Edna Namara, GPJ Uganda
Desie Namirembe, 84, is accustomed to making a living by weaving mats, but age-related frailty makes it difficult for her to travel to purchase supplies.
KAMPALA, UGANDA — Desie Namirembe, an 84-year-old weaver, spends her days without work because she’s too frail to go to town for the palm leaves she requires.
Margaret Komutala, a 58-year-old primary school teacher, is so fearful of the body odor she believes is inevitable with aging that she has increased her frequency of bathing and changing clothes.
Regina Nakirya’s tiny room has no electricity or plumbing. Left blind after a bout of high blood pressure, the 75-year-old relies on the kindness of friends and neighbors for basic necessities. “Bury me anywhere when I die,” she says, her body itching and red from bedbug bites. “I have no relatives. My friends are my relatives.”
The scourge of ageism in Uganda is widely acknowledged and falls particularly hard on older women, who are admonished not to remarry and who are all too often dismissed as feeble or attacked as “witches.”
Lack of adequate care for older people is a growing problem across much of sub-Saharan Africa, including Uganda. A 2017 study by the World Health Organization found that in Uganda, “there are almost no financial resources and there is little implementing capacity and skills to address older persons’ issues in government, civil society organizations and communities.”
Little has been done on a systemic scale, in part because of the country’s 40% poverty rate, says Stephen Wandera, a lecturer at Makerere University in Kampala, who studies access to health care for older people.
“In the past, older Ugandans were cared for by younger, live-in relatives,” he says. “But the pressure to earn income has broken that arrangement.”
Lydia Kiwumulo, a senior gerontologist with Uganda’s Ministry of Gender, Labour and Social Development, says older Ugandans are now frequently regarded as a burden. “The relationship has been punctured,” she says. “The collective responsibility has died.”
In a country of 47 million people, just 4% are older than 60, according to Africa Health, a journal published by the African Centre for Global Health and Social Transformation, a nonprofit organization in Kampala, the capital. But their numbers are growing, along with overall increases in the country’s population. In 2014, Uganda’s elderly population was 1.6 million. By 2050, experts expect that number to more than triple, to 5.5 million.
“A majority of older persons living in the rural areas are generally neglected and not provided with adequate social services,” David Okello, director of noncommunicable diseases and healthy aging at the organization, wrote in Africa Health in January.
“Uganda should benchmark other countries in dealing with older people,” Okello says in an interview. “With no intervention, the plight of the elderly will escalate.”
Some change may be on the way. Five members of the Ugandan Parliament charged with exclusively representing the interests of older people were elected in January. They took their seats in May.
Dominic Mafwabi Gidudu represents eastern Uganda. He already has secured rations of oranges, mangoes, cashew nuts and pawpaw seedlings for the older adults in his region.
Joram Ruranga Tibasiimwa, representing the western region, pledges to improve service delivery. “All health centers will stock drugs to aid the elderly,” he says, “and they will be exempted from long queues.”
But Patrick Menya, another senior gerontologist in the Ministry of Gender, Labour and Social Development, is skeptical of real reform, given the harsh economic realities and cultural biases in Uganda.
Access to financial resources for older people is uneven. By law, the oldest 100 people in each sub-county are eligible for a monthly government stipend of 25,000 Ugandan shillings ($7). But the funds are distributed disproportionately. In southwestern Uganda’s Rukiga district, for example, Rutaba Dina, 68, receives the stipend, but her uncle’s wife, Veneranda Nyinamafwa Kahigi, 83, doesn’t.
“The problem is accessibility,” Menya says. “At times older people miss out because they are forgotten.” He says the government-run National Identification and Registration Authority, which tracks all Ugandans, has undertaken a tally of national records to correct this problem.
Lack of supportive housing is another hurdle.
Jinja Home of the Elderly and Needy Persons, in Jinja, a district in eastern Uganda, is the only such center in the country operating with partial government support. At one point, it accommodated four older Ugandans, but after they died, the center halted the program for older people because of the coronavirus, says Peter Musoke, the center’s administrator.
Now, Menya says, the challenge of running a national home for the elderly is diverse cultures and languages. “It would be too much for the elderly, given the different backgrounds.”
The biggest challenge may be overcoming stigmatizing stereotypes about older adults in Uganda, such as the odor that Komutala worries all older people emit, says Fred Nakwagara, clinical head of the Directorate of Medicine at Mulago National Referral Hospital.
“Their smell is due to lack of care denied them by caretakers,” he says. “One will put off bad odor if they are not helped to bathe, and their beddings are not changed.”
Expert care would benefit Namirembe, who suffers from idleness, disorientation and confusion. “I see a human arm coming to strangle me whenever I am alone in the house at night,” she says.
With scant structural support in place, older Ugandans are left to rely on sympathy. A former client secured the single room for Nakirya, who used to earn income by taking in laundry. But her lack of sight and the room’s lack of plumbing made even the simple act of going to the latrine a test.
“I know I must turn right, step on a wood plank and follow it till I get to the end of it, then I will have gotten to the pit latrine,” she said. “Then I use my foot to feel the hole, and just next is the bathroom.”
Several weeks after this conversation, a neighbor stopped in to check on Nakirya and found her dead in her room. She was buried in a graveyard nearby. No cause of death was provided.
Nakwagara says Uganda owes its older residents more than a life of daily struggle: “A human being has a right to live to maximum life.”
Edna Namara is a Global Press Journal reporter based in Kampala, Uganda. She specializes in reporting about power and bodily autonomy.
