Mrs Silva and her family, current experience | Brazil

Mrs Silva and her family, current experience | Brazil

17 Nov 2021

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Mrs. Silva is in her late 70s, is from a Mixed-Race ethnic group (“pardo”), and lives in a remote rural area in Aquidauana city, state of Mato Grosso do Sul. Mrs. Silva is the maid of the large cattle farm owner and has lived with her family in a small cottage in that farm all her life. Mrs. Silva has always been really active and never felt the need to have health checks. Recently, Mrs. Silva has suffered a stroke, which has affected all her day-to-day activities and has led Mrs. Silva to develop memory impairment. Mrs. Silva’s increasing health needs has forced her daughter to quit her job and move in with her mother to provide full time care. Mrs. Silva depends on the public health service for all her health needs, and this is located within 20km distance by car. Her daughter has been extremely stressed and tired as she feels totally unsupported. She feels impatient with her mother and has used of physical restrains to contain her mom’s movements so that she can do the housework.

Mrs. Silva would probably already be linked to the secondary care system (in the urban area) due to her previous stroke. Her daughter would bring the memory symptoms up during one of her appointments and the neurologist would probably be trained to suspect dementia. Mrs. Silva and her daughter would have to do several trips to the main city for the clinical investigation, for which the farm owners would take her, or the municipality would send an adapted car through the social care system whenever she had an appointment, or Mrs. Silva or the farm owners would pay for a taxi privately.

The diagnosis is likely to take several months due to the need to wait for CT scans and other tests. Mrs. Silva would probably be prescribed anti-psychotic medication or another sedative medicine so she could be ‘easier to handle’. Mrs. Silva’s daughter might have access to carer’ groups at the outpatient clinic, but that is not a mainstream service, so one of her main unmet needs would be information about dementia and care. Besides, even if she had access to a carer’s group, living in a remote rural area could prevent her of participating in such activities.

Depending on the distance from the house, the primary healthcare team would visit Mrs. Silva every so often to check on her situation. These visits would probably be focused on the physical and clinical needs of Mrs. Silva, rather than supporting Mrs. Silva’s daughter with the care.

Mrs. Silva and her daughter could receive financial support from the farm owner or not. Mrs. Silva daughter would be entitled to disability allowance. They would be entitled to receiving diapers, wound dressing materials, medicines, and skin care. Due to the long distance to the city, it is possible that no private care provider would accept to provide care services at the farm, and all the care responsibilities would indeed fall on Mrs. Silva daughter’s shoulder. Mrs. Silva’s other male children would not help with the care.

Mrs. Silva would be hospitalised several times throughout the years due to complications of dysphagia and diaper use (e.g. pneumonia; UTI). As Mrs. Silva 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 Mrs. Silva. This would further increase the complexity of Mrs. Silva’s care needs, as well as her daughter’s anxiety levels and poor sleep quality. Mrs. Silva would become less mobile and would likely develop ulcer pressures due to lack of training and equipment to prevent them.