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June 20, 2013

Mandela’s Care Spotlights S. Africa Healthcare Needs for Elderly

by Anita Powell

South Africa's most famous senior citizen, Nelson Mandela, has spent nearly two weeks in a Pretoria hospital for a lung infection, and is receiving the best possible medical care, said President Jacob Zuma. But few others among South Africa's rapidly growing elderly population are faring so well. Advocates for the elderly say the services for senior citizens have dramatically decreased in the last two decades.
 
At 94 years old, Nelson Mandela has received round-the-clock medical care for more than six months in the comfort of his large home in a leafy, wealthy Johannesburg suburb. By all accounts, the anti-apartheid hero is doted on by his staff, his family and by top South African officials.
 
Mandela is not the standard by which South Africa’s treatment of its weakest members should be judged, though, according to advocates for the elderly. Rather, they say, the nation’s growing elderly population is increasingly marginalized by a government that has focused its health care on the young.  

Growing elderly population

South Africa’s elderly population is at an all-time high. The last census says about five percent of South Africans are over the age of 65. At the same time, nearly 30 percent of the population is younger than 15.  
 
Monica Ferreira, who heads the International Longevity Center South Africa and is the former director of the Institute of Aging in Africa at the University of Cape Town, says one example of this tilt in care for the young is that the nation has just eight registered geriatric doctors.
 
“There were all these geriatric clinics all over the place, there were all these support groups for older people with hypertension and diabetes, there was geriatric community nursing. Now, in [19]94, all this was stopped.  All the geriatric nurses were re-deployed to vaccinate children and so on. So the government’s priorities changed totally. They wanted to bring down the infant mortality rate. They wanted to give children the best opportunities in life, in survival as well," said Ferreira.

Multiple public health needs

Joe Maila, spokesman for the National Department of Health, said the government does care for its elderly population, but acknowledged that the department must perform triage when it comes to public health needs.  
 
“We are not discriminating against them; despite that we don’t have necessarily a lot of doctors and what-not," said Maila. "But it’s just that we have taken the issue of, for instance, the issue of HIV and AIDS, and, you see, we take it very seriously, that all the time we talk about it. And therefore that the people that are more vulnerable, the people who are more in trouble about it, are young people and women. It does not mean that we do not take care of the elderly. That is not true at all.”
 
Nursing professor Hester Klopper is CEO of the Forum for University Nursing Deans of South Africa. Klopper said the government’s policies for the elderly are excellent - but that the reality is far different. For example, she said, the elderly face long waiting times at understaffed clinics.
 
Mounting responsibilities

The elderly are traditionally revered in South African society. But in the past few decades, South Africa’s elderly have taken on a new role as they shoulder the responsibilities of a generation lost to AIDS. Many South African households are now headed by the elderly, and Klopper said it is common for children to be raised by their grandparents.
 
“So the older person is really caught in a very tight and a very difficult position in our country. There is no activism for them. They are almost silent," she said. "And then, of course, the other part that we see is because of the older person that is so dependent on the grant that they get from government, they are very careful not to speak out against anything that government does.”
 
That is exactly what was encountered when approaching several elderly South Africans outside the nation’s largest health care complex, Soweto’s Chris Hani Baragwanath Hospital.
 
A gentleman who gave his age as 64, but whose halting shuffle and missing teeth made him look much older, said he did not think the nation’s elderly were treated well. But he said he didn’t want to be seen as complaining about the government upon which he must rely.
 
So off he shuffled, alone, into the hospital.