Ageism in Egypt

“Everything was running smoothly. Our precautions were very strict, and we had stopped accepting visitors. Then one man insisted on seeing his father, and it seems that he also brought the virus,” said medical professional Abla Al-Kahlawi who recently made headlines detailing the struggles to contain the Covid-19 virus in a facility not designed for it in Egypt.
When Covid-19 made its way into the elderly care centre she works for, called Baqyat Al-Salehat, the numbers quickly rose to 20 cases. Confusion and shock swept over Al-Kahlawi when she discovered she would be caring for newly infected patients.
She knew that she needed to seek help from those with more expertise in virus control. “There are about 85 people at the centre, not including staff. I reached the point when I texted friends and groups that included doctors, asking them to help me because I did not know what to do about the increasing numbers,” Al-Kahlawi said.
She took things further by reaching out to the media and contacting experts. “I got incredible responses and support including from the prime minster, the minister of social solidarity, and the amazing Minister of Health Hala Zayed,” Al-Kahlawi said. “She immediately sent an ambulance to transport four cases that were in critical condition and a whole medical team. We began to prepare for their isolation.
“Through hard work and God's will, I'm happy to say we have no cases now, and we have celebrated those we had leaving the isolation unit,” she added.
However, though the situation was looking up, challenges still remained. The medical team tested all the residents at the centre, and when Al-Kahlawi contacted the families of those uninfected, they sometimes did not want them to come home. “I asked their children to take them, and they refused in some cases. Some asked me to send them through the police, but I know they would not be able to handle them because the patients had Alzheimer's, and it is a challenging condition,” she said.
When Al-Kahlawi's story broke, the public might have assumed that it was infected residents that the families were refusing to accept at home. Yet, even those confirmed to be uninfected still faced discrimination in some cases, drawing attention to the way society has come to view elderly people and concerns that ageism may be on the rise in Egyptian society.
The World Health Organisation (WHO) defines ageism as “the stereotyping, prejudice and discrimination towards people on the basis of age.” Ageism may exist in everyday life, hiding in plain sight, since the ways in which the elderly can be abused are countless. Physical, psychological, and financial abuse are some of the types of abuse that they can be subjected to, and awareness of such issues is linked to cultural views associated with older people.
The coronavirus has also led to ageism in many countries reaching even more troubling depths. On a global scale, the WHO says that “over 95 per cent of Covid-19 related deaths are in those older than 60.” And during a press conference in Cairo in June, Zayed declared that the death rate among Covid-19 patients in those over 60 years old could be as high as 60 per cent, causing some to suppose that the elderly are the main casualties of the virus.
But, of course, such views are dangerous on both a factual and a moral level. Before even mentioning the ethics of the subject, dismissing the disease as only targeting the elderly is inaccurate on several counts. All over the world more information is emerging about how younger people are being adversely affected by the disease as well, with an article in the US newspaper The Washington Post in late April noting how infected patients in their 30s in the US were having strokes leaving them “debilitated or dead”.
Many of these cases were asymptomatic, and the long-term effects of the disease are also difficult to understand because the virus is still being studied. Many people who have experienced the effects firsthand often urge the public to treat the disease as the pandemic affecting everyone as a result.
ELDERLY TODAY: Even if younger people are not being affected by the Covid-19 virus to such a large extent, the elderly make up a large number of the global population and are expected to continue to do so in the near future.
According to a 2017 study by the United Nations, “the elderly will more than double from 542 million in 1995 to about 1.2 billion in 2025, and by 2050 more than 20 per cent of the world's population will be 60 years old or older.” Projections from the same study also indicated that by 2050, “79 per cent of the world's population aged 60 or over will be living in the developing regions.”
Egypt is on a similar track. In 2019, the Central Agency for Public Mobilisation and Statistics (CAPMAS) announced that the number of elderly people in the county had reached 6.9 million. And while traditionally Egyptians, like other Arabs, are known to speak highly of the elderly, there have been fears that we are no longer practicing what we preach.
Sociologist Said Sadek believes today's different outlook can be traced to a few generations back. “In the past, Arab society was mainly dependent on extended families where different generations took care of each other and showed respect and obedience to the elderly,” he said. The elderly in Arab society used to enjoy better status and treatment “as authority was seen as being based on gender and age,” he added.
There are also clear reasons why Western and Arab societies often diverged in their views of the elderly. One point is that nuclear families (those consisting of two parents and several children) predominate in Western society, rather than more extended families. Even so, countries in the Arab world today seem to be going in a new direction and becoming closer to what has been the case in the West.
