{"id":443589,"date":"2017-03-12T12:12:30","date_gmt":"2017-03-12T12:12:30","guid":{"rendered":"http:\/\/www.moldova.org\/en\/?p=443589"},"modified":"2019-06-02T06:06:15","modified_gmt":"2019-06-02T06:06:15","slug":"alzheimer-moldova-still-outside-public-consciousness","status":"publish","type":"post","link":"https:\/\/www.moldova.org\/en\/alzheimer-moldova-still-outside-public-consciousness\/","title":{"rendered":"Alzheimer in Moldova, still outside the public consciousness"},"content":{"rendered":"Reading Time: <\/span> 9<\/span> minutes<\/span><\/span>

“In December, when I came home for three weeks, my mother could not remember me”, says Irina with a low voice. “We were both sitting on the sofa when I asked her: Mom, how old are you? Sixteen, she said”.<\/p>\n

Irina’s mother, Tatiana, experienced\u00a0her first memory gaps in 2011, after she retired. She was reading\u00a0less and less and sometimes was forgetting to wash her mug. She was more apathetic. The retirement coincided with the period when some neighbors she used to drink coffee with left the block. “I started to realize that we need to offer her time to adapt to the new lifestyle. Still, I proposed to search a half-day job or to get a dog, but I could not see in her eyes any desire to change something. I want to stay with you, with my friends- she told me”.<\/p>\n

In some months, the first changes of the personalities started. “My mother was always disciplined, a perfectionist. Suddenly though, many things started not to matter to her: not the news we used to watch together, every evening, not even the cleaning”. Tatiana’s family decided that the time to see a doctor came. The doctors recommended to do a MRI scan and prescribed treatment with injections. Even if she took the medicine, Tatiana’s state did not get well.<\/p>\n

Two years ago, the woman was consulted by a psychiatrist. “Then, I heard for the first time about Alzheimer. It was a shock for all of us. The doctor that we went to knew mother since the times she was healthy. He asked us: What happened? How did the disease evolve so quickly? We were asking the same thing”.<\/p>\n

***<\/p>\n

There is no official statistics in Moldova regarding the number having Alzheimer. “The Alzheimer dementia, like other types of dementia are included in the category of mental illnesses”, says Igor Nastas, professor at the Psychiatric Faculty of the Medical University “Nicolae Testemi\u021banu”. According to the National Bureau of Statistics, approximately 79000 patients of all ages are registered as suffering from mental and behavioral illnesses in 2015.<\/p>\n

Alzheimer is a type of dementia from among other that elderly people\u00a0develop. “All the information from our brain is based on the transmission of impulses, like telephonic paths. In the case of Alzheimer syndrome, some parts made out of insoluble protein, called amiloide, are left on the pre-synapses spaces and interrupt the connection. It is also said it is caused by\u00a0tau proteine, that forms balls and breaks the cerebral neurons. The disease is incurable” explains Dr. Nastas.<\/p>\n

The first symptoms of the illness can be mistaken with the changes specific to the old age: the old people forget where they put their glasses or the name of the person they met. In the case of Alzheimer, the symptoms are continually getting worse, affecting more than the memory of the patient.<\/p>\n

\"\"

Illustration by Irina Cle\u0219cenco<\/p><\/div>\n

***<\/p>\n

Galina, Elena’s grandmother, had her first symptoms in 2010, when her niece was a Medicine Student in the 2nd year. “Grandma Galina- favorite person of my childhood… She was born in Odessa region and learned Romanian when she moved to Moldova, thus she spoke it with a very cute accent”, tells Elena.<\/p>\n

The woman gave birth to 11 children and was the only doctor for three villages: Suhuluceni, Coropceni and Cli\u0219ova. Suhuluceni from Telene\u0219ti district, where she lived her life, loved her because she was always searching for understanding and good for all.<\/p>\n

At first, Alzheimer slowly advanced. “Grandma had short memory losses and then stable periods followed”, remembers Elena. But like a tsunami, after the wave gets to the maximal point, the wrath starts. Galina’s dementia seriously advanced.<\/p>\n

