His father died when he was a little boy, his mother when he was a young man. His grandparents, save but one, never made it to old age either. His wife is gone now, too, in the ground with four of their children, so forgive Yafesi Nakyanga’s surprise that he is still breathing.

Long past an age when the farmer could make out a visitor’s face, much less still bend in the fields, long past the bills that sapped his meager savings, long past all the heartache he has seen, Nakyanga is still living at 86, part of a swell of the old in the land of the young.

“I never expected,” he says softly, “to live this long.”

Across Africa, a wave of longevity is arriving, promising to reshape the demographics of a continent wholly unprepared for it.

On a continent torn by war, decimated by disease and choked by poverty, the progress that has led to longer lives is a reason for celebration. But as villages begin to fill with the old, pensions and social safety nets are minimal, medical care is lacking and routine problems of age are so commonly unaddressed that cataracts turn to blindness and minor infections end in death.

Longer lives, time and again, come with more suffering.

“They’re living in poverty. They’re living in pain,” says Kenneth Mugayehwenkyi, who founded Reach One Touch One Ministries to help older people. “That’s the old people that I see.”

In just 15 years, the number of people 60 and older has ballooned by an estimated 50 percent in sub-Saharan Africa, to about 67 million people. Even more dramatic growth awaits, with the World Health Organization projecting 163 million older people in the region by 2050.

Few resources await them. Festering poverty and desperation for the little help that is available could grow even worse as the U.S. and other western nations pull back foreign aid.

Mugayehwenkyi’s group is one of the only organizations in Uganda dedicated solely to supporting the elderly, and this day its team has arrived to Nakyanga’s small home on a dirt road in a village about a 90-minute drive from the capital.

A 26-year-old nurse, Derrick Ssemanda, in royal blue scrubs, hustles inside and sits beside Nakyanga. The man’s catheter has been causing pain and Ssemanda pulls white surgical gloves from a camouflage backpack and gets to work changing it.

“Are you strong enough?” he asks Nakyanga.

“I’m a strong man,” he replies. “I can handle it.”

Nakyanga sweated in the fields just to grow enough to feed children who would later die of AIDS and laid the bricks and poured the cement to build a house he nearly lost to medical bills.

He has no electricity or running water. His bathroom is an outdoor pit.

To make it to this age in a country like Uganda seemed impossible to Nakyanga. It’s made all the more an oddity by the fact that it is a country with one of the youngest populations in the world.

“You’re surrounded by young people,” Nakyanga says, “and you’re standing next to death.”

A file back at the Reach One Touch One office details Nakyanga’s many pains, the ulcers, the vision that’s nearly gone because he can’t afford surgery. He is thin and in tattered clothes, his hair is short and gray, and he says little without prompting, lying quietly as birds squawk in the distance.

Ssemanda keeps talking, trying to distract his patient from the procedure. He pushes a syringe’s plunger, sending an arc of saline in the air, then peels open the packaging to a new catheter, and before Nakyanga knows, it’s over, and the nurse is bounding for the door.

There are so many seniors to see.