11 March 2019

Nigeria's Elderly Suffering From Dementia, Not Witchcraft Says Activist

Around the world, every three seconds, someone develops dementia. By 2017, those living with dementia was close to 50 million. And by 2050, that number is expected to be close to over 130 million.

Those are the figures from Alzeimer's Disease International.

But how are countries around the world faring when it comes to taking care of the elderly, particularly those suffering from dementia?

When Chief Kikelomo Laniyonu Edwards returned back to her home country of Nigeria, she realized that as the growing population ages, their needs were not going to be met.

Since her return to Nigeria in 2012, Edwards has been working hard to bring awareness to the state of the elderly and to spread the word about one of the perils of aging: dementia, or more specifically Alzheimer's disease.

Her work with those suffering from Dementia comes from her time in the United Kingdom, where she ran three care homes. "Two of them [were] specifically for dementia. Three care homes and one care agency, where I would send people out to look after people within their own home" says the 60-something, self-proclaimed campaigner, whom I meet at Ibadan, Nigeria, in Oyo state.

Her return to Nigeria was not supposed to be long. "Mainly because I thought I was retiring. But I found there's quite a lot of work to do for Nigeria and in Nigeria" says Edwards.

Her work began after she noticed the treatment of the elderly through the eyes of tradition.

"When I first got here, there was quite a lot of noise about oh, 'they're witches, they're mad people' and people don't marry into [a] family that has madness or witchcraft in their families. So everybody is hiding the person with dementia."

But the issue is not only just hiding those suffering from dementia.

A search online locates videos of elderly people being harassed (or worse) for being thought of as a witch, or possessed by a spirit.

This video was reportedly taken in Nigeria.

In it, an elderly woman finds herself on the rooftop of a nearby house.

The woman appears confused as she looks around her.

People start yelling at her, calling her a witch, scared that she's performing witchcraft. She eventually climbs down by herself to a screaming crowd and the video ends.

The same video is posted on two different sites.

One caption reads: witchcraft is real.

The other one reads: an Alzheimer-ridden old woman who climbed a roof of a house almost lynched by awaiting crowds who hurl insults, abuses on her calling her a witch.

The latter is the type of thinking Edwards hopes to change.

She says often such victims are stoned or beaten.

"There's quite a lot. And it's sad. But that's the reality. Now wanting to draw people, my people that have dementia away from this cruel injustices, I find that I have to train the minds of the community."

Chief Anthony Anenih Geriatric Centre

Here in Oyo state, in the city of Ibadan, at the University College Hospital is where the fight has begun.

On a hazy Friday morning in Ibadan, I cut through a manicured lawn towards the entrance of the Geriatric centre.

Not far from me, is a statue propped high near the entrance that shows an elderly couple sitting together on a bench.

Dr. Olufemi Olowookere is the centre's current director. He is also a family doctor specialsing in geriatric medicine.

Showing me around the centre, he explains that this is the first geriatric centre in Nigeria.

"Many other ones will start springing-up very soon... . but this is the first of its kind in this country. And before this centre, we did not have anything like this. but now that we have this, the awareness is so high, courtesy of the effort of many people that have done a lot of on the ground work, and the government is getting to be involved in the care of the elderly," explains Olowookere.

Since its opening in November 2012, word of the centre has spread.

Today, patients arrive accompanied by their family.

Here they can get thorough testing and follow-ups via the different specialists and the different clinics made available.

For example there's a dental unit, ophthalmology unit, rheumatology unit, diet unit, and the memory clinic.

It's the memory clinic that is starting to make a difference.

"We don't call it dementia clinic. Some people when they say you are demented, they look at you [and] as[k] 'what are you talking about?' but when we say memory they can quickly identify" explains the director. He says its that type of wording that encourages people to seek 'memory' help rather than full on dementia.

Kiki gives a tight smile when it is referred to as a just a memory clinic.

As a member of the World Dementia Council, she founded and is the CEO of the Dementia Care Society of Nigeria.

She hopes to do away with the negative connotations associated with Dementia, and concentrate on education.

Kiki jumps up to pin a button on Olowookere, just like the one she wears herself, that states: Dementia Friend.

But already this clinic is a huge step for a country that remains very religious and close to its traditions.

"When you give people some results, say this is your result, depending on the fate of that person, they will say ' I reject it in Jesus' name'. We believe we don't want to always go against the belief of our patients. That's the training. What your patient believes has a lot to do with the way he recovers from his illness" adds Olowookere, stressing patience and compassion are the ultimate tools to convince people.

The centre is designed as a self-contained unit, away from the main hospital.

