Often we hear of the politicians, the privileged being flown to South Africa or India for treatment for review and for all sorts of treatment. Where do our old and vulnerable people go? Are the people flown out more human than those left behind? Does it always work when we are flown to South Africa? Most come back in a casket at colossal sums of Tax Payers money.
What greed! For how long are we going to continue with this barbaric uncaring behaviour? We need services close to ourselves and not taking chances with life.To illustrate this I have thought of looking at the plight of the elderly as they are the most vulnerable.
Old age is scary; brings along a lot of physiological and psychological changes to ones life. When I was young people told me things that would happen to me at puberty,I heard about mid-life crisis but had to get to mid-life to know what it is.
We do not have to get old to understand what old age is because most of us may never grow old but may be tasked to look after the elderly. You could be classified as elderly from 65 on wards though for some could be much early.
What happens in old age?
I will be as elementary as possible and I will avoid medical jargon and terminologies. From the head as one grows older the hair greys, suffice to say that even young people may have grey hair as a result of Genetic predisposition, but this is common amongst elderly people.
It is not un common to experience loss of Hair in old age,the hair cells reduce in number. Not un common in the elderly to have problems like dandruff and rashes. For this the elderly need special anti fungal creams and shampoos to treat and maintain the Hair lustre.
The Brain shrinks in old age and as the brain shrinks thought processing wanes. We lose brain cells as we grow older the brain density becomes lower. We are not as quicker and sharper as we used to be when we grow older. Our memory wanes. We begin to have memory lapses, forgetfulness.
Ever wonder in the village an elderly person forgets the route to his village and found him or herself in another village,people anonymously agreed that the Old person was a witch, why was he or she found in the wrong place wondering.
This commonly happens at night when the elderly go out of the house to relieve themselves they wonder off their hamlet into the other people’s homes and villages and are suspected of being witches; she was flying and dropped off in another village.
A lot of elderly people have lost their lives by lynching mobs because of this mystery of old age when just a little sensitisation for the community is all that is needed. If near a road side, they have ended up being struck by a Car and killed. We have read these stories in the papers and nobody has disputed them.Thus the power of ignorance.
Suffice to say that the western world are more inclined to a young leader due to some of these reasons highlighted. Thought processing. Do not deny the argument of experienced and tested leadership.
Mental Disease and Alzheimer’s may set in due to old age and this may cause confusional states. From shouting, memory loss, aggressive behaviour, self harm wondering, hallucinating, paranoid behaviour etc. This is largely a topic on its own and needing an article on its own.
The elderly may Lose sight as they grow older.Cataracts formation that need to be operated upon.Refraction and needing lenses to see. Other degenerative conditions of the elderly may be present needing very specialised care. This always takes me to my days at Kitwe eye clinic with Dr Jonathan Munkombwe the ophthalmologist. We did a number of cataracts extractions.Its a great service for the elderly. A bulk of opticians and ophthalmologists work with the elderly to keep them seeing.
Impaired hearing is common among the elderly.The elderly oftenly have got to be tested for hearing and hearing aids are prescribed for them. Loss of hearing can be the most frustrating thing in old age.
We all want to hear clearly and perceive things. Specialised Audiology department and Hearing aid department is so essential for the elderly.I have had my elderly parents who have had problems with hearing and needed audiological examination had to travel to access it. Lusaka or Kitwe,these facilities need to be accessible wherever they are old people.Most end up frustrated and chose to live with it.
What happens to your mouth when you grow older? You may lose all your natural teeth. A Dentist is not only for feeling cavities.They provide a huge service for the elderly in fashioning dentures for them. Dentures will definitely help the elderly person to bite and chew food.These facilities have got to be accessible to the elderly people. If they cannot chew food they will have a phobia for food:choking etc.they lose weight they get malnourished.
