Rebecca Goody talks to Anne Merriman, founder of hospice care in Uganda

It has been an exciting few years for Dr Anne Merriman, who describes herself as "an old lady with a lot of love still to give." Thanks to the help of the rest of the team involved in the work of Hospice Uganda, she was awarded the individual recognition award from the International Association for Hospice and Palliative Care in 2001. She also received the MBE in the 2002 New Year's honours list in acknowledgment of the contribution she has made to Ugandan health care.

However, Anne comments that her MBE "is for all those who have believed in the work and take part in it as much as for me. This includes the people in the charity shops in Liverpool, who kept the charity going in the early days, and all those who keep us in their prayers." Anne views everyone involved as part of the team: "I have a strong belief in the importance of team building. One of the most important steps is to distil this team spirit into all those working in the hospice so that the patient, their family and their needs are constantly at the forefront."

Even aged 4, Anne had an interest in working overseas, declaring to her mother that she would like to go to Africa. She fulfilled her early wishes a year after graduating from medical school when she became medical officer at a busy hospital in Nigeria. However it was back in her birthplace of Liverpool working as a consultant and senior lecturer in geriatric medicine during the '70s that Anne first developed an interest in palliative care. She explains, "I became acutely aware of the need for special care in end of life situations and particularly an approach to improve quality of life, bringing the terminally ill to peace." After completing a masters degree in international community health in 1982, Anne spent time in Malaysia and then in Singapore. While researching palliative care needs she felt drawn to meet the terrible needs she had unearthed. She helped to set up a volunteer group, now the Hospice Care Association which cares for 60% of patients with cancer in Singapore.

Anne then worked with Nairobi Hospice in the early '90s. She says: "I longed to help provide a hospice that was suitable to the African needs, affordable for the people, and acceptable culturally, and that it would be a model for other countries which would inspire and encourage palliative care efforts throughout the African continent." It was out of this desire that Hospice Uganda came to be.

Anne may be full of love but she is no push over: "I do have a short fuse at times, but one of my strengths is having the single mindedness to make something work and stick to it." This quality has been essential, especially in the early stages of Hospice Uganda, when there were many difficulties to overcome. One such challenge was when she attempted to raise funds at a time when the focus was on disease prevention: "If I had wanted condoms, I could have got millions, but because I was looking for money to care for dying people, there was no help." She also had a great struggle with some people within the Ministry of Health who didn't want morphine to come into the country. Yet now having seen the work of Anne and others at Hospice Uganda, Uganda has become the first African country where the Ministry of Health has incorporated palliative care into their five year national health plan.

So where does Anne's drive and energy come from? "I am sure that my firm belief in God being in charge of us and working through us to help others is a large part of my drive. The great need in Uganda in 1993 was to care for those afflicted with cancer or AIDS. The events leading up to my coming here were traumatic but on looking back were all part of God's plan for this work." She continues, "One of the most important lessons I have learnt is that God is there even when he appears to be absent." She admits, "Over the years I have had some regrets but looking back now, I see that they were temporary because all were leading to where I am today."

Anne has experienced many people and places: "I am from Liverpool and we can smile about many things because of the fun in life." On a more serious note, she compares her time in Uganda with that elsewhere: "Ugandans are very spiritual people, and I believe this helps them cope with life threatening diseases." She notes a different approach to grief and bereavement in Africa where the reality of life demands that grief be expressed and then moved on from. She feels that we in the West have much to learn: "The medical profession will not be able to give their best to the dying until they themselves have accepted death in the wider sense and in particular their own death. We must respect the autonomy of our patients and hold back from taking control."

Anne feels that the time has now come for her to wind down: "I would like to pull out of mainstream medical work, but always be available to help if I am needed for advice. I will miss the daily contact with patients and the satisfaction and joy of seeing a patient in severe pain and great distress become at peace with pain control and the love and support of our teams."

So what advice does would she give to others? "Consider why you chose to do medicine and stick to those values. To those responsible for choosing who enters medicine, make sure that their main motivation is to help others."

Further information

• You can contact Dr Anne Merriman at Hospice Uganda, PO Box 7757, Kampala, Uganda (email anne@hospiceafrica.or.ug).