Mr. Etende left to work in the city but since his wife passed on, he has become estranged to his children and now has problems with memory. Mr. Etende lives alone and since he has issues remembering appointments, it is possible that he might have stopped going to work and may eventually get fired. It is likely that Mr. Etende consumes alcohol because he has lost contact with family may resort to drinking alcohol to reduce boredom and to bond with his friends. If the latter (losing his job) happens it may lead him to abusing more alcohol thus worsening his condition. In the process of losing his way back from the shop, one of his neighbours may notice that something is wrong and may try to contact his extended family if there are any around the city. If Mr. Etende is in good terms with the relatives, they may come to his aid otherwise he is likely to find it difficult to deal with dementia not least because he is not in a good relationship with his family. Once they make contact with him, his relatives may contact the immediate family in the village to establish a relationship, then in the process take Mr Etende to a nearby public health centre to find out what is going on with him. Here, the services are likely to be paid out of pocket to obtain the card to record the next appointment and for medications. That is likely to be all Mr. Etende gets in terms of treatment from the health centre. Later on, the family may turn to friends and neighbours for advice on where to take Mr. Etende for the best and cheapest treatment. The friends and neighbours may also help to raise funds through well-wishers to take Mr. Etende to a higher level of care. While it is not a guarantee that he will be assisted because many individuals may assume he wasted his money on substance use, some may just assist because of close association with the family members or because of their spiritual belief on selfless giving without expecting a reward from the person.

With worsening of symptoms, the family may now decide to take him to either a private clinic or a national referral hospital where he is likely to be diagnosed due to availability of more experienced and knowledgeable medical staff (neurologists, psychiatrists, psychologists and psychiatric nurses). Here, Mr. Etende may be admitted for days if not weeks as the specialists treat him for possible alcohol attributed dementia. Assuming he had an active National Hospital Insurance Fund (NHIF), this would pay up to a certain amount depending on the hospital then he pays the balance through OoP. A male family carer (unpaid) is likely to be the one helping Mr. Etende at the hospital with activities like bathing and feeding (12 hours a day) him till Mr. Etende feels better. In Kenya, there is a shortage of health care workers with no nurse aids to help out with these activities and therefore relatives are called upon to help out. Eventually, the bills are likely to be paid out of pocket. In case the family did not take him to hospital, either due to denial, financial constraints or lack of knowledge on dementia, Mr. Etende’s condition could get worse prompting them to take him back to the village where the children would be expected to care for their father. However, if the children still go to school, a paid carer would be the highly likely solution and the family would organize for a male paid carer for him if they can afford or if Mr Etende’s siblings can support. In case Mr. Etende’s siblings in the city default to give financial support due to family conflicts that may arise, the children may find it difficult caring for their father if they are financially unstable. Mr. Etende is likely to experience stigma more in the village than in the city since people in the village lack knowledge on dementia as a condition and may say that Mr. Etende was brought home and is ‘waiting to die’.