A Study of Pastoral Care of the Elderly in Africa: An Interdisciplinary Approach with Focus on Ghana

By Samuel Ayete-Nyampong

In this book, Rev. Dr. Samuel AyeteNyampong has revealed his passion for the good quality of life for the ageing population in Africa and the development of Pastoral Gerontology courses in Theological Institutions across Africa.

This book is a resource material for building the capacity of church leaders in the provision of care and support for the ageing population in Africa.

All who read this book will find it inspiring, full of deep thoughts, and a challenge to the church and state, thereby provoking sensitivity to the needs of the ageing population in Africa.

This book is highly recommended for church leaders, theological students, students of Gerontology and to all who have a passion to promote the quality of life of the ageing population.

• Language: English
• Publisher: AuthorHouse UK
• Release date: Aug 26, 2014
• ISBN: 9781496989109

Samuel Ayete-Nyampong

The Reverend Dr. Samuel Ayete–Nyampong is a Minister of the Presbyterian Church of Ghana. His interest in pastoral care of the elderly was aroused during the early years of his ministerial career when he had to visit many elderly people as part of his responsibilities as a Parish Minister. After his first degree at the University of Ghana, Dr. Ayete–Nyampong was awarded the British Government Overseas Development Administration Shared Scholarship (ODASS) to do a postgraduate study in Pastoral Care and Counseling at the University of Aberdeen, Scotland, UK. Later, his course was upgraded to a PhD programme. His research interest at the PhD level was in Pastoral Gerontology. Dr. Samuel Ayete–Nyampong served as the Chairman of the Presbyterian National Committee on Ageing in Ghana. He has taught short courses on Ageing and Pastoral Counseling and also served as Adjunct Lecturer of Pastoral Care and Counseling at the Central University College in Ghana. He is an External Examiner for the University of Pretoria, South Africa. He is also the President of the Africa Association of Pastoral Studies and Counselling (AAPSC). Rev. Dr. Samuel Ayete–Nyampong has participated in several International Conferences. These include: The Annual Scientific Meeting of the Gerontological Society of America (San Francisco, USA), the Valencia Forum on Ageing (Spain) and many others. He was written five books including “Pastoral Care of the Elderly in Africa”, “Ageing in Contemporary Ghana” and “Ageing Gracefully”. He is the Founder of the Christian Action on Ageing in Africa (CAAA).

Book preview

2014 Samuel Ayete-Nyampong (PhD). All rights reserved.

No part of this book may be reproduced, stored in a retrieval system, or transmitted by any means without the written permission of the author.

Published by AuthorHouse 12/11/2014

ISBN: 978-1-4969-8909-3 (sc)

ISBN: 978-1-4969-8910-9 (e)

Any people depicted in stock imagery provided by Thinkstock are models,

and such images are being used for illustrative purposes only.

Certain stock imagery © Thinkstock.

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

Contents

ACKNOWLEDGEMENTS

ABBREVIATIONS

INTRODUCTION

Chapter 1

PASTORAL CARE OF THE

AGEING POPULATION IN AFRICA: A NEW CHALLENGE

Chapter 2

A SOCIOLOGICAL PROFILE OF THE ELDERLY IN AFRICA- THEIR PROBLEMS AND PROGRESS: A CASE STUDY ON GHANA

Chapter 3

SOCIAL CHANGE AND ITS EFFECTS ON THE ELDERLY IN AFRICA: THE CASE OF GHANA

Chapter 4

HEALTH AND MEDICAL PROBLEMS OF ELDERLY PEOPLE IN GHANA

Chapter 5

CONTEMPORARY CARE OF THE ELDERLY IN GHANA

Chapter 6

A GENERAL SURVEY OF OLDER PEOPLE IN BRITISH SOCIETY: A CASE STUDY OF THE WESTERN SITUATION

Chapter 7

A COMPARATIVE STRUCTURE OF PASTORAL CARE PARADIGMS: WESTERN AND AFRICAN- A CASE STUDY OF BRITAIN AND GHANA

Chapter 8

A THEORETICAL FRAMEWORK FOR CONTEXTUALIZATION OF PASTORAL CARE OF THE ELDERLY IN GHANA

Chapter 9

PASTORAL MINISTRY AND THE ELDERLY IN GHANA: A NEW PARADIGM OF CARE FOR AFRICA

Chapter 10

GERONTOLOGICAL EDUCATION AS PREPARATION FOR MINISTRY WITH THE ELDERLY IN AFRICA

Chapter 11

THE WAY FORWARD FOR AFRICAN PASTORAL CARE OF THE ELDERLY

BIBLIOGRAPHY

DEDICATION

I dedicate this book to my parents:

