The Phelophepa Train

On January 14, 2002, the Phelophepa train pulled into Aliwal North, the first stop of the new season, which will take it across four of South Africa's nine provinces. As always, each five-day stop has been carefully arranged by staff at Transnet, South Africa's national rail carrier, which spreads the word with local community leaders and others who live along 15,000 kilometers (9,320 miles) of track. Patients walk or cycle, sometimes dozens of miles, and stand patiently waiting their turn at their station, their village, or their junction. Train officials estimate that at least 1,000 people are seen at each of the 36 five-day stops per year.

To the people of rural South Africa, the Phelophepa (meaning "good clean health" in the Sotho and Tswana languages) train is a miracle. It has grown from its 1993 beginning as a two-car university optometry project to a 16-coach service including educational, telecommunications, medical/pharmacy, health, dental, psychology, eye, accommodation, dining, kitchen, and laundry cars – plus its own engine!

During its January to September journey, Phelophepa houses about 57 people full-time. This includes healthcare staff (community health nursing, dentistry, optometry, pharmacy) and senior university students, who serve two-week stints, gaining priceless experience. Meanwhile, catering and hotel management students work under the supervision of Colin Boucher, formerly master chef on South Africa's famous Blue Train. Three to four security personnel live on the train, and the national police provide additional security at each stop. Locals are hired at each stop to act as translators and laborers.

A Railway Veteran and a Fast Learner

"We go anywhere in South Africa where there is a railway line," says Lynette Coetzee, who has worked for Transnet for more than 30 years and is Phelophepa's project manager. As Coetzee told the Johannesburg Daily Guardian and Mail, "In fact, we sometimes even go where there is no railway line. One time, when we were going to Qamata (in the Eastern Cape) it turned out that the line had disappeared for some reason; someone had probably come along and pinched the tracks for scrap metal." Though repeatedly told it would take weeks to replace the tracks, Coetzee insisted it could be done in one week. She was right. She's been with the railroad for so long, Coetzee says, "they can't really try to tell me anything about why things can't be done with the train, track, or the schedule."

Coetzee has been with Phelophepa since the beginning: a beginning that coincided with major change in South Africa. The train started operating before the first free, all-races election in 1994. So, she relates, when Phelophepa arrived at its first stop, people automatically formed two lines: one for blacks, one for whites. Coetzee stepped in and supervised the merging of the two lines into one, saying: "Go home if you prefer two queues." Service would be provided on a first-come, first-served basis, not according to race.

Lillian Cingo has been the Phelophepa train manager since 1995. Born in rural South Africa, Cingo speaks four African languages. After training as a nurse and midwife in South Africa, she relocated to England in the early 1960s to further her studies. She worked in England for the next few decades and earned special qualifications in neurosurgical disciplines, tropical medicine, and HIV/AIDS counselling as well as a Master's degree in counselling psychology. On vacation in South Africa after almost 30 years abroad, she heard about Phelophepa at a cocktail party. "I thought, my God what is going to happen – I must work on that train!" So it was back to school to learn how to operate a train. "There has never been a woman who is manager on a train for a start – whether black or white. So I had to be taught how to do the hand signals, how to shunt the train [switch between tracks], how to check the diesel, how to check the pressure ...." After a whirlwind program that compressed six months of training into two weeks, she passed her test, scoring 95%.

Limitations and Sacrifices

As manager, Cingo has had to learn to buffer the great expectations that have been created: "Patients call this train 'The Train of Hope,' a magic train, a train that is going to solve everything ... It doesn't. It can't." For instance, Phelophepa is not a hospital-on-tracks. Its care functions are basic: health examinations and education; pharmaceutical dispensing; an eye clinic (which conducts screening and tests and dispenses glasses); a six-chair dental clinic (equipped for cleanings, fillings, extractions, and restorations); and psychological counseling.

Further, the train visits each station an average of only once every two years. Commitment to the train demands sacrifices. Staff are away from their families for nine months a year. Hours are long. Dentist Gleniss Denicker gives an example: "We had just finished a 10-hour shift and were filling in our quotas for tomorrow – and there were 10 other patients that came from 20 kilometers (12 miles) away crying for treatment. They said they'd been here for three days .? So I asked the students if they were willing to just work an extra hour and they were willing."

There is also the issue of housing. "Our living conditions are not exactly what one would want," Cingo says. But as manager, she was able to do some negotiating: she told Coetzee that she wanted a big bed, a bath, and to be able to go to the theater. Coetzee told her, "I can't do anything about your theater, and not much about the bed, but I can try to do something about the bath." Cingo smiles, "And I got my bath. And there are no compromises here – this is my bath and my bath only. After a hard day's work I come here, I soak, I think, I reflect, I feel better."

Support From Near and Far

Phelophepa receives support from academic institutions, professional bodies, government agencies, community organizations, media, and businesses – both South African and international. Transnet alone pays about 70% of the operating costs, which monthly is approximately 875,000 South African rand (approximately US$75,576). In addition, Transnet has made a R15 million (approximately US$1,300,000) capital investment in the train.

And, of course, there are individual supporters, such as Archbishop Desmond Tutu and his wife, Leah. Mrs. Tutu serves on the board of the American Friends of Transnet Phelophepa. With the rand's weakness against other currencies, the work of the Tutus in bringing in foreign donations is crucial in supporting Phelophepa. Although no examination fees are charged, patients pay modest fees, such as R5 (approximately US$0.45) per prescription and R30 (approximately US$2.60) for glasses. "People want to pay. They are proud to be able to pay," Cingo says, but adds, "many don't have the money and the students end up paying without us even knowing."

Rolling on

After Phelophepa departs, people will see more clearly; their teeth will stop hurting; their babies will be freer of the small infections and irritations previously left untreated because of the lack of the simplest medications. But that is not all. Coetzee explains, "We were always sad when we left a station because we know we will probably not return there for some time, and people continue to need healthcare."

So now, each community selects up to 25 people to attend the Edu-Clinic, to receive basic training in public health fundamentals, such as nutrition, environmental/personal cleanliness, and the prevention of STDs and HIV. These people form a core of public healthcare knowledge in their communities. The Phelophepa train project embodies Cingo's goal: "Health for all, physically and emotionally, hand-in-hand with reconciliation and nation building." Or, as she observed recently, "This train is about working together, but for me it is actually like a mini South Africa, a new South Africa, where men and women come together to give their best to build South Africa."

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