Mrs Fatima and her family, current experience | Brazil

Mrs Fatima and her family, current experience | Brazil

17 Nov 2021

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Mrs. Fatima is in her late 70s and lives with her daughter’s family in a riverside community located in a remote area in the midst of the Amazon forest. They all live together in the same small wood made house. Mrs. Fatima is descendant of the Tikuna indigenous tribe, with restricted Portuguese knowledge or fluency. Mrs. Fatima is well respected in her community as she has tried to keep her tribe’s culture ‘alive’ over the years. Mrs. Fatima has become increasingly withdrawn and has stayed alone inside her house most days in the past months. Her daughter is concerned as Mrs. Fatima has been having visual hallucinations, has become aggressive towards her small grandchildren, and has been forgetful. People who have been in her house have spread the news around the community that she is becoming ‘possessed’ with malevolent spirits. Mrs. Fatima’s family has consequently tried to keep Mrs. Fatima inside their house as much as possible, which has made her even more unwell. Her daughter has started to give her traditional herbal infusion hoping to calm Mrs. Fatima down. The city’s family health team visits the community once a month by boat, but Mrs. Fatima’s daughter fears that her mother will not accept help and so she has postponed/avoided talking to the health team about this.

Mrs. Fatima would be entitled to a consultation with the general practitioner (medic) through the public health system which provides universal healthcare that is free at point of access. However, general practitioners often do not have enough knowledge to diagnose dementia. In a remote setting such as the Amazon forest, the health priorities are likely to differ from a large Urban area, and health issues such as malaria, diarrhoea, and undernutrition, are likely to be prioritised over chronic conditions affecting older people. This is also partly due to the much smaller population of older people living in these communities.

Mrs. Fatima’s daughter would have difficulty in discussing her mother’s symptoms with the health care team due to language barrier and lack of understanding about what was exactly happening with her mom, which would probably lead to a deterioration of Mrs. Fatima’s health and wellbeing before any action could be taken by the health team, and this would delay the diagnosis considerably. Other symptoms of dementia, apart from hallucinations and aggressiveness, could not even been noted by Mrs. Fatima’s  family given the lack of information about the condition. If the health team were actioned and suspected dementia, Mrs. Fatima and her daughter would need to travel by boat to a large city (such as Manaus) to go under further examination and tests. Several months would past and several trips to the big city would be necessary for Mrs. Fatima to be diagnosed.

If a diagnosis were made, the medication could be brought to Mrs. Fatima via the healthcare workers on their monthly visits. However, Mrs. Fatima would be unlikely to have access to psychosocial support or formal care mainly due to the remote area she lives in.

Mrs. Fatima’s daughter would slowly become her full-time carer, and probably little training and information would be available for her. Even if Mrs. Fatima’s family could pay for the long-term care, which would probably not be the case, service providers would not be available for her at the community she lives in. Mrs. Fatima would probably become more isolated as the disease progressed, and that would be both encouraged and accepted (as a sign of respect) by her family. Other senior tribe members would try to ‘cure’ Mrs. Fatima with natural medicines and other healing practices, which would make Mrs. Fatima more anxious and angrier.  Though Mrs. Fatima is highly respected in her community, people could be afraid of her behaviour due to the belief that this was caused by malevolent spirits. However, another possibility would be that people in the community would take care of Mrs. Fatima and supervise her when she was walking around the community. This could minimize the chance of Mrs. Fatima getting lost and contribute to keep her independence as she could go to the river to wash her belongings, for example.