“Arab society is changing in social structure as extended families decline and nuclear families advance due to economic changes,” Sadek said. “The children of the elderly are now leaving houses near their elderly parents and relatives to find houses closer to their work instead,” he added.
Of course, the elderly population in Egypt has been keeping a close eye on the media coverage and how events have been playing out under the impact of the coronavirus. When the virus first hit Egypt, some hospitals quickly found themselves at maximum capacity, scrambling to find alternatives such as converting to quarantine-specific facilities.
When the elderly hear of such shortages and complications, they might worry that hospitals are being forced to choose between helping younger people with a stronger chance of survival, or older patients at a higher risk of death, with such stories being common, for example, in Europe.
Covid-19 has also caused the population as a whole to discuss the care given to elderly people, safety measures, and their quality of life. It also brings to mind elderly care centres and what they truly mean for many, whether in a pandemic or otherwise, with one 2017 study published in the Menoufiya Medical Journal noting how the number of social welfare institutions in Egypt dedicated to the elderly has grown.
In 2007, there were 115 centres and that number had increased to 176 by 2015. Though this increase is a positive development, it also emphasises concerns at an ageing population. And institutional care has become crucial for some old people because of the physical and emotional stresses and the unavailability that is often associated with being a caregiver.
Hind Abdallah is a writer who also volunteers in residential homes for the elderly in Alexandria. She has got to know many of the residents, and many did not paint an entirely happy picture of their lives. “Many residents would tell me that all they would like is a visit from the children who put them there, but some never visited even once,” she said.
Despite the fact that the residents typically get along well, they sometimes crave things from the “outside” world, and their simplicity is sometimes heartbreaking. “I remember an elderly lady showing me photographs of herself when she was younger, and one was of her looking elegant in a fur coat. She asked me if I could get her a certain kind of chocolate, and was overjoyed to receive this little connection to the past,” Abdallah recalls.
She takes her daughter with her on most visits, and she also encourages others to volunteer in elderly homes, even if they do not have a relative residing there. Though she feels some elderly care facilities leave elderly people feeling abandoned, others may offer more mixed views. Al-Kahlawi, for instance, believes that it varies.
“Everyone feels loved and connected to each other. They are delighted to feel they belong in a place with others like themselves. They can communicate with others that they do not really know,” she said. “I've seen two elderly women from completely different walks of life who do not really know each other sleep close together like kittens. They often revert to a simple, almost child-like state,” she added.
“I have seen a devoted wife insisting on staying right by her husband and visiting him daily. I have seen a daughter who adores her father and always comes asking about him. But I have also seen a son take his mother here, pretending she is his housemaid. Some people have put their parents in homes in order to travel and then never ask about them,” she added.
Al-Kahlawi said it had even reached the point when someone who was told about his mother dying, responded by saying, “well, what am I supposed to do about it? Why don't you just deal with it?”
Of course, some have their own reasons to forego residential homes and take care of their ageing relatives themselves. One woman, Nermine, for example, feels that Egyptian culture and how the elderly view residential homes are deeply intertwined. “I have seen some people whose parents urge them from the start to think of themselves. However, generally this sort of thinking is hard for parents,” she said.
Elderly parents can feel like a burden to their children, but Nermine tries not to let her personal aspirations get in the way of what she feels is right.
AGEISM AND MENTAL HEALTH: Women's increased participation in the work force and the declining ideal of the extended family might have negatively affected the traditional support networks that older Egyptians value so highly and affect how families care for elderly relatives.
“I never expected what would happen in the future, and that I, as her only daughter, would be completely responsible for her,” Nermine said, talking of her mother. “It is like all of a sudden you are forced to build your life around someone else's schedule,” she added.
“Even socially, my relationships and the places I feel free to go are completely affected. Simply put, she needs me, and it is not easy to be in this sort of situation,” Nermine said. “Sometimes you might feel angry, but gradually you can find a space to move through without compromising your responsibilities.”
When someone takes on the role of primary caregiver for an ageing parent, it may dawn on them that they are getting older too. Nermine is aware that she herself is changing, and sometimes she asks herself, “am I just used to a slower a pace now, or is my age catching up with me?”
Being a career-driven person makes matters more difficult. Nermine can “no longer tell” if her goals are “on temporary pause or have been cancelled.” Meanwhile, she suggests that self-care can go a long way towards improving mental health. “I remember to set my own rhythms instead of always moving to hers,” she commented.
