Early one Sunday morning in January 2020, Dr Temitope Farombi was told a woman in her 70s was in trouble and she needed to come quickly. Farombi, a consultant neurologist, found the woman lying topless in the street in Ibadan, Nigeria, surrounded by a group of 15 people beating her with sticks.
“They wanted her to confess to witchcraft,” says Farombi. “If she didn’t confess, they were going to beat her more.”
Farombi approached the mob and showed her ID card that said she was a doctor at Ibadan University College hospital. “I wasn’t scared, my only goal was to save the old woman from being lynched,” she says.
The woman, dishevelled and confused, had knocked on someone’s door demanding to be let in, Farombi learned. The owner of the house believed an evil spirit had come to visit and called the community for help.
Farombi suspected the woman was living with dementia. She explained that the woman was not a witch, and asked if anyone had ever come across an older person who wandered off and got lost. Many had. This was a symptom of a medical condition, she added. The crowd dispersed and Farombi attended to the woman.
Across Nigeria, and other countries in Africa, people living with dementia are often accused of witchcraft. Symptoms such as forgetting basic details and changes in behaviour are seen as evidence of evil. People have been set on fire, stoned, beaten to death and buried alive. Often it is disadvantaged and marginalised people in society, and mostly women, who are targeted.
It is impossible to know how many attacks occur, as most go unreported, but the UN estimates there were at least 20,000 victims of “harmful practices” across 60 countries between 2009 and 2019 – including children. Those targeted included people with albinism, disabilities and mental health problems. The UN human rights commissioner expects numbers to increase.
The human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year – and three quarters of them are in the developing world.
NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease – heart attacks and stroke. Approximately 80% are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanisation make being unhealthy a global phenomenon.
NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality – and being poor makes it less likely you will be diagnosed accurately or treated.
Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and communities is staggeringly high.
In low-income countries NCDs – typically slow and debilitating illnesses – are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.
'A common condition' is a Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.
Tracy McVeigh, editor
The African Union published guidance for parliamentarians on accusations of witchcraft last year, following the adoption in 2021 of a UN resolution on the elimination of harmful practices related to accusations of witchcraft.
The term “witchcraft” was introduced by European colonialists to refer to Indigenous beliefs and practices but has evolved over time with influences from Christianity, Islam and other religions. Accusations of witchcraft and subsequent attacks may result from the belief that the accused has caused, or may cause, harm using supernatural powers they allegedly possess.
In Nigeria, accusing someone of witchcraft is illegal, punishable by up to two years in prison. However, the law is rarely enforced, according to Leo Igwe, the founder of Advocacy for Alleged Witches. “People believe the conception of a witch is seen as something that should not be accommodated or protected by the law,” he says.
When Farombi went to the police after saving the woman who had been attacked, no action was taken. “The police don’t know such cases happen,” she says. “There’s no structure, no welfare system. They told us to take her wherever.”
After she calmed down, the woman started mentioning places she could remember. Farombi found the house where she had grown up. Family members weren’t aware she was in the city, as she had moved to live in another state. Farombi spoke to the family about dementia, and the woman is now safe living with one of her children.
More than 55 million people have dementia worldwide, and more than 60% of those live in low- and middle-income countries. Nearly 10 million new cases are recorded annually and it is the seventh leading cause of death globally.
However, ignorance surrounding the condition is pervasive. In Nigeria, many people have never heard of dementia, says Farombi. “There’s a huge knowledge gap at community level about what dementia is,” she says. “Families are often embarrassed and lock their family members in, or out, or dump them in spiritual centres to pray for them, hoping evil spirits will be released.” Some people attend traditional healers who, at best, end up delaying diagnosis and, at worst, perpetuate harmful myths, says Farombi.
After treating people with dementia who showed signs of abuse at her clinic and seeing videos of older people accused of witchcraft being attacked, Farombi set up Brain Health Initiative Nigeria, which does community outreach, runs support groups for caregivers, and hosts a hotline.
Josephine Anenih, a former minister of women affairs in Nigeria, founded the Alzheimer’s Disease Foundation after she discovered in 2011 that her younger brother had been diagnosed with the condition in Germany. She had never heard of Alzheimer’s. “It is ignorance that is the problem,” she says. “A lot of geriatricians don’t even know how to deal with [dementia].”
She built the Ignatius Akubude Centre, named after her brother, in her home town, Amawbia, in southern Nigeria, which runs activities for older people and conducts medical outreach.
The two organisations are part of a coalition pushing the government to adopt a national dementia plan. “That is where we can start talking about how to take care of people with dementia, how to support caregivers and how to create dementia friendly communities,” says Anenih.
Igwe adds: “If information and awareness about dementia is put out there, it can help us drastically reduce, and end, the abuses.”
