Mmaphone Gaadinagme, 88, is slowly losing her memories. She was born in Thamaga, a village in Botswana about 40 kilometres from Gaborone, the country’s capital. There she grew up, got married and had five children. “Sometimes I don’t remember how many of them have died… Now I know that there are three. The other two are not here, they moved to another city. I live alone in my house,” she says. The woman speaks while sitting on a plastic chair in the social centre in Thamaga, where she has gone to collect her pension. “I arrived late because I forgot my bag. Halfway there I realised that I needed it to keep the money and I went back to get it. I am afraid that by forgetting these things, people might accuse me of witchcraft. I know that this is something that has happened to other people here,” she says.
Gaadinagme’s fears are not unfounded. “In many villages, relatives abandon their relatives when they show the first signs of dementia. Communities accuse them of witchcraft and many people do not want to be associated with these things,” explains Kago Paledi, director of the Pelonomi Foundation, She is dedicated to raising awareness and educating about these stigmatised diseases. “Imagine someone getting up at night, without clothes, leaving the house and starting to walk around talking to themselves. Imagine what someone who sees this must think, but who has never heard of dementia or Alzheimer’s in their life. They don’t know anything about the causes, consequences or symptoms. All of this creates really sad situations,” she describes.
Family members often abandon their relatives when they show the first signs of dementia. Communities accuse them of witchcraft and many people do not want to be associated with these things.
Kago Paledi, Pelonomi Foundation
Paledi talks about theft, marginalisation and sick people forced to live locked up by their own families. “Because they don’t understand what is happening, the carers – the vast majority of whom are close relatives – don’t let people who show signs of dementia go anywhere. They lock them up as if they were cursed,” she explains. At her foundation, she and her team teach people to understand above all. They go to villages to explain that neither dementia nor Alzheimer’s are a death sentence. “We tell relatives to promote social activities, to get sick people out of their homes, to take them to church, to weddings… And when we see them again, they recognise that the improvement is evident,” Paledi says.
An increasingly aging population
Africa is a continent with a young population, where the average age is barely over 19 years oldbut at the same time, medical and social advances are boosting life expectancy. According to the World Health Organizationby 2050 there will be 163 million Africans over the age of 65. This figure represents an increase of 120 million compared to the 43 million in 2010.
The International Federation of Alzheimer’s Associations estimates In 2015, there were 2.13 million people living with dementia in sub-Saharan Africa and the number is expected to rise to 3.48 million in 2030 and 7.62 million in 2050. “We don’t know how big the problem is. In countries in the Global North, hospitals often have brain scans and patients can make appointments with a neurologist, receive neuropsychological support, have blood tests… All of that is very limited in Botswana. The only way to diagnose here is through clinical interviews, i.e. the doctor talking face to face with the patient,” says Dr Lingani Mbakile-Mahlanza, a professor at the University of Gaborone and the only one of the country’s two neuropsychologists who specializes in Alzheimer’s and dementia.
By 2050, we estimate that the number of people living with dementia or Alzheimer’s in Botswana could grow by 250%.
Lingani Mbakile-Mahlanza, neuropsychologist
Botswana, home to 2.6 million people, is not a poor nation, as the exploitation of diamond mines and tourism based on ethnic wealth and exclusive natural parks have resulted in a State considered middle incomeBut older rural residents do encounter problems like those described by Mmaphone Gaadinagme.
“By 2050, we estimate that the number of people living with dementia or Alzheimer’s in Botswana could grow by 250%,” Mbakile-Mahlanza estimates. She has documented several cases of witchcraft accusations and says that a lack of resources and studies prevent her from knowing exactly how prevalent both diseases are in Botswana, something that occurs practically throughout the region. For example, she has to collect data village by village. “I was recently in a village about 20 kilometres from Gaborone. We gathered about 200 older people and asked them to raise their hands if they had memory problems or if they knew someone who might suffer from these diseases. I remember that more than 80% answered yes.”
Mbakile-Mahlanza explains that in Botswana and in the vast majority of African countries there is a lack of memory clinics, specific centres for the treatment of dementia, specialists and, ultimately, a commitment from institutions translated into public policies. “Health professionals themselves do not know much about these diseases. And diagnoses often depend on this knowledge,” she says. It is a struggle that is also overshadowed by other diseases that do receive the attention they deserve, such as HIV. Botswana, with a prevalence of 20.3%is the fourth most affected country in the world by the AIDS virus after South Africa, Eswatini and Lesotho. “But this does not mean that work cannot be done on it; we know that around 40% of the causes of dementia are preventable,” says the neuropsychologist.
The expert calls above all for a change of mentality to face the challenges ahead. “Much more support is needed. I don’t know where we will be in 25 years. Maybe we are already late, but it is better to start as soon as possible than to never start at all,” she says. The truth is that the Government of Botswana, a consolidated democracy (ranked 39th in the Corruption Perceptions Indexwhere Spain, for example, is 36), has already achieved significant social progress. For example, It grants a pension of about 530 pulas (about 36 euros) to all its citizens over 65 years of age.. This is the money that Mmaphone Gaadinagme has gone to collect from the Thamaga social centre. “Sometimes, when I get home, I put the money away and then I forget where I left it. I spend hours looking for it. It’s my head’s fault, it doesn’t work the same way it used to,” she says.
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