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
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