“You must have a fine intelligence to realize that something is not good with you. And grandma understood it”. After one year, Galina asked her niece what was happening to her. “Look, granny, sometimes you forget some things. There are periods when you don’t recognize us- I told her this. She was conscious enough about her situation”.<\/p>\n

Once the dementia advanced, Galina was less and less present. The illness made her remember\u00a0her life from the end to the beginning. Initially, she though she was a young woman. Then, that she goes to school, then to kindergarten and that her daughter is actually her mother. “She started to forget us, the family. She had only some moments when she came back, when she was of extreme lucidity and she could recognize us all”, says Elena. The family was taking these moments as miracles.<\/p>\n

\"\"

Grandma Galina and her daughters \u2013 Ludmila, Mariana, Olesea (2010). Personal archive<\/p><\/div>\n

***<\/p>\n

With a similar speed, Tatiana’s dementia advanced. “When I came back from the Netherlands in May 2016, I saw by how much the situation got worse”, tells Irina. Most of the time, her mother, former secretary of President Lucinschi and worker of the National Bank, could not recognize the family. And only sometimes, Tatiana would look to her daughter and ask naturally: “Irica, when did you come? I did not even notice when you came”.<\/p>\n

Alzheimer syndrome makes the patients gradually lose their personality, like in fog. “Before Alzheimer, my mother was very exigent, even with me. She encouraged me to go to foreign language courses”, says Irina. During one year, the family hosted American Peace Corps volunteers, so that Irina listens to natives speaking English. Now, Irina speaks six languages: Italian, French, Russian, Romanian, English and Dutch.<\/p>\n

At 27, Irina left for the Netherlands. Her departure coincided with the retirement of Tatiana. “It was the time to find a goal\u00a0in my life. Sometimes, I feel guilty that I left, but at that moment, I wanted to be more independent. I am happy that my brother and my father stood next to her”, she confesses. At that moment, Irina could not realize that emigration would help her support her mother.<\/p>\n

\"\"

Mother Tatiana and her daughter, Irina. Photos from 2014-2016, Personal archive<\/p><\/div>\n

***<\/p>\n

The expenses for supporting an Alzheimer patient are high. Irina’s mother needs permanent supervision, so the family employed two assistants that work two weeks each in a month. “We give a monthly salary of 400 euros (4500 lei) to the assistants. The medicine is expensive: at least 1000 lei for one month. I am helping my mom from here,\u00a0from the Netherlands. I cannot understand how other families cope with it”, she says. Elena remembers that her grandmother was prescribed medicine that she could not find in Moldova. “They were efficient, but we could not buy them here. Buying them from Romania would cost 300 euros and they would last only for approximately one month”, tells Elena.<\/p>\n

The list of compensated medicines<\/a>, approved by the HealthCare Ministry on 23 September 2016, does not include any medicine destined strictly against Alzheimer syndrome. “The medicine from this list are recommended for states associated with Alzheimer syndrome like depression or convulsions. There are no strictly Alzheimer medicines in this list”, confirms Dr. Igor Nastas.<\/p>\n

If somebody with Alzheimer wants to benefit from state support, the person needs to have a certificate of disability, issued by the National Council for Determining Disabilities and Work Capacity. “A multidisciplinary commission, composed of psychiatrists, psychologists, neurologists and social assistants examine the person: how he or she walks, socializes or memorizes. The specialists conduct the IQ test and other necessary research. After complete examination, the person receives the disability certificate as well as recommendations from the experts”, explains Narcisa Mamaliga, deputy director of the Council.<\/p>\n

Nevertheless, the disability pension does not cover the expenditures. According to the latest Social Report issued by the Work, Social Protection and Family Ministry, the average pension for people with severe disabilities was only 1173 lei in 2015.<\/p>\n

<\/p>\n

***<\/p>\n

Comparing to other dementia, Alzheimer makes people be aggressive, sassy and depressive. This type of dementia puts its footprint on all the family members that take care of the patient. “Grandma Galina was waking up during the night, agitated, and could start going somewhere. My mother could not get any rest. Then we decided to take turns: each of us for eight hours, without interruptions. That’s how the last months of grandma’s life passed”, tells Elena.<\/p>\n

