Central Asia’s elderly suffer in silence

Published: 13 August 2004 0:00 CET

John Sparrow

If it were left to her pension, Evdokia Davydochkina would be in trouble. After paying the electricity and water bills, she would not have enough left to buy a loaf of bread each day.

Like hundreds of thousands of lonely older people in Central Asia she scrapes by, worrying what tomorrow will bring, fearful of illness, dreading incapacity.

Many suffer in silence with far less than the bare necessities defined by international standards. Resourcefulness and willpower keep them going, homemade remedies replacing the health care no-one can afford, home-grown ingredients providing a deficient diet.

But there is hope for Evdokia, 65, and five of her friends in Ak-Suu district of Issyk-Kul province, in north-eastern Kyrgyzstan.

For now they have Pretty Girl to help them. She cannot solve all their problems but she does improve their diet and put some much-needed cash at their disposal.

Pretty Girl is a nine-year-old cow expecting her third calf.

She was provided by the Issyk-Kul branch of the Kyrgyzstan Red Crescent, one of five cows so far supplied as part of a so-called home-kitchen project aimed at improving the daily nutrition of groups of lonely elderly in the region. As they calf, resources grow and more groups will enter the fold.

It is Evdokia’s job to tend Pretty Girl. She has the warmest hands, says neighbour Nadejda Starchenko, 79, so she does the milking, getting an average of seven or eight litres a day.

Twice a week, the women take a litre each for themselves and the rest is sold, either from their homes to regular customers or on the local market. The money goes into a revolving fund that covers the cow’s care and upkeep and provides the women with essential support should they be confronted by a minor crisis. But first and foremost it is about nutrition.

Evdokia is up with the lark to milk Pretty Girl. The cow is kept at her home and, unless the weather is especially inclement, is led off after milking to munch the grass in the nearby hills.

“She’s a nice quiet cow,” Evdokia says, “and all that pasture helps her produce the very best milk, something we could never afford without her. Milk was one of the things we had to give up after our husbands died and the children left. But how we missed it. Now we make things like porridge again, and have our tea with milk.”

Poor pastorale
The number of lonely elderly people in Central Asia has risen dramatically since the break-up of the former Soviet Union. As economies failed and unemployment rose many younger people looked for a future elsewhere and many chose to settle in Russia. Few could afford to take ailing and elderly parents with them.

They stayed at home and with state care dwindling, were forced to fend for themselves.
When the women of Ak-Suu come together in Nadejda’s small home after the morning milking, little seems to be amiss.

The interior may be Spartan, but with its blue-painted windows, the tomato and pepper plants growing against the outside wall and chickens scurrying about, the one-storey house is straight from a pastorale. Then the ladies in headscarves start talking.

They live on pensions of around 500 soms (between $12 and 13) a month, less than half the cost of what is deemed to be the minimal food basket in this country. They put the monthly figures together and outgoings exceed their incomes: 300 soms for utilities, 300 soms for a loaf of bread each day, 200 soms for sugar and butter.

What about health care? “We cannot afford it,” says Evdokia. “Do you know what it costs to visit a clinic? At least a thousands soms.”

Between them they have a thousand alternatives: herbal remedies they got from their mothers, and from their mothers’ mothers. All of them suffer from rheumatic pains when the weather turns cold, which in Ak-Suu can mean minus 35 centigrade.

So they make an extract of lilac which, in a poultice, is said to work wonders.
What if you break your leg? “We would probably borrow money from neighbours.” Or Pretty Lady’s revolving fund these days of course.

While the thought of approaching winter makes them shiver, these women need no lectures in preparedness. Through the summer they have gathered firewood, made charcoal and somehow from their miserable pensions they saved a few soms for emergencies.

“We heat only one room,” explains Evdokia. “We sleep, eat, do everything in it and leave the rest of the house until spring.” Such women deserve a Pretty Lady.

People power
The lend-a-cow scheme is one of a series of empowerment projects contained in Red Crescent branch development programmes supported by the Netherlands Red Cross. In Kyrgyzstan, Tajikistan, Uzbekistan and Turkmenistan they are enabling the Red Crescent to strengthen their grassroots and widen their community base.

Behind it lies a philosophy of working with the people for the people, known as participatory community development (PCD). Helping people to reduce their vulnerability to social, economic and natural disaster, PCD mobilizes community action and complements the grassroots networks of Red Cross and Red Crescent National Societies.

“Rather than have people wait for services to be delivered to them, we want to involve them directly in Red Crescent activity as volunteers and activists,” says Violeta Lombarts, of the Netherlands Red Cross.

Mitigating the plight of the elderly is a Red Crescent priority across the region and in Kyrgyzstan a range of services is being developed.

