Lack of Frail Care Policy Strands the Elderly

MOST of Namibia’s frail elderly are struggling in the absence of a State frail care policy. Those with money can afford spending their last days in a private facility or acquire a nurse to manage their lives in the comfort of their homes.

Namibia has laws that take care of the elderly but being old, frail and unable to depend on hospital services because of a lack of policy is quite another.

Frailty is not just physical it can have mental dimensions too that interfere with daily life abilities.

Joe Johnson (74) broke a hip at his home in Walvis Bay on 20 February. He died 30 days later although his wife Erica said he was ‘successfully’ operated on, discharged and declared ‘okay’ by the doctors.

“What hope do folks have if the ones they turn to for help turn their backs on them because they are ‘old’? asked Erica.

When Joe was injured until his death, Erica watched his health spiralling downward because of a stressed health system. First, the only working ambulance at Walvis Bay was in Windhoek. The other “old one” was broken. Red tape caused major delays in having it repaired.

A private service, St Gabriel Community Ambulance Trust, was summoned instead and rushed Joe to the Swakopmund State Hospital for X-rays because the X-ray facility was out of order at Walvis Bay.

From there Joe needed to get to Windhoek for surgery and was brought to Katutura in Windhoek by a Swakopmund state ambulance.

“I called daily. There was either no answer or I would just be put on hold or transferred. No one would tell me how Joe was. They were extremely rude and even told me I called too often. Eventually, I learned from a Dr Hamupembe that the operation went well but that Joe is old and was a little confused. He however gave the impression that Joe would be okay,” said Erica.

Joe was discharged a few days later and brought to Walvis Bay. It was understood that he would go home from there. This impression was short-lived when Erica saw Joe again for the first time since his fall.

According to her Joe was literally half the man he was.

“He was lying naked on a bed for all to see. He was in pain, bruised and dehydrated. He said they had stripped him of his dignity. I cried and all I heard from the staff was ‘he is old’,” said Erica.

The nurses said he must get nappies, which Erica had to buy. Getting information was frustrating. There was no Namibian doctor, and apparently they knew nothing of Joe’s condition.

Joe was sent back to Katutura. This time Walvis Bay provided an ambulance. Erica claimed she received irritable treatment when calling to hear about Joe.

An acquaintance of Erica at Windhoek was asked to look into Joe’s situation and what they heard was troubling.

“He said we need to get Joe out of there quickly. No one was helping,” according to Erica.

Another acquaintance allegedly acted as a doctor to get the mobile number of Dr Hamupembe, who told him that Joe was suffering from dementia. The ‘doctor’ requested for Joe’s discharge for a second opinion.

A state ambulance driver meant to pick Joe up from Katutura forgot him when he had to pick up another patient. More money had to be collected from friends and sympethisers to get St Gabriel Community Ambulance Trust to fetch Joe. This time Gladys, the Johnson’s domestic helper went along to be a familiar face to Joe. Erica’s health could not handle the stress.

“Joe was lying in a room that stank of urine. He looked neglected. He was injured,” said Gladys, adding that nurses could not explain the injury on Joe’s arm.

Gladys packed his belongings and claimed that no records for his hip operation was given. She asked a nurse to help clean and change Joe whereupon the nurse allegedly scowled at her for interrupting her lunch. She did not help. St Gabriel’s ambulance staff helped instead.

At Walvis Bay, Joe was brought to Welwitchia private hospital for a few days with about N$20 000 donations. Here, doctors supposed Joe should have had physiotherapy after the surgery. He developed bedsores. There were concerns that he would get pneumonia.

After three days, Joe showed improvement but the funds ran out and the options were limited: either he went to a frail care facility, which the Johnsons could not afford, or went home. Doctors said no more could be done.

Joe spent a few days at home but his condition crumbled. Getting frail care equipment at home required the employment of a registered nurse.

There just was no money for that. Erica said her church helped get Joe into the private Huis Palms frail care unit where he died three days later on 22 March.

“The system failed us,” Erica said. “When Joe was stripped of his pride he gave up. He was a fighter all his life not a quitter. The system must change. Patients, regardless of age, can’t be treated like cattle.”

Gabriella Teleman, founder of St Gabriel Community Ambulance Trust said it is a tough job that asks people to give more than they get in return.

“A lot of people hate what they do and they bring their bad mood to the patients. They go to hospital and have a ‘we don’t care attitude’ because they know they will get their salary. There is no passion and heart,” Teleman said.

Teleman has been in the emergency care service for 40 years.

“Namibia needs to recycle staff. Ask those wanting to reapply why they want to do this whether it’s just another job or because they love caring for people. With this there must be a performance contract. This will reform the sector,” she said. “The only difference between state and private facilities must be comfort. Service and workers must be the same.”

For those who see health work as just a job, irritability towards patients, especially old people, comes naturally. Those who consider it a calling will be able to cope with the demands of scared patients because that is what they were called to do regardless of the pay and circumstances.

On the other hand, patients coming from conservative dispensations and traditions, and who have survived independently all their lives, can also make life difficult for their carers.

Dr Ludwig Walters, an orthopaedic surgeon in Windhoek who’s been in the industry for about 35 years understands the frustrations the elderly may have.

He said for the white elderly who come from an apartheid dispensation it was “very intimidating” being suddenly left at the mercy and in the hands of younger black nurses a situation that would rub both parties up the wrong way – unintentionally which is amplified by a stressed health system.

“It’s not just the white elderly. Many of the old black people from rural areas come here for help and they cannot speak a word of English and Afrikaans while everyone at the hospital will only speak English. This communication gap is also very frustrating for the patients and they feel helpless and scared because they cannot communicate their problems,” said Walters.

“Can things be done better? Sure. It’s all a work in progress but we are trying the best we can with what we have.”

Justifiable excuses?

Erica Johnson is convinced that had Joe received proper care at the right time he could have spent his last days in a more comfortable and dignified manner with more hope of recovery.

Unfortunately this dream was not realised within the state system, nor does the state offer anything more for the elderly than general health care – but not outside the hospital.

A private doctor who wished not to be named, from Walvis Bay, who saw Joe shortly before he died, said the state health practitioners are doing all they can.

“The state is not obliged to give frail care. They treat patients but once they have done that they can’t do more because Namibia does not have a frail care policy,” he said.

Treating the sick and discharging them as the state should do is one thing, as was the case with Joe, although questionable in quality. Frail care of the patient 247 is another, and this is what Joe needed but could not afford. A state frail care facility could have made a big difference.

This doctor said that it was a ‘catch 22 situation’ for those who needed frail care but cannot afford it. Dr Hamupembe said: “I am a junior doctor. I don’t operate and I am no longer in the orthopedic section.”

He referred questions to his former senior Dr Walters, who although helpful, was unable to recall Joe.

Walters said juniors like Hamupembe are more involved with discharges and referrals, but not surgeries. He also said it is hard for old people to recover from hip operations and that such injuries could trigger dementia.

Questions about Namibia’s frail care plans to the chief social worker at the ministry of health and social services, Lena Coetzee, were redirected to the ministry’s public relation officer, Ester Paulus, who said: “We do not have to answer all of your questions.”

Paulus said the ministry has started drafting a Bill on Rights, Protection and Care for older persons to establish, register and manage old age homes.

The bill will also ensure that every home or other place of residence for older persons should establish a frail care unit, while geriatric units will form part of a health facility or hospital.

“MoHSS will give priority attention to this bill during the 20162017 financial year,” she said. “The support and care of older persons are of high importance in Namibia. It is however not the sole responsibility of government, but that of families, communities and the private sector as well.”

Source : The Namibian