Papa John Benaiah Ayete

and

Mama Alice Agyekum Ayete,

whose old age and its problems and progress, challenged and inspired me to undertake the research and write this book for the benefit of all elderly people who share similar experiences. Unfortunately, they did not live to see the completion of this research and to enjoy the benefits of the emerging ministry for the elderly in Africa.

ACKNOWLEDGEMENTS

I am very grateful to God for making it possible for me to start and complete this book. Through the initial research that has led to the writing of this book, He has convinced me of a new ministry He is preparing for the growing number of the ageing population in Africa.

I am also grateful to my former Professors (Ian Bradley, Alan Main, and William Storrar) of the University of Aberdeen, Scotland, for their interest and supervision of the original doctoral research and for their constructive criticisms which helped to shape the work.

I am also indebted to Miss Helen Odamtten, formerly of the Language Centre of the University of Ghana, who read through the transcript of this book and offered many good suggestions.

I am indebted to my family for their prayers and encouragement. I am particularly grateful and thankful to my beloved wife, Dr. Lilian Ayete-Nyampong, and my children- Daisy, Angie and John Ayete-Nyampong for sharing with me all the pain, sorrows, joy and happiness that I experienced during the period of the research that has culminated into this book. May they continue to share with me the blessing and success of the new ministry: Pastoral Care of the Elderly in Africa.

Finally, I dedicate this book to my parents, Papa John Benaiah Ayete and Mama Alice Agyekum Ayete, whose old age and its problems and opportunities, challenged and inspired me to undertake the research for the benefit of all the elderly who share similar experiences. Unfortunately, they did not live to see the completion of this research and to enjoy the benefits of the emerging ministry for the elderly in Ghana and Africa as a whole.

ABBREVIATIONS

KEY TO THE PRONUNCIATION OF SOME AKAN LETTERS

o to be pronounced as in ‘o’range

e to be pronounced as in ‘e’rror

INTRODUCTION

Ageing is a subject for discussion, research and social policy in many developed and developing countries. In Ghana (as well as in many other African States), the realisation of the challenges of ageing is emerging as a result of the social changes that have weakened the traditional support system and plunged the once respected, venerated and cared-for elderly people into difficulties relating to their status, potential value and well-being within the new Ghanaian society.

The study which has culminated in this book was an attempt to address the problems of ageing people in Africa, using Ghana as a case study from a Christian pastoral care perspective. It is in the hope of creating awareness at both statutory and non-statutory levels of the need to develop alternative support systems to enhance the status and well-being of the elderly on the African continent in general and the Ghanaian society in particular.

The research thus involved a comparative study of the general situation of the elderly in Britain and Ghana and the contextualisation of some of the care programmes in the Ghanaian situation. Contextualising pastoral care for elderly people in Ghana required a critical analysis of John Patton’s communal contextual paradigm and James W. Fowler’s faith development theory. These theories help in the understanding of the concept of ageing (Fowler’s) and the context within which to apply appropriate pastoral methodology (Patton’s). The methodology enabled the development of pastoral care models which emphasised community as the context within which pastoral care can be effectively practised for elderly people in Ghana and Africa as a whole.

The pastoral care model (communal pastoral care) developed in this book is to be sustained through pastoral and gerontological training and awareness for both clergy and laity within the Church. While this book has focused on a system of pastoral care for use by Ghanaian churches to maintain the well-being and dignity of older people, it has also thrown up important implications for the academic discipline of practical theology and for pastoral care as a vocation for the community of God’s people within the context of the world community.

DATA COLLECTION

The process used in the collection of data involved interviews and active listening to gather information from the elderly, lay pastoral carers, ministers, and other carers serving the voluntary and state agencies involved in the care of elderly people in Britain and Ghana. Open-ended rather than formally structured questionnaires were used because of their advantage of being flexible and able to elicit more information from their subjects. The use of relevant documents is part of the method of data collection. Such documents or data cover population statistics and projections, church records and records from residential homes for the elderly in Britain (from both Church and voluntary organization homes). It is hoped that the multi-dimensional approach in collecting data is the best method to achieve the goals of the research published in this book.

