Alice Mary Nasanga, who is about 70 and was banished by members of her family after she was accused of witchery, sits in her home in Nabalanga, Uganda, in November. (AP Photo/David Goldman)BY MATT SEDENSKY, ASSOCIATED PRESS
Across Africa, a stunning success story has quietly taken hold: Decades of progress have begun delivering a wave of longevity that promises to reshape the demographics of the continent. But as lifespans lengthen and villages begin to fill with the old, pensions and social safety nets are minimal, medical care is lacking and routine problems of age are so commonly unaddressed that cataracts turn to blindness and minor infections end in death.
Longer lives, time and again, come with more suffering.
“They’re living in poverty. They’re living in pain,” says Kenneth Mugayehwenkyi, who founded Reach One Touch One Ministries to help older people. “That’s the old people that I see.”
In just 15 years, the number of people 60 and older has ballooned by an estimated 50 percent in sub-Saharan Africa, to about 67 million people. Even more dramatic growth awaits, with the World Health Organization projecting 163 million older people in the region by 2050.
Respect for older people is deeply ingrained in African cultures and the presence of an elder is a source of joy for many families and a point of pride for many villages. But on this continent known for its staggering number of the young, the challenges of growing old never before arrived in a large-scale way. Scores of interviews across a dozen African countries and a review of research and data make clear how few resources await those who reach old age and how much festering poverty disrupts their final years.
“Everything is lacking,” says Dr. Mie Rizig, a Sudanese-born neurologist at University College London who researches aging and dementia across Africa.
Falling birthrates and rising life expectancies have combined to bring the aging revolution nearly everywhere in the world. As the number of older people has multiplied, even the richest countries have stumbled to meet their needs, triggering warnings of catastrophe when the same challenges are heaped on some of the globe’s poorest places.
Rzig concedes Africa’s challenges are steep but remains hopeful it can learn from other regions’ mistakes and capitalize on what she sees as its innate advantages: Cultural values that make tending to the vulnerable second nature; a network of public health programs for communicable diseases that provide a framework for addressing problems related to aging; and an unrivaled population of young people offering economic promise and a strong ratio of potential caregivers.
“The continent has a kind of inherent power,” says Rzig, part of an Africa task force for the Davos Alzheimer’s Collaborative. “Africa could be a model for the rest of the world.”
Here in Uganda, Mugayehwenkyi has built one of the country’s only organizations dedicated solely to supporting the elderly, and this day, a Reach One Touch One team has arrived at Nakyanga’s small home on a dirt road in a village about a 90-minute drive from the capital. A 26-year-old nurse, Derrick Ssemanda, in royal blue scrubs, hustles inside and sits beside Nakyanga. The man’s catheter has been causing pain and Ssemanda pulls white surgical gloves from a camouflage backpack and gets to work changing it.
“Are you strong enough?” he asks Nakyanga.
“I’m a strong man,” he replies. “I can handle it.”
Nakyanga sweated in the fields just to grow enough to feed children who would later die of AIDS and laid the bricks and poured the cement to build a house he nearly lost to medical bills.
He has no electricity or running water. His bathroom is an outdoor pit.
To make it to this age in a place like this seemed impossible to Nakyanga. It’s made all the more an oddity by the fact that it is a country with one of the youngest populations in the world.
“You’re surrounded by young people,” Nakyanga says, “and you’re standing next to death.”
Nakyanga is thin and in tattered clothes and his hair is short and gray. His medical file is thick but he makes little chatter and offers no complaints.
Ssemanda keeps making small talk, trying to distract his patient from the procedure. He pushes a syringe’s plunger, sending an arc of saline in the air, then peels open the packaging to a new catheter, and before Nakyanga knows, it’s over, and Ssemanda rises from his seat.
The list of people clamoring for Reach One’s help is long. It is just one small aid group in one African nation, but to shadow its workers is to see themes that repeat across the continent.
The nurse bounds for the door. There are so many seniors to see.
