Can Tamils ​​die for Tamil

India: Few can age gracefully

120 million people on the subcontinent are older than 60 years. There is a lack of retirement homes and care services. Many old people live in misery.

Refuge: Nursing homes and care services that look after the poor elderly are rare in India. In addition, hardly anyone wants to work in geriatric care. Photos: Benjamin Füglister

You can find them in every dark corner in the megalopolis of India. They crouch in every corner, on every dirty curb. Sometimes they even lie in front of the toilets of larger hospitals, writhing in pain. Wrapped in the smell of feces and urine. In a country like India, says Father Thomas, they are undesirable, rejected. We're talking about old people, some of whom are sick and poor as a beggar, people without rights, without a roof over their heads. You are the forgotten.

Father Thomas is one of the few who doesn't want to forget. The pastor is in his late 60s. He has lived all over the world and served the people there. But at some point, he says, he realized that he had to help in his own country, his own state, Tamil Nadu. With the help of donations, he has set up five hospices in recent years. They are oases of calm for currently 750 destitute, mostly old people, whom the government does not want to take care of. In places like the one near Chingleput, which is currently the largest hospice, they are given a bed, food and medicine.

Working into old age

Growing old in India has little to do with dignity. “Those who are old should die” is the common way of thinking. 120 million people in India are currently older than 60 years. By 2050, says Prof. AB Dey from the All India Institute for Medical Sciences (AIIMS) in Delhi, it will be 320 million. The majority of these people have to work physically well into old age. In rural areas it is 66 percent of men and almost 30 percent of all women. Whether they are sick does not matter, says Matthew Cherian, managing director of Help-AgeIndia, India's largest non-governmental organization (NGO) that works for the elderly. According to Cherian, only 1.6 percent of these elderly people benefit from the only form of old-age pension available in India, the Indira Gandhi National Old Age Pension Scheme. You get around five US dollars a month. According to surveys by the NGO, the family situation of elderly people often turns out to be particularly bad: 50 percent are abused, they are beaten, verbally abused, and punished with food deprivation. Depression is therefore not uncommon. "This is not a country for old people, it is a country for the young and smart," says Cherian.

In order to alleviate at least part of the suffering, the NGO is committed to the welfare and rights of the forgotten in all Indian states. 142 mobile medical units are in use. Since HelpAgeIndia was founded in 1978, doctors who volunteer for the NGO have treated 23 million people. Most of them suffered from chronic illnesses. In addition, the NGO spends food, clothing and money, organizes health camps for the elderly and sends emergency services to the countryside to help. At the urging of HelpAgeIndia, the scope of health insurance coverage for the poor in India (Rashtriya Swasthya Bima Yojana, RSBY) was expanded specifically to include the elderly in 2016. "We want more older people to finally apply for the insurance card," says Jain Nishant from the German Society for International Cooperation (GIZ) in Delhi. GIZ and the Indian government introduced RSBY in the country around ten years ago.

Oasis of calm: The Welcome House (above) is one of five facilities in which Father Thomas and his staff look after old people from the street.

Big families break up

Like Father Thomas, Shri Shreenath Hegde knew that he had to do something about the suffering of the elderly. Also because he believed he recognized a trend that had long been observed in western industrial nations: the breakup of the extended extended family. In 1982 he opened a retirement home in the center of Mangalore. Across India, only 214,000 people are housed in homes like this one. The majority of the total of 50 beds are given to people who have nothing. A handful of beds go to people who can pay for the accommodation themselves or their families. Most of the women who can be found here make a reasonably satisfied impression. The rooms look clean, but many of the beds are empty. The problem: there are hardly any staff. “Nobody wants to do the work here,” says Hegde.

Dr. Mohanraj Raj has the same problem. Raj runs an outpatient private nursing service. A novelty in India. “The nursing profession is not well respected. Nobody wants to take care of older strangers, ”reports Raj. He has to drive to the borders of Karnataka, far from Mangalore, to find staff. Unemployment is particularly high here. Therefore, especially the women are still willing to take care of the elderly. Raj pays his caregivers 14,000 rupees a month. In addition, there are various insurance policies that he takes out for you. You will receive a one-week training course to introduce you to elderly care. Then they are ready for use. You would have to work seven days a week. They would have one day off a month. That is normal, says Raj.

Finding people who are willing and trained to work in elderly care is one of the greatest challenges for the subcontinent. "We simply don't have enough skilled workers to cope with the growing number of elderly and sick elderly people," says Prabha Adhikari, Professor of Internal Medicine and Geriatrics at Yenepova Medical College Hospital in Mangalore. Only eight doctors in all of India are trained to become specialists in geriatrics each year. The subject is only taught at four universities. According to Adhikari, many doctors do not want to specialize because they earn far more as specialists in internal medicine. The geriatrician sees no solution in old people's homes: "Old people are not happy there."

At some point die with dignity

When Father Thomas closes the door of his ambulance for the last time, it is 4 p.m. He had been walking the streets of Chennai since seven in the morning. He drove all dark corners, walked all toilets at hospitals. He was able to collect eight people and place them in his makeshift ambulance. One has a wound on his leg with pus flowing out of it, another is smeared with feces, a woman is mentally confused and keeps mumbling that she will soon be released. The smell that comes from the ambulance is almost unbearable. The sun goes down as Father Thomas takes the last dirt road to the Welcome House. He and his two employees will soon wash the new residents, shave their hair and give them medication to relieve the pain. After that, they will sleep. Eat something. And then sleep again. And eventually die with dignity.

Martina Merten

The author's research was made possible by a Global Health Reporting Grant from the European Center for Journalism and the Bill and Melinda Gates Foundation.