DELIMITATION

The original research reported upon here, covers only the mainline churches mentioned because of limited time and volume of work required. Excluded also from the research are the Pentecostal and the ‘Independent African churches’ in Ghana. However, brief mention is made of those churches whose pastoral care provision for the elderly is a joint venture with one of the selected churches, or any whose pastoral care ministry has a direct relationship with a selected church. It must be noted however that the aim of this book is not to encourage exclusivism but to promote cross-cultural or inter-church exchanges of resources for the mutual benefit of the elderly at both national and international levels. Collaboration in pastoral care for the elderly is therefore encouraged.

DEFINITION OF TERMS

Pastoral Care: For the purpose of this book, pastoral care is defined as: The act of showing love as a Christian to another person (Christian and non-Christian) through the establishment of a helping relationship in which both the giver and the receiver of love mutually benefit and God is glorified.

Elderly Person: Any person who has attained the chronological age of 65 years or above.

This definition differs from other definitions which use the official retirement age to label one as old.¹ This latter criterion has its deviations because official retirement age varies. It is not permanently fixed in many countries, and is subject to legislative changes. In Ghana for instance, where the majority of the population are not in any form of government employment, people can be found actively engaged in their private jobs for as long as their health allows. Typical of this group are farmers and traders. The term ‘elderly’, as defined above, will be used interchangeably with the term ‘older adults’.

Traditional Society: Any social structure which emphasizes the concepts, belief systems, rituals, symbols and myths embedded in its historical past as a guide for social and moral behaviour, and which distinguishes it from other societies.

PROBLEMS AND PROSPECTS OF THE RESEARCH

Every stage in life has its own challenges. The older adult is more vulnerable to physical and psychological hazards leading to temporary or chronic disability. Some of the disabilities which can obscure objectivity in information elicited from the elderly include ‘dementia’ and ‘confusion’. The confused and the demented are unable to contribute meaningfully to a questionnaire unless one understands their often primitive symbolic language.² A second problem encountered is the lack of adequate statistical and demographic data on the elderly in Ghana. In addition, the area of study- pastoral care of the elderly- is not yet as much researched in Africa as in the industrialized countries. This problem obviously leads to a lack of adequately documented research on ageing. This statement does not however deny the existence of a few valid and reliable sources of research work, such as that of Professor Araba Apt of the University of Ghana and other African scholars within and beyond the continent of Africa.

The problems cited above should not inhibit research for there is the possibility of achieving a breakthrough and contributing significantly to knowledge in an unprecedented way. The research was therefore carried out in the hope that it would lead to:

1. The construction of an appropriate and contextually relevant pastoral care model for the care of elderly people in Ghana in order to enhance their dignity and well-being.

2. The encouragement of elderly people to use their potentialities so as to contribute significantly to society.

3. The arousing of social consciousness to the problems and potentials of ageing with the hope of eliciting a caring and supportive response from Ghanaian communities- both Christian and non-Christian.

4. A comparative analysis of the socio-cultural milieus which promote or hinder the provision of care for elderly people in Britain and Ghana with the goal of stimulating cross-cultural exchanges of information on ageing, resources and personnel between churches, government and non-governmental organizations engaged in gerontological issues.

5. The promotion of a new contextual and anthropological thought in practical theology and consequently helping to define objectives for churches in their effort to offer pastoral care.

6. It is also hoped that this pioneering study will lead to further research in the areas of practical theology and gerontology or the new field which I prefer to call "Pastoral Gerontology".

