Amir’s 87-year-old father has been battling renal failure and sepsis in a private hospital in the capital city of Pakistan, a country known for its failures to tackle health problems. Each time he attempts to get closer to his frail father in the Intensive Care Unit, he instinctively looks away.
“Abbajan has led such a full life. We have always seen him in command, both while in service in the Pakistan Air Force, as well as at home. I deliberately avoid eye contact with him because it hurts me to see him dependent and helpless,” said the 52-year-old son.
In spite of his critical condition, Amir’s father is blessed — his children do not consider him a burden. They value his presence and hold him in high esteem. And as far as they can afford, are striving for his comfort as he struggles with severe ailments.
Pakistan is beset with a paradox when it comes to care of the elderly, a discipline termed ‘geriatrics’ in medicine. On the one hand, there is absence of care-giving institutional support in the public system, while on the other, there is a strong culture of family support, with members of the immediate family inevitably serving as care-givers for the elderly.
However, the latter may not remain the case for long. While Amir’s generation still recognises the importance of looking after old and ailing parents, his own son, aged 16, is quite dispassionate.
“Perhaps, the greatest tragedy of our times is the erosion of family support which the elderly in Pakistan traditionally enjoyed,” Amir remarked. He believes adoption of western lifestyles, urbanisation, breakdown of joint family system, and unhindered access to electronic gadgets and information have led to disintegration of our value system.
Conversely, it may take a few years before support for the elderly in Pakistan declines to the extent seen in the west, where families tend to be much more atomised and scattered. They are hence more unlikely, unwilling, or unable to care for old and ailing parents in the comfort of their own homes.
Care of the elderly is slipping down the list of priorities as men and women submit to long grueling hours and chase impossible targets. “When I ask my son if he will be there to comfort me as I grow old,” Amir revealed, “he shrugs and tells me not to be ‘senti’ (a hip expression for ‘sentimental’). His attitude is a cause for concern. I am worried that if I live beyond 65, I will be lonely and unsupported.”
Declining family support is not the only factor that increases the vulnerability of the elderly in a developing country such as Pakistan. In many western countries, robust health-related social support systems are in place to ensure care for people who cannot afford exorbitant fees.
In the UK, for instance, acutely sick elderly who require temporary hospitalisation get free treatment and food via the National Health Service (NHS), which is funded from compulsory taxation. Long-term hospital beds are available for elderly patients suffering from terminal illnesses. Moreover, there are residential hospices that offer palliative care, as well as free treatment and food. Although funded by charities, patients and their friends are encouraged to make donations to hospices, if affordable for them.
In Pakistan, on the contrary, health shocks frequently drain families of their hard-earned savings and expose them to heavy debts. And those who neither have savings nor ways of borrowing money simply die sooner.
“More than 73% of the population in Pakistan pays out-of-pocket to access healthcare,” an internationally acclaimed public health specialist Dr. Sania Nishtar informed in response to an enquiry. She says it is estimated that more than 40 million Pakistanis risk spending catastrophically on healthcare.
Even though social protection is a declared government priority, Dr. Nishtar says the country’s existing health-related social protection systems “provide narrow coverage and are plagued by a number of challenges, of which abuse, graft and patronage are the most salient.” She also reveals that social protection funds cover less than 0.3% of the total public sector health budget.
Poverty caused by having to spend savings on health is another fear that adds to the stress endured by the elderly. “Whenever conscious, Abbajan asks me how I plan to foot the bill, which has sky-rocketed to Rs 2,78,000 within nine days of hospitalisation,” said Amir, the family’s sole breadwinner. “The concern is not misplaced as a pension of Rs25,000 is his only source of sustenance,” he added.
The absence of decent health care facilities for the elderly in public and private hospitals is a critical gap that needs to be bridged. While it would be over-ambitious to expect designated in-patient or community facilities for patients beyond the age of 65, efforts must be made to meet at least the barest minimum standards of care.
The nursing staff in most hospitals lacks the very basics of compassionate handling of the elderly. Psychosocial counseling remains a distant dream. Elderly patients are seen queuing up for hours for diagnostic tests or medical consultations, with hospital administrations unconcerned.
Pakistan’s elderly make up only 7% of the population. Interventions that could provide them with a comforting environment do not require a mammoth investment. Whilst it is critical for the government to step up effective social support and protection for the elderly as it takes stock of its policy, it is also important that we revisit our changing societal values, which impact our homes, families, and loved ones.
To begin with, just an iota of compassion would suffice to make the elderly feel a tad more loved and cared for, as they await their transition to the hereafter.