Mr D and his family, current experience | Jamaica

Mr D and his family, current experience | Jamaica

23 Feb 2022

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Mr. D lives by himself in a mid-size town since his wife passed away last year. His children have moved to the bigger city to work and can only visit once a month. Over the last few months Mr. D has found it more difficult to look after the house and himself. His son noticed that his father does not seem himself and is worried about him and what people may think if they see his father.

Having noticed his father’s declining ability to take care of himself and his household, Mr Donovan’s son is likely to take his father to the clinic (around 5 miles away from Mr Donovan’s residence) within Mr Donovan’s community for a GP to assess the nature of his health decline. The GP is likely to monitor Mr Donovan for some time given the early stages of his illness and will remain his primary source of professional medical support. Mr Donovan will likely have several missed appointments as he may forget, and his son may be unable to travel from the city to the rural community where his father resides due to time constraints. It will also be challenging for Mr Donovan to travel the distance on his own, given his current health condition, as this would involve waiting at the “bus stop” or a “taxi-stand” for a privately operated public passenger vehicle (PPV), such as a car or bus as the government-operated transportation system is not provided outside of the capital city, Kingston and surrounding urban areas. Should Mr Donovan’s symptoms worsen due to lack of appropriate interventions, he will likely be referred by his GP to a psychologist or psychiatrist. Though psychologists are located throughout Jamaica, the majority are within the Kingston and St Andrew region, a predominantly urban region with the highest population density. As a result, Mr Donovan will likely need to travel with his son to meet these professionals.

Mr Donovan’s son’s concern for his father’s welfare may encourage him to consider relocating his father to his home to take care of him. However, depending on the living arrangement in the city, Mr Donovan’s son may need to retrofit his home or move to another location to accommodate his father’s care needs. Despite this well-intentioned aspiration, Mr Donovan may be unwilling to move from the community in which he was born and raised. As a result, his son is likely to hire a live-in domestic worker to care for Mr Donovan. The domestic worker will help in activities of daily living, ensuring that Mr Donovan makes his doctor appointments and maintain the home. Additionally, the family will enlist the support of trusted neighbours within the community to keep an eye on Mr Donovan in the community. Mr Donovan’s son would have exchanged numbers with the identified persons.

Mr Donovan’s son will also receive support from his girlfriend, who will make regular trips to visit Mr Donovan. During these visits, Mr Donovan’s son’s girlfriend, will receive updates from the domestic worker, observe Mr Donovan, assist with household chores, ensure that necessities such as food in the house are sufficient, and assess any household needs. However, due to work obligations, these trips may be inconsistent. Additionally, given the gendered norms in Jamaican society, there is a possibility that the primary unpaid care role will heavily fall on Mr Donovan’s girlfriend, with her spending three times (244 minutes) the amount of time on care than Mrs D’s son (90 minutes) (CaPRI, 2018) on each visit, while Mr Donovan’s son provides financially.

Alternatively, Mr Donovan’s son may consider placing his father in a residential home depending on the progression and severity of symptoms. Nursing homes, though costly, will be able to provide 24-hour care to persons who are unable to live independently. In addition to the cost barrier, this option will be met with resistance from Mr Donovan and community members, who may criticize his son by viewing the decision as neglect and a lack of care. As a result, the family may hire either another domestic worker, family friend or a practical nurse who can rotate shifts to facilitate 24-hour care. These care options will be financed out-of-pocket and will likely be unsustainable.

The lack of knowledge surrounding dementia and the associated fear of stigma may reduce the avenues that Mr Donovan’s son has to seek advice and support. When neighbours inquire about Mr Donovan’s health concerns, Mr Donovan’s son and girlfriend will refrain from saying dementia, and instead say “he is just not well, but will be better soon”. As such, his network will be limited to his close family members, including his siblings, girlfriend, friends who he trusts and the GP.