KAMPALA, Uganda
In the packed aisles of this city’s largest market, every passageway is choked with people, but none of them are old. At an elementary school graduation, hundreds pack the audience, but no grandparents appear to be among them. Even in the pharmacies and optical shops up and down this 1.8-million-person capital’s clamorous downtown, the faces are entirely young.
Follow the frenetic streets of Uganda’s cities to the web of dirt roads pockmarked by craters and bordered by banana trees, though, and thousands of villages await, each a smattering of huts of mud and houses of crumbling cement, seas of red soil splashing with walls of green vegetation, and churches beneath humble steeples or even humbler roofs of corrugated aluminum.
In each of them, Africa’s aging revolution comes into focus, with burgeoning communities of the old. It is a reason for celebration on a continent marked by hardship, but for those rushing to keep up with this new population’s needs, it is also a reason for fear.
“We are not ready,” says Carole Osero-Agengo, who leads Africa programs for the nonprofit HelpAge International from Nairobi, Kenya. “There is development, but we don’t have an aging lens. There are programs, but they don’t cover the whole country. There are so many gaps, but those gaps are being filled so slowly.”
The shift underway across the continent is striking. Advances in nutrition, sanitation and clean water; robust responses to HIV and malaria; and dramatic declines in infant mortality have combined to bring longer lives.
From 2000 through 2020, all of the top 20 life expectancy gains across the globe were posted by African countries.
Gains in life expectancy have fueled growing populations of older people virtually everywhere in the world. But the speed at which it is happening in Africa is unprecedented.
Many rich countries took a century to see their percentage of older residents double. Uganda is expecting to quadruple its share of older people over the course of just 40 years.
Similar projections repeat across sub-Saharan Africa.
“We haven’t had the luxury of time that the developed world had to prepare,” says Dr. Ogugua Osiogbu, the head of geriatrics at National Hospital in Abuja, Nigeria, and one of the continent’s few specialists in medical care for older people.
Though the African Union and varied countries have drawn up plans to address their aging populations, implementation has been uneven. Few goals have been addressed in any substantive way and older people remain absent from most governmental priorities.
In Uganda, like elsewhere in Africa, there has been little government investment in pensions, health care and caregiving support for the country’s oldest. Little U.S. aid goes directly to groups focused on the aging population, but the destruction of the USAID program under President Donald Trump has nonetheless made things worse.
Paired with cutbacks by some European countries, the loss in aid has translated to the demise of antipoverty programs, food distribution operations and AIDS clinics, all of which benefit the elderly. Help for victims of natural disasters, which have an outsized impact on the old, have faced the chopping block, as have surveillance and response to infectious diseases, to which older people can be more susceptible.
Reach One Touch One relies strictly on donations. It has struggled to keep up as costs have risen, cutting back food deliveries from monthly to every two or three months. While it is the largest organization of its kind in Uganda, ROTOM operates in just two of the country’s 146 districts.
“It is a drop in the ocean,” says Grace Nabanoba, a field worker for the agency. “The need is so deep.”
At the time of ROTOM’s founding in 2003, Uganda counted just over 900,000 people 60 and older.
Today, there are more than 2.2 million.
Life, for many of them, is blanketed in disappointment and hardship and pain. But on a continent that, for as long as anyone has tracked lifespans, has lagged the rest of the world, the surprise of a longevity revolution is thrilling.
At a small home ROTOM operates to care for seniors, three women sit beside one another, erupting in a fit of delight when visitors appear. One woman, Veronica Nakattee, who’s unsure of her age, throws her cane to the ground in excitement. Another, an 80-something named Donanta Nanyanzi, breaks into a dance. The third woman, Dorothy Ndibanje, at 93 the oldest of the trio, stays seated, but allows a huge smile to spread across her face.
Nanyanzi and Nakattee tease Ndibanje about her toothless grin.
“I sold off my teeth,” she replies, prompting a round of laughter.
“We’re always giggling like this,” Ndibanje says. “We’re so happy to be alive!”
