Wilma den Hartigh
South Africa's second state-of-the art clinic on wheels, Phelophepa II, has hit the tracks, taking much-needed primary health care services to the country's poorest rural communities.
The new train comes equipped with the latest technology, which means it can provide even better health care services to those who need it most.
In February 2010, South African rail, port and pipeline company Transnet announced that it had set aside more than R80-million (US$10-million) for a vital corporate social investment project, to boost accessibility to primary health care in rural areas of South Africa.
That project was Transnet's second health care train, known as the Phelophepa II, the latest addition to the company's Phelophepa fleet.
Phelophepa, which means 'good clean health' in Setswana, is a flagship project of the Transnet Foundation – Transnet's specialist unit for corporate social responsibility (CSR).
Its predecessor, the Phelophepa I, is known worldwide as a forerunner in primary health care provision.
The train made history when it became the first sustainable South African CSR initiative to receive the prestigious UN Public Service Award for its excellence in public service delivery.
The second train, which will operate simultaneously with the Phelophepa I that started in 1994, is to follow in its predecessor's groundbreaking footsteps.
With the introduction of Phelophepa II, Transnet will more than double the number of people who benefit from the facility, taking the total to an estimated 370 000 people every year.
The train travels 36 weeks a year, visiting regions with inadequate access to medical services. The healthcare staff consists of 20 core employees and close to 30 student interns preparing for careers in a variety of health-related fields.
Both health trains are part of Transnet's commitment to help South Africa achieve the UN Millennium Development goals, which include reducing child mortality, improving maternal health and combating HIV/Aids, malaria and other diseases.
A symbol of hope
At every village and town on its route, the clinic on wheels is changing lives.
Phelophepa has become a symbol of hope for many people, bringing life-saving health care to thousands of underprivileged rural communities who cannot afford even the most basic health care services.
One patient at a time, the Phelophepa II's on-board primary healthcare, dental, optometry and psychology services are giving more people an opportunity to live a healthy, quality life.
Transnet has published a glossy coffee table book on Phelophepa's journey, filled with many stories of how the health trains are helping to make South Africa a better place.
Onke Mazibuko, manager of the Phelophepa train, says that when the news gets out that the mobile clinic is in town, people come in their numbers, often travelling long distances to be treated.
The staff can only see so many patients every day, but people are willing to wait in queues and even sleep outside the train as they wait to be treated.
Mazibuko and his team live on the train, staying for a week or two at each of the train's various stops. In some communities they visit, there is just one doctor for every 5 000 people.
"Every place we go there are different stories," he says.
At one of the stations, a farmer complaining of toothache left the train so grateful to the dental team, that he returned later carrying bags of potatoes, tomatoes and oranges.
Dr Lynette Coetzee, manager of the health portfolio at the Transnet Foundation, remembers when an 87-year-old grandmother from KwaZulu-Natal visited the mobile clinic.
She was hoping to receive a pair of glasses so she could see the letters in her Bible, even though she was unable to read. Her eyes were tested, the glasses were made, and a young optometry student fitted them carefully on her face.
"You look beautiful in these," he told the old lady. She sat in silence for a while, and then she started crying. The student was worried that there was something wrong with the glasses, but the woman was only crying because she was happy - she never thought that a young white boy would tell her she looked beautiful.
She was able to see the world clearly for the first time in years.
Every year the Phelophepa eye clinic dispenses thousands of pairs of spectacles to adults and children, and adults pay a nominal cost of R30 a pair.
Dr Terence Giles, manager of the Phelophepa eye clinic, recalls a visit to a school for the blind in a township just outside Port Elizabeth in the Eastern Cape. The screenings showed that as many as half of the children in the school were not actually blind – they just needed glasses.
"It was a wonderful feeling to make the blind see," Giles says.
In the book, the train's previous manager Sister Magdeline Ntikinca, who passed away in 2010, said Phelophepa gives a voice to people's health and wellbeing.
"A lot of people say to us that the train listens to them," said Sister Maggie, as she was fondly known. "It hears their concerns and it makes them feel that they matter."
Modern facilities on board
The Phelophepa II will offer the same health care services as Phelophepa I – it is just more technologically advanced.
The 18 Phelophepa coaches are old donor passenger coaches, refurbished – they were completely rebuilt according to new designs and specifications.
Phelophepa II is fitted with enhanced communication, ablution and air conditioning systems, wheelchair platform lifts for disabled people and new advanced medical equipment technology.
Pharmaceutical company Roche has also expanded its Phelophepa sponsorship. It now includes funding of the primary healthcare clinic, with a diabetes care programme and oncology clinic; a medicine dispensary; school health services and education programs for health workers and staff for both the original and the new train.
Roche chairman Franz Humer said that the company is proud to have continuously grown its support for the Phelophepa trains.
"It has such a remarkable impact on the lives of thousands of people every year," Humer said.
Some of the other new technological developments on the second train include a vacuum toilet system, the first for passenger type coaches in South Africa.
The toilets are connected to a retention tank that prevents sewerage spillage onto the rail tracks. The vacuum toilets also save water and for each flush half a litre of water is used, compared to the conventional system that uses four to five litres.
The communication and data system installed in Phelophepa II is the most advanced system yet installed in a train in the country. It is also the first time that optic fibre has been used as a network medium on trains.
The air conditioners fitted to the new coaches are much more power efficient, while still providing the best cooling and heating capability. Certain air conditioning units, such as those in the health and dental coaches, have been modified to eliminate the possible spread of germs into the corridors by altering the airflow.
The train's special needs facilities make it possible for disabled people to receive medical attention with greater ease. Wheel chair lifts are fitted at strategic positions on the train, making it possible for people with special needs to access dental, optometry and health care facilities.
The wheel chair elevator can lift 300kg, which means that a person in a wheel chair as well as the caretaker can use it at the same time.
Cosmetic upgrades to the new coaches are improving patients' experience of the train. The cubicles on Phelophepa II's psychology clinic have each been painted a different colour. This was done to make clients feel more relaxed and comfortable during the sessions.
In the dentistry coach, the dental cubicles are more spacious, compared to the previous arrangement, and now have ultraviolet devices to help destroy any airborne germs.
Lessons in humility
For the clinic staff, spending time on the train provides ample opportunities for many lessons in humility.
"Not everyone in South Africa can take good, clean health for granted," said Sister Maggie. "More than anything else Phelophepa can teach us why we should never abandon hope."