CHAPTER 1

PASTORAL CARE OF THE

AGEING POPULATION IN AFRICA: A NEW CHALLENGE

The 20th century witnessed an increasing awareness of the needs of the elderly and the necessity for the provision of care which would sustain their well-being. Concern has been expressed world-wide for the elderly; and statutory and voluntary organizations, including churches, are being encouraged and challenged to provide care and welfare facilities to enhance the quality of life of the elderly. This concern for the wellbeing of elderly people has been intensified since the beginning of the 21st century, leading to many millennium conferences being organised to address these issues at both national and international levels.³

DEMOGRAPHY

Contributing to this consciousness of and passion for gerontology is the recognition of the growing population of people aged 60 years and above; and the increase in general life expectancy. The ‘United Nations Plan of Action’ on ageing discussed this population phenomenon and stated explicitly that:

From 1975 to 2025, the number of persons aged 60 years and over throughout the world would increase from 350 million to over 1,100 million, or by 315% compared with the total population growth of 102%. By 2025, the ageing would constitute 13.7% of the population.⁴

A general picture is depicted in the ‘Demographic Yearbook’, especially on the life expectancy of selected nations.⁵ It will be noticed from the figures in the quotation above that the demographic trend spans both developed and developing countries. There are also marked differences between regions. For example, in 2012, 6 percent of the population in Africa was 60 years and above, compared with 10 percent in Latin America and the Caribbean, 11 percent in Asia, 15 percent in Oceania, 19 percent in Northern America, and 22 percent in Europe. By 2050, it is expected that 10 percent of the population in Africa will be 60 years and above, compared with 24 percent in Asia, 24 percent in Oceania, 25 percent in Latin America and the Caribbean, 27 percent in Northern America, and 34 percent in Europe.

Between 1990 and 2025 the rate of increase in the population of older adults in developing countries is expected to be 7 to 8 times higher, but in some developing countries there is an expected increase of between 200% and 300%.⁶ There are, however, over 30 million people in sub-Saharan Africa who are estimated to be over 60 years old. In fact, figures from International aid organisations indicate that the number will double by 2030. According to ‘Global Ageing’ Report on Africa published by HelpAge International, by 2050, the number of people over 60 living in Africa will increase from just under 50 million to just under 200 million.⁷

This phenomenon of the ageing population is therefore being experienced by all countries, especially those in less developed countries where social welfare facilities and policies for ageing are not developed.⁸ The Global Aging Report has also confirmed that ‘in contrast to the developed world, which grew rich before it grew old, the developing world, where 81% of the world’s population lives, will grow old before it grows rich, with older persons among the poorest and most vulnerable’.⁹

IMPLICATIONS

The opening discussion on population growth in relation to the elderly inevitably carries implications which have both positive and negative consequences for the elderly and society as a whole. It should be noted however that ageing affects society and vice versa. As the number of the population aged 65 and above increases, it theoretically decreases the percentage of the economically active population, that is, those capable of supplying labour for the production of goods and services. This increases economic dependency on society because retirement generally results in a reduction in income, and in Africa for instance where a greater percentage of the elderly are peasant farmers, ill health and hazardous environmental conditions might prevent them from maintaining life-long peasantry.

The plight of the elderly, apart from its economic consequences, has social, health, psychological, spiritual and cultural consequences which demand action by family, government and non-governmental agencies such as the churches to provide the optimum condition to enhance the quality of life of the elderly. This however does not imply a perpetual dependence by the old on the resources of society. Rather it could be an avenue for the stimulation of the elderly to continue to contribute, according to their ability, to the sustenance of society. This could be done through the sharing of experiences and wisdom with the younger generation, and the continuing use of their skills and expertise for the general good of society as far as their health permits.

THE PROBLEMS OF THE ELDERLY IN AFRICA

Caring for the elderly has traditionally been the responsibility of the family. In Africa and some pre-literate cultures, the family (both nuclear and extended) deem it a divine responsibility to care for their elderly, and a few decades ago, before the impact of modernization and the subsequent partial breakdown of family values, the elderly were venerated because of their unique position in relation to the ancestors.¹⁰ In their present situation, they have become vulnerable to the forces of social change and have generally become dependent on the generosity of society for their well-being. In post-independent Africa, the agency of modernization with its attendant unprecedented devastation of established traditional social structure and cosmology poses four major problems:

1. The elderly appear to lack family support and care.

2. As the number of the elderly population increases, the dependency ratio increases.¹¹

3. There is pressure on African states to expend their limited financial resources to provide health care and other welfare services for the elderly.

4. There is an inter-generational gap caused by the imaginary boundary drawn to separate the pre-modern traditional and post-modern generations.

