Examines

Freelance writer and editor Lucy Schiller bumped up against the issues of aging, eldercare and loneliness through her grandmothers. When the family pulled her maternal grandmother, Mary Ann, from assisted living during the pandemic, Schiller became her primary caregiver. Her paternal grandmother, Anita, was less fortunate; she contracted COVID-19 from a home healthcare aide and died in a hospital.

As she relates in “Aging Out,” the shock of Anita’s death was a factor in Schiller’s abrupt relocation from a central New York college town to Pittsburgh, where she knew no one. Schiller calls the move “a half-desperate plan to simply change the background scenery of my life for the millionth time.”

While grieving, scrambling to make a living, taking long walks with her dog and wrestling with her chosen solitude, Schiller embarks on a quest to understand the institutions and attitudes that shape old age in America. “What was the relationship between personal fear of oldness and the ways in which oldness was structured in society?” she asks.

The resulting book, a deliberately meandering account of her Steel City sojourn, weds memoir, travelogue, philosophical rumination and journalistic investigation. Schiller, an MFA graduate of the University of Iowa and now an assistant professor of nonfiction at Texas Tech University, is a fluid writer. But most of what she covers is well-trod ground.

It’s worth asking whom she envisions as her audience. Most older readers know this territory; younger ones have other, more pressing concerns, including how to afford life in the here-and-now.

Perhaps Schiller, a millennial in her 30s, hopes they will identify with her personal struggles. But her loneliness seems largely self-imposed, perhaps compounded by what she describes as “a severe strain” of obsessive-compulsive disorder. “It turns out, laughably, that an interest in privacy, and staying quiet about internal feelings, are hallmarks of this condition,” she writes, offering a partial explanation for her wariness of company.

Pondering the American way of aging, Schiller initially adopts a posture of ignorance and naivete so extreme that it seems like a pose. She puzzles out the distinctions among nursing homes, assisted living facilities and continuing care retirement communities, as well as home healthcare. And she underlines the fact that, when it comes to long-term care in the United States, only the relatively well-off have good choices. This isn’t exactly news.

Another Schiller inquiry involves the familiar complexities of Medicare. She notes that, as a public program for seniors, it is so inadequate that it requires private options, such as Medigap and Medicare Advantage, to paper over coverage gaps. Picking the best plan for one’s needs can be a daunting option, requiring trained help or careful study. Schiller attends an informational seminar by a broker for Medicare Advantage plans and decides, unhelpfully, that they are neither “a solution or a problem.”

Schiller’s reporting methods rely, to some extent, on serendipity. “I tended toward … a kind of diffuse sallying through the world, staying open to the coincidence, digression, and movement,” she writes. She calls the method “antinarrative.”

All that sallying takes her down some unexpected byways. She returns to a western Pennsylvania town called Harmony, where she once had “a horrible, endless date over crepes,” to investigate a strike over pay and working conditions at a troubled nursing home. That leads to a long discussion of the use of restraints on the elderly.

At one point, Schiller finds a company called Papa that employs younger “Pals” to assist older adults. With the backing of health insurance companies, the Pals provide companionship, transportation, housecleaning services and more. Schiller tries something similar as a volunteer for a health insurance company, reaching out to an elderly Black woman by phone. They stumble over time into an unlikely friendship.

One problem with all these efforts to mitigate old-age loneliness, Schiller notes, is that the loneliest generation is actually Gen Z. And the loneliness surveys themselves, she suggests, may be suspect.

Schiller delves, inevitably, into the history of AARP, an organization that even in its earliest days was entangled with the health insurance industry. And consumer advocate Ralph Nader, for whom she does some editing work, tips her to the story of activist Maggie Kuhn, founder of the Gray Panthers.

Kuhn, Schiller writes, understood “the tension between the social so-called nothingness of old age and its vibrant realities.” Which brings Schiller to the intersection of aging and disability, and to Programs for All-Inclusive Care for the Elderly (PACE), which provide community-based care as an alternative to nursing homes.

In the end, Schiller has a go at parsing her own motivations. “I had descended into the strange subterranean structures of aging, almost as a way to avoid the contemporary world … ,” she writes. “Age … was a helpful distancing tool: older people’s vulnerabilities, including those of my own grandparents, helped to distract me from my own present and future. … I still did not know how to seal over the gaping wound of the pandemic, how to move forward.”

For all her verbiage, she can find no easy fix, nor even a complicated one. “It was not possible for me to imagine a solution to the level of fragmentation, pain, and dysfunction I saw,” she writes, leaving readers without much justification for having followed her rambling, idiosyncratic quest.

Klein, a cultural reporter and critic in Philadelphia, has been a three-time finalist for the National Book Critics Circle’s Nona Balakian Citation for Excellence in Reviewing.

