Issue - September 2007

September 2007

In this issue, Amy Pollock reviews the successes of Arnold Brower's school garden project, while Lucy Witter talks with the rector of an English school enrolling impoverished students; we hear form Save the Children about their reconciliation programme after the Cochabamba riots in more...

September 2007

Why Bolivia needs dementia care volunteers

Chris Sheratt tells Cocha-Banner about his experience researching dementia care in Bolivia

by: Chris Sherratt
Projects Abroad Volunteer
Bristol - United Kingdom
Advises profesionals who work people with dementia

I suspect that everyone who volunteers with Projects Abroad goes home with some ideas of their own about how to solve a few of the world´s problems. After four weeks volunteering in Cochabamba, I came up with one of my own – to find out about the possibility of founding dementia care volunteer projects in Bolivia.

Back home in England I work in dementia care. I advise agencies working on behalf of people with dementia on how to raise the standard of care they deliver. My idea was to contact some of the people involved in dementia care in Bolivia, and to get an idea of the kind of care given in this country. The idea quickly evolved, morphing first into writing an article for the Cocha-Banner, so as to raise awareness of this issue, and then into the possibility of dementia care volunteer placements in Bolivia. I wanted to make this project idea different for Bolivia in two ways: it would be working with older people, when most agencies here are working with younger people - and it would also operate in the rarelyaddressed area of mental health.

I started by making contact before I came to Bolivia with some people in La Paz who were setting up a voluntary group to support people with dementia. When I arrived in La Paz, I met with a retired doctor who was hoping to set up a similar effort in Cochabamba. But in reality, this group wasn´t up and running yet, so it was not going to be helpful to my cause in the short time I was going to be in Bolivia.

What is dementia?

When people get older, they often forget things. Dementia is a stage further than just forgetting, as people who get dementia lose more abilities than memory, often even losing the ability to remember where, or who, they are. Some people lose the ability to do simple things like eating and getting dressed.

Dementia is a term that covers a wide range of conditions. Many people have heard of Alzheimer’s, the most common form of dementia, but some of the other more common forms are known as vascular dementia, which is caused by blood clots that restrict the flow of oxygen to the brain, dementia with Lewy bodies - which can cause hallucinations and poor physical coordination - and frontal lobe dementia, which often causes personality changes.

Dementia is more common in older people, with about one in 5 people aged over 80 likely to suffer some level of dementia. But no one knows how or why people get it, and at present there is no cure, so while medicine can lessen some of the symptoms, it cannot make it go away.

But not everything is bad news – even people with advanced dementia keep some bits of the person and personality they became over the years of their life, and good dementia care is rewarding work, helping people to find and make the best of what they still have, what is called person-centred care. You can learn more about dementia (in English) at .

Next was an exciting visit to a home caring for people with dementia. How do you get permission to visit a home for older people? Simple: you stand at the front door, take a deep breath, and ring the bell. I was unsure about my Spanish, but decided to try my luck on my own, and came away with an invitation to visit some days later. “How can you help us?” they asked. Looks good, I thought. So I turned up a few days later, together with Projects Abroad representative, acting as interpreter. Having to pretend to her that I knew what I was doing helped me to put on a brave face – you never know what is going to happen when you go to a place where people with dementia live, so it is always exciting, but it is a bit terrifying too, even for people who work in this field.

The home, Hogar de San Jose, is run by a religious order, Hermanas de los Ancianos Disemparados. I was welcomed in by Sister Alicia and Sister Marie Carmen, and given an introductory talk on the basics – 145 elderly people living there, of whom about 50 need a high level of care. People are normally admitted here because they need to be looked after full-time and have nobody else to care for them – many are destitute, and have even been found abandoned. In many ways, the work this order does struck me as being similar to projects helping abandoned children.

We walked round the huge home, housed in beautiful bright buildings - not ideal for people with dementia, I thought, but at least fresh, light and clean. We met some of the residents. One lady gave me a friendly bite – she was not attacking me, she just puts anything into her mouth, and we parted with a friendly kiss on the cheek. Another had only arrived to live in San Juan the day before and the staff knew hardly anything about him. We talked for a few minutes, and he said that he would like to call a meeting to discuss the important things we were talking about. Another had been living in Bolivia for 40 years, but the sisters have difficulty communicating with him as he had reverted to speaking in his native tongue, German.

Luckily, I speak a bit of German, and we had a surprisingly coherent discussion – he had lost his skill in Spanish, but still had a lot of other abilities. And so it could have gone on. People who have lost some of their mental abilities, and find themselves living suddenly in a strange place that might not have much in common with the homes and families they used to live in, often express their distress and fear in the only way they can. I felt sure that the woman who bit me puts things into her mouth as a comfort, yet it would be easy and commonly done to read it as aggression.

The sisters at Hogar de San Jose told me that there was little medical support for them - in England, medical staff would support a home like San Jose- but when a person´s behaviour causes real difficulties for the staff there, they are admitted to the psychiatric hospital. So, with the help of Projects Abroad I visited the psychiatric hospital, Instituto Psiquiatrico San Juan de Dios, about 8 kilometres outside Cochabamba, and met doctors Jose Coba and Dra. Angela Quispe. The hospital has 240 patients from the age of 16 upwards, and they confirmed to me that people from San Jose are occasionally admitted for ´short periods´. But it was clear that the hospital was really set up for younger people. “We believe that people with dementia are best cared for by their families,” Dr. Coba told me. I learned that there is also a community mental health programme, but sadly, it does not support people with dementia. So, it seems families caring for relatives who have dementia do not get any support.

Yes, this is only a straw poll in one city, but how does what I have seen compare with what I am used to back home, where, to be honest, the services are far from adequate, and are of course under-funded? My view is that people in Bolivia are working hard and to the best of their abilities to help people with dementia, but there are too few of those people, and they have neither the time nor, I suspect, the ability to respond to the needs of people with advancing dementia.

One other point: the residential home I visited is run by a religious order, and is staffed mainly by 10 sisters who live in the home and devote their lives to the work - unpaid of course. The hospital is also linked to a religious order, the Hospital Order of St John of God. We met Father Joaquin Sanchez, who explained that the order runs two homes onsite for people with long-term mental health problems. So even though the service for people with dementia has its shortcomings, it seems that the wider range of services for people with mental health needs is dependent on support from religious and voluntary agencies, and surely without them, would not be able to function at all.

What about volunteer placements, then? Both Sister Alicia and Father Joaquin made clear that there could be openings there - so what are we waiting for?

A plain of water named Cochabamba
The denseness of its groves, the great variety of birds, which are pleasant to sight and sound, plentiful mountains of cedars, and another kind of wood. This landscape is different to the nearby valley of Clisa which is six leagues southeast from the city (Oropeza)....
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