In Karakol, the Issyk-Kul capital, a bath and sauna that the public pay for are free for the elderly and poor children, as are a laundry and Red Crescent medical rooms where doctors, a dentist, an optician and a physiotherapist ensure that Karakol’s most vulnerable people receive basic health care and medication. Home visits are made to the housebound.

A club and choir bring others together to sing songs – sometimes with a tear in the eye - from the Soviet Union period. “Being alone you speak to no one,” says 79-year-old Elena Maximova. Her husband is dead and she has lost touch with a son who lives somewhere in Russia.

“I love singing and my friends are my family now. I tell them my troubles and they tell me theirs. Sometimes we find solutions.”

To the south, in Naryn province, volunteers call on a growing number of older people although Red Crescent chairlady Aigul Jumakanova warns that they get to only ten per cent of those they would like to reach.

Lives, however, are being saved and suffering alleviated.

No one else visits 86-year-old Zainap in Naryn city. Were it not for two young women who call on her twice a week she would probably have died last winter. They found her lying immobile with a broken leg.

The Kalchaeva sisters, 107-year-old Toktobubu and 90-year-old Sadyke, have each other but in their geranium-adorned whitewashed house, they are nonetheless isolated.

The elder woman is bedridden and her sister walks with difficulty using two sticks. Yet the local authority does nothing for them. They depend entirely upon the Red Crescent, and the volunteers’ bi-weekly visits.

“Very nice young people,” says Sadyke. “I can’t imagine what I’d do without them?”
Certainly they would go without medication because their meagre pensions are their only income. Aigul Jumakanova is using the case to garner support for medical rooms similar to those in Karakol.

“We must also reintroduce our visiting nurses,” says the Red Crescent’s Issyk-Kul chairlady, Jypara Kadyralieva.

Visiting nurses
Home care for the elderly and disabled was paid for by government in the Soviet Union and the Red Cross and Red Crescent was famous for it. From the Baltic to the Caspian Sea and from the Chersky Mountains to the Pamirs, its visiting nurses were a lifeline.

With the collapse of the Soviet state, however, funding declined or stopped completely, and in the newly independent states, the number of nurses dropped dramatically. Home care services began to unravel as economic constraints brought hard times.

Other Red Cross and Red Crescent National Societies offered help. The Swedish Red Cross for example, kept countless services running. But when their funds ran out, home care was in crisis again.

The Uzbekistan Red Crescent was helped by the Swedes. A decade ago its Tashkent city branch had 360 visiting nurses but today it has 41 helping 700 elderly people. They work six days a week and the equivalent of US$15 a month, paid for mainly by local fundraising.

As elsewhere in the former Soviet Union, more sustainable sources are hard to find and new ways of cooperating with the state are clearly a key to the future.

The authorities know the advantages of the Red Crescent in providing community service as an auxiliary to government. It strengthens state care in many places and the ability of its volunteer network to reach and assist the most vulnerable is second to none throughout Central Asia.

The importance of voluntary service in restoring home care in the region is being underlined in Tashkent. They dearly need more funding for nurses, but trained volunteers, the Red Crescent says, could make the service more viable. By providing social assistance they could shoulder a burden now placed on the nurses and boost the programme considerably.

The Tashkent city branch plans to do this by bringing in Red Crescent Youth. “Our young people are saying they want to contribute,” says Dr Delorom Berveva, who coordinates home care activities.

“What we foresee are these young volunteers dealing with household necessities, cleaning, shopping, taking care of repairs and keeping an eye on things. Our nurses could then focus on medical issues instead of having to do simply everything.”

More volunteers could be found, she believes, among the elderly. There are many healthy, mobile older people sitting at home, feeling no longer useful, she says. Their lives would be richer helping their peers as part of the Red Crescent programme.

For now, all still depends on nurses like Zilola Mirzeva with her caseload of 35 people. She is more than a nurse. Yes, she takes their pulse, measures blood pressure, provides them with care and medication and calls in a doctor when necessary.

But she is also a companion, a listener, as well as a household help. Widow Tamara Ahmedova, 72, looks forward to her visits. “I have nobody else to talk to but God,” she says.

Saving the lifelines
Such scenes are repeated across Central Asia. Progress is slow but evident. After finance stopped in 1995, the Tajikistan Red Crescent lost all its nurses but a modest recovery followed. Today there are 72 caring for 1,500 bedridden elderly nationwide.

More nurses are needed. The Ministry of Social Care wants the Red Crescent to expand its services. One option being explored would utilize other Red Crescent nurses who visit homes in a TB programme. Their role would simply be widened.

Strategy 2010, the International Federation’s guidelines for the decade, emphasizes that government is responsible for ensuring that health and social welfare systems meet the needs of the population, particularly the most vulnerable.

It is a role the Red Cross and Red Crescent should never take over. But social safety nets are failing and the Red Crescent sees the consequences.

Saving the elderly’s lifelines has to be made sustainable. Helping them to help each other has to be part of the answer.