Médecins Sans Frontières (MSF), an international humanitarian organisation, has released its 2025 activity report for Nigeria, and the findings are sobering. The medical emergency organisation, also known as Doctors Without Borders, unveiled the report during an event in Abuja, North Central Nigeria, on Wednesday, May 13, documenting the disturbing rise in malnutrition cases in the country’s northern region.

With more than 3,500 workers delivering essential healthcare services across ten states, MSF reported treating over 440,000 children for malnutrition, more than 300,000 individuals for malaria, and assisting with over 33,500 deliveries in 2025.

This surge, according to the humanitarian organisation, underscores the fragility of Nigeria’s health system and the growing vulnerability of women and children in conflict-affected regions.

The 2025 report shows that MSF recorded more than 600,000 outpatient consultations, 48,000 inpatient admissions, and treated 341,239 patients for malaria, 38,753 children for measles, 6,123 patients for diphtheria, and 985 others for meningitis across its facilities in the region.

These findings are specific to the ten Nigerian states where MSF has been operating since 1996, including Jigawa, Kano, Katsina, Kebbi, Sokoto, Zamfara, and Cross River. The organisation says it has provided a wide range of essential medical services, including paediatric and maternal health care, treating children with malnutrition, responding to disease outbreaks, caring for survivors of sexual violence, offering mental health support, and performing life‑saving surgical interventions. 

The MSF country representative, Ahmed Aldikhari, revealed that in 2025, the organisation observed a pattern consistent with that of previous years, starting in 2022. Aldikhari stated that malnutrition is one of the year’s greatest challenges, linking it to the region’s fragile conditions, which are severely affected by insecurity that has worsened food security.

“We are seeing a vicious cycle where malnutrition is both a cause and a consequence of diseases such as measles, malaria, and diphtheria, among others, which continue to affect vulnerable communities, especially when healthcare is delayed or inaccessible,” he said, suggesting that Nigeria might soon experience the peak of the malnutrition crisis. 

“That is why we are consistently working side-by-side with the ministries of health, humanitarian affairs, budget and planning at the state and federal levels, and also, with our Nigerian colleagues to ensure that efficient services are provided, but they are not enough.”

HumAngle has previously reported on the broader impact of the crisis, stressing how displacements, insecurity, and climate change, among other natural and human-induced disasters, have compounded the problem. In July 2025, MSF, in collaboration with the Katsina State government, mobilised state and non-state actors to address the escalating malnutrition crisis in the northwestern region. 

During the 2024 MSF conference in Abuja, organised in collaboration with the North West Governors’ Forum and the Katsina State Government, stakeholders emphasised that malnutrition in the northwestern region is no longer a seasonal emergency but rather a structural crisis that requires urgent mobilisation. The governors acknowledged that insecurity and climate pressures were eroding food systems, but MSF urged greater investment in therapeutic feeding centres and preventive programmes.

Northern Nigeria continues to face a critical malnutrition crisis, with Katsina particularly affected, according to MSF’s 2025 activity report. Findings reveal that since 2021, MSF has been present in the state, with the organisation’s leadership revealing that they have witnessed a sharp rise in the number of malnourished children since responding to the growing crisis in recent years.

In 2025, MSF reported treating the highest number of malnourished children in Katsina. With the support of the state Ministry of Health, the organisation focused on preventing illness and malnutrition to reduce mortality and morbidity among children suffering from acute malnutrition.

“Katsina State has faced a chronic malnutrition crisis for over a decade, driven by insecurity, climate shocks, limited primary healthcare services, and high birth rates,” the report revealed. “Throughout 2025, MSF admitted 26,445 patients for inpatient care, provided treatment to 146,301 children through its outpatient centres, and conducted 15,387 outpatient consultations for malaria.”

In response to this, MSF established a new Ambulatory Therapeutic Feeding Centre (ATFC) in Mashi and a second inpatient therapeutic feeding centre at the Turai Yar’aduwa Hospital to handle the increased patient load during peak seasons.

Beyond nutrition in Kebbi, the report states that MSF responded to multiple infectious disease surges and outbreaks by tackling the increase in meningitis cases from February to May, while supporting the Ministry of Health facilities in Jega, Gwandu, and Aliero with logistics, medical supplies, staff training, and facility rehabilitation.

Following the escalating insecurity in neighbouring Zamfara and Niger that led to mass displacement to the Danko-Wasugu areas of Kebbi State as of June, the humanitarian organisation provided basic healthcare and distributed non-food relief kits to vulnerable households.

In Zamfara alone, MSF admitted 47,164 children to inpatient therapeutic feeding centres and provided 14,167 outpatient consultations in 2024, with numbers continuing to rise in 2025. According to Aldikhari, this increase in admissions is due to multiple overlapping crises, including conflict and insecurity in the northwestern and northeastern regions, which have displaced thousands of families, cutting them off from farmlands. 

While the 2025 activity report warns that malnutrition is no longer a seasonal emergency but a permanent feature of Nigeria’s humanitarian landscape, it also highlights the fact that the sheer scale of admissions suggests the crisis is outpacing the humanitarian response.