Mr E and his family, current experience | Jamaica

Mr E and his family, current experience | Jamaica

23 Feb 2022

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Mr. E has left his family many years ago to work in a big city. While he visited his family once a year, his children have become increasingly estranged and he has lost contact with them after his wife passed away five years ago. He lives on his own in a small flat. Mr. E finds it difficult to find his way to the shops and back, has difficulty remembering appointments and often forgets about eating.

Though the first point of contact, regardless of location, is typically the General Practitioner (GP), Mr Errol may have direct access to a psychologist or psychiatrist without needing a referral from a general practitioner. However, culturally, men are less likely to seek medical help until their medical condition becomes unbearable. Further, if he is unaware of the possible nature of his challenges, the visits to his GP will likely be general check-ups. Through these check-ups, if the GP notices any changes in Mr Errol’s cognitive skills, he will recommend a cognitive assessment to provide a provisional diagnosis. A referral may be made to a psychologist or psychiatrist who will instruct Mr Errol to do diagnostic tests to rule out alternative explanations of symptoms and identify an accurate diagnosis.

Mr Errol is unlikely to follow up on the referrals to conduct these tests if left up to him. However, Mr Errol is likely to have a romantic partner who visits frequently and may encourage him to follow up on the referred tests; unfortunately, her efforts will be met with much resistance. His GP will be Mr Errol’s primary professional support. The GP, having observed Mr Errol’s cognitive decline, may contact Mr Errol’s listed emergency contact. Mr Errol’s deceased wife is likely to still be listed as his emergency contact. At this point, the GP may request to update this information, in which the contact information of his current romantic partner will be provided. Mr Errol, however, may ask the GP to refrain from contacting anyone out of feelings of embarrassment and will likely deny any changes in cognition.

Being estranged from his children and the loss of his wife, Mr Errol’s support will come from his romantic partner, along with trusted friends, co-workers or his extended family members. His extended family members, having observed Mr Errol’s cognitive decline, may, on their own, attempt to contact his children to encourage them to attend to their father’s needs. Unfortunately, due to limited contact, the children’s numbers and addresses may have changed. To note, though estranged from his children, under the Maintenance Act (2005), his children are obligated to look after Mr Errol. Specifically, Part V, section 10.1, states that “every person who is not a minor has an obligation, to the extent that the person is capable of doing so, to maintain the person’s parents and grandparents who need such maintenance by reason of age, physical or mental infirmity or disability.” Failure to do so can result in criminal charges; however, this law is not enforced. In fact, Jamaica’s public hospitals are faced with challenges of family members neglecting their loved ones, further indicating that the Act is not enforced. Though abandoning Mr Errol into a public facility is an unlikely scenario given Mr Errol’s mild symptoms, it may become a reality as the disease progresses. Additionally, living wills and power of attorney that can buffer this reality does not apply to persons with cognitive deficiencies in Jamaica. As such, if there is no reconciliation or favourable response from Mr Errol’s children, Mr Errol is not left with many options to handle his affairs on his behalf.

His main source of advice and support will be his GP and romantic partner. The lack of awareness surrounding dementia may result in Mr Errol facing stigma by persons whom he interacts with while engaging in everyday activities. Furthermore, the lack of family support may make Mr Errol vulnerable to financial fraud from persons in his network or even his children, given their strained relationship.