KIMBERLEY, South Africa, 3 August 2004 — Patients wrapped in coats and blankets against the bitter cold crowd together, thrusting prescriptions through the train’s window.
Inside, PhD pharmacology student Freddy Mohlala takes the slips one by one and hands back medicine to each patient who has come from miles around for cheap medical attention.
“I think everybody who’s in the health profession has to come and get this experience”, Mohlala said.
This is Phelophepa, a very special train which is in the diamond-mining town of Kimberley to celebrate its 10th birthday. Its name is taken from the Pedi language of central South Africa and means “Good, clean health”.
Since its first journey in 1994 a few months before South Africa’s first democratic elections, Phelophepa has provided healthcare to the country’s poorest areas, helping those priced out by a public health system in crisis.
This is an unusual stop for a team more used to rural stops.
“It’s quite urban...Phelophepa is known for visiting rural villages, where people don’t have access to basic healthcare services,” said the project’s founder, Lynette Coetzee, who lives on the train for 9 months a year.
Away from towns, some patients wake at 3 o’clock in the morning and walk up to 30 km (20 miles) to get to the train, funded mainly by Transnet, South Africa’s public transport company.
Phelophepa’s staff, including 39 university students, treat more than 1,200 patients a day.
“When we went to the Eastern Cape (a very poor province), in Swartkops at 4 o’clock in the morning we had more than 2,000 people waiting outside”, Coetzee said.
The reason is simple: even poor people can afford Phelophepa.
“I came here because it’s much cheaper than a normal clinic,” said 21-year-old John Leppen, waiting at the eye wagon where he will pay just 10 rand ($1.62) for a sight test — a fraction of the normal cost.
Optometrist Thabo Nabe makes up spectacles to prescription.
“It’s my second year on the train,” he said. “It’s a very satisfying and rewarding job. I would do it forever if I could.”
Phelophepa’s manager, Lillian Cingo, describes the first decade as an “absolute success,” but wishes there was another train. Although Phelophepa spends a week at each stop, in some areas this is simply not enough.
“Whatever we do we’re not even touching the tip of the iceberg,” she said.
Cingo said Phelophepa would do well in the rest of Africa.
“We complain a lot in South Africa for our needs, but let’s face it, the rest of Africa is worse than us, particularly in health problems.”
The train’s eye, dental and health clinics treat an average of 40,000 patients a year. Every week 9,000 rand ($1,432) is spent on salaries for local people — many of them hired as interpreters in a country that has 11 official languages.
It also offers a free counseling service and educational programs including one on HIV/AIDS, which affects more people in South Africa than in any other country.
AIDS has added to the burden on a healthcare system already struggling to recruit skilled staff in rural areas as doctors and nurses leave in droves for better paid jobs abroad.
South Africa has an ambitious program to give life-saving anti-retroviral drugs to HIV sufferers, but the train is unable to provide adequate monitoring to distribute the drugs.
Medical students from South Africa’s rich cities volunteer to serve two-week stints on the train to see the desperate needs of patients in rural areas. Some even pay their own way.
“You gain a lot of experience...These patients are so needy of the treatment you give them and so appreciative,” said 24-year-old Yoemna Khatib, who is spending two weeks helping in Phelophepa’s dental wagon, paying for accommodation on the way.
For Rosa Marais, a 22-year-old medical student from Johannesburg, working in the eye wagon is great training. “In our clinic you don’t see all the different diseases that you see on the train,” she said. “And of course it’s very nice to see people smiling in the end if they can see something”.
Students are key to the train’s success, Coetzee said. “They’re fresh every two weeks and they come prepared,” she said.
