Tahmima Anam

Dying old and alone in Bangladesh

One of my father's older brothers, Manzur Anam, died last week. He was in his early 70s, and though the medical reasons for his death were many, it was loneliness that killed him.

There is a prevailing sense that the old in places like Bangladesh age with their large extended families around them, and that age gives them power, respect and status. It is in the West, we have been told, where they disrespect their elders and abandon them to nursing homes.

But while the ageing population in Bangladesh may have enjoyed some measure of security in the past, dramatic changes in the social fabric - rapid urbanisation, mass migration and a focus on the nuclear family - have heralded a transformation in the way we regard and treat our old.

My uncle lived in Dhaka's modern architectural convention: the apartment building built on the site of an old family estate. He came home from work every day and sat on one corner of his 1950s green sofa and ate dinner in front of the television. On Fridays, he played a regular poker game he'd begun with friends 40 years ago.

In the servants' quarters lived his housekeeper, Lucky, a young woman who looked after him with efficiency and tenderness in his last days (he was estranged from both his wife and his son). In the rest of the apartment building were the extended family - the sons of my father's other three brothers, and their wives and children. His nephews (my cousins) dutifully kept vigil at his bedside through several long illnesses.

Yet, there was no one to hear my uncle cry out when he fell from his bed. It was Lucky who discovered him the morning after his stroke, lying helpless on the floor where he'd fallen.

Bangladesh self-identifies as a young country with an old culture. The nation itself is only 43 years old; we refer to ourselves as a young democracy, an emerging economy, a nascent political culture. Even our anxieties are those of a nation whose young dominate the national agenda: With a median age of 24, we worry that, if they are not educated and provided with jobs, the young men will become radicalised, the young women will marry too early. At the same time, we fetishise a past in which the family unit was large and capacious enough to absorb the needs of all generations.

So how will Bangladesh cope with its ageing population? The number of seniors is set to rise sharply, largely because of improved health care. It is estimated that nearly 44 million Bangladeshis - 23 per cent of the projected population - will be over the age of 60 by 2050. This demographic shift will force us to think critically about ageing, what the anthropologist Lawrence Cohen calls "the body in time". We still revere the old in the ways we always have, by referring to an old person as the head of the family. As the eldest man of his generation, we treated my uncle like the patriarch he was.

Yet he aged alone and out of sight. This is because while the ageing body as a symbol retains power, the ageing individual is more and more a person whom it is possible to neglect. He is relegated to his subdivision of the family property, his illness sanitised by the new hospitals we are grateful to have throughout the city, his solitary life witnessed only by the people paid to look after him.

For Bangladeshis like me, living far from home, the question of what will happen to our ageing parents is a pressing one. For the hundreds of thousands of migrants who leave Bangladesh every year to work abroad, there are parents who are left behind, often to look after grandchildren. Those families back home are the ones who have to cope with the alienation of being left behind.

What is pressing for a middle- class family is all the more challenging for a poor one. In "development speak", there is a category of people in Bangladesh who are referred to as the ultra poor - the bottom 10 per cent who live without income or resources. The old and the disabled make up a disproportionate number of the ultra poor; even the aid packages designed to help them are sometimes ill-suited to their needs. There are means-tested state pension programmes for older people, but bureaucracy and poor access mean that enrolment is far lower than it should be.

To address the impending demographic shift, we must first admit that we are no longer a society that has automatic safety nets for the old, that the fantasy of better ageing is just that - a fantasy rooted in our denial of how old people are treated. We must then go about the hard work of creating new systems that address the challenges we are about to face.

We need better nursing care, more palliative care in hospitals and national health-care initiatives aimed at the older population. Development programmes and nationally funded pension plans must be made more accessible. Most important, we need to help older people form their own communities in order to reduce the crippling loneliness and isolation of ageing.

My uncle's funeral was attended by more than 300 people. Friends and colleagues commented on his sense of humour: It appeared that he had laughed with his friends when they told stories of their happier, fuller families, hiding the shame of his own isolation behind a quick wit and a ready smile. Few were privy to the reality of his last days. "It is ironic," my mother wrote to me, later that day, "that a man so beloved should have died alone."


The writer is an anthropologist and the author of the novel A Golden Age.