In March 2011, my American father followed in the footsteps of his long-ago ancestor — Sir Francis Drake — and came to the shores of Lima, Peru, hoping to find not gold, but rather a bit of sanity and comfort in the home of me and my husband, Jorge. My father’s Alzheimer’s, which had just been diagnosed, got worse quickly, and Jorge and I desperately searched for the magic combination (medications, skilled help, environment) to make his world stable again. Could we find it in respiradona-laced grapes, activist nurses, miraculous saints and Peruvian telenovelas?
In other posts, I’ve written about how affordable home-health aides are in Lima, a benefit that greatly helped our family when caring for my American father in Peru.
Today I want to share another bonus of caregiving in Lima: how medications are sold and dispensed. The Latin American system is so different than the for-profit model used in the United States, it’s shocking–and I mean that in a good way.
Basically, consumers at a Peruvian pharmacy can get almost any medication they want for about 70% less than what it would cost in the United States–without a doctor’s prescription. This savings applies only drugs that are no longer under patent and which are currently manufactured by several companies or as generics. New medications under patent are still full price.
For instance, the memory drug Excelon was still under patent when my father was taking it in 2011, so we had to pay full price (more than US$100 a month) for it in Lima. However, the eight other medications he took daily (Omeprazol, Sertraline, etc.) were available in generic form, and we ended up spending about US$80 a month for all of them together.
The savings were considerable, so we didn’t need his US insurance to cover drug costs. (His prescription plan didn’t work down in Peru anyway).
I know that some readers are still stuck on that phrase in the third paragraph–“without a doctor’s prescription.”
Yes, that’s right. With the exception of certain drugs (see below), medications are freely dispensed in pharmacies sin receta (without a prescription), and overall, this works to the consumer’s favor in Peru, apart from the hazards of self-medicating. People do go to doctors and get prescriptions, but they aren’t necessary for initial purchase. And this system makes it much easier when you are a caregiver to an elderly person and you have to keep up with lots of refills.
One of the surprises of bringing my 86-year-old father to Peru was seeing how much he ultimately thrived on having lots of human contact. To be blunt, his being doted on by sweet-tempered Peruvian women helped transform him from a vain, self-absorbed, prickly old man into a calm person who was actually kind of nice to be around. (Getting him on antidepressants—which I suspect he had needed for years–also helped.) Being part of la comunidad (the Spanish word for “community”) was an integral part of his emotional care.
Never a physically demonstrative person, my father had lived a rather solitary life in the United States. Widowed at age seventy-seven, he lived alone in a four-bedroom house in northern Florida and resisted having me, Jorge and Sam come live with him when we proposed the idea. His interactions with other people were limited to weekly church services, monthly Masonic meetings and brief transactions with grocery clerks, bank tellers, doctors and nurses. This wasn’t really that big a change from the way he had lived when my mom was alive. For decades my mother had been the center of his emotional life; when she died of lung cancer in 2004, he bought a toy poodle and lavished his affections (and Krispy Kreme donuts) on that. He had no close friends to speak of, just people he had known up north long ago and with whom he exchanged annual Christmas cards.
Moving my father to live with us in Peru put us in a different, more humane, paradigm.
In contrast with the United States—which prizes, above all, independence and individualism—Peru is a country of collectivism. Continue Reading
Old people can suprise you. My father sure did. At age 86, newly diagnosed with Alzheimer’s and unable to care for himself, he agreed to go to Peru to live with me and my husband. He boarded a plane in Orlando and said goodbye to his house, his dog, his country — every trace of the person he had been. From the moment his plane touched down in Jorge Chavez Airport, his life was never the same. Alzheimer’s + a foreign country + a completely unknown language (Spanish). His new reality was, to say the least, disorienting.
Some elderly people might have wanted to kick the bucket right then and there. And at first, my father did. “Why are you feeding me?” he asked. “Go away. I’m dead.” He went on a hunger strike. He barely drank. For days this went on, then we hooked him up to an IV and pumped some fluids into him. An intelligent doctor prescribed an appetite enhancer, an antidepressant. One day my father showed up at the dinner table: “What’s to eat? I’m starving.”