All the different clinics, operating rooms and day facilities are located close-by to minimize walking around.

And while it is a private centre, and patients pay out of their own pockets, the hospital does have an insurance plan that the government has now taken over, making it more affordable for people.

The idea of the centre is to encourage people to bring their elderly family members to the facilities when loved ones notice the early signs of a problem, explains Olowookere."So those things, when they come we do some assessments for them and in the course of doing their assessment we do what we call a 'comprehensive geriatric assessment'. And in the process of doing that, we do some mini mental examinations to determine some of those. Even though it is not conclusive there are other tests that we also can conduct on them. From there we will be able to pick those ones that were think we have dementia and we have a clinic for them."

Geriatric medicine

In a country the size of Nigeria, with a population of nearly 200 million, the number of elderly persons continues to increase.

That was part of the reason behind the establishment of this geriatric centre, which was the brainchild of Temitope Alonge.

The recently retired Chief Medical Director was driven by a personal story to open such a centre, and not merely a department:

"Regrettably, my mother who was also elderly did not survive congestive cardiac failure because she was managed in a remote area where they had no geriatric practice. I think she had an overdose of the antihypertensive and all the medication they were giving to her to try and dry up the fluid in her body."

Which is why he says more care is needed to such patients, especially in an era where home-care is no longer the norm.

Parents both work; children move away from home, even to other countries.

So the elderly are left without much help, but they require a special kind of care.

"We've since got to know that elderly patients are not old adults. If you give them the same dosages of the medications on the premise that they are older adults, the chances that you might overdose them because there is a very fine line between health and disease in this group of people."

Knowing that difference is what propelled him to seek funding for the establishment of the centre, to avoid such unnecessary deaths amongst the elderly.

He sees the centre as a way for patients to go home and be better cared for by their family.

The hospital now is also offering training programmes to home-care givers, so families can hire in-home care if needed.

And there is an actual in-patient facility, whereby patients can stay up to 30 days.

This idea of dropping off your parent or grandparent at a homecare facility is still a new idea in Nigeria explains Alonge and very much associated with western culture as he saw while studying in England.

So a short-term care home is a way to introduce people to the idea and allow for east to meet west.

And it's the traditional elements that the medical staff here don't want to lose, namely the care and energy into looking after one's own.

Reconciling tradition with western medicine

Dementia is considered a "progressive disease of the brain" explains Dr. Tope Farombi, the in-house neurologist at the clinic.

Losing one's memory is the big flag of someone suffering from a form of dementia explains Farombi. "They fear that they may not recognize themselves or their loved ones again, and when they lose memory like that, that's affecting their daily activities . . . such as the usual things they do for themselves, calculations, going to walk, going to market, going to having activities with friends and families and even being able to groom themselves becomes a difficult task for them."

She says they try to encourage people to seek help when the early signs set in.

But in the case of Nigeria and other sub-Saharan countries, traditions are still very strong and so the role of the supernatural occupies a role in the main culture.

And the fear of being possessed by another spirit, or witch is often a conclusion drawn when someone encounters a patient suffering from this form of dementia.

The doctor describes one recent case of a woman who found herself in the west of the country after she boarded a bus from the east. "And there in Lagos, she didn't know where she was, she didn't know anybody . . . and they were about to stone her to death when a good Samaritan had to intervene and take her to the police station."

The woman was about to be stoned because she was reportedly muttering inappropriate things "so they tagged her a witch" says Farombi.

And so with the growing importance of geriatric medical care in Nigeria, comes the chance to educate people on such medical situations.

Farombi stresses the importance of education. "We don't just give medication, we have to educate the family and the carer to let them understand the basis and the essential of this disease and open their hearts to let them know it's not going to go away, it's going to be as long as the patient lives . . . So we have to educate and educate."

Tradition with tradition

Edwards knew that even before families would come to a medical facility, they had to know that there was a potential medical situation on hand.

So she decided to begin with the King in her region.

"I got to the King and got him to get all his chiefs together; all the chiefs they have their own villages and communities that they rule over" explains Edwards.

During the meeting, she says it was then she stressed that this erratic behavior and memory loss is a medical condition and not something tied to the supernatural. "You can see the lights turn on, 'wow, is this what it is?' 'Oh so that is what was wrong?'" and at that point she knew things might start changing.

During her seven years, she has worked to establish a functioning Nigeria branch of the Alzheimer's association.

Her membership with the World Dementia Council has given her access to more means of training people locally.

And she herself has opened up her own care-home, Rossetti Care Limited Nigeria, specifically for those suffering from Dementia in neighboring villages.

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