The situation of elderly people in Africa can be better perceived using the modernization theory of Cogwill and Holmes. They proposed in 1972 that the status of elderly people can be understood if we focus on different features of social organization evident in traditional societies and those related to modern industrial societies. They suggested that as society becomes more modern and industrialized, and where there is a high rate of residential mobility, older people become less important and less useful to society, and their skills also become obsolete.¹² Many elderly people in Ghana seem to have been abandoned or neglected by the country’s rush to be modern and economically independent. The once dignified, venerated and productive elderly people who were cared for by the extended family, and supported and protected by the social structures of traditional society now seem to be aliens in the new world of modernization. Formal education, the industrial market economy and being youth are now dominant issues which have displaced and relegated the elderly to the periphery of social life and left them to struggle with poverty, ill-health and loss of status.

With longevity and an increasingly high proportion of the aged above 65 years, the concept of ageing and becoming old evoke anxiety and fear among both young and old. Lack of social welfare systems¹³ and viable government policies¹⁴ for older adults¹⁵ coupled with the weakening of the extended family support system pose the questions: What can be done to help and care for elderly people in African society?; How can we encourage elderly people to utilize the potential within them to contribute to society and thereby to assert their usefulness and functionality?; What insights can be gained from other cultures (Western) to enlighten any method adopted to care for elderly people in Africa?¹⁶; Can the churches which have pioneered many development programmes in Africa since the missionary period initiate this attempt to address the problems of ageing on the continent? Could Africa possibly revive and share its family-oriented practices of elderly care with Western nations who need to re-discover the role of family in the care of elderly people?

The thesis upon which this book is based proposes that:

(1) the Church in Africa which was at the forefront of the continent’s development during the missionary era and still exercises considerable influence in society, can develop relevant pastoral care programmes which are informed by pastoral and gerontological theories and also by insights obtained from the experiences of some ‘partner’ churches involved in pastoral care of elderly people in other continents;

(2) any method of or insight into pastoral care ‘imported’ from any Western culture ought to be contextualised to make it relevant to address the African pastoral and gerontological problems;

(3) contextualization requires the careful consideration of the African cultural context in three main areas:

i. The religious ontology and world view of traditional society;

ii. The sense of community which African society upholds;

iii. The contemporary socio-economic situation in Africa.¹⁷

With these three factors under consideration, the task of this book will therefore be to construct a communal pastoral care model for the care of elderly people in Africa, using Ghana as a case study for generalisation. The methodology will also involve the use of insightful theoretical concepts from John Patton’s ‘Communal Contextual’ paradigm and James W. Fowler’s ‘Faith Development Theory’. The aim of this method is to gather data which is comparative and inter-cultural in nature and which will inform the development of an African pastoral care paradigm.

In constructing this model of pastoral care, this book recognizes that pastoral care is the vocation of the whole people of God- both clergy and laity- and it is within the context of this sanctorum communio¹⁸ that communal pastoral care can be effective and relevant to the issues of ageing in Africa and the World as a whole.

The research reported in this book used a methodology that involved the study of elderly people in their environment. This encompasses the structures within the social setting which determine their well-being such as the political will and social policy, non-governmental voluntary organizations whose activities affect them directly and indirectly, and the religious institutions (churches) which provide pastoral care and spiritual nurture. Such a research will require an objective analysis of the socio-cultural context in which these elderly people live, especially some of the socio-economic and health problems which threaten their well-being. The methodology has therefore utilized both anthropological and theological approaches in order to develop a contextual foundation for the construction of a communal pastoral care model for Ghana in particular and Africa as a whole.

The research therefore has been broad-based, integrating theoretical principles from other disciplines such as psychology and sociology because as Mervin Koller indicated, the study of ageing and its socio-psychological problems, after all, cuts across numerous fields of enquiry.¹⁹

CHRISTOLOGY AND PASTORAL CARE:

