Mr Gabriel and his family, current experience | Brazil

Mr Gabriel and his family, current experience | Brazil

17 Nov 2021

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Mr Gabriel is in his late 60s, is from a Black ethnic group, and lives with his son’s family at the top of an urban slum (‘favela’) in Rio de Janeiro. Mr Gabriel has diabetes, and is insulin dependent. He also has hypertension, arthritis, and chronic pain. Due to all these health issues, Mr Gabriel has increasingly avoided going down the favela hill as the streets are tortuous and have led Mr Gabriel to fall several times in the past. The high levels of violence also prevents Mr Gabriel from getting out and about as he has lost a son during a shooting. Mr Gabriel stays most days on his own as his son/daughter-in-law are working and his grandchildren are in school. Mr Gabriel feels as if he is a burden to his family, so he tries to avoid ‘complaining’ to them about his health needs. He has been feeling different recently, with mood swings, memory lapses, and dizziness. He is really scared about what could happen to him, which has made him feel really upset and lonely for several weeks already.

Mr. Gabriel would probably continue in this situation for a little while and his symptoms would be faced as normal part of ageing until his son or daughter-in-law noticed something that called their attention, such as serious memory loss (e.g. forgetting the oven on). Mr. Gabriel’s several health issues would likely mask his dementia symptoms and professionals would probably say that his symptoms are due to side effects of the medication in use or to his blood sugar levels.

Healthcare provision is free of charge at the point of use, and family visits are commonly provided by the primary healthcare teams. However due to the difficulty in access, the community healthcare team would tend to visit less often that area and the communication between Mr. Gabriel and his GP would probably be made through his son, who would likely be busy working full time in the city. Mr. Gabriel’s son or his daughter-in-law would also collect his medication monthly free of charge at the primary healthcare unit.

Once Mr. Gabriel’s family or health team noticed his symptoms, Mr. Gabriel would be taken for an appointment with the GP at the health centre, or a community health agent would arrange a visit of the family health team, where Mr. Gabriel would be examined. If the GP suspected of dementia, Mr. Gabriel would then be referred to a specialist as part of the secondary care system. Several months are likely to pass before Mr. G can be assessed by the specialist, who would do the neuropsychological assessment and would ask for further exams. The entire process to diagnosis is likely to take over a year. During this period, Mr. Gabriel is likely to be “supervised” by a neighbour in the absence of his family. Another possibility is that his daughter in law may decide to quit her job to stay with Mr. Gabriel. Nonetheless, this might not be an option due to the financial burden this decision could pose on her family, so it is likely that Mr. Gabriel’s care would depend on neighbours or more distant family members or he would be left to his own care.

When Mr. Gabriel received his diagnosis (if any), they would access any specific medication free of charge through the “high-cost medication system”, which requires several documents and exams in order to have access. In terms of non-medical treatment, it is likely that he would not have access to any, given the believe that his symptoms were consequence from the natural ageing process.

Due to his difficulty in getting out and about outside his house, Mr. Gabriel would likely continue to be isolated in his own community, and his dementia and other co-morbidities would deteriorate quite fast. Another possibility is that the family health team would visit Mr. Gabriel once a month, but the focus of the consultation would be his symptoms, medication, and physical care, with little support or information on the psychosocial aspects of his daily life.

Mr. Gabriel would probably be cared for by his daughter-in-law until his death, through which time he would be on and off the hospital for several infections and other health issues. As Mr. Gabriel became more and more dependent, the health team would decide (without the family involvement in the decision process) to use a feeding tube to feed Mr. Gabriel. He would also be using diaper quite early in the process, which would increase his risks for UTI infection. The diapers would be provided to Mr. Gabriel free of charge by the SUS.

The family finances would become deeply affected by Mr. Gabriel daughter-in-law’s possible unemployment and Mr. Gabriel’s care costs. She would face a lot of the complex health needs of Mr. G with very little support (if any). She would become depressed and would probably not look after her own health during the period she provided care to her father-in-law.