Before she started to forget things, Elizabeth Mustafa was relearning how to walk. Her diabetic foot ulcer had gotten out of control and her right leg had been amputated.
Leaning on her four-wheeled walker, she would try to manoeuvre herself around the house as someone, usually her daughter-in-law Victoria, accompanied her, watching, guiding, removing objects from her path.
Three years before she lost her leg, in 2010, Elizabeth fled religious rioting in northwestern Nigeria after receiving threats that her house and grocery store would be burned down. Seeking safety, she moved to Ibadan to live with one of her six sons and his family.
She loved telling her four grandsons stories about life in Ghana, where she was born and lived with her parents until 1969 when Ghana’s then-prime minister, Kofi Busia, passed the Aliens Compliance Order, forcing African migrants – many of them Nigerian, like Elizabeth’s parents – to leave.
Now 66, Elizabeth still enjoys telling stories about her life back in Ghana. The boys sit around her in their living room in Alarere, Ibadan, listening attentively and chipping in with anecdotes of their own as she remembers the school she attended, the friends she had.
“They [Ghanaians] are nice people. They show love,” she says in Ashante Twi, before translating it to English.
A smile spreads across Elizabeth’s face as she eases herself onto the brown sofa, holding a small radio to her belly.
“She remembers things from long ago. All others are pockets of memory,” Victoria Mustafa explains gently.
‘Where am I?’
The Mustafas live on a neat, quiet compound. The white-walled living room is punctuated by cream curtains that drape the windows and the entrance to the passageway leading to the bedrooms.
Victoria says this was where they were sitting a few years ago, shortly after the amputation, when Elizabeth suddenly asked: “Where am I? What am I doing here? What’s the name of this town?”
Some mornings, Elizabeth would hold a tube of toothpaste for minutes, staring at it, before finally asking what it was used for. There were times when she could not remember the names of her relatives.
“We were thinking, ‘What’s this? What’s going on?’ We didn’t understand what was happening,” says 42-year-old Victoria, who is wearing a purple shirt – the official colour of the Alzheimer’s awareness movement.
Victoria, who is from Kaduna, first met her future mother-in-law in 2004, two years before she married her son and moved to Ibadan.
“She was active and loved to tell stories,” she recalls.
The change seemed sudden. Initially, the family assumed she was seeking ways to cope with the loss of her leg. Then they grew irritated with her.
“We thought she was just being difficult,” Victoria says.
It was when she started to wake in the middle of the night, struggling to reach her walker, demanding that the door be unlocked so that she could go and open her grocery store, that they realised something was wrong.
‘A pathology of the brain’
Victoria and her husband took Elizabeth to the University College Hospital, Ibadan (UCH), where they were referred to a psychiatrist.
The psychiatrist treated her for depression. But, says Victoria, “after a long time, she was still not well”.
They took her to the hospital again in 2016 and, three years after she first started showing signs of confusion, Elizabeth was diagnosed with dementia.
“I had never heard of dementia,” Victoria says.
Dr Temitope Farombi, a consultant geriatric neurologist at the Chief Tony Anenih Geriatric Centre at UCH, explains that relatives often assume that the early signs of dementia – confusion, irritability, difficulty performing familiar tasks and memory loss – are just normal signs of ageing.
But, Farombi says, “ageing is a physiological process, while dementia is a pathology of the brain. It presents in the form of memory loss and behavioural abnormalities”.
The doctor sits at her desk in her office, explaining that issues affecting older people are rarely reported.
“Early diagnosis helps stall other associated risk factors that could accelerate the progression of dementia,” Farombi explains, adding that “meditation can help improve cognition”.
Farombi started working with dementia patients in 2015. She says she looks for signs, like an inability to remember the name of an object (asking for a thing that is used for eating, for example, but not recalling the word ‘spoon’), going to the mall with a shopping list and coming back with nothing, or driving to an event but returning in a taxi.
Other symptoms include difficulty processing instructions, confusion about time or place, being suspicious of people around them, and depression, she explains. People in the later stages of dementia can experience bowel and bladder incontinence and an inability to communicate. “And at the end, you see them bedbound, severely dependent on people,” Farombi says.
A healthy lifestyle and diet can help to reduce susceptibility to dementia, the doctor explains, but “no drug can reverse it”.
The challenge of geriatric care
Love and support from family and early medical intervention can help improve the living standards of people with dementia, says Olayinka Ajomale, a consultant geriatric social worker and the executive director of the Centre on Ageing, Development and the Rights of Older Persons in Ibadan. But, says Ajomale, geriatric care is at an early stage in Nigeria.
UCH is the only hospital in Nigeria with a full-fledged geriatric care centre.
Every year, experts in different aspects of gerontology are invited to conduct training sessions for doctors from across the country at the UCH’s geriatric care centre. “All tertiary institutions should have centres like this, not just units,” says Ajomale.