From early burial rites to ancient cave paintings, spirituality has long held a central place in human societies. French philosopher Pierre Teilhard de Chardin famously commented, “We are not human beings having a spiritual experience; we are spiritual beings having a human experience.” I came to fully understand this in Uganda, where communities deeply acknowledge the potential spiritual realities beyond the material world.
I arrived in Uganda on May 19th, 2025, to begin an experiential internship with the Palliative Care Association of Uganda (PCAU), facilitated by Global Partners in Care.
The timing was poignant—Dr. Anne Merriman, “grandmother of palliative care” and founder of Hospice Africa Uganda, had passed away the day prior. Since 1993, Dr. Merriman had lived among the Baganda ethnic group in Uganda and had wished for a vigil to be held at her home after her death.
In the Buganda region, death is not the end of life, but rather a transition into the spiritual realm that continues to influence those on earth. The ceremonial acts are more than just a celebration of life—they are a unifying time to restore community balance, reestablish connection with the spiritual, and reaffirm one’s place in the larger story of life.
That night, I sat by a fire as hymns were sung, stories told, and prayers offered. We also shared a meal and participated in liturgical practices led by clergy. In these activities, grief and love coexisted, creating an unrestrained, inviting environment for all to properly mourn.
Coming from a culture where solitude seems to be a central component of bereavement, I couldn’t imagine being almost compelled to share my grieving feelings with others. Yet, I was amazed with the profound connectedness before me. What keeps us from doing this back in the United States? What was so unique about Ugandan spirituality? Why am I feeling so emotionally connected when I have no previous connection to these people?
In drafting their 2022-2026 strategic plan, PCAU recognized the importance of spiritual care as a core component of palliative care and prioritized improving practices across Uganda.
In palliative care, spiritual care suffers due to limited training, inconsistent approaches, and the lack of standardized tools. Drawing on perspectives from clinical providers, leading researchers, and patients, PCAU developed a Spiritual Care Assessment Tool (SCAT), utilizing the well established FICA (Faith/Beliefs; Importance and Influence; Community; Address in care) tool for adults and BELIEF (Belief system; Ethics and Values; Lifestyle; Involvement in a spiritual community; Education; Future events) tool for children.
During my internship, I spent two weeks at Little Hospice Hoima (LHH) in Western Uganda, one of the two sites where PCAU had piloted the SCAT. Travelling for hours to reach patients, I was filled with pure joy seeing the length which providers would go to provide hope and relief to their suffering patients. They made it clear: health is not a privilege for the fortunate, but a right owed to every human being.
While I appreciated the relief medications brought, I was once more captivated with the deeper healing found in conversation.
What brought the provider and patient so close together—they had just met? While conversations always included physical pain, patients quickly delved into spiritual topics.
Due to physical limitations, patients are often unable to attend weekly prayer services that once satiated their appetite for spiritual connection. In Hoima, where spirituality is woven into daily life, patients often look towards spiritual practices for healing. In desperation, patients sometimes will hastily switch religious affiliations on supposed promises of a miracle. However, when a miracle doesn’t come or patients become uncomfortable with required practices, they seek reconciliation with the religion they followed all their life.
Equipped with the SCAT, providers were able to more thoroughly assess a patient’s spiritual needs, diving into topics such as religious conversion, social stigma, peace with God, and reception of sacraments or special prayers. In addition, providers were better able to collaborate with local religious leaders to ensure questions related to religious beliefs were adequately answered.
While the SCAT was helpful for assessing religious needs, I noticed deeper spiritual distresses about meaning, identity, and purpose. Constrained by their illness, daily work activities and strong connectedness with a community were no longer viable options for patients to derive meaning in their lives. Why was I cursed with this illness? What does it mean for me to be alive? If I die tomorrow, will that be the end? Lying in bed, patients wrestle with these questions that drive at the core of our being. While many have religious teachings to draw upon, I began to question whether these were enough to satisfy the depth of their longing. In this struggle, peace slips beyond reach, and restlessness lingers ever closer.
In addition to the pilot at LHH, PCAU partnered with the pediatric ward of the Uganda Cancer Institute (UCI) to integrate spiritual care into inpatient units. Due to UCI’s heavy load of patients, interactions are short, leaving limited time to assess spiritual needs. Diligent work from trained palliative care providers, however, gives us hope that these services will be fully integrated in the future.
Furthermore, assessing the spiritual needs of children has been especially difficult in the pilot of this work. Children, especially those ages eight to eleven, do not comprehend some of the questions being asked. To address this concern, LHH providers joined PCAU team members and Center for Hospice Care volunteer Roberta Spencer to discuss potential solutions. Providers were reminded that they won’t have all the answers, but any effort to help patients feel heard, connected, and dignified is itself an act of spiritual care.
PCAU is piloting the SCAT with support from Center for Hospice Care (CHC) through Global Partners in Care (GPIC). As they improve the tool, they are actively seeking more partners to join them—particularly as they prepare to scale this work across the country in 2026.
In addition to brainstorming more ways to administer pediatric spiritual care, PCAU hopes to develop a smaller, compact tool to bring into the field, further resources to educate providers about the elements of spirituality that religion doesn’t always address, and an emphasis on spiritual care practices like song, dance, meditation, and prayer to provide tranquility.
Finding innovative ways to administer to the spiritual needs of patients is far from a straightforward task. Spirituality shows large variation between patients, each with their own religion, traditions, and spirituality. By helping patients navigate spiritual pain and by crafting tools like the SCAT to guide them in that journey, PCAU is doing more than reducing physical suffering. They are helping write a more human story—one where medicine meets meaning, and where, even in suffering, the spirit finds dignity and peace.
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https://globalpartnersincare.org
Noah Lim is a student at University of Notre Dame. Working as a Global Partners in Care intern, he spent 8 weeks in Uganda working with the Palliative Care Association of Uganda (PCAU) Executive Director, Mark Mwesiga, supported the writing of this article.
A wonderful reflection thank you Noah for highlighting spiritual care and for children . Much to build on
Thank you for this well written article highlighting the importance of integrating spiritual care in palliative care. The Spiritual Care Assessment Tool was developed after extensive professional research and input from a variety resources. It is a testament to the Palliative Care Association of Uganda in recognizing and honoring the spiritual beliefs of patients and families who rely on their faith as a source of strength and comfort in difficult times.
A wonderful reflection
Hello Noah, I have read your reflection severally and its heart warming to see how this work has evolved. We are looking forward to building on this work.