KITABURAZA, Uganda
In the night, when all that glows on this hilltop is the moonlight and all that moves are branches tickled by a soft breeze, the tumult returns. The old woman grows convinced her house is on fire and, panicked, drags the table, chairs and the rest of her few worldly possessions, outside. Unable to calm his mother, her son knows just one way to end it.
He locks her up.
“She yells,” the son, 62-year-old Herbert Rutabyama, says matter-of-factly. “She pounds on the door.”
Dementia’s prevalence has long been muted on this continent where lifespans have trailed the rest of the world for as long as anyone has kept track. But as the population of older people increases across Africa, experts are seeing a spike in new diagnoses, each of them bringing profound challenges to the patient and their family.
A surge of new cases of dementia is expected across Africa in the coming years as the demographic shift continues. But, already, the desperation of those caring for people living with diseases like Alzheimer’s is beginning to show.
They turn for help in a place with little to offer. In many of the languages spoken on this continent, they don’t even have a word for dementia.
This day, the crew from Reach One Touch One is making its rounds in this western Uganda village about an hour north of the Rwandan border. Nearing the woman whose middle-of-the-night visions are so unnerving, aid worker Moses Kahigwa musters as much sunniness as is splashed outside the lush valley below.
“You look good!” he coos.
The woman, 87-year-old Alice Ndimuhara, gives him an icy glare.
“This looks good to you?” she says.
It’s just past noon and Ndimuhara hasn’t had anything to eat today. She has no money. All her limbs feel weak. Her headache never seems to go away.
If not for visitors, she would’ve just stayed in bed.
“My life is just meaningless,” she says.
Her son, Rutabyama, arrives from working in the field, wearing tall black rubber boots that are coated with mud. Sweat wets his forehead.
Don’t be fooled by his mother’s sass. This, he says, is one of her good days.
It’s been a few years since she started wandering from the house and showing other signs that something was wrong. He took her to ROTOM’s clinic and they said she had dementia. His father has been diagnosed, too.
“It’s really, really hard,” he says of managing their care.
When Ndimuhara wanders off in the daytime, her son will set out to look for her, sometimes finding she’s made it as far as the next village. But when her nighttime confusion returns, he’s unsure what to do. He puts a padlock on her door and nails her window shutters closed and resists unlatching them even when she screams and pounds.
“You know better,” the mother says when the subject comes up.
It’s not entirely uncommon. The United Nations’ chief voice on the rights of older people, Claudia Mahler, issued a report in 2022 warning of elders being locked in their rooms and tied to trees in their yards, without citing the countries in which it was common.
Even for the wealthiest people in the richest places, the solutions offered for those with dementia are inadequate, amounting to salves for a disease with no cure.
Here, though, there is basically nothing. Rutabyama believes caring for his parents is his responsibility. Even if he could afford a nursing home, the country has only a handful and the closest one is a day’s drive away.
As Africa’s longevity revolution makes itself known in a thousand ways, the problems that come with it are being dumped in a place where they have lots of company.
Elders, no longer able to walk, are trapped inside with no wheelchair. But what good would it do if sidewalks are missing, streets are cratered and homes are unnavigable shacks?
Untreated cataracts leave many blind. But how do you broach surgery when even a ride to the doctor is a quandary and even a simple pair of glasses is out of reach?
Dementia brings ostracization and accusation. But who can help if belief in witchcraft is wide, cognitive expertise is sparse and the language hasn’t even a word for the diagnosis?
Rutabyama doesn’t know the answer to those questions and doesn’t defend his choice to lock his mother up.
It is another flawed response to a question with no good answer.
NKULAGIRIRE, Uganda
Uganda is a land of verdant hillsides and fetid trash heaps, of crowded city markets and countryside chapels.
Cherubic babies, swathed tight on their mothers’ backs, turn to eager schoolchildren, who sing songs about someday becoming nurses and lawyers and teachers. Young men and women, in turn, diplomas in hand and little opportunity in sight, end up in dead-end jobs at home, or shipped off to places like Dubai, working in security or construction.
