Rwanda has only one geriatrician currently, according to Rwanda Biomedical Centre (RBC). This statistic suggests that there is one specialist in the elderly’s healthcare for around 707,000 old people (aged 60 years and above) in 2020 as per estimates from the National Institute of Statistics of Rwanda (NISR).
And, the Ministry of Finance and Economic Planning projects that senior citizens are expected to double by 2032.
A geriatrician is a medical doctor specialised in the healthcare needs of older adults who often have multiple medical conditions.
They study geriatrics, which is a branch of medicine specialising in the health and illnesses of older age and their appropriate care and services, according to the World Health Organization (WHO).
According to the American Geriatrics Society, a geriatrician can care for up to 700 patients.
Elie Mugabowishema, Head of Nsindagiza, an organisation striving for the welfare of the elderly told The New Times that lack of specialists in the treatment of old people’s medical conditions was resulting in poor healthcare.
"Some old people are not interested in going to doctors at hospitals because when they explain their ailments, [sometimes] doctors tell them that it is the norm for old age and they cannot change it,” he said, indicating that they do not receive effective treatment.
"We have been advocating for geriatricians for long. They are much needed,” he said.
He said that the elderly are prone to chronic and health-threatening diseases such as diabetes, hypertension, and hepatitis, adding that the current Covid-19 pandemic which is a viral respiratory disease also has devastating effects on them compared to the young population.
When the National Commission for Human Rights was presenting its activity report for the financial year 2019/2020 to both chambers of Parliament on Wednesday, October 14, 2020, Senator Cyprien Niyomugabo, said that geriatrics has not been given enough attention, yet it is needed in Rwanda.
Niyomugabo represents public universities in the Senate.
"The Ministry of Health and that of education should start devising plans for geriatrics education in order to improve healthcare for the elderly,” he said.
Developing a geriatrics programme in Rwanda
Dr François Uwinkindi, Manager of Non-Communicable Diseases Division at RBC told The New Times that Rwanda is waiting for four more geriatricians who are expected to graduate from France and Belgium next year (2021). This will bring the total to five, given that there is one in the country so far, which also said will not be enough.
He indicated that the country wants to include geriatrics in medical academic curriculum and start teaching related courses, which is expected to start in 2022 after the four have completed their studies.
"We want to build on those five geriatricians in order to start geriatrics subspecialty here in the country,” he said, pointing out that having medical personnel trained abroad was more expensive than domestically.
Meanwhile, Uwinkindi noted that there are specialists in internal medicine who have been helping in the treatment of old people. But, he said that they should train in geriatrics so that they provide comprehensive health care to the elderly.
"Under the Ministry of Health’s 10-year programme to train medical personnel, there is also training enough specialists in geriatrics,” he said, adding that as the country develops, it gets many old people, hence the call for many specialists to cater to their health needs.
Common health conditions associated with ageing
The World Health Organization (WHO) says that common conditions in older age include hearing loss, cataracts and vision problems, back and neck pain and joints diseases, chronic obstructive pulmonary disease, diabetes, depression, and dementia.
Older age is also characterised by the emergence of several complex health states that tend to occur only later in life and that do not fall into discrete disease categories. These are commonly called geriatric syndromes.
They are often the consequence of multiple underlying factors and include frailty, urinary incontinence, falls (that result in injuries or can be fatal), delirium and pressure ulcers.
Frailty is a medical condition that occurs as a result of ageing-associated declines in energy, strength, and function that increase a person’s vulnerability to stress and disease, while delirium is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment.
Globally, there were 703 million persons aged 65 years or over in 2019, and that number is projected to double to 1.5 billion in 2050, according to the World Population Ageing 2019, a report by the Population Division of the United Nations’ Department of Economic and Social Affairs.
The report indicated, the share of the population aged 65 years or over increased from 6 per cent in 1990 to 9 per cent in 2019.
In 2018, the WHO reported that by 2020, the number of people aged 60 years and older will outnumber children younger than 5 years, but that all countries face major challenges to ensure that their health and social systems are ready to make the most of this demographic shift.