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It's a part of getting older that many people worry about - the increased chance of developing diseases like Alzheimer's that cause dementia. But in wealthy countries, getting an early diagnosis can at least help a person's family understand and support them and sometimes get them on medications that can ease their symptoms. In lower-income countries, many people with dementia don't get that chance and suffer needlessly as their condition goes unrecognized. NPR's Nurith Aizenman reports on an effort to change that in Kenya.
NURITH AIZENMAN, BYLINE: So this is the house here?
SUSAN MUTUA: Yeah, I think so.
AIZENMAN: To give a sense of how big a challenge dementia poses in Kenya, a community health volunteer named Susan Mutua is leading me through an orange grove to a small concrete-block house belonging to a widow named Joyce Mutisya.
JOYCE MUTISYA: (Speaking Kamba).
AIZENMAN: Mutisya, who's 71, is full of laughter as she teaches me the proper greeting in the local language here, called Kamba.
MUTISYA: (Speaking Kamba).
AIZENMAN: (Speaking Kamba).
MUTISYA: (Speaking Kamba, laughter).
AIZENMAN: But her mood turns sad as she describes some ways her mind started betraying her, beginning about six years ago.
MUTISYA: (Speaking Kamba).
AIZENMAN: Like, she'd go to check on her chickens and, without quite realizing it, place her house keys next to the eggs. Then there was a time her church entrusted her with the funds for a building project.
MUTISYA: (Speaking Kamba).
AIZENMAN: "About $130," she says - a hefty sum in this farming community just outside the southeastern town of Wote.
Mutisya, who was church treasurer, says, when she went to deposit the money in the bank, she realized she had completely forgotten where she had stowed it. For three months she told no one, praying she'd find the cash before anyone asked for it, until one day she happened upon it stashed under her mattress.
MUTISYA: (Speaking Kamba, laughter).
AIZENMAN: "No one ever found out," she says.
But even then, Mutisya says of this problem of forgetting, as she calls it...
MUTISYA: (Speaking Kamba).
AIZENMAN: ..."I just thought it was because I'm getting older."
It never occurred to her that she might have a medical condition until last spring, when she was first visited by Susan Mutua, the community health volunteer who's brought me here today. Mutua is one of 10 locals who were enlisted by a team of Kenyan researchers to go house to house among 3,500 seniors in the area armed with a screening tool. Mutua takes it out of her purse. It's essentially a checklist of questions...
MUTUA: OK, let me show you the...
AIZENMAN: ...Things like, have you been feeling isolated? Have you had memory lapses? Can you repeat this sequence of words?
MUTUA: Like, here, we have house. We have a boat. We have fish. And I tell them, repeat as I've said.
AIZENMAN: Mutisya's responses raised enough red flags for Mutua to refer her to the local hospital for a professional opinion. The lead researcher behind this effort is Christine Musyimi of the nonprofit Africa Mental Health Research and Training Foundation. Speaking from her office in Kenya's capital of Nairobi, Musyimi explains that the first goal was to answer a pretty basic question - how prevalent is dementia in Kenya?
CHRISTINE MUSYIMI: That has been a life-changing program in Kenya because it is the first one to generate that information and evidence.
AIZENMAN: Normally, this screening questionnaire is used by health care workers. But the hospital in Wote has just one psychiatrist on staff.
MUSYIMI: Serving a population over a million - so in the entire county, there is no other psychiatrists.
AIZENMAN: By training up the volunteers to do the initial screening, Musymi's team was able to estimate that among adults over age 60 in the county, 9% have some form of dementia. Musyimi says getting that data has been crucial because it's helping her make the case for the ultimate goal here - ensuring that Kenyans with dementia get early care for their condition. By referring all these people who screened positive to the hospital...
MUSYIMI: We are creating a need, telling the policy makers that, you know, something needs to be done about dementia.
AIZENMAN: And the project is actually part of a global initiative to address dementia, called the Davos Alzheimer's Collective, that's funded by the World Economic Forum and is supporting similar efforts in rich countries like the United States, but also many lower-income ones, like Armenia, Brazil, Jamaica and Mexico. In Kenya, Musyimi says the next task will be to ensure that people who screen positive have more places to seek help and access to psychotropic medications that can sometimes ease dementia symptoms.
MUSYIMI: For example, if someone is having hallucinations.
AIZENMAN: But Musyimi says it can often also be enormously effective to simply treat other conditions that can exacerbate dementia - diabetes, AIDS and hypertension.
MUSYIMI: So just improving the quality of life of this person.
AIZENMAN: And back at her home by the orange grove, Joyce Mutisya says that was her experience.
MUTISYA: (Speaking Kamba).
AIZENMAN: She did get to the hospital, where she was given pills to bring down her blood pressure. The effect on her mind was noticeable. Now, she says, I can make plans with friends and still remember it when they show up. But best of all is a sense of peace. Before, Mutsiya says, I was so stressed wondering what was happening to me. Having someone you can talk to about this...
MUTISYA: (Speaking Kamba).
AIZENMAN: ...It felt like God's grace.
Nurith Aizenman, NPR News, Wote, Kenya.
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