For many, to make it to old age here is to toe the line between joy and misery, to wrap oneself in vivid fabric, stand in a radiant sun and dance outside church, singing in gratitude, only to return to a darkened shack, wrinkled and stooped, and go to bed alone and hungry.
“Old age is not something to brag about here,” says 75-year-old Tereza Nabunya. “Poverty strikes when you’re old.”
Nabunya’s roof leaks. She has no tank to collect water and the nearest well is deep in the bush, about a half-mile away. She is wracked with pain and needs to see a doctor.
There is no way to pay for any of it, so she weaves a mat from papyrus leaves to try and earn some money. She figures it’ll take a week to weave and much longer to find a buyer. It will go for 3,000 shillings – less than a dollar – and will be spent as soon as it’s in her hand.
A far higher proportion of Africans work in old age than anywhere else in the world. In desperation, they dig neighbor’s gardens in exchange for food or collect firewood and try to sell it for a few shillings. There are few options. There is little help anywhere.
The government safety net is minimal and most charities are focused on the young.
“That is the tragedy of getting old in Africa,” says Dr. Zelalem Habtamu, who leads operations in Ethiopia for Cure Blindness, which does cataract surgeries on older people around the continent. “They are working on child health, they are working on maternal healthy, they are working on HIV and malaria, but it’s very rare to see the government or the NGOs working to help the elders.”
In Nabunya’s case, she turned to Reach One Touch One, which put her on its waiting list for aid. Some are on the organization’s waitlist a year or more. Others die without getting off it.
About four of 10 older Ugandans fit World Bank criteria for extreme poverty, meaning they live on less than $2.15 a day. Just 3% of older Ugandans live on more than $10 a day.
That poverty is at the heart of nearly every problem that rises with the longevity boom.
Reverence for the old is entrenched in Africa, but parents often seek household help from children just as economics force the young far away for work. Patients clamor for care, but with no insurance, they put off treatment, avoid tests, or forego doctors altogether. Elders are betrayed by their aging bodies, but poor village life dictates they must sow and reap crops, gather firewood and fetch water.
“The old people,” says 88-year-old Pafras Jjemba, “are left with nothing.”
Jjemba wears gray pants that hang loose and beaten-up black shoes with mismatched laces. He is on ROTOM’s waiting list and, right now, he has barely anything to eat.
Many older Africans worked in informal jobs and had no means to save for an age they never thought they’d reach. Across the continent, social security programs are often minimal, where they exist at all. While nearly seven in 10 people of retirement age around the world receive a pension, only about two in 10 in sub-Saharan Africa do, according to International Labour Organization estimates.
Uganda does have a public pension, known as SAGE, for Social Assistance Grants for Empowerment, though it is only open to people 80 and older and its benefits are tiny: Just 25,000 shillings (about $7) a month.
Jjemba was rejected when he applied and isn’t sure why.
It’s a story heard again and again among the country’s old. Aid workers say they see many of their clients turned away for lost IDs, wrong dates of birth in government records, and other mistakes that can take years to clear up, if ever.
And so one man survives on the pity of neighbors who give him bananas, while down the road, a woman gets by on one meager meal a day. A woman shrieks in pain over the swollen ankle she can’t afford to have looked at, while a man who clamors for a soda has gone so long without one that he can’t even recall what kind of soda he likes. In village after village, elders dream of owning a goat or having some chicken on their plate or just having enough soap.
“Sometimes,” says 84-year-old Kellen Bakeshungisa, “I want to close my eyes and not open them again.”
NYAKITABIRE, Uganda
A drought had dragged on for months. Fields of onions, potatoes and beans went dry. Hungry and desperate, the villagers sought someone to blame.
Their target? A gray-haired, slightly stooped 81-year-old woman.
The woman, Ayder Kanyomushana, said she was beaten by neighbors who believed she was a witch and responsible for the drought. The pain of the attack, they thought, would cause her to cry and her tears, in turn, would spark the rain to return.
