In Summary
  • Now through provision of care to patients and families, this country is recognised as one of the best services in Africa, and coupled with the training of nurses and doctors, specialist palliative care is now available in 90 per cent of the districts. This is further supported through the Palliative Care Association of Uganda, headed by Ms Rose Kiwanuka, Dr Merriman’s first Ugandan nurse. Training is also extended to the community volunteer workers who support the patients in communities to bring the suffering to the attention of the nearest palliative .
  • As a result of Dr Makumbi’s pioneering efforts and from hard work of many stakeholders Uganda has been shown to have the best integrated service in Africa! Working with government, policy was changed so that nurses are trained in palliative care and work in the homes and oral morphine is now supplied free by our government to those who are prescribed by a registered prescriber.

Among the tributes to Dr James Makumbi (RIP), I doubt that any has described his gift of palliative care, which changed the stories of Ugandan patients suffering and dying from life-limiting illnesses like cancer and Aids. Palliative care focuses on improving the quality of life of patients with serious illnesses.

Pain relief is a key goal therein, and when pain is severe opioid medications are a cornerstone patient treatment. Dr Makumbi, the Minister of Health at the time in 1993, allowed and supported the first imports of powdered oral morphine in 1993.

Without the availability of affordable oral morphine, Uganda would not have been the country to be the model for palliative care since holistic care is impossible when the patient is unable to think of anything but the pain, with a family desperate for the relief for their loved one.

Why did Dr Makumbi do this? Dr Anne Merriman MBE came to Uganda in 1993, as part of a feasibility study in five countries, to see where to put a model for newly founded Hospice Africa, to bring peace to those suffering from end-of-life conditions. Dr Makumbi’s answer to their request was “Our people here are suffering so much from cancer and from Aids. Please bring palliative care to our people”.

At the time, HIV prevalence was 38 per cent and “slim” disease was easily recognisable. Dr Makumbi supported our efforts to meet officials for the permissions and the regulatory documents required to buy morphine powder and have it imported into Uganda. This year Hospice Africa celebrates 25 years since the introduction of palliative care to Uganda.

Now through provision of care to patients and families, this country is recognised as one of the best services in Africa, and coupled with the training of nurses and doctors, specialist palliative care is now available in 90 per cent of the districts. This is further supported through the Palliative Care Association of Uganda, headed by Ms Rose Kiwanuka, Dr Merriman’s first Ugandan nurse. Training is also extended to the community volunteer workers who support the patients in communities to bring the suffering to the attention of the nearest palliative .

As a result of Dr Makumbi’s pioneering efforts and from hard work of many stakeholders Uganda has been shown to have the best integrated service in Africa! Working with government, policy was changed so that nurses are trained in palliative care and work in the homes and oral morphine is now supplied free by our government to those who are prescribed by a registered prescriber.

In 2000 the Health Sector Strategic Plan stated that “Palliative care is an essential clinical service for all Ugandans”.
Thousands of Ugandans are now receiving palliative care in their homes as well as in some of the hospitals. Oral morphine brings peace to the patient and the family.

Dr Eddie Mwebesa,
Chief Executive Director- Hospice Africa Uganda