Across Africa, a shortage of care marks the end of life
[September 02, 2025]
By MATT SEDENSKY
MUKONO, Uganda (AP) — Maybe it’s something as simple as a urinary tract
infection that has 80-year-old Erisafan Khayiki doubled over in pain. Or
a kidney stone. Or something more.
The only thing certain is a truth that repeats across this continent:
For a poor man like him, there are few options. And so this will be the
day that he dies.
As more and more Africans reach old age, economic realities are often
clashing with the needs of late life. When a medical bill is too much to
face or even a ride to the doctor is out of reach, a patient can begin a
spiral toward a painful death.
“For so long, Africa’s population has been youthful. Over the years,
medical care has improved for them. But for the old it has not,” says
Dr. Lenusia Ahlijah, who is one of Ghana’s few geriatricians. “There are
no trained people who understand any of the special health problems of
the elderly. We have to find a solution.”
A lifetime of poverty can bring unique challenges in old age.
Some who, for years, passed up doctors when they were sick, relying on
cheap, over-the-counter antibiotics, experience drug resistance. Others
who have gone without treatment for hypertension end up with vision loss
or vascular dementia. Untreated injuries are, in part, to blame for one
in five older Ugandans having a severe disability.
Even using the bathroom is intertwined with an older person’s wealth.
Forced to squat over a latrine and no longer able to support themselves,
some touch the ground, and with water precious, they pass up handwashing
and contract typhoid.
“Omwavu wakufa,” goes a phrase in Luganda, one of Uganda’s native
tongues, an expression that gained popularity as COVID raged. “The poor
man will die.”
Across much of Africa, older people fall into a blind spot of public
health systems that prioritize infectious diseases, maternal care and
children. Trained geriatricians are rare, national health care programs
are limited, and clinics are rarely equipped to manage chronic
conditions tied to aging. Many older people have little access to
doctors and, if they see one, often forego necessary diagnostics or
treatment to cut the costs.
“I will not check for this,” Mugerwa says they’ll say, “I will not check
for that.”
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Maria Kimono, 69, left, walks past the shirt belonging to her
husband, Erisafan Khayiki, 80, who died just days before at their
home in Nabalanga, Uganda, Friday, Nov. 22, 2024. (AP Photo/David
Goldman)
Eventually, it comes to a head.
Khayiki is sitting on his bed when a nurse ducks to enter the doorway of
his tiny room. He is wincing as he clenches a thick walking stick that
rests against his temple.
“I’m in pain,” he says softly.
It is beyond the nurse’s capacity to diagnose, though. He tells Khayiki
he isn’t sure what is wrong and that he will have to go see a doctor at
the clinic.
“There’s nothing I can do here,” the nurse says.
They agree a ride should be arranged for him to see a doctor, but act
with no urgency.
As night falls, Khayiki cries out in pain. He wonders aloud if he can
survive. He stirs and talks and frets so much that his wife, Maria
Kimono, goes to sleep in the other room.
By morning, he is dead.
If Kimono had known this would be her husband’s last day, she wouldn’t
have chastised him for not listening and wouldn’t have left him alone
when his moans grew loud. She hopes he was proud of how she took care of
him as he ailed, how she’d struggle to carry him outside when he asked,
how she’d been faithful to him to his last day.
He had spent years working as a pump attendant at a Kampala gas station,
sending back money to care for his family. In old age, even with his
sight gone, he showed up to church gatherings and could be seen singing
and, on occasion, dancing.
He was buried in the yard, just beyond the clothesline, near a
grandchild who went before. An Anglican minister came and said prayers
and friends gathered and bowed their heads.
Maybe things would have been different, Kimono says, if her husband
wasn’t so poor.
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