It’s never too late to get healthy

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Barbara Ruben

Dr. Gayle Porter (left) and Dr. Marilyn Gaston created Prime Time Sister Circles to help older African American women improve their physical and emotional health. The circles are facilitated by the nonprofit Gaston & Porter Health Improvement Center, and work to spread recommendations from the doctors’ 2001 book, Prime Time: The African American Woman’s Complete Guide to Midlife Health and Wellness.
Courtesy of Gaston & Porter Health Improvement Center

A few years ago, Gertie Elam lost her job as a federal contractor, and soon after that had surgery for colon cancer.

“It was a very difficult time in my life. I was so stressed, not getting enough sleep, worrying about what would happen,” said Elam, who lives in Suitland, Md.

A friend at church suggested Elam join a support group she co-facilitated called Prime Time Sister Circles — not just to help manage her stress, but to instill healthier habits as well.

The program, begun by two local doctors in 2003, offers 12-week classes at no charge for African American women ages 40 to 75.

Later this year, its founders — Dr. Marilyn Gaston, a former Assistant U.S. Surgeon General, and Dr. Gayle Porter, a clinical psychologist formerly on the faculty of Johns Hopkins School of Medicine and senior mental health advisor at the American Institutes for Research — will start groups for women of all ethnicities.

The two doctors started the Sister Circles after they realized there was a paucity of health information for black women at midlife. The two were already friends 20 years ago, when they appeared on the same BET show, speaking about this demographic.

When they got back to their offices the next morning, they had piles of messages from viewers asking for advice and looking for more information.

“We started looking for a repository of information, and there wasn’t one,” Porter recalled. “I was at Hopkins and Marilyn was at NIH, and there was nothing that you could pick up and say, ‘these are issues related specifically to midlife black women.’”

So they decided to forge their own path to helping women during a period in their lives when they may be stressed with careers, caregiving for aging parents and/or grandchildren, and facing illnesses caused by poor lifestyle choices.

Health disparities

First, they wrote Prime Time: The African American Woman’s Complete Guide to Midlife Health and Wellness, which rocketed to the top of Essence magazine’s bestseller chart.

The book focuses on health areas in which black women have statistically poorer outcomes — from high blood pressure to diabetes. The book, whose first edition came out in 2001, published graphs that delineated the stark disparities in life expectancy and health between older white and African American women.

In the 16 years since the book was published, statistics still paint a bleak picture and serve as a wake-up call to women to make changes in their lives, Gaston said.

Nationally, diabetes affects 1 in 4 African American women 55 years and older, and is the fourth-leading cause of death for all ages, according to the Black Women’s Health Imperative.

About four out of five black women are overweight or obese. More than half have high blood pressure, according to Gaston.

Not surprisingly, these factors affect life expectancy, and lead to a great disparity in the local area in particular.

A report issued by Georgetown University last year found that black females in the District of Columbia have a life expectancy of 76.2 years compared to 85.2 years for white females — the widest gap in the nation, Gaston said.

The Georgetown study also found that African American residents of Washington, D.C., both male and female, are six times more likely than white residents to die from diabetes-related complications. They are also twice as likely to die from coronary heart disease and stroke. Black women are 1.5 times more likely to die from breast cancer.

Gaston and Porter set up focus groups to help them decide how to best address these issues, and help women make better food choices, reduce their salt intake, lose weight, exercise and lower stress levels.

“These changes are extraordinarily difficult to make at any point in your life, and certainly at midlife,” Gaston said.

During the focus groups, “The women were so funny,” Porter recalled. “They said, ‘Docs, don’t send us a perky 20-year-old who weighs 90 pounds to tell us how to exercise, when we haven’t exercised since we were in eighth grade, and tried not to do it then.’”

Both Gaston and Porter fit the demographic they wanted to help, and they only hire Prime Time Sister Circle facilitators who have already been part of a circle.

Today, Gaston is 78 and Porter is 71. To date, more than 3,000 women have taken part in the circles, many of which continue informally for years after the initial program began. The circles are now functioning in seven states, and the doctors say they envision them spreading much further.

New circles starting

New 12-week sessions start in March and April in Washington, D.C. and Prince George’s County, Md. There will be groups offered during the day, evenings and weekends. For a schedule of where and when the groups will meet, call (202) 403-6266.

They are free for women to join, and are funded by grants from the Ford Foundation, Kaiser Family Fund, Astra Zeneca and others.

