My wife and I have just returned from Africa. We had opportunities to get a glimpse at the new rainbow democracy that has emerged after the elections in 1994 following the abolition of the Apartheid regime. It has been to the credit of Nelson Mandela, who negotiated a bloodless transition aimed at preserving the infrastructure of this resource-rich country.

One cannot avoid seeing the social and economic challenges facing this country. Per published statistics, there is a 38% unemployment rate, and only 37% of households have a man in the house. With this as a background, I was honored to visit a poor neighborhood, Hanover Park, in the flatlands outside of Cape Town. I was asked to speak to staff of a long term care complex called Rehoboth Age Exchange.

The center consists of a day center with rooms for respite care as well as freestanding apartments. Across the street they have an assisted living with about 76 beds occupied predominantly with elders who suffer from Alzheimer's and other neurodegenerative diseases.

The drive through the neighborhood revealed many "parks" with shipping containers meant as temporary housing that became permanent housing to many immigrants. The new constructions built by the government had a sign" humane housing"! Rehoboth is an island of goodwill in this community. There is a long waiting list to get in. The center was built a few years ago with philanthropic and governmental funds. This year most founders stopped supporting the center, leaving a beautiful space and a needy community without the resources to hire physical therapists to operate a modern gym with a state of the art therapy pool and various equipment. During my visit, one patient was treated by an occupational therapist, who was hired to do both jobs.

The meeting with staff, mostly self-taught , was inspiring. Care aides and “house mothers” all charged with taking care of very disabled demented persons were using a lot of common sense and generosity to care for these people. Faith and devotion, including prayers and reminiscing, are the primary behavioral interventions at their disposition. They use very few medications to treat behaviors, and as one career worker said,  “You have to be very gentle with them when they act out, do not confront them; rather redirect them."  Physicians are not part of the team and are seldom utilized in the day-to-day care. Should the need arise, the patient will be transported to a day hospital in the center of town for evaluation and treatment. The senior staff admitted that the medical community is not very tuned to dementia care.

I was very impressed by their strong motivation to provide the right care for the elderly, many rescued from abusive families. The elders in this community are targeted because they receive a monthly allowance of about 110 U.S. dollars:  a fortune for some.  They risk being ripped off by their own grandkids who leave them with a can of dog food (the cheapest meat) and walk away with the rest.  Rehoboth offers community outreach by inviting people to visit share a meal with elders for a small fee (one dollar) or have tea and cake. By doing so, they try to expose the community to the problems facing their elders and educate the younger generation to respect their elders.