“They almost killed me,” Kanyomushana says. “It was really terrible.”
In parts of Africa, accusations of witchcraft lead to beatings, banishment and even death, with the victims overwhelmingly older people. As the continent’s population of older people surges, some fear the problem will too.
Advocates say they see a growing number of cases where the accused is a person with dementia – a condition not widely understood on the continent. Whatever the reason a person may be targeted, though, the results can be devastating.
It’s been three years since Kanyomushana first had fingers pointed at her, but the accusations have continued to bubble up. It didn’t help that after she was beaten, the drought broke and the rain fell, cementing what some already believed true. A few months ago, a group of villagers again targeted her, uprooting and destroying her garden.
“See what we’ll do to you,” she says one boy threatened.
Reach One Touch One Ministries intervened to get Kanyomushana out of her home while they confronted villagers. They warned they would take those involved to court and that they could face prison time.
Kanyomushana isn’t sure how it all started. She wonders if it might have been a local woman she says has long hated her, jealous over the sweet potatoes she grows.
“Sometimes they just point a finger,” says Norah Makubuya, a project manager at Reach One Touch One. “They just say, ‘It’s that person.’”
Before the problems began, Kanyomushana says a piece of bark cloth – a fabric made from the pounded bark of trees – went missing from her small home. She thinks someone took it to a local witch doctor to have it looked at and determine if she’s guilty.
The witch doctor who was consulted was Fredianah Tibeijuka, who is in her 70s and says she was born with a gift to heal. In her small home, in a stout metal basket beneath a lofted bed are the tools of her trade – a jumble of twigs and roots and herbs.
“This is to help people give birth,” she says as she unscrews a jar’s pink cap. “This is to help people that have swollen body parts,” she says pinching at something else. “This stick, I burn it,” she says, an antidote to make poor people become rich.
She cannot answer why she hasn’t grown rich from the same stick and she doesn’t know why so many of those who are accused of witchery happen to be older people like her. All she is sure of is that she didn’t get it wrong in branding Kanyomushana a witch.
“I’m telling you and get it right,” she says sternly. “That woman is a witch. She is a really, really bad person. She deserves to die. I cannot help anyone who is a witch. I curse them.”
Similar stories repeat around Africa.
Leo Igwe, a 54-year-old Nigerian who started Advocacy for Alleged Witches to help those facing accusations, says more than 70% of the cases his organization receives involve older people. Igwe says witchcraft accusations are also used sometimes by families looking for an excuse to dump an elder they no longer want to be saddled with caring for.
The cases are about evenly split between men and women, but Igwe says women suffer the worst outcomes, including being mobbed, brutally injured and even killed.
Witchcraft accusations are not unique to Africa, nor to older people, and progress has been made in many parts of the continent in addressing the issue. Nonetheless, supernatural beliefs are widespread and some find them a catch-all explanation for life’s ills. Even some who are hurt by accusations find it hard to let go of their belief in the occult.
Alice Mary Nasanga, who is about 70, was banished by some members of her family after a brother claimed he survived her witchery. She says he went to money-hungry witch doctors who affirmed his accusation and that nearly everyone went along with what he said.
“He made up a story and everyone believed him,” she says.
In the next room, Nasanga’s 30-year-old son lies on a dirty concrete floor, naked and moaning. He’s steadily deteriorated since getting malaria and no longer can speak.
Nasanga says she looks at him and can’t help wondering if he might be under a spell. Witchcraft, she says, may not just be the cause of his illness but the only thing that can save him.
Data on witchcraft accusations is sparse, making it difficult to say whether the problem is any better or worse than the past. But Igwe says it tends to follow the ebbs and flows of the economy, with cases increasing during downturns, as parts of Africa are in today.
“When people are not able to meet their material needs they take a leap into the supernatural looking for the solutions,” he says. “Witchcraft becomes handy.”
As Africa becomes home to more and more older people, advocates for accused witches say they’re seeing a greater number of cases involving people with dementia. Igwe’s organization says at least 30% to 40% of the cases it handles involve cognitive issues.
