Knock, knock.
Who's there?
If you're an older resident of a low-income area outside Cape Town, it might be Gloria Gxebeka. She's a 63-year-old grandmother and retired cook who used to spend her days at home alone and glued to the TV, especially the American soap opera The Bold and the Beautiful. But now she's got a new job. She goes door-to-door, checking on the health of other older folks in her neighborhood.
Gxebeka works for the program AgeWell Global, directed by Dr. Mitch Besser, an American physician. Besser also founded mothers2mothers, an organization that trains HIV-positive women to mentor other HIV-positive women when they're pregnant.
That idea — moms helping other moms — turned out to be very effective at preventing mother-to-child transmission of HIV in Africa. So Besser wondered how else this peer-to-peer model of health care might be applied.
He started thinking about his parents and some of their aging friends. "Their children have moved away, they can't drive anymore, and in many respects they become prisoners of their households," Besser says.
Then he thought: Why not have other older people check up on them?
One morning, Gxebeka and a co-worker, Thami Mlotaywa, stop in to see 86-year-old Ann-Marie Fisher, a fellow grandmother who has a raspy voice and walks with a cane. They sit with Fisher on a saggy couch and read a list of 20 questions from a customized cell phone. Has Fisher felt confused or dizzy in the last seven days? Has she had trouble breathing? Did she skip any meals?
Gxebeka and Mlotaywa then look around Fisher's home and make 20 observations: Are there any tripping hazards? Has Fisher been well enough to keep the place tidy?
Gxebeka enters all of this information into the phone, which has a special app that does a calculation. A message appears: Based on the information, Fisher does not need to see a doctor or social worker.
Then comes the best part of the visit: the gossiping. The women recall stories from their younger years, including a time when Gxebeka saw her husband walking down the street with another woman.
"I was so cross!" she says, laughing.
AgeWell Global employs roughly 30 workers who go door-to-door and serve a client base of more than 100 people. For some workers, it's the first job they've ever held. They work 20 hours per week and are paid above minimum wage.
Directors of AgeWell Global say it's too early to know if the program has medical benefits, such as diagnosing diseases earlier or reducing hospitalizations. But preliminary data collected by the organization suggests an emotional benefit: a reduction in depression among people who receive the visits, according to a commonly used test.
The people who do the visiting seem to benefit, too. Gloria Gxebeka used to complain about her health: "My blood pressure was always up, my sugar was always up." But she claims that working regularly, and spending time with her neighbors, has made her feel better. "I'm really feeling excellent, fantastic, number one," she says.
And she can still watch The Bold and the Beautiful after she gets home.
Transcript
AUDIE CORNISH, HOST:
As people get older, they face more health problems - think arthritis, heart disease. They often face emotional challenges, as well, like social isolation and loneliness. But what if there were a way to tackle all these problems at once? NPR's Anders Kelto found a program in South Africa that does just that.
ANDERS KELTO, BYLINE: A few weeks ago, I met a woman named Gloria Gxebeka. She's 63, and she lives in a low-income area outside Cape Town. Every morning, she gets up at 5:30 and wakes up her grandsons.
GLORIA GXEBEKA: Knock, knock.
KELTO: She makes them breakfast, helps them pack their bags.
GXEBEKA: Are you ready for school, Clarence (ph)?
CLARENCE: Yes.
KELTO: And then, she does something that always makes her a little sad.
GXEBEKA: Goodbye to granny. (Unintelligible).
KELTO: She sends the kids off to school. When they're gone, she gets lonely.
GXEBEKA: The children are at school. My daughter is at work. I'm alone.
KELTO: For years, she just stayed home and watched soap operas all day. She's a big fan of "The Bold And The Beautiful." But her health started getting worse.
GXEBEKA: My blood pressure is always up. My sugar is always up.
KELTO: But then, a few months ago, she got a job with a new program in her community. Now, instead of sitting home all day, she goes door-to-door and helps identify her neighbors' health problems. I spent a day following Gloria around on her new job.
GXEBEKA: (Unintelligible).
KELTO: Her neighbor, a 75-year-old woman named Thami Mlotaywa, works with her. They walk along a gravel road through a maze of shacks and went up to a small, brick home.
GXEBEKA: Knock, knock, knock.
KELTO: A woman with a cane let them in. Her name was Ann-Marie Fisher, and she was 86 years old. They sat on a saggy couch, and the two women began asking Fisher some questions.
GXEBEKA: Have you been feeling confused or dizzy in the last seven days?
KELTO: They asked if she'd been having trouble breathing or had skipped meals. And it felt more or less like a doctor's visit. But here's the thing - the two women asking these questions, they have no medical background. One was a maid and the other was a cook. And that's the whole idea behind this new program.
MITCH BESSER: What we're doing is training your neighbor, your friend to contribute to your better health.
KELTO: Mitch Besser is the director of the program, AgeWell Global. He used to run an organization in Africa that trains HIV-positive women to mentor other HIV-positive women through pregnancy. That idea of mothers helping other mothers turned out to be really effective. And Besser wondered, how else might it be applied? And then, he started thinking about his own friends who were getting older.
BESSER: Their children have moved away. They may have lost a spouse. They can't drive anymore. And in many respects, they become prisoners of their households.
KELTO: And then he thought, hey, why not have other older people, who themselves might feel lonely and isolated, check up on them? He did some research, and found no one was doing that.
GXEBEKA: (Foreign language spoken).
KELTO: Gxebeka finished asking Fisher about her health and entered her answers into a cell phone. The phone had a special app that did a calculation and displayed a message. In this case, Fisher does not need to see a doctor or a social worker. And that meant it was time for the next part of the visit, the part everyone loves: the gossiping.
ANN-MARIE FISHER: (Laughter).
KELTO: Gxebeka talked about the time she saw her husband walking down the street with another woman.
GXEBEKA: And I was so cross. And then we fought together. And friends liked that (laughing).
KELTO: The people who run AgeWell Global say it's too early to know if the program has medical benefits like fewer hospitalizations or diseases being diagnosed earlier. But they have preliminary data that shows a big emotional benefit. Basically, people who receive these visits have less depression, as measured by a commonly-used test. And the people doing the visiting seem to benefit, too. Gloria Gxebeka, who used to watch TV all day, said having regular work and just spending time with her neighbors had improved her health.
GXEBEKA: I'm really feeling excellent, fantastic, number one.
KELTO: And she can still watch "The Bold And The Beautiful" after she gets home.
(SOUNDBITE OF TV SHOW, "THE BOLD AND THE BEAUTIFUL")
KATHERINE KELLY LANG: (As Brooke Logan) I was wondering when you'd come upstairs.
GXEBEKA: Brooke. Oh, say, naughty girl.
KELTO: Anders Kelto, NPR News. Transcript provided by NPR, Copyright NPR.
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