As the population of older people increases across Africa, experts are seeing a spike in new diagnoses
In the night, when all that glows on this
hilltop is the moonlight and all that moves are branches tickled by a soft
breeze, the tumult returns. The old woman grows convinced her house is on fire
and, panicked, drags the table, chairs and the rest of her few worldly
possessions, outside. Unable to calm his mother, her son knows just one way to
end it.
He locks her up.
“She
yells,” the son, 62-year-old Herbert Rutabyama, says matter-of-factly. “She
pounds on the door.”
Dementia’s prevalence
has long been muted on this continent where lifespans have trailed the rest of
the world for as long as anyone has kept track. But as the population of older
people increases across Africa, experts are seeing a spike in new diagnoses,
each of them bringing profound challenges to the patient and their family.
A surge
of new cases of dementia is expected across Africa in the coming years as the
demographic shift continues. But, already, the desperation of those caring for
people living with diseases like Alzheimer’s is beginning to show.
They turn for help in a place with little
to offer. In many of the languages spoken on this continent, they don’t even
have a word for dementia.
This day,
the crew from Reach One Touch One is making its rounds in this western Uganda
village about an hour north of the Rwandan border. Nearing the woman whose
middle-of-the-night visions are so unnerving, aid worker Moses Kahigwa musters
as much sunniness as is splashed outside the lush valley below.
“You look
good!” he coos.
The
woman, 87-year-old Alice Ndimuhara, gives him an icy glare.
“This
looks good to you?” she says.
It’s just
past noon and Ndimuhara hasn’t had anything to eat today. She has no money. All
her limbs feel weak. Her headache never seems to go away.
If not
for visitors, she would’ve just stayed in bed.
“My life
is just meaningless,” she says.
Her son,
Rutabyama, arrives from working in the field, wearing tall black rubber boots
that are coated with mud. Sweat wets his forehead.
Don’t be
fooled by his mother’s sass. This, he says, is one of her good days.
It’s been
a few years since she started wandering from the house and showing other signs
that something was wrong. He took her to ROTOM’s clinic and they said she had
dementia. His father has been diagnosed, too.
“It’s
really, really hard,” he says of managing their care.
When
Ndimuhara wanders off in the daytime, her son will set out to look for her,
sometimes finding she’s made it as far as the next village. But when her
nighttime confusion returns, he’s unsure what to do. He puts a padlock on her
door and nails her window shutters closed and resists unlatching them even when
she screams and pounds.
“You know
better,” the mother says when the subject comes up.
It’s not
entirely uncommon. The United Nations’ chief voice on the rights of older
people, Claudia Mahler, issued a report in 2022 warning of elders being locked
in their rooms and tied to trees in their yards, without citing the countries
in which it was common.
Even for
the wealthiest people in the richest places, the solutions offered for those
with dementia are inadequate, amounting to salves for a disease with no cure.
Here,
though, there is basically nothing. Rutabyama believes caring for his parents
is his responsibility. Even if he could afford a nursing home, the country has
only a handful and the closest one is a day’s drive away.
As
Africa’s longevity revolution makes itself known in a thousand ways, the
problems that come with it are being dumped in a place where they have lots of
company.
Elders,
no longer able to walk, are trapped inside with no wheelchair. But what good
would it do if sidewalks are missing, streets are cratered and homes are
unnavigable shacks?
Untreated
cataracts leave many blind. But how do you broach surgery when even a ride to
the doctor is a quandary and even a simple pair of glasses is out of reach?
Dementia
brings ostracisation and accusation. But who can help if belief in witchcraft
is wide, cognitive expertise is sparse and the language hasn’t even a word for
the diagnosis?
Rutabyama doesn’t know the answer to those
questions and doesn’t defend his choice to lock his mother up.
It is another flawed response to a question with no good answer.
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