Dr. Temitope Farombi, a geriatric neurologist in Ibadan, Nigeria, started a “Dementia Not Witchcraft” campaign six years ago to educate the public about the disease. She was prompted by incidents involving older people who wandered from their homes and then were attacked by someone who perceived them as a supernatural threat.
“You started seeing older adults being in harm’s way,” says the 44-year-old doctor, “and people hunting them, beating them, burning them, stoning them.”
Education is also at the heart of the work being done by Berrie Holtzhausen, the founder of Alzheimer’s Dementia Namibia. He has gone village to village and tribe to tribe in Namibia, both helping those accused of witchcraft and trying to prevent future cases by teaching people about brain disorders like dementia that may spark accusations.
Because there is so little familiarity with dementia, witchcraft becomes a go-to explanation for out-of-the-ordinary behaviors another villager might exhibit.
“Why can’t they find their way back from the river? Why are they talking to themselves at night? Why are they undressing themselves and walking between villages?” Holtzhausen says, mimicking the questions he hears. “If you are turning gray, you are a witch.”
Holtzhausen, 68, is a former pastor who began working with dementia patients about 15 years ago. The work has taken on a new dimension since he, too, was diagnosed with Alzheimer’s disease about four years ago.
He has noticed a progression of the disease since his diagnosis. One time, he walked off from a store with a pair of glasses without paying for them. Sometimes he notices himself getting angry or having bad dreams. Other times, he struggles to find a word.
Still, he plans to continue his advocacy as long as he is able.
“I think this is what’s keeping me alive,” he says.
NKULAGIRIRE, Uganda
Past a smoldering pile of trash and two bleating goats, through a doorway beginning to buckle beneath the weight of the bricks above, is a darkened room where a skeletal, 70-year-old man lies on a pillowless bed above a floor littered with trash.
The lone window’s shutters are closed but enough shards of sun make it through holes in the corroded roof to see Joseph Malagho’s ribs poke at the skin of his torso and legs like twigs inside his olive green pants. As he struggles to sit up, leaves crinkle beneath him on a soiled sheet. His mattress sags. The air is thick and stale.
Malagho has no illusions about the difficulty of growing old. But the fact that he is here at all is its own miracle.
Across Africa, millions who once faced the death sentence of an HIV infection have survived only to face something nearly as daunting: old age.
As infections have dropped markedly and antiretroviral drugs have reduced mortality, the turnaround of the AIDS crisis has helped build Africa’s longevity revolution. Lives that were expected to be cut short instead continued decades more, changing the demographics of those facing the disease and fueling the rush of people encountering health systems that were never built for old age.
Malagho isn’t sure when he was infected, but he was diagnosed about five years ago. His health has steadily declined since. He has tuberculosis now, too, and can barely stand.
He hasn’t left this room in months.
There is barely any soap for his wife to wash him with a rag. His lone source of entertainment, a small radio, has gone dead, and there’s no money for batteries. He has lost most of his teeth and can’t afford dentures, but there is little food to eat anyway.
“If there is food or not,” he says, “I don’t even care.”
He urinates into a small white bucket and his wife hurls it outside just as the first drops of rain begin to strafe the roof and start leaking to the space below.
Reach One Touch One sponsors Malagho and has dispatched a field worker, Grace Nabanoba, to check on him this day.
The organization distributes food and medicine to many of its beneficiaries and helps repair homes, install water tanks and provide basic items, like a bed for seniors who are sleeping on dirt floors. But there are limits to what it can do and Nabanoba feels helpless as she stands before Malagho.
She promises him batteries for his radio and exits the home. Sometimes, after visiting him, colleagues will ask her why she’s quiet and she’ll slink off to cry.
“Some situations,” she says, “are too hard to bear.”
MUKONO, Uganda
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 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 the country’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.”
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.
MUBUSHURO, Uganda
Some things have changed as Joy Okwanjire has grown older: Ears that struggle to hear, a back that throbs in pain, and savings that have faded away.
