Mrs Gloria and her family, current experience | Jamaica

Mrs Gloria and her family, current experience | Jamaica

23 Feb 2022

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Mrs Gloria is a 65-year-old retired teacher living within the rural area of St Thomas, Jamaica and seen as a role model in her community. She is currently the primary caregiver of her 15-year-old granddaughter, whose mother has been working in the United States of America for the last 10 years. In the last two years, Mrs Gloria’s 15-year-old granddaughter realises that she has gotten increasingly forgetful and has neglected duties such as cooking, cleaning, collecting her pension cheque from the post office and remittances from the Western Union sent from her daughter. At 15, Mrs Gloria’s granddaughter has now taken over these duties due to her grandmother’s challenges. The community members, who all know Mrs Gloria, have noticed the change in her behaviour and have seen her wandering at nights. Mrs Gloria also notices her decline in memory, but insists it is just “old age.”

Mrs Gloria, a stalwart in her community and who more than likely has taught many of its members, would likely continue to trivialise and attribute her symptoms to “old age”. She will continue to avoid seeking professional help due to feelings of embarrassment, pride and fear of being thought of differently (stigmatised) by those who admire her. Her feelings of embarrassment and guilt may also arise due to Mrs Gloria’s heavy reliance on her 15-year-old granddaughter.

Despite the minimisation of her symptoms, Mrs Gloria is likely to still have regular check-ups at her General Practitioner (family doctor, GP). These check-ups would be minimally subsidised by the NI Health Gold, which is a national health plan for pensioners under the National Insurance Scheme (NIS) which retired teachers have access to. Her doctor may notice changes in her behaviour and recommend that s/he administer a cognitive test.

It is customary that GPs with a longstanding relationship with their patients, especially in rural settings, will retain the client instead of referring them to a neurologist or psychiatrist. However, there is the possibility that the GP will seek guidance from a colleague in psychiatry or neurology in considering the course of treatment. The GP may also consider Mrs Gloria’s financial situation and instead prescribe non-pharmacological treatment, including dietary changes, the use of herbal treatment, and support Mrs Gloria’s family providing her with herbs such as ginseng, guinea hen weed, coconut oil, peppermint, etc. In addition, even if the GP would like to refer Mrs Gloria, she will not follow up on the referral out of fear of being diagnosed with dementia and what others may think. Regardless, though Mrs Gloria has health insurance, the coverage from public health insurance is significantly lower than private insurance, and as such, she may encounter difficulties financing such services. Due to these factors, professional medical support will be provided by Mrs Gloria’s family doctor.

There are two main possibilities for changes in the family arrangement for Mrs Gloria. Firstly, should Mrs Gloria’s symptoms worsen, her teenage granddaughter will become her primary caregiver, spending a minimum of 4 hours per day providing unpaid care (CaPRI, 2018). Balancing the care for her grandmother and attending school may become overwhelming for the granddaughter and will likely negatively impact her school engagement. Due to a likely decline in Mr G’s granddaughter’s educational performance and the possible shame experienced at school and within the community, she may opt to stop attending school, without consulting with anyone, to focus on Mrs Gloria – spending on average 7 to 8 hours caring for her grandmother. This decision will also be communicated to Mrs Gloria’s daughter, who though not in support, is left with no choice but to continue sending remittances to support her family from a distance. Important to note, though the granddaughter is under 18 years of age, within Jamaica, students under 18 can use their student identification card to collect remittances up to USD 500 or its equivalent.

The second change in living arrangement includes Mrs Gloria’s daughter, who lives in the USA and is unable to return to Jamaica due to her immigration status, arranging for a trusted family member to move into the home to assist in caring for Mrs Gloria to allow her daughter to continue her studies. This trusted family member will more than likely be a female who is unemployed/informally employed and has experience caring for older persons.

Due to the lack of information and understanding of Mrs Gloria’s condition, the family will likely lean on their immediate family and social network for support, especially the church. Specifically, Mrs Gloria’s granddaughter, who is still unaware of the nature of Mrs Gloria’s symptoms, will continue speaking with her mother via telephone and video call but may develop resentment towards her for not being physically present, particularly during these times. The granddaughter may also turn to her closest friends to distract her from her responsibilities. Mrs Gloria’s daughter, residing overseas, will likely be concerned for her daughter’s and mother’s wellbeing. Furthermore, she will likely feel guilty and frustrated that she cannot be there for her family.

Mrs Gloria’s social network, who are likely to be retired as well, will offer support to the granddaughter by way of taking turns monitoring Mrs Gloria when the granddaughter has to leave to collect Mrs Gloria’s pension, remittances, pay the utility bills and do grocery shopping. Other forms of care and social support may be provided by the church through home visits and meditative prayer, led by the pastor and elders of the church. However, the church may counteract the messaging from the GP, as the church members may see dementia as a normal part of ageing, “a curse”, “retribution for past actions”, or something to be overcome through spiritual healing without medical or scientific-based treatment/intervention.

Unfortunately, and despite support from some community members, the family will still experience stigma from other members of the community. Some community members will withdraw from Mrs Gloria out of fear that her condition is contagious. The main support will continue to be provided by the family doctor and the social network of family and friends. As her symptoms progress, care will continue to be provided within the home by her granddaughter and trusted family member.