Trisha Wilson has spent her career designing beautiful spaces for some of the world’s richest people and most luxurious hotels, from Dallas and New York to Beijing and Dubai. Now she’s turning her attention to some of the poorest in society, in places like south Texas and South Africa. That may seem like an unlikely transition. But then, Trisha Wilson’s career has been filled with many unexpected turns.

This is a woman who jump-started her interior-design career with cold calls to Trammell Crow and Ralph Lauren, who succeeded in clinching business deals in the male-dominated Middle East (her firm is in the midst of a 24-hotel project in Mecca), and who acquired a home in South Africa and then a desire to help its impoverished children.

“In our business, we do the highest of the highest: 747s and princes’ homes and the best hotels. You start believing that that’s how the world is,” she says. “But in fact, what’s really important is what we see in South Africa and what we will see in south Texas when we start the program here.”

After a 40-year career, Wilson, 65, earlier this year stepped away from day-to-day involvement at her Dallas-based Wilson Associates to focus on the work of the foundation she created.

During the past decade, The Wilson Foundation has been instrumental in bringing modern education and medical care to South Africa’s Limpopo province, an area north of Johannesburg with high levels of poverty and disease.

A private school was built and scholarships awarded to many young students who otherwise might not be educated. A fledgling clinic that helps residents stricken with HIV and AIDS was expanded with hospice care and drugs to help HIV-positive residents. Through partnerships with Southern Methodist University and UT Southwestern, young teachers and medical students have traveled from Dallas to South Africa to help on the ground.

“It’s a real success story. They have saved many, many lives,” says Dr. Tawanda Gumbo, a director in the office of global health at UT Southwestern Medical Center.

If this reminds you of another successful woman who opened a school in South Africa, well, yes, Wilson does know Oprah Winfrey. Her firm worked on Oprah’s school there.

Wilson has always had the confidence and drive to achieve big goals. She credits her success in the business world to an innate ability to connect with people and cultivate relationships—more Oprah than Lean In (though Wilson certainly exhibits the aggressiveness that Sheryl Sandberg espouses for women in her best-selling book). And being a woman, Wilson says, has its advantages.

“There are some things women can get away with that men can’t, like asking personal questions and getting to know a person,” she says. “I usually make friends with my clients. I’m not intimidated by anything. I ask questions.”

Her work in the Middle East, for example, began when a princess in Abu Dhabi saw pictures of the Lost City resort her firm designed in South Africa, and hired her to work on a palace. Wilson got to know the sheikha (who was only allowed to work with a woman), and later designed homes for family members in the United States.

“I have always been a positive thinker, maybe naively so,” Wilson says. “I think naivete is such a huge thing on my side. And curiosity.”

Her latest passion began after she bought a ranch in South Africa and witnessed the plight of poor, sick residents nearby. Now she wants to provide help in Texas along the border, where conditions for some people are similarly dire.

“The same model can work in Texas,” she says. The Wilson Foundation has approached Project HOPE, a New York-based organization focused on global health issues, to find a site along the border where it can launch education and healthcare programs, says John J. Canterbury III, the foundation’s executive director.

The groups are looking at communities in Brownsville and El Paso County and hope to begin a Texas program in the next year. Meanwhile, at UT Southwestern, the focus is shifting to medical research. With help from Wilson’s foundation, the school is involved in research on tuberculosis with the University of Cape Town, trying to learn what is causing a rise in drug-resistant TB cases in South Africa. The findings, Gumbo says, could also help in Dallas, which has one of the highest TB rates in the country.

Says Wilson: “Rather than putting Band-Aids on things, we want to eradicate the disease.”