From Where I Sat Was No Man`s Land

How do Filipinos care for their elderly? We are said to be kinder compared to our global counterparts, but compassionate though we may be, have we pulled all stops in giving our older brethren their due? Eva S.E. Aranas-Angel shares a comparative experience and offers long-term suggestions on how we can do better for our seniors.

Eight years ago for almost a month, I was in Chicago. I was fortunate enough to have been granted a stint in two of the top Geriatrics and Behavioral Health hospitals in the midwest, if not most of the US.  After corresponding through e-mail, the CEO of the hospital network arranged for a much longer one-on-one mentoring for me with the director of the Neuroscience Institute.

On our first meeting, I was instantly smitten and bowled over by the lovely Italian doctor. I remembered having previously seen her in the past dementia conventions in various venues as well as having been just behind her on the queue on my way to visit Topkapi Palace in Istanbul. She never remembered me of course, but I did have vivid recollection of her because at the time of the tour, while everyone else was wearing loafers and flats and shirts and jeans,  she stood out in very vogue hot off the fashion pages—three-inch pumps, tweed Chanel suit and an emerald green scarf that complimented her fair, flawless skin.

She was fashionable then and she was just as fashionable when I saw her again. She had arrived at the institute a few minutes ahead of me and called me to her office. She was a very kind middle aged lady who didn't look the part. She offered me a book (a compendium of neuropsychological tests that may be used for evaluating dementia). ‘Read this’ she told me. ‘I need to call my son.’ The son earlier, she explained, had been injured from a minor skiing accident. She ended her call with  ‘Ciao, ciao carissimo. Mama loves you!’

After the perfunctory introductions—she asked about my background and my interests among other things—her secretary gave her a list of patients she was to see that day. She pored over the sheet, wiping her furrowed forehead.

‘Eeeeva, why are they doing this to me?’  She complained, her lips now contorted. 

‘I beg your pardon, Doctor?’ I asked, befuddled.

‘They gave me twenty patients today! These HMO’s!’

I gave her a quizzical look. ‘ Let’s get started!’ She rose from her chair, grabbed her doctor’s bag and went out of the room, her snake skin stilettos clip-clopping on the narrow aisle that led to the examining room. 

The first patient that day happened to be an eighty year old  lady who had been assessed by the case manager/social worker to be well enough to be sent home after her stint in the nursing home. 

After having examined the old lady, the doctor asked me to come sit in the family conference.

The meeting room, as it was in most big hospitals, was massive. It had a long beech conference table that must have been meant for twenty-four people lined with the cushiest of ergonomic chairs.

That there were only four of us made the room much bigger and much more hollow, even sad. Because while Dr. Tina and I sat in the middle,  the two other parties were set apart, too—the brother sat on one end of the table and the  sister, her head bent as she was knitting, sat on the other end.

For a brother and sister who had not seen each other in six months, they seemed so polarized. Later on I learned too that they had not spoken to each other even much longer than that.

You see, the daughter lived in California. The son lived in Florida. The mother lived in Chicago.

The meeting was to determine who would oversee and take care of their frail old mother.

The daughter didn’t want to.  She had young children and she lived in ‘Freakin’ C-A-L-I-F-O-R-N-I-A,’ she yelled.

The son didn’t want to. He was in between jobs and neck deep in debt and he’s in staying in a ‘dump in Florida!’ he grumbled.

The two would exchange heated words between them and because of their distance from each other, had to shout, holler, yell and scream.

‘Stop that knitting you b–tch.’

‘All you do is drink.’

‘Yeah, and who has been bailing you out all this time?’

There was a volley of verbal exchanges between the two. Dr. Tina and I were like spectators in a tennis match, our heads turning right and left, the atlas on its axis. 

In spite of the Doctor mediating, interrupting their embarrassing discourse, the two would not let up. All we could do was stare and listen to their cussing and cursing and muckraking and unorthodox public display of adult misbehavior.

The Doctor had had enough of the fighting  of these two not-so-grown-up middle-aged adults. She was incensed. It was almost palpable. She stood up and told them to call her when they were ready to talk with her as the eleven o’clock appointment had arrived. 

She asked me to follow her and as soon as we closed the door behind us, she sidled up to me and said  ‘ These two need to see a shrink!’

I could only shake my head. 

Back then, in the summer of 2008, I muttered something to myself: How lucky Filipino older persons are because despite the poverty and other challenges, we remain to be a closely knit, caring and loving family. That what I have witnessed would never happen in my country. 

And then, eight years later come the staggering demographics. The Philippines has become a country of over 100 million Filipinos. 

Population aging is said to be fastest in Southeast Asia, with Older Persons comprising 15% of the total Filipino population by 2025. The exodus of overseas Filipino workers has been growing exponentially. More and more women are in the work force, turning their backs to the traditional role of nurturing and housekeeping. Families have been migrating in record numbers, leaving everything behind, including their parents. Even the church and the United Nations have taken note of 'invisible families'  as both parents work overseas, leaving their children home. And in effect, in the rationing of precious time and resources, the everyday Filipino older person has become more invisible.

Over decade ago, an issue of Time magazine ran a story about baby boomers. Its conclusion resonates in Philippine society, in fact in any society with an aging population. Its message was universal: Breakthroughs in scientific research and advances in medicine have allowed older persons to live longer. Longevity. But that is not crux of the matter. The capstone would have been, if a society is able to make its people live longer, then it is also its duty to make those added years to their life, quality years. Quality of Life.

Perhaps, it is time for government agencies like the Department of Health and the Department of Social Welfare and Development to set their sights on older persons, who, despite the Expanded Senior Citizens Act of the Philippines (ESCAP 2010), remain marginalized. 

The PHIC programs like the Case Rate pays for hospital confinement (acute care) but not for long term (nursing home, sub-acute care)  or preventive programs (adult day care services). Senior Citizens Centers were built but these were not being utilized for reasons they were put up. 

I hope a more comprehensive program will be drafted and legislations enacted for older persons. They must be responsive to the needs (health and social) of Older Persons giving life to the mantra of the United Nations, that is, 'a society for all ages.’ 

As to the old mother in Chicago, she was put back in the nursing home.

Neither the son nor the doctor wanted to take care of her. May the Filipino mother or father not suffer her fate. If no family member can house her, they, the family and/or the government must give them a home.

(Dr. Aranas-Angel is a Davao City-based Geriatric Medicine specialist with special interest in the care of patients with memory and behavioral problems. She completed her Fellowship in Geriatric Medicine at St. Luke's Medical Center and a short course in Geriatrics and Gerontology at the International Institute of Aging-United Nations (INIA-UN) in Valletta, Malta. She may be reached through evaenzo@gmail.com)