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January 4, 2012 9:00 pm
The vagaries of Cape Town’s trains have made Mpho Mbhele an hour late, but it does not take long for a smile to replace her flustered apologies. She is a vital presence, a picture of health, and looks younger than her 41 years.
She is also HIV-positive, having been infected by her former husband who then threw her out. She has lost one of her three children to Aids.
It is a common story. Three-quarters of the world’s HIV-positive pregnant women live in 12 African countries, including South Africa. At Chris Hani Baragwanath Hospital in Soweto, 8,000 HIV-positive women give birth each year. This is more than in the whole of the US. Untreated, 40 per cent of those women will give birth to infected babies.
It does not have to be that way. Ms Mbhele is one of an army of HIV-positive mothers who persuade pregnant women to take an Aids test, advise them to submit to the treatment that will help ensure their babies are born healthy and then support them if they need antiretroviral drugs to stay alive to look after their children.
These “mentor mothers” work for an organisation founded in 2001 by Mitchell Besser, an American obstetrician whom I first met when he was an undergraduate in the 1970s. Mothers2mothers (m2m) operates in seven African countries, employing 1,475 mentors and site co-ordinators who deal with 78,000 women each month.
Dr Besser set up m2m after his frustration, while working at a Cape Town hospital, at how few pregnant women agreed to be tested for HIV and how little time he and his nurses had to counsel those who did take the test and proved positive.
The mentor mothers not only help to compensate for the dire African shortage of doctors and nurses. Pregnant women are also more likely to listen to HIV-positive women who have had children themselves.
That the mentors look so well is one of the keys. When I visited a clinic in the South African province of KwaZulu-Natal in 2010, the chubby-cheeked mentors made a strong contrast with the drawn and coughing patients.
The mentors, who are trained and paid a salary, provide the answer to the many women who say they don’t want an HIV test because they don’t want to discover that they are going to die. “Do I look like I’m dying?” the mentors ask.
Their other central role is helping defeat the HIV stigma. Speaking in m2m’s central Cape Town office, Ms Mbhele waves away my question of whether she minds her name appearing in a newspaper published worldwide. She doesn’t believe people should hide being HIV-positive. Women who come to the two clinics she supervises aren’t all as brave about their status. “They say ‘we can’t disclose like you’,” she says.
She knows what it is like. It took her time to tell people she had HIV. She knows, too, that antiretroviral tablets, while life-saving, are not easy to take. “Three in the morning, three in the evening. It’s very hard to remember,” she says. There can be side effects. For three months at the beginning, she suffered numbness in her leg. But she tells the mothers that they have a duty to their children. “I say, ‘You must live long, you must take your ARVs.’”
These mentoring lessons apply elsewhere too, including in business. Dr Besser says patients are often readier to listen to their peers than to supposed authority figures. He also asks whether, with health costs under pressure in both developed and developing countries, doctors and other medical professionals are always the most effective deliverers of care. As populations age, isn’t there a role, for example, for the more robust elderly to support those whose health has declined?
Peer mentoring exists elsewhere; Alcoholics Anonymous is a leading example of people who have changed their lives supporting others who are struggling to do so.
What of companies? A 2007 review of the research literature into corporate mentoring by Barry Bozeman and Mary Feeney of the University of Georgia shows it is overwhelmingly seen as something senior people do for their juniors. “A mentor is generally defined as a higher-ranking, influential individual in your work environment who . . . is committed to providing upward mobility and support in your career,” is a typical example.
There is a role for people like that, although they might better be called sponsors than mentors. As with the mentor mothers, someone who started where you are would surely be more credible and effective.
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