But at least one thing remains the same: A long daily walk to gather water.
Across Africa, where most of the population has no running water, the task of collecting it from a stream, bore hole or spring typically falls to women and children.
It is a responsibility that knows no age: As the continent’s population of older people grows, so too does the number of older people fetching water on arduous daily treks.
“It is a bit difficult,” Okwanjire, who is in her 70s, says. “But I have no option.”
And so, as a thick morning fog blankets the valley below, Okwanjire departs the mud hut she calls home in this hilltop village and sets out on her daily journey.
She wears a long, emerald dress splashed with purple, sandals on her feet and carries a 10-liter plastic jug in her left hand, setting off on a narrow, slippery path bracketed by bean stalks.
The path rises and dips and Okwanjire at times extends her right arm to keep her balance. Birds chirp and a baby goat cries but their sounds are muted by a distant chainsaw.
Along she goes, down a slick, rocky hill, grabbing at the vegetation as she descends. Along she goes, past the fields where women work, through the steep drops, beside the cloudy pool that once was safe enough to drink and used to be her collection spot.
She walks for 27 minutes before arriving at a wispy stream, where she steps down to a rock ledge and nearly slips before dipping the yellow jug in the water and filling it.
Okwanjire shoves a firm, green banana in the mouth of the jug as a stopper, takes one deep breath in, and hoists the jug, placing it lengthwise atop her head. She starts back up the hill.
The hardest part of her journey has begun.
A few minutes up the steep hill, Okwanjire takes the jug from her head and puts it on the ground in front of her, lowering herself to sit in the grass.
“I’m tired,” she says.
Every few minutes it is the same, just as every day is the same. She stops again to rest, then continues the journey that she started as a child.
Many older Africans without running water rely on a relative for help, sparing them a difficult chore. Okwanjire isn’t so lucky.
“Sometimes I wish I could have someone to help me,” she says.
When Okwanjire’s husband was alive, he raised bees, and when the season was good, he could fill a 20-liter jug with honey and sell it for around 400,000 shillings ($109). He bought her dresses and was able to put meat on her plate, but those days are gone.
He died about three years ago, and the bees followed soon after.
“Old age is challenging,” she says. “There are so many things that you need.”
She took up weaving mats to try and make some money, but she only sells six or eight a year and, after materials, each one earns her about 3,000 shillings (80 cents). Sometimes she earns a little extra digging her neighbor’s gardens.
She doesn’t have enough to see a doctor much less install a water tank.
So her walk continues.
On she goes, past a bleating goat that bucks its head into her right leg, past three colorfully garbed women weeding in the field. A few drops of water escape from the jug’s mouth and rocks and twigs crunch beneath her feet. She rests here and there, but mostly she makes an arduous trip look effortless. Her steps are sure. She says she has never fallen.
“When I bend down it hurts,” she concedes, “when I get tired it hurts.”
Okwanjire conserves as best she can, spacing out how often she cleans herself, and reusing water from the utensils she washes. Still, a daily walk is needed.
The clouds part and the sun shines down as a cool breeze blows. Tall grass and ferns tickle at Okwanjire’s legs, and leaves, browned by the sun, brush against her arm.
And then, finally, her home, its façade cracked with age, comes into view.
She has made it. She puts the jug outside her front door, then doubles over, placing her hands on a chair. All told, the trek took 82 minutes.
“I’m really tired,” Okwanjire says. “Very, very tired.”
One day, she knows, she may no longer be able to walk this hill or hoist this jug. She doesn’t know what she will do. That is a problem for another day.
Tomorrow, she says, she will walk again.
MAGOGO, Uganda
A boy scales the trunk of a jackfruit tree, pawing at his prize, yellow and swollen. Down the road, another child runs beside a bicycle tire with a stick, a phalanx of kids chasing along. Sunlight shines on the young all through this country’s villages and cities, strapped to the backs of their mothers, singing in schoolyards, sailing across soccer fields.
Meanwhile, in the shadows, in crumbling houses and dim mud huts, a new population of the old blossoms.
