I have been travelling through Bolivia for the past month, and before coming here, I knew very little about this South American country. It is not a country that is much discussed in Europe, yet, I think the case study of Bolivia can give interesting insights into how dementia is viewed and addressed in Latin America. Bolivia is landlocked, located in central South America and has an estimated 11 million inhabitants. It borders Chile, Peru, Brazil, Paraguay and Argentina. 59% of its population live in poverty. Although informative these statements do not really explain what Bolivia is like. I have seen an incredibly diverse nation. Not only in landscapes that range from dense jungles to 6000m high snow-capped mountains, but also in its people. The Spanish started conquering the Inca Empire in 1524 and the country now known as Bolivia was part of the Spanish empire until it declared its independence in the mid-19th century. There remains a division until today between the indigenous people and those of Spanish descent. Politically it is relatively unstable, and protests and roadblocks are part of daily life. Although big cities like Santa Cruz, Sucre, and La Paz have everything one could wish for (despite central heating perhaps), Bolivia’s infrastructure is severely lacking. Particularly roads connecting more remote destinations are often mere dirt tracks, which makes travelling arduous and (at times) dangerous.. So, how is dementia care delivered in a place like this? And how will it be delivered in the future?
Latin America is one of the most rapidly ageing regions in the world, and 3.4 million people are estimated to be affected by dementia in this region. In Bolivia it is estimated that 40,000 people have dementia, however, no exact figures are available. It is thought that less than 5 to 10% of dementia cases are diagnosed with most people never being identified by the system. There are several reasons for this, including lack of specialists able to make diagnosis, difficulties in accessing healthcare services (particularly in remote regions), lack of awareness and lack of funding to promote appropriate healthcare policies. Less than 1% of the population has access to mental health services, and mental health in general is not considered a priority. Specialised care for people with dementia remains limited and in communities, especially in rural areas, there is little capacity to cope with dementia cases. Ignorance and stigma lead to mistreatment and abandonment. Usually the person providing care for someone with dementia is a woman – a daughter, wife or daughter-in-law. This reflects the fact that Bolivia remains a patriarchal society, where men dominate.
In 2013 project Forget Me Not was launched to improve dementia care in Andean countries, including Bolivia, Peru, and Colombia. The project team in Bolivia developed and validated an integrated care approach for dementia diagnosis and treatment. This involved the participation of patients, families, health services, authorities and communities across Bolivia. As part of this project the Neurocognition laboratory with a focus on screening for dementia and providing training for family and caregivers was established in Santa Cruz. Over 650 health provides from 16 health facilities in La Paz and 12 in Santa Cruz were trained in dementia diagnosis in management. A virtual telemedicine platform was developed to be used in the rural areas of La Paz from September 2015 onwards. Furthermore, more than 11,000 people from different communities received information about dementia.
Projects like this are key to improving dementia care. However, they are also important because they provide people with information about dementia and raise awareness. Helping people understand what it means to have dementia will affect the way they treat someone with dementia. In addition, it helps to support caregivers that can struggle with the burden of care. Nonetheless, in the long-run it is clear that countries in Latin America need to implement integrated healthcare policies that support the increasing numbers of people with dementia living in extremely culturally diverse communities. Although estimates vary the number of people with dementia in Latin America is expected to increase to 27 million in 2050. Bolivia is a developing country, ever-changing, and its government now faces the task of rising to this new challenge.