Mrs A and her family, current experience | Kenya

Mrs A and her family, current experience | Kenya

16 Feb 2022

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Mrs. A is in her 70s and lives with her husband in a small village in a rural area. Mrs A’s daughter and her family live nearby. Over the last year her family has become increasingly worried about Mrs. A, as she keeps losing things and puts items into odd places. A friend has told the daughter that Mrs. A had been wondering in the village and seemed a bit lost. The daughter is worried about what people may think or say about and how they may react to her mother. Mrs. A used to have a very neat house and looked after her appearance. She also helped her daughter with the children. Over the last few months Mrs. A seems to be no longer interested in these things. Mother and daughter used to have a good relationship, but recently there have been a number or arguments. The daughter is thinking of taking Mrs. A to the community health centre, but she knows that her mother does not like to go there.

Mrs Ambetsa lives in a small rural village with her husband while her daughter and the family live nearby. She started losing things and putting things in odd places causing much worry to the family about her state of mind. But after her daughter found her roaming in the village seeming lost, she began thinking about taking her mother to the community health centre though the mother does not like to go there. It may take a while before she actually takes her mother to the community health centre (public) because the family will need some finances. At the health center, consultation is free, one just needs 10 Kshs (approximately 0.1 $) to buy a file for recording purposes. However, she may be required to buy the prescribed medications if unavailable at the hospital (this is the often case) which is an added expense. Transport expenses are likely to be high due to poor infrastructure in the rural villages of Kenya while at the health centre, services are likely to be paid out of pocket e.g. card expenses to document personal details and next appointment date and drugs which may be unavailable at the centre. This is likely to take even longer if the daughter is the sole provider for her own family and her parents as well because she will take longer to secure the health care finances. It’s also possible that the family may never take Mrs Ambetsa to the health center because of inadequate finances for out of pocket expenses. While the daughter may be the primary carer at home for her mother, the husband to Mrs Ambetsa could be the one accompanying her to the health centre in case the daughter is involved in other activities elsewhere. However, this happens on rare occasions as the primary carer prioritizes the mother’s health as a child’s obligation, spiritual fulfilment and to avoid neglect or shame from the community. In rural Kenya, some roles are exclusively assumed to be of the female gender (the setting is more patriarchal than urban settings) such as care giving role regardless of their gender and health status. At the health centre, Mrs Ambetsa is likely to get a clinician (a nurse or a clinical officer) who is highly likely not to provide a diagnosis and might send Mrs Ambetsa home with a reason that it’s just a ‘normal’ part of aging. On the contrary, due to fear of stigma, the daughter may also decide not to take her mother to the health center because of how people will react to her mother’s condition. Therefore, limiting access to health care services.

Considering that the relationship between the mother and daughter is not at its best (due to constant arguments), Mrs Ambetsa will likely not get the best of care from the daughter, therefore posing a threat to Mrs Ambetsa’s quality of life and her health outcome eventually in terms of the care she receives. It is also possible the arguments between them come up because Mrs Ambetsa feels stigmatized because she feels treated like a baby because the daughter may assume the mother is ‘turning into a baby’. Although there may be need for another carer, Mrs Ambetsa’s family is not likely a get a paid carer since getting one is quite expensive especially in the village and might strain the family’s income greatly. Even if they were to get a carer, it would just be a casual domestic worker from around the village without proper knowledge on dementia care and support. Getting a carer (outside family) would also be unlikely due to fear of being judged because it’s considered the family’s duty to care for a loved one living with dementia. Moreover, Mrs Ambetsa’s seemingly aggressive behaviour is likely to make it harder for a paid carer to agree to care for her. Since the daughter has another family to tend to, she’s likely to care for her mother during the better part (eight-ten hours a day) of the day leaving Mrs Ambetsa alone in the evenings when the daughter goes back to her home. If the grandchildren are not schooling (below five years), they would be left playing and the mother would request the oldest child to come to the grandparent’s house if they have a problem. The daughter is expected to have prepared food for the children before going to take care of her mother.  The daughter is likely to care for her mother on a daily basis, at the same time taking care of her household so that the husband does not feel abandoned or the carer does not face stigma from the community for not performing her duty as a wife (giving care to the husband). However, this might be a source of conflict because the husband is likely to feel as though the wife is going back to her home and abandoning him. Although getting a paid carer is a possible solution, the family may not afford it.

In the event that the family is not able to take Mrs Ambetsa to hospital due to high costs, they would consult friends and neighbours on how best to help Mrs Ambetsa. The friends might advice Mrs Ambetsa’s family to consider traditional healers who are likely to be very accessible and available in the rural setting. The services of faith healers might also be sought because in the rural setting, most people (including Mrs Ambetsa’s family) are likely to believe that persons living with dementia are cursed or bewitched. As much as there are friends, neighbours who may be giving advice and emotional support, there are those who may not want to associate with Mrs Ambetsa or her family (husband or daughter). In future, even when Mrs Ambetsa’s condition gets worse, the family is still less likely to seek medical attention because they would believe it’s just aging maybe because they lack knowledge on dementia or they might still be scared of being stigmatized or deny that Mrs Ambetsa has dementia.