31 July 2012

Uganda: Book - Audacity to Love

book review

Author: Dr Anne Merriman

Publisher: Irish Hospice Foundation, 2010

Volume: 296 pages

Cost: Shs 35,000

Available from Aristoc.

Dr Anne Merriman, the author of Audacity to Love, has spent 28 years working as a missionary doctor in Africa, 17 of them in Uganda. In 1985, she introduced palliative care to Singapore, and in 1993 to Uganda. Currently she heads Hospice Africa's international programmes, supporting new initiatives in much of English and French-speaking Africa.

Her concern has been the relief of suffering and the provision of holistic care to the millions of patients and families in Africa affected by cancer and/or Aids. This book is her story. In it she aims to tell readers about her experiences working with the sick and terminally ill; to explore the ethos and the spiritual and ethical principles behind hospice and palliative care; and to offer practical advice for those intending to work in that area.

Her story, which is to a large extent, the story of Hospice Africa, began in Singapore with the first survey of patients who were sent home "because there was nothing more to be done."

"Hospice" is a philosophy of holistic care which can be given to the patient in the place most appropriate for themselves and their families. This "place" is increasingly recognized as in their homes, particularly in Africa, and most especially in Uganda which has among the best

palliative care in Africa. (Hospice Africa came to Uganda in 1993, when life expectancy was 38 years and the HIV prevalence was considered 30 per cent.) The word "hospice" has the same root as hospital and host/guest, and in this kind of care the patient is a guest, meaning s/he will have a word in all decision-making until the moment of death.

Dr Merriman traces the history of palliative care to the woman in the Gospel who'd had a haemorrhage for twelve years, had spent all her money on doctors and was no better (Mark 5: 25-26). In the fourth century, a devout Christian, Fabiola, opened her home to pilgrims who were travelling across Europe to the Holy Land.

In England, for example, sick people used to be looked after by religious brothers and sisters in hospices; when these were dissolved by King Henry VIII, the soulless work-houses eventually took over. In modern times the hospice movement, which does immense good, has spread rather shyly. The lack of personnel perhaps?

Key to holistic care is empathy, putting oneself inside the skin of the one suffering, and seeing a divinely-created soul there: intuition, patience, sensitivity, touch therapy in which the patient s/he feels loved and not a nuisance. Dr Merriman's experiences introduce us to many people, of all backgrounds, levels of education, degrees of sickness, presidents and new-born babies from the village, and with her Irish gift of the gab, she makes them come to life and enjoyable. There are many illustrations too, and one that stuck was titled "The total pain of a child". A boy is holding on to his bed rail, tears and fear filling his face, his hair already grey. A worthwhile book.

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