“Those who suffer from Alzheimer need love and understanding. It is important to take them seriously, because they are sure about they think”, says the young woman. “On a summer day, grandma was convinced that it is Christmas Eve and she needs to cook\u00a0cozonaci<\/em>. Nobody contradicted her”. They cooked\u00a0cozonaci\u00a0<\/em>together while the roses were blossoming outside.<\/p>\n

Elena and Irina say that taking care of an Alzheimer-ill person emotionally exhausts the family. “My mother was having heart pain and nightmares. I, as a Medical Student, immersed into studying this illness. I was reading studies, I almost came to an obsession”, says Elena. In both cases, no medical worker offered (or suggested) any psychological assistance to the two families.<\/p>\n

***<\/p>\n

Starting from 2014, Moldova is conducting a reform of the mental health services. 36 community centers of mental health were set in most of the districts and serve almost 75% of the population.<\/p>\n

In the changing process, Moldova is helped by the Swiss Government that finances the “MENSANA” project- Support for the reform of the mental health services-, implemented by Trimbos Institution Moldova. With a 5 million euros budget, the project aims at ensuring the well-being of users of the mental health services through facilitating access to community-level services, much closer to their houses.<\/p>\n

“The staff of the community centers are composed of psychiatrists, psychologists, social and medical assistants. Their role is to monitor and help patients with severe mental health problems, to prevent the aggravations and to ensure the rehabilitation. All the Community Centers have the function to help the patients’ families to understand better what is the state of their beloved ones and how they can contribute to their rehabilitation”, explains Victoria Condrat, local project manager.<\/p>\n

Thanks to the Swiss Government, Moldova has the chance to become the only Eastern European state with a completely reformed system of mental health. Until that is achieved, the current system must suffer different changes.<\/p>\n

“We have districts where there is one or no psychiatrist, like in Soroca. Generally, many doctors leave”, Victoria continues.<\/p>\n

<\/p>\n

Another lack in the current system is the lack of the National Clinical Protocol for Dementia. “What is a protocol? It is a fundamental document, created by national and international experts. In our case, it would describe what is dementia, how you can find it and how you can treat it- based on studies and scientific proof. After everything is approved, all doctors in the country must comply with this protocol. Moldova does not, yet, have this kind of document”,\u00a0<\/em>concludes Victoria Condrat. Its elaboration and approval by expert commissions and HealthCare Ministry are part of the Action Plan of MENSANA project and is planned for the autumn of this year.<\/p>\n

At the moment, there are two social services offered to families with Alzheimer-ill persons: personal assistance and Respiro. The first one allows a family member to become the personal assistant of the patient or to request one from the state. Even if the 60th Law stipulates the right for a personal assistant, the state cannot provide enough for all persons with severe disabilities. Currently, there are 1935 personal assistants, whereas the number of people with serious disabilities is more than 27000. The average salary of a personal assistant varies from 900 to 1600 lei.<\/p>\n

The second service, Respiro, offers 24-hours assistance to the people with serious disabilities for a period of maximum 30 days a year, while the family and the caretakers can benefit from a break. Nevertheless, the 5 Respiro service centers can provide only for 177 beneficiaries in a year.<\/p>\n

***<\/p>\n

In May 2016, Irina went together with her mother to the Mental Health Center from Buiucani (district of Chi\u0219in\u0103u), where the psychiatrist asked some easy questions. “She was asked what day is it. She was embarrassed, she did not know the answer and she tried to guess. When she was asked about our location, she said Calfa, Anenii Noi district, her home village. She was wrong, although you could see that she was making an effort”, tells Irina.<\/p>\n

The test the psychiatrist gave is Mini-Mental State Examination<\/a>\u00a0that includes some simple questions. For every question there are points. “This test can be conducted\u00a0by anyone: a member of the family or the family doctor if it’s about a mental illness”, explains Dr. Nastas.<\/p>\n

“I want people to talk more about this illness, I want campaigns of support for families. When the dementia of grandma advanced, we did not know what to expect”, says Elena.<\/p>\n

Galina, Elena’s grandma, died in July 2012, on\u00a0a hot day. For their family, a year of pain followed, gradually replaced by acceptance. “We could not do anything for grandma to save her memory, but, for other patients, other families, it is worth to talk about Alzheimer”, says Elena.<\/p>\n