This takes us to the next problem in the elderly -swallowing.As we grow older swallowing may pose a problem.The muscles of the throat that propel food downwards may slacken. Specialised assessments may need to be undertaken for swallowing to prevent choking and to encourage eating. This is a very important unit of care for the elderly. Some end up on blended diets,puréed diets or soft diets depending on risk assessments.We need these services were ever our old people are in Zambia.
Dieticians play a very important role in the care of the elderly as they also prescribe diets for the elderly. The elderly are prone to lose weight for various reasons and some already explained. Their senses are oftenly in reversal, may lose sense of smell,taste etc. It is an important role that the dietician plays to prevent malnutrition in the elderly.
They may recommend food supplements,artificial feeding etc remember in the elderly they suffer shrinking of organs as well and one of them is the stomach may not hold the same volume of food.It is not un common to get stomach cancer in the elderly.Gastric irritability is common anti acid medication need to be availed to the elderly.
The skin being one of the largest part of the body in old age suffers lack of elasticity and shrinks.Wrinkles as well.In some various dermatological conditions become a problem needing prescribed maintenance medications and creams.Specialist Dermatologists need to be available.Because the skin is so fragile and weak it breaks easily and if laid in bed for a long time or sat in chairs forms sores due to pressure.
Specialised mattresses, beds,wheelchairs.cushions and forms are prescribed for this.Equipment therefore forms another bulk of the care for the elderly,whether in a Hospital or at home.
They may have difficulties to walk due to age or stroke,may need physiotherapist to attend to them use aids like Zimmer frames,wheelchairs.They may need hoists and other mobility Equipments to mobilise them.This is the reality about ageing.
Skeletal problems arthritis, aches and pains become the norm in old age needing constant medication pain killers etc.
In old age your bowel motion may not be as regular as a young person this could be due to immobility,being in a wheelchair or in a chair for sustained periods.It is so common that the elderly need laxatives and apperients to help them to open bowels.They need to take them regularly or they become constipated and fear to eat lose weight subsequently.Constipation can cause other surgical complications.
Healthcare
I was having a chat with one of my Zambian GP friends in the United Kingdom about Physiological changes that happen to the aged and how they are managed in the developed world and we were looking at the delivery gap in the third world in general. May be it is truly time to set up partnerships and meet these Gaps, government good will is required.
In saying this I echo the words of wisdom from those requesting the Diaspora to help create jobs back home. May be such partnerships are key. Deliberate policy is required. I am saying this to pre empty your condemnation of me being an arm chair critic from the confines of Europe, I love Zambia, my blood flows Zambian and will ever be, that is why I plead the best for every Zambian.
A huge amount of money in the developed world is channeled towards alleviating this problem. Medicine and professional care to ensure safety and standards of care are met. It has created the bulk of jobs in the west as it is essential, would do the same in Zambia if explored. Aspects of medicine and care for the Elderly and Mentally ill are specialised.
Two weeks I lost a wonderful Grand Mother on my wife’s side, she was 84 in Kwacha Kitwe.She had piercing pain in the chest complained about it for a short while and suddenly died.This to me is a typical case of Heart Attack that lead to death.How many of these deaths do we experience in Zambia?what do we attribute them to? A Kalumba? Witchcraft?
You can replicate these stories of our senior citizens dying of cardiac arrests in our arms and homes.A robust Ambulance and paramedic system is critical to attend to these emergencies in our homes-a 999 or 911 facility.Suffice to say that this does not affect the elderly alone but even our young people;our policy makers as well,former and current Presidents;what has been done about it? Are we awaiting another incident?
With a specialised unit for management of strokes most of the stroke patients do recover very well.We need these services in our country.A robust ambulance service again goes with a good road network.In the west United Kingdom it’s often within 5 minutes response time.These are achievable services,we did achieve this during ZCCM time,we had a robust Ambulance system.
Strokes and cardiac arrests due to burst blood vessels,weak blood valves and clots which are common in the elderly due to ageing.It is therefore not un usual for the elderly to be on Aspirin permanently and warfarin type of drugs to prevent blood clots.Lots of them do take medication for Hypertension.Anti cholesterol medication -Statins-are routine in the elderly.Blood tests need to be done for INRs with these medication consistently(In medical terms INR stands for International Normalized Ratio. It measures how long it takes for the blood to clot) .A good laboratory investment in all districts cannot be overstated.Its a must and need to be equiped.
