Johannesburg — Thousands of rural people now have access to health services that they could not afford at their local hospitals, writes Nawaal Deane
No, Phelophepa is not a circus with trapeze artists, performing animals and clowns. It is a health-care train that travels through eight of South Africa's provinces to bring health services to rural towns.
The day Phelophepa visited Letaba, a small rural town in Limpopo, hundreds of locals wait at the dismal station. Promptly at 10am the train pulls up. Chairs are lined up outside the coaches, with brightly coloured names indicating the various clinics. Like a circus, Phelophepa is welcomed in communities because marketers are sent to each town two weeks in advance to publicise that the train is on its way and will be visiting the town for five days. The marketers put up posters and meet schools and community health-care workers.
It has been nine years since Jannie Ferreira, a professor at the optometry department of the Rand Afrikaans University (RAU) in Johannesburg, came up with the idea to provide rural South Africa with primary eye care.
Through the sponsorship of local and international donors, such as Colgate, the train grew from its initial three coaches to 16 coaches, which now house the eye clinic, dental, health care, education and psychology clinics.
Under the watchful eye of the Transnet Foundation Trust the train operates for 36 weeks a year, visiting four provinces (excluding Gauteng)every second year. On average the train treats about 42000 patients a year, with the Outreach programmes touching the lives of 100 000 individuals.
Apart from servicing 380000 patients since 1994, the train helps to educate and empower existing health-care services by referring patients to the nearest hospital, social worker or community doctor.
For most patients the train offers services they cannot afford at their local hospital. The train charges R10 for an eye test and R30 for a pair of spectacles.
Heather Ngomane (57), who lives near Letaba, has just bought her first pair of spectacles. She took a taxi from her home at 5am to meet the train and queued for eight hours to have her eyes tested. "I am feeling very happy now because I can read the paper. I heard this train will come this year and they said it is cheap," says Ngomane.
The doctors, nurses and psychologists working permanently on the train get paid a salary from the donors or from Transnet. They live in cramped conditions, but "when you see the gratitude on [the people's] faces, the satisfaction you get is far greater than if you work just for money in private practice", says Kamal Desai, the resident dentist who has lived on the train for two years.
Every second week a batch of young students is deployed by their universities to do a two-week practical course as part of their third- or fourth-year degree. "For these students the train is an eye-opener because they realise how many needy people there are in South Africa," says Sam Hlongoane, the resident optometrist.
Ronel Wiesner, an optometry student at RAU, says she never knew how many people had problems with their eyes. "In Jo'burg we do not have so many people that have pathological diseases. The experience taught me a lot. The people are so grateful for the treatment." She sits at a table outside the train where a variety of spectacles is on display. "All students should come on this train to see how desperately we need more health-care workers."
Deputy train manager Magdelein Ntikinca, who is affectionately known as the "mother of the train," has been part of the train for nine years and left her four children in the Eastern Cape. "But I do not regret one day and love my job," she says.
The Roche-sponsored health-care clinic is the heartbeat of the train. This is where patients first report so that nurses can examine them and then refer them to the other clinics. "These people come to the train and get the sympathy from the nurses here," says Ntikinca. "The patients ask for what they need and even if they do not have enough money, they are treated." She says the train has had an impact on rural people, who could never afford basic eye or dental costs.
For those patients who have never heard of psychology or never thought they could afford the services of a psychologist, the psychotherapy clinic is an unusual section of the train. Resident psychologist Clarissa Malan says most rural people do not know much about how psychotherapy can help them, but the clinic does workshops at schools and churches to teach people how to deal with stress and difficult circumstances.
"We make people aware of the resources in their community so when the train leaves they know where to find the support," says Malan.
She says the majority of the problems they deal with are financial or stress-related, but sometimes they get requests from schools to give a talk on how to deal with children who are abused. "I've grown a lot from living on this train. I've seen circumstances influencing people's lives and seen people's strength," says Malan.
Phelophepa's education clinic is one of the most effective means of empowering the community. On board is a training compartment where volunteers are educated for five days in basic health care. The volunteers receive manuals to take to the community and health-care clinic workers go out to schools to screen children for hearing, eye infections and tooth decay.
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Mapitso Mathebulathe, spokesperson for the Transnet Foundation Train, says the train will be sustained as long as the company is making profits. "There have been many requests, especially in neighbouring countries like Mozambique, and Zimbabwe, for the expansion of the train's services. The company is still looking at ways and means to see if it's viable to expand outside South Africa."
Mathebulathe says there have been requests that Transnet should have a train for each province, but this is not possible. It costs R908000 a year to run the train -- a cost far too high for most provinces to sustain. Currently the train is looking for donations of groceries and cleaning equipment and detergents.
"The train's chef buys groceries from each town we visit so in this way we give back to the community," says Ntikinca.
One of the problems is the growing number of people visiting the train. Sometimes people have to be turned away. "But no one leaves the train without medication or spectacles, if they cannot afford it there is a fund that provides for them," says Ntikinca.
Phelophepa ends this year's run on September 23 but in the second week of January next year the train will start making its way to the Free State, Mpumalanga, KwaZulu-Natal and the Western Cape.\