Author: Victoria Colesnic<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

Reading Time: <\/span> 9<\/span> minutes<\/span><\/span>“In December, when I came home for three weeks, my mother could not remember me”, says Irina with a low voice. “We were both sitting on the sofa when I asked her: Mom, how old are you? Sixteen, she said”. Irina’s mother, Tatiana, experienced\u00a0her first memory gaps in 2011, after she retired. She was reading\u00a0less […]<\/p>\n","protected":false},"author":6,"featured_media":443590,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"class_list":["post-443589","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-society"],"content_social_share":"Reading Time: <\/span> 9<\/span> minutes<\/span><\/span>

“In December, when I came home for three weeks, my mother could not remember me”, says Irina with a low voice. “We were both sitting on the sofa when I asked her: Mom, how old are you? Sixteen, she said”.<\/p>\n

Irina’s mother, Tatiana, experienced\u00a0her first memory gaps in 2011, after she retired. She was reading\u00a0less and less and sometimes was forgetting to wash her mug. She was more apathetic. The retirement coincided with the period when some neighbors she used to drink coffee with left the block. “I started to realize that we need to offer her time to adapt to the new lifestyle. Still, I proposed to search a half-day job or to get a dog, but I could not see in her eyes any desire to change something. I want to stay with you, with my friends- she told me”.<\/p>\n

In some months, the first changes of the personalities started. “My mother was always disciplined, a perfectionist. Suddenly though, many things started not to matter to her: not the news we used to watch together, every evening, not even the cleaning”. Tatiana’s family decided that the time to see a doctor came. The doctors recommended to do a MRI scan and prescribed treatment with injections. Even if she took the medicine, Tatiana’s state did not get well.<\/p>\n

Two years ago, the woman was consulted by a psychiatrist. “Then, I heard for the first time about Alzheimer. It was a shock for all of us. The doctor that we went to knew mother since the times she was healthy. He asked us: What happened? How did the disease evolve so quickly? We were asking the same thing”.<\/p>\n

***<\/p>\n

There is no official statistics in Moldova regarding the number having Alzheimer. “The Alzheimer dementia, like other types of dementia are included in the category of mental illnesses”, says Igor Nastas, professor at the Psychiatric Faculty of the Medical University “Nicolae Testemi\u021banu”. According to the National Bureau of Statistics, approximately 79000 patients of all ages are registered as suffering from mental and behavioral illnesses in 2015.<\/p>\n

Alzheimer is a type of dementia from among other that elderly people\u00a0develop. “All the information from our brain is based on the transmission of impulses, like telephonic paths. In the case of Alzheimer syndrome, some parts made out of insoluble protein, called amiloide, are left on the pre-synapses spaces and interrupt the connection. It is also said it is caused by\u00a0tau proteine, that forms balls and breaks the cerebral neurons. The disease is incurable” explains Dr. Nastas.<\/p>\n

The first symptoms of the illness can be mistaken with the changes specific to the old age: the old people forget where they put their glasses or the name of the person they met. In the case of Alzheimer, the symptoms are continually getting worse, affecting more than the memory of the patient.<\/p>\n

\"\"

Illustration by Irina Cle\u0219cenco<\/p><\/div>\n

***<\/p>\n

Galina, Elena’s grandmother, had her first symptoms in 2010, when her niece was a Medicine Student in the 2nd year. “Grandma Galina- favorite person of my childhood… She was born in Odessa region and learned Romanian when she moved to Moldova, thus she spoke it with a very cute accent”, tells Elena.<\/p>\n

The woman gave birth to 11 children and was the only doctor for three villages: Suhuluceni, Coropceni and Cli\u0219ova. Suhuluceni from Telene\u0219ti district, where she lived her life, loved her because she was always searching for understanding and good for all.<\/p>\n

At first, Alzheimer slowly advanced. “Grandma had short memory losses and then stable periods followed”, remembers Elena. But like a tsunami, after the wave gets to the maximal point, the wrath starts. Galina’s dementia seriously advanced.<\/p>\n

“You must have a fine intelligence to realize that something is not good with you. And grandma understood it”. After one year, Galina asked her niece what was happening to her. “Look, granny, sometimes you forget some things. There are periods when you don’t recognize us- I told her this. She was conscious enough about her situation”.<\/p>\n