As the Covid-19 pandemic swept across Egypt, the Health Ministry also addressed how mental health concerns were growing. In late March, head of the ministry's Mental Health Secretariat Mona Abdel-Maqsoud said that “a team of 150 mental health specialists received online training in providing remote psychological support for coronavirus patients and their families, as well as to medical teams in quarantine hospitals.”
She urged all specialists in mental health, community initiatives, and psychiatric departments to participate in the online training. Approximately 1,500 psychiatrists, nursing staff, and social workers submitted requests. The ministry also set up emergency helplines to offer psychological support to the public run by the ministry's mental health department.
But mental health has been a challenge in Egypt since long before the pandemic. According to the WHO, “the number of hours given for training in mental health in medical schools and other health training institutions is limited [in Egypt] and does not reflect the importance of this field as a contributor to morbidity.”
Poverty can also play a role in analysing mental health patterns. In 2018, Egypt's Mental Health and Addiction Treatment Centre declared the results of a nationwide study conducted with CAPMAS, for example, showing that those most affected were in rural rather than more urban areas. A sample of 22,000 families found that the governorate of Minya had a high percentage of anxiety and depression disorders in particular.
Though the stress informal caregivers can go through can sometimes appear overwhelming, it is the silent suffering of the elderly where ageism often comes into most direct view, however.
Rania Shoukri, a psychotherapist, told Al-Ahram Weekly that mental health and age could be connected. “It is well-known that mental health in the elderly often deteriorates with time, whether it affects memories or the perceived order of events. Their changed view of reality can lead to their feeling more sensitive,” she said.
Shoukri believes that the experiences of the elderly living away from their children vary. “If the person already had interests beyond caring for their children, they may be able to use their new free time positively and better adjust to the later part of their life,” she said. She also believes that if a child is raised to believe that he or she should take care of his parents, he will more naturally grow up with the same mentality, though this cannot be guaranteed.
“If once the children grow up, and circumstances make it hard to take care of their parents, they still try to check on them regularly while trying to find someone to be their caregiver,” Shoukri said. “The sense that they did not choose to be alone is often what pains the elderly the most, as is always the case whenever someone feels they are forced into a negative situation,” she added.
REMEDIES: Stigma is at the heart of many issues related to ageism, and it comes in different forms ranging from the vulnerability associated with ageing to a lack of services devoted to the elderly.
Civil society organisations often work in such areas because they are aware the government cannot tackle them all. “Of course, the role of NGOs is key, and we should not depend on just the government. The services and awareness campaigns the government implements are certainty important, but civil society's role is always helpful,” Shoukri said.
As a mental health practitioner herself, Shoukri believes retirement and nursing homes should be a choice based on several factors. Fortunately, the elderly sometimes see their appeal.
“How independent and comfortable at home an elderly person is should of course be considered, but I should also mention that there are plenty of people who want to move to these homes and socialise with others the same age as well,” she said. “Loneliness is tough on everyone, but elderly people who are not as healthy as they used to be or are grieving the loss of loved ones might have trouble channeling their energy towards activities and socialising,” she added.
Shoukri believes that “a person must foster a love and exploration of life.” In many ways, those who feel fulfilled by hobbies and passions are better equipped to deal with the challenges of old age.
Different people may have their own thoughts about how ageism affects the country, but many agree that it does not just come from a single place. A 2008 study published in the International Journal of Older People Nursing entitled “Attitudes of Egyptian Nursing Home Residents towards Staying in a Nursing Home” corroborates the fact that residential homes in Egypt “fulfil a number of specific functions”.
The study included interviews of 21 residents in four different nursing homes and found a pattern suggesting that “older persons from low-income groups stay reluctantly in charitable institutions due to disrupted social networks, whereas residents in fee-charging institutions may accept their families' decision.”
Sadek believes that in the end respect and appreciation is what older people desire. He feels that more privileges should be given to the elderly in “all public services from transportation to health care.” Moreover, “the media should stop negatively portraying the elderly as stingy, greedy, and out of touch with the changing social reality,” he added.
This is a point many agree with, but some believe it is essential to go further than that. Abdallah looks back at the visits with her daughter to residential homes and knows that society still has a long way to go. “I take my daughter with me on visits in the hope that she will treat the elderly kindly and maybe even remember that as I grow older myself,” she said.
*A version of this article appears in print in the 27 August, 2020 edition of Al-Ahram Weekly