17 Nov 2021


Mrs. F 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. F’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. F’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. F’s  family given the lack of information about the condition. If the health team were actioned and suspected dementia, Mrs. F 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. F to be diagnosed.

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

Mrs. F’s daughter would slowly become her full-time carer, and probably little training and information would be available for her. Even if Mrs. F’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. F 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. F with natural medicines and other healing practices, which would make Mrs. F more anxious and angrier.  Though Mrs. F 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. F and supervise her when she was walking around the community. This could minimize the chance of Mrs. F getting lost and contribute to keep her independence as she could go to the river to wash her belongings, for example.