Once the dementia advanced, Galina was less and less present. The illness made her remember\u00a0her life from the end to the beginning. Initially, she though she was a young woman. Then, that she goes to school, then to kindergarten and that her daughter is actually her mother. “She started to forget us, the family. She had only some moments when she came back, when she was of extreme lucidity and she could recognize us all”, says Elena. The family was taking these moments as miracles.<\/p>\n

\"\"

Grandma Galina and her daughters \u2013 Ludmila, Mariana, Olesea (2010). Personal archive<\/p><\/div>\n

***<\/p>\n

With a similar speed, Tatiana’s dementia advanced. “When I came back from the Netherlands in May 2016, I saw by how much the situation got worse”, tells Irina. Most of the time, her mother, former secretary of President Lucinschi and worker of the National Bank, could not recognize the family. And only sometimes, Tatiana would look to her daughter and ask naturally: “Irica, when did you come? I did not even notice when you came”.<\/p>\n

Alzheimer syndrome makes the patients gradually lose their personality, like in fog. “Before Alzheimer, my mother was very exigent, even with me. She encouraged me to go to foreign language courses”, says Irina. During one year, the family hosted American Peace Corps volunteers, so that Irina listens to natives speaking English. Now, Irina speaks six languages: Italian, French, Russian, Romanian, English and Dutch.<\/p>\n

At 27, Irina left for the Netherlands. Her departure coincided with the retirement of Tatiana. “It was the time to find a goal\u00a0in my life. Sometimes, I feel guilty that I left, but at that moment, I wanted to be more independent. I am happy that my brother and my father stood next to her”, she confesses. At that moment, Irina could not realize that emigration would help her support her mother.<\/p>\n

\"\"

Mother Tatiana and her daughter, Irina. Photos from 2014-2016, Personal archive<\/p><\/div>\n

***<\/p>\n

The expenses for supporting an Alzheimer patient are high. Irina’s mother needs permanent supervision, so the family employed two assistants that work two weeks each in a month. “We give a monthly salary of 400 euros (4500 lei) to the assistants. The medicine is expensive: at least 1000 lei for one month. I am helping my mom from here,\u00a0from the Netherlands. I cannot understand how other families cope with it”, she says. Elena remembers that her grandmother was prescribed medicine that she could not find in Moldova. “They were efficient, but we could not buy them here. Buying them from Romania would cost 300 euros and they would last only for approximately one month”, tells Elena.<\/p>\n

The list of compensated medicines<\/a>, approved by the HealthCare Ministry on 23 September 2016, does not include any medicine destined strictly against Alzheimer syndrome. “The medicine from this list are recommended for states associated with Alzheimer syndrome like depression or convulsions. There are no strictly Alzheimer medicines in this list”, confirms Dr. Igor Nastas.<\/p>\n

If somebody with Alzheimer wants to benefit from state support, the person needs to have a certificate of disability, issued by the National Council for Determining Disabilities and Work Capacity. “A multidisciplinary commission, composed of psychiatrists, psychologists, neurologists and social assistants examine the person: how he or she walks, socializes or memorizes. The specialists conduct the IQ test and other necessary research. After complete examination, the person receives the disability certificate as well as recommendations from the experts”, explains Narcisa Mamaliga, deputy director of the Council.<\/p>\n

Nevertheless, the disability pension does not cover the expenditures. According to the latest Social Report issued by the Work, Social Protection and Family Ministry, the average pension for people with severe disabilities was only 1173 lei in 2015.<\/p>\n

<\/p>\n

***<\/p>\n

Comparing to other dementia, Alzheimer makes people be aggressive, sassy and depressive. This type of dementia puts its footprint on all the family members that take care of the patient. “Grandma Galina was waking up during the night, agitated, and could start going somewhere. My mother could not get any rest. Then we decided to take turns: each of us for eight hours, without interruptions. That’s how the last months of grandma’s life passed”, tells Elena.<\/p>\n

