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"An elderly Afghan man carries firewood over his shoulders in Afghanistan" Image Aref Karimi, AFP/File Read more: http://www.digitaljournal.com/news/world/norway-named-best-place-to-grow-old/article/406285#ixzz3tA0DnzLR

How are we treating our elderly?

By Dr Khesrow Sangarwal

According to the GlobalAgeWatch Index 2013, Afghanistan is the worst country in the world for older people. The country has been rated the second worst in the subsequent data published.

Afghans have a proud tradition of respect and care for their elderly. For centuries, Afghan culture and society have celebrated ageing, and have perceived old age as a source of wisdom and knowledge.

Politically, Afghan elders have always been put at the forefront of governance and decision-making by the monarch or head of the State. While the youth have fought deadly battles and wars, the elders have led those battles from afar. The very first head of the modern Afghan State was selected by a Loya Jirga of elders from various Afghan tribes, and thereby the success and advancements of the newborn political regime was ensured. In fact, the present day Afghan Constitution has allocated the upper house of parliament, De Mushrano Jirga, literally translated as ‘the assembly of the elders’, to the elders of the country.

In Afghanistan, family is the only institution that not only cares for the elderly but is also led by its eldest member.

However, urban living, and the adaptation of the busy, modern, and westernised way of living over the past two decades have fundamentally challenged this tradition. It is often argued that Afghan society now lacks the sort of moral and ethical will that it once held in relation to its older members. This new way of life simply cannot afford the kind of resources that an increasingly expanding, and expensively demanding elderly population requires.

According to the GlobalAgeWatch Index 2013, Afghanistan is the worst country in the world for older people. The country has been rated the second worst in the subsequent data published.

While advanced medical care, and better quality of life have contributed to improved human longevity and the increase in the average life expectancy in Afghanistan, it has exerted unprecedented pressure on family dynamics, as well as the State economy.

The urban Afghan family often faces a painful dilemma when it comes to caring for their elderly. The absence of easily available and affordable assisted living facilities, and families’ reluctance to take up such facilities has more than often resulted in older individuals living a distressing and neglected life.

At Discourse Hour this week, a group of intellectuals and professionals discussed the fate of our elderly in an ever changing Afghan society.

Afghan tradition

Most participants reiterated the commonly held belief among Afghans, that Afghan society treats their elderly very well. By giving examples, and sharing family stories of caring for parents and grandparents, the participants argued that since Afghanistan is a very traditional society, and as it is common with any tradition-oriented society, the role of history, custom and religion is prominent. All of these three institutions in Afghanistan require individuals and families to respect and care for their elderly.

Moreover, in Afghanistan, especially in rural areas where the majority of Afghans live, the male offspring and their children stay in parental house well into adulthood, and are financed and fed from the parental finances. This give the elders a significant financial authority for a very long time as the main owners and sustainers of the household.

Other participants, however, challenged the thought that Afghans inherently and invariably care and look after their elderly any better than other societies. They argued that suboptimal care, and negligence are symptoms of poverty, and if a society suffers from chronic poverty for decades, or even centuries, one cannot expect better quality of life for the most vulnerable members of the society, in this case the elderly.

It is therefore important for us to identify accurately the situation of our elderly in society in order to reflect it in national health and social care policies.

There is a commonly told story in Afghanistan where a man places his elderly and frail father in a pannier, intending to take him away from his house and abandon him in the desert, having been fed up with his personal care, and needs. Whilst in the process of taking him away, his son asks where his grand-father is being taken. The man replied that he is taking him to a better place. The little boy said: “ Okay, but make sure you bring the pannier back so that I can use it to take you away to a better place, when you are old.” The story concludes that the man surrendered to his guilt, and started looking after his elderly father at home.

This story, one participant observed, serves both sides of the argument. While it is a testimony to the presence of the issue of poor elderly care in society, it also highlights society’s moral stance on the importance of care and respect of the elderly in the society.

Poverty

Poverty is the greatest challenge to modern human society, both on a political, and on an individual level. It threatens the very fabric of society. When feeding, and surviving comes to the forefront of one’s daily life, all other issues including morals and ethics take a back seat.

It is needless to say that decades of military and political conflicts have destroyed Afghanistan’s institutions, and in turn the welfare of society. The elderly being a vulnerable section of any society, is inevitably affected significantly by the ongoing conflict in Afghanistan and its sequelae.  The inadequate and ineffective healthcare system, the scarcity of affordable and safe food and water, the expanding population, and the competition for land and accommodation are some of the challenges that have affected the Afghan elderly the most.

In the past the traditional family, and Afghan values served as a safety valve against these challenges. Now that the new urban and westernised lifestyle has challenged these values without fully integrating new modern values to replace them, our elderly are more than ever vulnerable.

Longevity

Despite the fact that Afghanistan has one of the world’s worst life expectancies, the general trends in enhanced human longevity has benefited Afghanistan too. One of the greatest challenges of human longevity anywhere in the world is the prevention of deterioration in quality of living and health. Although the elderly in Afghanistan may have benefited from the global trends in human longevity, it has unfortunately failed to catch up with global improvement in quality of living. In other words, the challenge of human longevity in Afghanistan is possibly the gravest anywhere in the world. 

There is no such thing as state funded social care for the elderly in Afghanistan. In most cases where families cannot afford to sustain the necessary welfare of their elderly, there is little alternative resources to rely on, and the elderly suffers a tragic and painful neglect.

Law and discrimination

The participants observed that there is a legislative vacuum when it comes to the affairs of the elderly population. Apart from some vague and general articles about discrimination in Afghan constitution, there is little law to ensure the safety and wellbeing of the elderly. This, many believed, should be a priority for the government to address in regards to its elderly .

Legislation ought to cover the entire range of issues contributing to the present state of the elderly in Afghanistan, from health and social care to neglect, abuse and discrimination. Moreover, the law should oblige the government and state institutions to prioritise elderly care and take active measures towards ensuring improved elderly welfare. Devising and developing specialist geriatric and palliative training programs for doctors, nurses, and other healthcare professionals will go a long way in improving elderly wellbeing. Adopting allied healthcare disciplines like occupational therapy, physiotherapy, pain management etc will improve the quality of life for the elderly.

Assisted living facilities

Assisted living facilities including nursing homes and care homes are becoming increasingly popular worldwide, as a safe way of ensuring a better living quality for the elderly. Despite its challenges and shortcomings, assisted living facilities bring practical solutions to many difficulties faced by the elderly and the frail. However, even in the Western world where modern assisted living facilities started, many older people and their families are reluctant to take up these facilities as a living options, and prefer to live in their homes, as independently as possible.

In Afghanistan, there are no known assisted living facilities of significant scale. Some participants thought that due to cultural and traditional limitations such facilities may not attract much interest among Afghans. Others argued that since there is no evidence to support these assumptions, if such facilities are piloted in Afghanistan, it may prove surpassingly popular, owing to increasingly stretched family resources, especially in urbanised Afghanistan.

The way forward

It was concluded that the subject of elderly care needs to be brought up and talked about more often as part of a process of modernisation of Afghan society. It was appreciated that some of the above may be perceived as unrealistic suggestions for Afghanistan where arguably more acute issues are on government’s priority list. However, starting a debate, and raising public and professional awareness on elderly care is paramount for civilised society.

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