The young lady delicately adjusted her multicoloured tob and dabbed at her multicoloured face, looked down at her notes, and cleared her throat.
‘These days, doctora,’ she chirped at her middle-aged scholarly guest, ‘we bear witness to a certain phenomenon, a phenomenon which is alien to our society.’
‘Yes,’ the doctor gravely agreed.
‘This phenomenon,’ the young hostess said with a growing look of disdain on her face, ‘is the appearance of… homes for the elderly.’ This last part she spat out with a look of pure, multicoloured disgust.
The guest was a geriatric physician; a doctor who is specialized in the health of the elderly. In developed countries where advanced medicine and socioeconomic circumstances have extended the life expectancy, the elderly form a significant percentage of the population. In the US 13% of the population was aged 65 years and older in 20101, while in the UK the 10 million people currently older 65 years of age are expected to double in number in the next 20 years2.
In Sudan, despite medicine and socioeconomic circumstances actually getting worse, the life expectancy has nonetheless increased. However, unlike their more developed peers, the elderly in Sudan are plagued with a plethora of diseases and conditions, not the least of which is poverty. The lack of health education and affordable healthcare complicates these conditions, making growing old in Sudan a heavy, heavy burden.
Having an elderly and almost completely dependent relative around the house is a taxing issue. They need help with everything: feeding, bathing, soothing, pain management, grooming, entertainment and general safety. They need medication and diapers and special bedding, even flooring and a guard at the door to prevent them from wandering out and getting lost. They need a proper diet and a friendly face and loving hand that will wipe away their irritation and fear and sadness. All these things cost money, time and patience; and in Sudan not everyone has the means to provide these.
I once asked people what they thought of services for the elderly. All the answers were along the same lines of disgust as the young woman hosting the family show: these were abominations, things that were un-Sudanese and must be fought. It is the family’s duty to take care of their elderly whatever the cost, and to even try and share this responsibility with someone else is to have failed this duty; it is selfish, cruel and unforgiveable, and anyone who does it is to be judged and condemned. Only one person had the idea that, actually, specialized services for the elderly are not such a bad idea after all. This person had stayed at home and taken good care of her own elderly mother for several years, was educated and well off, and had travelled the world and seen how other people live. And more importantly, she was reaching old age with several illnesses of her own, and had some idea of what she was about to face. She, like myself, had reached the conclusion that specialized services for the elderly are not only necessary, but are in fact a right to be given when trusted and affordable.
The problem with Sudanese people’s refusal of these services is that the majority of them don’t realize that they are doing more harm than good to their relatives. Most people cannot afford proper necessities such as hospital beds and air-mattresses that distribute the person’s weight to prevent bed sores. Patients are fed lying down or inadequately propped up and they choke and inhale their food, causing them aspiration pneumonia, which can easily kill them. Lying down for long periods without movement causes bedsores which, especially in the presence of diabetes and general ill-health, do not heal and become infected. Bathing a dependent person is a difficult task, especially if the person is heavy or uncooperative. This part of general care is frequently neglected and some people even believe that it does the person more harm than good. When old age is accompanied by dementia, this doubles the problem. Demented people want to get out of bed and out of the house, they are violent and verbally abusive, refuse to eat and be bathed or have their catheters inserted/changed. They don’t sleep and don’t let anyone else sleep either. They embarrass people in front of guests. They spit out their medicine and knock things over. They do not recognize family and believe everyone is their enemy. It’s exhausting and heartbreaking, and a lot of people simply can’t keep up with it.
But it’s no one’s fault, and everyone here is a victim. No one wants to grow old and dependent on other people for their very life, and young people have their own families and jobs and careers to take care of. Asking for help does not mean neglecting one’s duties towards their elderly relatives; it just means that they don’t have the means to solely provide the proper care this elderly relative deserves. Some people have to make a choice between working to be able to provide and to stay at home to take care of their parents. Some people simply have no idea how to take proper care of a sick and bedridden person; how to recognize signs of illness, the right way to clip their nails without hurting them, how to provide physiotherapy to prevent their joints from freezing up from disuse. A lot of these things can be taught, but still need regular supervision.
Specialized care can be anything from dedicated homes for the elderly (which the Sudanese society finds the most despicable), daycare units that provide care for several hours a day, and the home nurse. All of these are severely lacking in Sudan, and what little services available are of terrible quality. In order to improve these services we first need to improve the society’s attitude towards the needs and rights of the elderly. The society cannot continue to judge people who seek help as ‘bad sons and daughters’. Just as it is accepted to take a 6 month old child to daycare, the same acceptance towards specialized care for the elderly is needed, and will come eventually. The large home in which extended families live together is fast dissolving; we are turning into a society where the household is restricted to parents and their children, and occasionally a grandparent or 2. Just like there is usually no longer a relative to take care of the child, there is no one to take of the grandparent or parent. We’re getting there anyway, so we might as well get used to it and make the best of it.
Elderly parents deserve just as much care as they gave their own children and grandchildren. They also had a life full of accomplishments and memories and aspirations, and they made sacrifices for their children and went to different lengths to provide them with a good life. No one wants to end up bedridden and a burden on anyone else; but it is the way of life:
)يَا أَيُّهَا النَّاسُ إِن كُنتُمْ فِي رَيْبٍ مِّنَ الْبَعْثِ فَإِنَّا خَلَقْنَاكُم مِّن تُرَابٍ ثُمَّ مِن نُّطْفَةٍ ثُمَّ مِنْ عَلَقَةٍ ثُمَّ مِن مُّضْغَةٍ مُّخَلَّقَةٍ وَغَيْرِ مُخَلَّقَةٍ لِّنُبَيِّنَ لَكُمْ ۚ وَنُقِرُّ فِي الْأَرْحَامِ مَا نَشَاءُ إِلَىٰ أَجَلٍ مُّسَمًّى ثُمَّ نُخْرِجُكُمْ طِفْلًا ثُمَّ لِتَبْلُغُوا أَشُدَّكُمْ ۖ وَمِنكُم مَّن يُتَوَفَّىٰ وَمِنكُم مَّن يُرَدُّ إِلَىٰ أَرْذَلِ الْعُمُرِ لِكَيْلَا يَعْلَمَ مِن بَعْدِ عِلْمٍ شَيْئًا ۚ وَتَرَى الْأَرْضَ هَامِدَةً فَإِذَا أَنزَلْنَا عَلَيْهَا الْمَاءَ اهْتَزَّتْ وَرَبَتْ وَأَنبَتَتْ مِن كُلِّ زَوْجٍ بَهِيجٍ( الحج: 5
(O mankind! if ye have a doubt about the Resurrection, (consider) that We created you out of dust, then out of sperm, then out of a leech-like clot, then out of a morsel of flesh, partly formed and partly unformed, in order that We may manifest (our power) to you; and We cause whom We will to rest in the wombs for an appointed term, then do We bring you out as babes, then (foster you) that ye may reach your age of full strength; and some of you are called to die, and some are sent back to the feeblest old age, so that they know nothing after having known (much), and (further), thou seest the earth barren and lifeless, but when We pour down rain on it, it is stirred (to life), it swells, and it puts forth every kind of beautiful growth (in pairs).)22:5
This care is the responsibility of these same children; but we must acknowledge and accept that there are limits to what each individual can provide. Instead of blaming and criminalizing, we must attempt to find proper solutions that are acceptable to everyone. It is part of our teaching as humans and Muslims first and Sudanese second to take care of our own; but we should be – and are – allowed to ask for help. This generation and the generations to come need to make sure our parents can grow old in Sudan with dignity.
1Older Americans 2012, AgingStats.gov
2The aging population, parliament.uk