“Those who suffer from Alzheimer need love and understanding. It is important to take them seriously, because they are sure about they think”, says the young woman. “On a summer day, grandma was convinced that it is Christmas Eve and she needs to cook\u00a0cozonaci<\/em>. Nobody contradicted her”. They cooked\u00a0cozonaci\u00a0<\/em>together while the roses were blossoming outside.<\/p>\n

Elena and Irina say that taking care of an Alzheimer-ill person emotionally exhausts the family. “My mother was having heart pain and nightmares. I, as a Medical Student, immersed into studying this illness. I was reading studies, I almost came to an obsession”, says Elena. In both cases, no medical worker offered (or suggested) any psychological assistance to the two families.<\/p>\n

***<\/p>\n

Starting from 2014, Moldova is conducting a reform of the mental health services. 36 community centers of mental health were set in most of the districts and serve almost 75% of the population.<\/p>\n

In the changing process, Moldova is helped by the Swiss Government that finances the “MENSANA” project- Support for the reform of the mental health services-, implemented by Trimbos Institution Moldova. With a 5 million euros budget, the project aims at ensuring the well-being of users of the mental health services through facilitating access to community-level services, much closer to their houses.<\/p>\n

“The staff of the community centers are composed of psychiatrists, psychologists, social and medical assistants. Their role is to monitor and help patients with severe mental health problems, to prevent the aggravations and to ensure the rehabilitation. All the Community Centers have the function to help the patients’ families to understand better what is the state of their beloved ones and how they can contribute to their rehabilitation”, explains Victoria Condrat, local project manager.<\/p>\n

Thanks to the Swiss Government, Moldova has the chance to become the only Eastern European state with a completely reformed system of mental health. Until that is achieved, the current system must suffer different changes.<\/p>\n

“We have districts where there is one or no psychiatrist, like in Soroca. Generally, many doctors leave”, Victoria continues.<\/p>\n

<\/p>\n

Another lack in the current system is the lack of the National Clinical Protocol for Dementia. “What is a protocol? It is a fundamental document, created by national and international experts. In our case, it would describe what is dementia, how you can find it and how you can treat it- based on studies and scientific proof. After everything is approved, all doctors in the country must comply with this protocol. Moldova does not, yet, have this kind of document”,\u00a0<\/em>concludes Victoria Condrat. Its elaboration and approval by expert commissions and HealthCare Ministry are part of the Action Plan of MENSANA project and is planned for the autumn of this year.<\/p>\n

At the moment, there are two social services offered to families with Alzheimer-ill persons: personal assistance and Respiro. The first one allows a family member to become the personal assistant of the patient or to request one from the state. Even if the 60th Law stipulates the right for a personal assistant, the state cannot provide enough for all persons with severe disabilities. Currently, there are 1935 personal assistants, whereas the number of people with serious disabilities is more than 27000. The average salary of a personal assistant varies from 900 to 1600 lei.<\/p>\n

The second service, Respiro, offers 24-hours assistance to the people with serious disabilities for a period of maximum 30 days a year, while the family and the caretakers can benefit from a break. Nevertheless, the 5 Respiro service centers can provide only for 177 beneficiaries in a year.<\/p>\n

***<\/p>\n

In May 2016, Irina went together with her mother to the Mental Health Center from Buiucani (district of Chi\u0219in\u0103u), where the psychiatrist asked some easy questions. “She was asked what day is it. She was embarrassed, she did not know the answer and she tried to guess. When she was asked about our location, she said Calfa, Anenii Noi district, her home village. She was wrong, although you could see that she was making an effort”, tells Irina.<\/p>\n

The test the psychiatrist gave is Mini-Mental State Examination<\/a>\u00a0that includes some simple questions. For every question there are points. “This test can be conducted\u00a0by anyone: a member of the family or the family doctor if it’s about a mental illness”, explains Dr. Nastas.<\/p>\n

“I want people to talk more about this illness, I want campaigns of support for families. When the dementia of grandma advanced, we did not know what to expect”, says Elena.<\/p>\n

Galina, Elena’s grandma, died in July 2012, on\u00a0a hot day. For their family, a year of pain followed, gradually replaced by acceptance. “We could not do anything for grandma to save her memory, but, for other patients, other families, it is worth to talk about Alzheimer”, says Elena.<\/p>\n

Author: Victoria Colesnic<\/strong><\/p>\n

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