My father had nursing aides to care for him at our house. They were sweet-tempered, patient souls who didn’t speak a word of English. When he took off all his clothes and threw them in the corner, they calmly picked them up and held them out. “Mister John, put them on, please,” they said in Spanish. Take your pastillas [pills]. Drink your jugo [juice]. Day after day after day. Thank god for the language barrier. They had no idea he called one of them “the fat one” and thought that the small, androgynous aide with glasses was a man.
Fast forward six months: My father is sitting side by side with his nurse, on the couch, watching a telenovela. A drop of mucus hangs from his nose. She glances over, reaches into her sweater sleeve, and wipes the drop off with a tissue that she keeps there for for that purpose. Then she checks her wristwatch.
“Meester John, sus pastillas.”
“Quieres algo a tomar?”
“Si,” he says.
“Jugo de manzana?”
We all thought his story was over. But as he continued to show us, right up to the end, a new chapter was writing itself. The true wine of astonishment, indeed.
Spoiler alert: If you want to preserve the illusion that hospital care for the elderly is efficient, cost-effective and caring, read no future.
My father spent more than a week in the hospital after his collapse in January 2011. He received physical therapy to help him walk again. He received antibiotics. The nurses were caring and on the ball. But what the heck was wrong with him?
I never got any real answers.
By the time I arrived in Gainesville, my father had been on antibiotics for two days. I wanted to know what the infection was. After several days of pestering, one of the nurses confessed: They hadn’t taken a urine sample for testing before they started the antibiotics, so there was no way of knowing what kind of infection he had. They presumed he had a urinary tract infection. Since antibiotics are the necessary treatment, they had started him on them right away.
Looking back on it, I should have known much earlier – way before his collapse or the discovery of the condom – that my father was not right in the head, that his problem was much more than an imaginary impacted colon. His digestive plumbing worked great, it always had. His mental state – well, that was another matter. He’d always been spacy, had held himself aloof from people, was known for uttering non sequiturs. But I should have known that his mental state was slipping. As recently as December, he’d repeated himself multiple times at Christmas dinner with friends of mine. That should have been a clue. Why hadn’t I thought to get him a household companion? Why hadn’t I seriously entertained the idea of our moving back to help him?
Because he was obstinate and didn’t want help.
Because he was not fond of people.
Because he liked living on his own and had said he didn’t want us to interfere.
Because I found it easier living far away from him, where he couldn’t be cruel to me.
As you can probably tell from the title of this blog, this is an Alzheimer’s story, the story of my father’s descent into the disease, and the strange ride that I and my family took along with him. And like many Alzheimer’s tales, it begins not with the onset of the disease, but rather, with the moment the family learns of the diagnosis. My dad, you see, never knew he had Alzheimer’s.Continue Reading
“Failure to thrive,” was the EMTs’ initial assessment.
It was two days after the collapse, late afternoon, and I was standing in my father’s hospital room, after having taken a five-hour flight from Lima to Orlando, then a two hours’ ride by car to Gainesville. The bright florescent lights shone on the newly polished linoleum floor, some kind of heart monitor beeped in the background. My dad was propped up in bed, his face gaunt, an IV tube stuck in his arm.
His face brightened when he saw me. “Barb….”
“Oh, Dad, god.” I bent down to hug him. He felt bony – much thinner than when I had visited him at Christmas time a month earlier. How could someone change so much in so short a time?
“What happened?” I asked.
“I don’t know.” He blinked his watery blue eyes. “I think I was in my house.”
I walked over to the chart pinned on his wall. My dad was being given intravenous with glucose, vitamins and antibiotics. What were those for?Continue Reading
In January 2011, I had a strange conversation with my father.
My husband and I were living in Peru, our home for the last five years. My father, a healthy 86-year-old widower, was living in his home in Florida. He was all alone except for his poodle, Charlie Brown. Still, he got out regularly – errands, church, weekly meetings of the Masons. I wasn’t too worried about him. Years before I had gotten him one of those Life Alert things, and he wore it around his neck. His neighbors looked in on him. Plus we talked several times a week. This was one of those times.
“Dad, I tried calling you earlier,” I said. “The phone just rang and rang. Where were you?”
“Oh, Barbara. It’s all screwed up…” His voice trailed off.
“Dad, where were you?” I persisted.
“I’m right here,” he said, his voice keening.
“Is everything okay?”
“All they gave me is goddamn crackers.”
“Dad, you’re not sounding okay.”
“Just Townhouse crackers. Shut up!” This to the dog, who was yapping in the background.Continue Reading