Africa’s Challenges

It was obvious the existing Western model of palliative care in 1990 would not be sustainable across Africa given the generally and often unstable socio-economic infrastructure. (In 1990, South Africa and Zimbabwe had stable governments, strong economies, and prosperous social systems; instability has resulted in Zimbabwe’s current conditions.) The simplest and most direct treatment for controlling pain is affordable morphine in a reconstituted oral solution; but strong myths and fear surrounding morphine, its regulation, and its allocation has influenced governmental policies. Many African countries bar the importation of morphine. In other countries where it can be imported, only a strictly limited number of doctors are allowed to prescribe it. This high-level policy directly influences the lack of cultural acceptance of morphine at a grass-roots level; sometimes when morphine is available, some patients refuse it. Even if morphine were culturally acceptable and available, its Western forms (tablet and injection) made it much more expensive than most Africans could afford. Thus, to meet this great need for palliative care, a new model was needed that would provide creative solutions to the myriad of problems blocking its success. In 1993, Dr. Anne Merriman’s vision, fearlessness, and years of experience gave her the essential tools needed to found Africa’s first palliative care model: Hospice Africa Uganda.