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Migrant Health Care

DW staff (jp)June 23, 2007

Better support for patients with dementia is among a slew of hotly debated reforms to the German health care system. Experts fear that immigrant sufferers in particular are likely to fall through the net.

Immigrant patients often fall through the cracks of the health care systemImage: dpa

In Germany, some one million people are diagnosed with dementia, and the figure is expected to double by 2050, experts say. Patients require a specialist diagnosis in order to claim insurance, which all too often fails to secure them the support they need. Up to 40 percent of dementia cases end up falling through the net. Many of the patients have immigrant backgrounds.

In 2004, the Workers' Welfare Organization (AWO) in Gelsenkirchen set up a specialist department for migrants, offering information and advice and pushing for change within the country's hospitals and care homes. Its long-term goal is to see German health care adapt to the needs of immigrants with dementia.

The difficulties

Taking cultural sensitivities into accountImage: Bilderbox

These needs can be unpredictable. One of the first symptoms of dementia is a loss of short-term memory. The recollections that remain tend to be of events that happened in the patients' childhoods. So when the patient comes from another country, their carers often find themselves unable to help.

"Many of the immigrants in this country only arrived here at the age of 18, 19 or 20," said Reinhard Streibel from the AWO. "They came here to work, and now they're in their 60s and 70s. Even though they might have learnt to speak German at work, or by getting to know their neighbors and so on, as soon as they begin to show the symptoms of dementia, they will start to forget the German language."

Most treatment and support so far provided by the health services is tailored to the needs of German patients. Streibel said it is high time more culturally diverse services were made available, and his department -- with its official name "You are not alone" -- aims to take a first step towards a gradual improvement. The project is funded by North Rhine-Westphalia's Ministry for Integration, and so far, is the only one of its kind on Germany.

"We field queries about (the department) from all over the country," Streibel said. "To begin with, most of the interest came from the Turkish community, but over time we've seen growing interest from Polish and Russian families."

The department prints information leaflets on the illness and how to seek help in Germany. It also provides memory cards and a DVD about coping with dementia. This was developed in cooperation with the Turkish Alzheimer's' Society based in Ankara and was originally broadcast on Turkish TV to mark World Alzheimer's' Day.

Tradition and taboo

Das Altenheim Haus am Sandberg in Duisburg
Germany's retirement home for TurksImage: DW

According to the experts, the issue has long been taboo in Turkey. Turkish-born Bedia Torun, a consultant with "You are not alone," said this is partly because dementia is only now becoming more common in the country.

"The average life expectancy used to be lower in Turkey than in other European nations," she said. "That means that people tended to die before they reached the age when dementia usually hits."

On average, this happens at 65. But now that life expectancy in Turkey has risen to 71.3 -- according to the Turkish Statistics Office -- dementia has become more widespread.

Rare as it has been, many still feel the illness is shrouded in shame. Cultural and religious prejudice often stand in the way of appropriate treatment, and the Gelsenkirchen department wants to do what it can to change these mindsets.

"Among Muslims there are people who believe that a person suffering from dementia is being punished by Allah," Torun said. "When others hear that sort of thing they try to hide the member of the family with the illness and keep them out of sight."

Also difficult for Turkish families is dealing with parents who need looking after. Traditionally, they are the head of the family -- and shown due respect. A sudden onset of dementia, with the loss of dignity it usually entails, can be traumatic for families used to unbending hierarchies.

"Family members can have trouble adjusting to the fact that their father is no longer able to be in charge," Torun said. "Suddenly he needs looking after, he no longer recognizes his own children."

But like many other countries, Turkey has also seen a shift in family values. Often, children have grown up and moved away. Then, care of ailing relatives has to be done by professionals in the absence of nearby family members. This is another reason why Germany has to improve its support programs.

"We need to be able to provide more Turkish-language services for migrants struck by dementia," Streibel said. "So far these are completely unavailable."