Rehabilitation is therefore a necessity. Rehabillitation units assist the elderly to recover most of the lost functions due to strokes.They need to be equipped and must be in every District.
In Zambia we do not like to take medicine.In the West it is a way of life and in my view that is the difference between a short and sustained life.Our compliance to medication is poor hence rendering our lives short.We do not like to see a Doctor and often we see one when it is critical.Our preventative medicine needs enhancement.It is common to see someone by the age of 70 taking not less than 20 tablets a day,my Dad who is 78 takes only one tablet,is he so health that he does not need the extra tablets.
The Elderly suffer from urinary tract problems as well.The Kidneys and bladder shrink and it is not un usual that they develop an enlarged prostate or at worse cancer of the Prostate.These need to be screened and checked not only at UTH but everywhere where the elderly are.They may be prescribed permanent medication in the form of hormones to help control the size of the prostate gland or be operated upon.The enlarged prostate impedes on urine flow,not un common as well to find elderly with in dwelling catheters or supra pubic catheter which need trained staff to insert and care for.When I work out here in the West I wonder every day whether they are no elderly people that need these services in Zambia.
The immune system of the elderly weakens and are susceptible to various infections needing quick treatment and referral.
I care for a lot of elderly people on thyroxine hormone replacement tablets,tests are frequently done for thyroid functioning test.As much as we have an enlarged thyroid problem in Zambia known as the Goitre, I still think we also have a problem of hypothyroidism.
Care at home is what we must focus on as we are able to look after our own in our homes since we are not highly industrialised.We need specialised institutions for RESPITE care where those caring for the elderly and the vulnerable can take them so that they can also have a break for a short while.
I can go on and on.But the major point is as we are fit and well we should think about the time when we shall be un fit,old and vulnerable.Its not the money we have put in the Bank or invested when we are well that will look after us but the systems we have put in place.Alot of people have a misconception that our investments will look after us when we grow infirm,not always.We need to develop workable systems to do that.If you have a cardiac arrest you need an ambulance with trained staff and equipped.You need to be transferred to a unit to be managed etc flights to Johannesburg for treatment must not be a solution those are quick fix solutions to a problem for the rich and the privileged in the corridors of power.What about the masses.What about those in Shangombo,Chadiza,Chama and Mununga?
A workable effective social services is another thing our elderly people need.If we spend money on the elderly to feed them and allow them a decent life we will be living up to the tag of a true Christian nation.The Government needs to pour money in meeting the health needs and care of the elderly.Facilitating care of the elderly needs to extend to their homes and villages.Some one maybe saying where does the money come from?From the money we waste in corruption activities and other forms of greed.If we as a nation genuinely lobby for funds for care of the elderly it will be granted because the West is grappling with this problem right now.It’s a genuine cause to lobby money for.
ZCCM did well to send its people for training and attachments to the developed world.Government can attach people to institutions to the developed world to train and learn what needs to be done.I still think ZCCM approach was the best if it was emulated for the rest of the country today Zambia would have been miles a head.Most of the Diaspora Highly Skilled Zambian Nurses and Doctors and other specialised Professionals are willing to provide expertise and knowledge even for free to ensure the critical aspects of our economy are attended to.Identification of these people is easy and group them into adhoc advisory committees.Some are willing to come back home for half or a quarter of what they earn wherever they are as long as seriousness is implored,systems are put in place,equipment is purchased,staff are trained etc
We need to make it better for all.Elderly care is not only about washing and cleaning them up.It is about all these highly specialised aspects and coordinating the services.You require skill,knowledge and tact to discharge these services.I can go on and on.There is much more that affects the elderly and there care.I merely stating a case for care cause one day I will be an old man needing all these.
KALEBALIKA !
By J.Sakala
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