Hospice Africa Uganda

HAU-IHPCA-LOGOMay12 (1)(Link to Hospice Africa Uganda: http://www.hospiceafrica.or.ug/)

In 1993, Dr. Anne went to Uganda, starting with a small team of three nurses, only three months worth of funding, and a vision of physical and emotional peace for millions. Achieving such a goal is only possible with great passion, or as Dr. Anne puts it, “the fire in the belly”.  That fire has not only grown, but ignited the spirit of others. Twenty years later, enormous progress has occurred, resulting in a staff of 130 and an operating budget of 2.8 million euro, which has included establishing three hospice sites in Uganda that promote and provide training and teaching programs to professionals, as well as community and family members.

Each of the three hospices in Uganda provides models for different socio-economic areas but with the same mission of being culturally acceptable and affordable. One of the many important mechanisms being implemented that allows these objectives to be achieved is HAU’s outreach program. These programs provide training to selected community members who are taught to identify individuals in need of palliative care services. Thus, HAU has gained credibility by having a respected local liaison, in addition to identifying patients who are too ill to leave their home and access treatment. Many are bedfast, and others will never be able to afford fare to the local health facility. Thus, alerted hospice teams are able to go to these patients’ homes and provide them with holistic care.

Dr. Anne’s vision and strategy for expanding palliative care throughout Uganda and other African countries has also included providing training in palliative care to doctors, nurses, pharmacists, paramedics, community leaders and students in both under and post graduate levels. For palliative care to become viable and reach all those in need, its success and sustainability depends on the training in and acceptance of this form of care into the existing healthcare systems. Hence, training programs commenced immediately in 1993.  HAU began with short courses, ranging from three to seven days, and teaching undergraduates at Makerere University. Training has included even spiritual advisors and traditional healers over the years. In 2003, the Government of Uganda was the first in the world to change the statute which allows nurses and clinical officers trained by HAU to prescribe morphine. HAU immediately offered a nine-month residential Diploma in Clinical Palliative Care (DCPC) in collaboration with Makerere University. This diploma allows nurses and clinical officer, on successful completion, to deliver specialized palliative care and, importantly, prescribe morphine.  In 2012, the “Rapid Prescribers” course began training clinical officers in how to provide palliative care and prescribe morphine. The institute of Hospice and Palliative Care in Africa (IHPCA) commenced Bachelor degrees in palliative care for Africa in 2010. The wide spectrum of training (carried out by hospice and other organizations who have taken up this call) has advanced the expansion of palliative care, bringing the gift of peace to those in greatest need.

Anyone who has witnessed a loved one wasted away by disease and cancer knows the immeasurable value of nurturing the last remaining moments of human life. The people of Uganda have personally experienced the impact of these initiatives. Children with Burkett’s lymphoma, a common cancer in Uganda which presents as a huge, painful growth on the side of their face, have experienced a vast improvement in the quality of their daily lives: instead of crying for hours from the unmitigated pain, they are finally able to smile and sleep through the night. When the pain is controlled, parents are able to attend to important matters, meet the needs of other family members, and even return to work. The files of palliative care practitioners have amassed thousands of these individual stories because Dr. Anne has the ability to understand a problem and develop an innovative solution to meet an otherwise crushing reality. This powerful program has made Uganda the first country to increase its number of professionals trained in palliative care, thus providing care in 66 districts to over 42,000 patients and their families through the work of HAU as well as those who have received HAU’s training. Still, the demand is far greater than palliative care practitioners are currently capable of serving.

Dr. Anne continues to focus on this enormous need; rather than slowing down and congratulating herself on her success, she is constantly looking for ways to improve this system and expand her model to help more people.  At age 77, the fire in her belly has become a furnace. She continues to travel around the world, regularly advocating for palliative care, providing education and strategic leadership, personally fund-raising, and increasing awareness about the need for a solution. Dr. Merriman’s vision reaches far beyond the borders of Uganda…