In a modest home in Uganda’s capital, Jane Mwesige, a nurse from a hospice that has revolutionised end-of-life care in Africa, sings a gospel song with her patient, Jonathan Luzige.
These home visits, which blend affordable medical treatment with spiritual solace, are a vital part of Mwesige’s work with Hospice Africa Uganda.
Founded in 1993 by Dr. Anne Merriman, Hospice Africa Uganda brought comprehensive end-of-life care to a continent where it was then available in only three other countries. By the time Merriman passed away in May at the age of 90, her model had reached over 40,000 Ugandans and spread to 37 African nations.
Jonathan Luzige, 30, whose colon cancer makes movement difficult, eagerly joins Mwesige in song from his home. “I feel very happy, and it made me feel stronger knowing there are people who can care for me,” he shared. Mwesige emphasised the universal need for such services, stating, “Palliative care is all about taking care of patients. Every one of us, or one of our relatives, may need the service.”
A Simple Solution, Profound Impact
Born in Britain to Irish parents, Merriman’s journey included training as a doctor and becoming a nun before she left her order to help establish palliative care in Singapore. Arriving in Uganda during the height of the HIV/AIDS epidemic, she initially had only enough charitable funding for three months of work and a minimal staff.
The renowned and persuasive Merriman successfully convinced the Ugandan government to permit the import of morphine powder. She used this to create an oral solution she had developed in Singapore—a simple remedy, made in a bucket over her kitchen sink, that proved invaluable to thousands.
Hospice Africa Uganda, now sustained by NGO and charitable funding, distributes this solution free of charge to hospitals and clinicians in recycled plastic bottles. Facing a shortage of doctors, Merriman also championed legal changes that allowed nurses to prescribe morphine and deliver it directly to patients’ homes, earning her the local title of “jaja” (grandmother) of palliative care in Africa.
Irish Ambassador to Uganda Kevin Colgan, at Merriman’s funeral, described her as having “huge determination and drive,” noting that “When Anne heard a ‘no,’ she always turned it into a ‘why not.'”
Overcoming Challenges and Continuing the Mission
Despite the progress, significant gaps remain. The World Health Organisation estimates that around 500,000 people in Uganda require palliative care, but only 11 per cent currently have access.
In the past year, the hospice’s 90 staff served approximately 2,000 patients across three districts, though they sometimes face resistance.
“There are some patients who don’t want to be referred to hospice, because once they are referred… they have a feeling they are going to die tomorrow,” explained Executive Director Prossy Nkayanga.
For many Ugandans, with about 40 per cent living on less than $2.15 a day, according to the World Bank, the cost of treating illnesses is prohibitive. Luzige, diagnosed with cancer in 2022, could not afford a crucial test after an operation and chemotherapy.
His tumours have since spread, leaving him bedridden and unable to work. His sister, Josephine Namawejje, left her childcare job to care for him, supporting them by selling snacks. “It is very hard to see your big brother in a condition like this,” Namawejje said quietly, describing him as her “best friend.”
Luzige, whose business school graduation photos adorn his walls, now worries about being a burden. “I had a dream of making something better in the world,” he shared, adding, “This condition delays what I wanted to accomplish.”
The hospice staff remain committed to expanding their programmes to reach more individuals like Luzige, ensuring Merriman’s compassionate work endures.
Nurse Mwesige was with Merriman in her final moments, singing to her as she does for other patients. “I tried my best to make sure I used the same lessons that she taught us to make her as comfortable as she could be,” Mwesige reflected. “I never let go. I kept watching over her.”
