2009; Volume 10, No 10, October



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Dr. Anne Merriman

I am writing this in Bali where I am spending a few days with my “jogging” friends and family. Yes, I am reminiscing about my time in Singapore in the 80s, when I used to jog and swim and when I was young and beautiful. But more importantly, I reminisce here about our team’s pioneering experiences together as we introduced hospice care in the Republic.

I enjoyed a wonderful week with the Hospice Care Association of Singapore. This charity was registered 20 years ago. It followed 4 years of voluntary home care by a team of dedicated nurses and myself. Those were days of joy and sorrow, but most importantly real relationships were made with patients and the team.

Cynthia Goh, Rosalie Shaw and I, all originators, were invited to speak at a medical symposium in early September.

Cynthia Goh is now a leading palliative care physician in Singapore and nowadays in the world. She joined Sr. Geraldine a palliative care nurse at St Joseph’s Home, and I in 1986.

Rosalie Shaw, took up my post initially with the Hospice Care Association in 1994. She has written a book describing some of her experiences with the gentle people of Singapore. For me the book is “deja vu” and brought back fond memories of our times struggling as unpaid volunteers. The book is beautifully written and was reviewed by Roger Woodruff in the February IHPCA Newsletter (http://www.hospicecare.com/news/09/02/reviews.html ). Rosalie later became a leader in other countries in S E Asia through the Asia Pacific Hospice Palliative Care Network. During the recent anniversary forum, she described the work she conducted in other countries of SE Asia that were so similar to our experience in Africa. Rosalie is now in active retirement as she continues to visit and teach in many countries in the AP region.

It was a real joy to be welcomed with open arms to our homecoming by fellow initiators and the present team that looks after 900 patients today in their homes. At the end of our volunteer time between1984 and 1989, we cared for (after work) 450 patients and families. Reflecting on what we did then, it was very different from my more recent experiences in Africa. It was however preparation for the commencement of Hospice Africa in 1993. Had it not been for the pioneering days in Singapore, where palliative care was considered similar to the old Chinese death houses that were demolished by the Government in Sago Lane, perhaps I would not have had the stamina to venture into new territory in Africa. The real breakthrough in Singapore was the distribution in 1986 of the WHO best seller Cancer Pain Relief. The Minister of Health of Singapore had experienced in his own family the pain of dying because of cancer and realised that it need not have happened. Cynthia Goh led the negotiations with the government to promote hospice care.

While in Singapore in 1984, I researched the needs of those going “home” due to cancer. I found that these patients were indeed suffering due to a lack of knowledge, skills and medications that were well known and available to those practicing modern hospice medicine elsewhere. It was ethically impossible for us to not do something about it. With two pharmacists, a formula for an oral morphine solution (without the additions found in the Brompton’s cocktail) was devised and we started using it. We were providing treatment for pain and other symptoms using my own experience gained in palliative care in Liverpool along with what we learned from Robert Twycross’s books. We introduced educational programmes for doctors and nurses and taught palliative care through my university appointment in the Department of Community, Occupational and Family Medicine. We opened the door to holistic care for our patients.

During the 20th anniversary celebrations, relatives and former medical students who are now well established doctors, and some specialised in palliative medicine, visited with each of us to tell of their joy at meeting us again after all this time. It was very special as we revisited the past and looked to the future.

It was gratifying for me to see the progress that has been made since those early days in the 80s. Patients now receive free treatment in hospice programs, with over 70% of cancer patients receiving care in palliative care programs and in the past 20 years they have cared for 28,000 patients. Training is in place for volunteers and specialist palliative care physicians. The government supports all Sinaporeans while geriatric care and palliative care are growing together with 50% of the cost of the latter being financed by the government.

God made individuals and countries very different. The palliative care needs must also be different to meet the needs of each culture. Palliative care has moved in the world in many ways to meet the needs of the suffering. As long as these needs are foremost in our intentions, it will grow and reach those in need. Singapore has done better than most. They have also reached out to the more difficult areas in SE Asia. I will watch from the next life and pray and hope to see how quickly Uganda and Africa will meet the needs of their people in their own special way.

Anne Merriman, MD (Uganda). Doctor Merriman is Founder and Director of Policy and International Programs at Hospice Africa in Uganda and is an IAHPC Board Member.

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