'family', including three housekeepers and 15 dogs, once led by Adam and Eve. When Eve died she declared that Adam was grieving and found him a new partner.
A warm, welcoming hostess, she was renowned locally for her Tuesday night dinners where 12 or more guests would include local dignitaries, visiting specialists and overnighting donors and volunteers.
But she could also, as she put it, create a frosty atmosphere in a tropical climate. In one notable case, she highlighted the tragedy of Robert, a terminally ill 12-year-old boy with a huge cancer, a Burkitt's lymphoma, on his face. Robert slept under a counter in his aunt's shop and Merriman regularly took him to the hospice for a change of scene.
He grimaced in pain as they drove across the many potholes along the way. Merriman said: 'After his [Robert's] death, the President of the USA, Bill Clinton, visited Uganda … They levelled the road so he wouldn't get a bump on the bum. The Roberts of this world do not count. But Presidents do. How sick is that?'
Anne Merriman, doctor, was born on May 13, 1935. She died from respiratory failure on May 18, 2025, aged 90