Across Africa, young and old are divided in their visibility as resources gush toward children and many elderly are left behind. But the fates of old and young are intertwined.
“Both of them are suffering,” says Dr. Emmanuel Mugerwa, who planned to become a pediatrician before switching to geriatric care at a clinic run by Reach One Touch One. “Both of them don’t have a lot of things that they need.”
Africa is home to the world’s youngest population, filled with countries like Uganda, where a staggering half of its people are under 18 years old. While the continent’s population of older people is a tiny minority, it is fast growing. Together, these bookended age groups share much in common.
Children and people 75 and older have the highest poverty rate, according to Uganda government statistics, and they often live together. Among households with older people, an estimated one in six are “skipped generation,” with grandparents and grandchildren.
At a campus operated by ROTOM, a school is just across from a home where a dozen seniors are tended to by a single caregiver. Uniformed children pray the “Our Father” in an open-air hall on the other side of a wall from an older woman who arrived here with bruises all over that staffers say came from a daughter who beat her with a stick.
It is the final day of school before a holiday break, and two girls in pale red jumpers with periwinkle collars leave campus just as shoeless children begin kicking a ball across a damp field. The girls exit the property’s gate, walking past a boy whose cheeks are wet with tears, then up a dirt road lined with corn stalks and banana trees. On the periphery, goats graze, ducks and roosters wander and a tower of mud bricks bakes in the sun.
The girls pass chickens pecking at trash, shopkeepers sweeping their landings, men playing a dice game, and a pile of burning trash sending an acrid plume to the skies, before arriving home. In a sign of respect, they kneel before the woman who cares for them, 94-year-old Rose Liru.
The girls – 11-year-old Brenda Mungulu, Liru’s grandniece, and 9-year-old Parvin Nakawesi, her great-granddaughter – have been left by parents who no longer can care for them. They quickly change into after-school clothes and get started on their chores.
Liru says she doesn’t have the energy to mother the girls and acknowledges the twin realities of their presence: They are both a burden and a gift. She feels all the weight of being responsible for them while knowing they are also helpful around the house.
She wonders how much longer she will live and what will happen to the girls when she’s gone. For now, she is all they have in this world and will do her best for them.
“I protect them. I defend them,” she says, noting elders like her often fill in for children and grandchildren. “Old people, we are the ones who hold families together. We are the ones who pray for you. We are the ones who do good. We are the ones who are next to God.”
In houses where old and young live side by side, elders often struggled to sustain themselves even before they found themselves with another mouth to feed and school tuition to pay. A majority of older Ugandans are illiterate and, among the very oldest, the rate is staggering, with more than eight in 10 people 85 and older unable to read or write. Though school is not free here, it is a point of pride for elders to educate their young.
Felista Kemitaare, whose home is off a steep rocky path before a panorama of lush hills, is one such woman. At 78, she has been thrust back into parenthood, caring for an 11-year-old granddaughter. She rarely has enough food and, of the little bit she is able to grow, she must sell some to help pay for her granddaughter’s tuition.
Today, a ROTOM field nurse, Winnie Katwesigye, has arrived to check on Kemitaare, who sits below a poster of the late Pope Francis, the light from the doorway shining on her face. Her beans are not growing well and her aches and pains are getting worse.
“I have no choice,” she says, “but to be a strong woman.”
She grabs a walking stick in her right hand and heads barefoot up the steep hill to her garden, where she takes a hoe, swatting at the earth. It is too early to harvest, but she is desperate, so she begins pulling anemic potatoes from the ground, some as small as shooter marbles, some about the size of a small plum, tossing them in a green plastic dish. She lifts her torso slowly and walks back down the hill taking tentative steps.
Norah Makubuya, a ROTOM project manager, says she tries to teach adult children in the community just how difficult it is for those forced to become parents again in old age.
“Their burden,” she says of the adult children, “becomes their parents’ burden.”
LONGER LIVES
Celebration and concern mix as more Africans reach old age