JESUS AS MODEL FOR CARE

Jesus Christ, the founder of the Church, demonstrated in his personal life and ministry, the importance of caring for and liberating humanity from its besetting sins and crises. Using parables and vivid illustrations to evoke deep reflection on everyday encounters, he taught his disciples, crowds and individuals the divine imperative in doing ‘good’ and caring for one another. The parables in Matthew chapter 25: 31-46, and Luke chapter 10: 25-35 about the sheep and the goats, and the good Samaritan respectively demonstrate a universal concern for the care of people irrespective of their colour, culture, country, character or chronological age. In another instance, Jesus’ reference to the Good Shepherd²⁰ is an important lucid and graphic presentation of the pastoral image which demonstrates the love and compassion of which he was possessed in the care of people. Alastair Campbell in his book ‘Rediscovering Pastoral Care’ adds another dimension to Jesus’ use of the pastoral image. He argues that Jesus used the shepherd image in his teaching to show God’s ‘strenuous and often surprising concern’ for people who have gone astray.²¹

Theological scholarship in general has given divergent opinions about biblical interpretations in a bid to understand the narratives of the Bible. The person of Jesus and his ministry have not escaped the scrutiny of scholars. Some scholars have labelled historical events in the Bible relating to the incarnation, sacrificial death, resurrection and the second coming of Jesus as mythical. Scholars who hold different opinions on this issue range from D. F. Strauss at one end of the spectrum to R. Bultmann at the other.²² Bultmann, for example, sought to demythologize these central affirmations of the Christian faith and reduce them to more intelligible expressions for modern men and women who are sceptical about the supernatural. These divergent hermeneutical conceptions in Christology can sometimes obscure and render ambiguous the simple stories about Jesus which inspire his followers to imitate his life. Even if we use modern and recent approaches like Friedrich Schleiermacher’s romanticist hermeneutics (which seek to know the mind of the author by reaching behind the text and thereby discovering the cause of the text),²³ or the existential and phenomenological interpretations of Martin Heideger²⁴ or better still the socio-critical approach attributed in its originality to Wilhelm Dilthey,²⁵ the story of Jesus including his commandment to love and care for one another, cannot be obliterated by rationalistic interpretations of scripture. This position does not however endorse the neo-orthodox theology which developed in reaction to Liberal Protestantism.

BRIEF HISTORY OF PASTORAL CARE: PRE AND POST-REFORMATION ERA

The tradition of pastoral care, which in the 2nd and 3rd centuries (before the Reformation) emphasized penitential discipline and public penance,²⁶ was reshaped by the reformers and succeeding generations of Christian churches. According to John T. McNeil, Martin Luther who was the ‘architect’ of the reformation had in view the integral liberation, health and enrichment of souls.²⁷ This vision of Martin Luther represented a shift in emphasis from penitential discipline to genuine pastoral care of the individual in need and his community. This presupposes the integration of psychological, spiritual, socio-cultural and political dimensions in an effort to find solutions to human problems. An analysis of Luther’s view reveals certain parallels with New Testament models of care which reflect the original holistic approach depicted in Jesus’ life and teaching. Christian churches in the 21st century share the same basic concern for the care of individuals with a goal of fulfilling the commandment of Jesus to love and care for one another. They however differ in their conception and emphasis on the pastoral ministry. This has affected the direction of pastoral care and the content of the theoria and praxis which compose the academic discipline of practical theology.²⁸

PASTORAL CARE: A GENERAL REVIEW

Since the beginning of the 20th century, pastoral care has experienced heterogeneity in theoretical outlook. This has been the result of differences in theological interpretation and its consequent bearing on pastoral care. Interestingly, none of these theological perspectives is exclusive, that is, they are all integral parts of a uniform theological whole which serve as a basis for further theological reflection and research.²⁹ An important example is Seward Hiltner’s explication of pastoral care using the ‘shepherd model’.³⁰ Eduard Thurneysen also proposed in his book ‘A Theology of Pastoral Care’, that pastoral care is a form of the proclamation of the gospel.³¹ This view gives pastoral care an evangelical approach which aims at conversion and spiritual discipline.³² Browning’s postulation that pastoral care has a moral dimension also deserves mention.³³ In ‘Practical Theology’, a book he edited and to which he wrote the Introduction, he attempted to conceptualize Practical Theology as composed of an ethic of principle (the aspect of theology concerned with questions such as ‘Who is the good person?’) and an ethic of disposition (the principles needed to make judgement about what is good).³⁴ A more recent pastoral ethicist/theologian is Alastair V. Campbell whose lively book ‘Rediscovering Pastoral Care’ has sought to re-define the meaning of pastoral care by his use of imagery, thus highlighting in pastoral care a symbolic significance.³⁵ As