Gaston and Porter recently secured a five-year NIH grant to study how well the circles work. In conjunction with Johns Hopkins, they will compare 300 women in the circles in Washington, D.C. with 300 others getting the usual standard of care for high blood pressure, with quarterly visits to primary care doctors, medication and diet advice.

They hope the data will show that the women in the circles — who meet two hours a week to get expert advice, share challenges and hold each other accountable — have better outcomes.

Chronicling successes

They already know the program is working. Gaston and Porter published an article last year in the Journal of the American Medical Association describing some of the health improvements of circle members so far.

“We’re seeing a 20 to 30 percent drop in blood pressure levels. We’re seeing dramatic increases in physical activity level. All the women are exercising now. It might just be walking three times a week, but they’re moving. We’re seeing a significant change in portion control and salt intake,” Gaston said.

The doctors also like to share anecdotal information on the impact of the circles.

For Elam, the program made such a difference in her life that she signed up to train to become a co-facilitator for a Prime Time Circle of her own.

“It’s a very good program, especially for women who don’t take the time to take care of themselves,” Elam said.

“Many women in this age group are caregivers to parents, some of them are grandparents who are more like parents to the children. They just don’t have the wherewithal to take care of themselves, to go get checked and do these things,” she said.

One woman adopted her 9-year-old grandson after his mother died of AIDS. The grandmother told him how they were going to get healthier together.

She taught him to read nutrition labels on food, something she had learned in her group. One day, when the grandmother placed a bag of Doritos in the cart at Giant, he picked up the bag and said, “Nana. Look at all this fat! Look at all this salt!”

“He told the cashier, ‘We have to put this back because my nana is going to live to see my grandchildren, and she can’t eat this if she’s going to do that,’” Porter recalled.

“For us, it was a dream come true,” she said. “This was exactly the kind of spread that we wanted to see.”

Dreaming big

And it was exactly the kind of futures both women dreamed for themselves when growing up poor in the projects in the Midwest.

Gaston was born in the public housing apartment where her mother lived in Cincinnati. A huge snowstorm prevented her mother from getting to the hospital.

When Gaston was 12, her mother fainted due to blood loss from undiagnosed cervical cancer. She hadn’t gotten care because they had no money and no health insurance.

“I decided that day to become a doctor. We were poor and didn’t get the care we needed. I wanted to help people like that,” Gaston recalled.

She ignored school counselors who told her she would never get to medical school because she had three strikes against her: She was black, a woman and poor.

Not only did she graduate from medical school, she went on to become the first African American woman to direct a Public Health Service Bureau, and only the second African American woman to achieve the position of Assistant Surgeon General and rank of Rear Admiral in the U.S. Public Health Service.

As director of the Bureau of Primary Health Care, she was responsible for a budget of $5 billion, serving 12 million poor, underserved and disadvantaged people.

Prior to her appointment as Bureau director, her work at the National Institutes of Health changed the management of children with sickle cell disease, significantly decreasing the illness and mortality in young children, for which she is internationally recognized.

Porter grew up in similar circumstances in Chicago public housing, the oldest of five children. She remembers as a child watching the movie The Search with her mom. In the movie, Montgomery Clift played a man who helped reunite children with their parents after the Holocaust.

 “When the movie was over, I turned to my mom and said, ‘I want to do that. I want to work with kids and help them feel better.’ That’s never changed for me,” she said.

Earlier in her career, Porter became the first director of two outpatient mental health centers for the Washington, D.C. Commission on Mental Health Services, working primarily with children.

“I was seeing all of these grandmothers, great-grandmothers who were primary caregivers for these children, and their health was in the toilet. Nobody was talking about their physical health, but we tried to address some of their mental health issues,” she recalled.

Together, in 2006 the doctors were in the first group of winners of the annual Purpose Prize, which recognizes people over 60 who are applying their passion and experience for social good.

But more than prizes and grants, Gaston and Porter turn to the women in their circles and their families for validation about the impact of the program.

One woman fell into a major depression after her husband died of a heart attack, as did her son. They self-medicated with comfort food, until someone told her about the Prime Time Sister Circles.

“At first, her son was very upset because his mom changed everything with food, so they were eating better. Later, her son came to one of the meetings,” Porter recalled.

“It brings tears to my eyes just thinking about it. He said to us, ‘Docs, I want you to know, you not only saved my mother. You saved me. Because as she changed, I changed. I didn’t want to, but your program saved both our lives.’ For us, it’s just so gratifying.”

For more information about Gaston, Porter and the Prime Time Sister Circles, see, or call (202) 403-6266 for a schedule of circles starting in the area this spring.