United Press International - April 6, 2004
Steve Mitchell, United Press International

Called Phelophepa, meaning good, clean health, the "healing train," as some locals have taken to call it, celebrates its 10th anniversary this year. During that time, it has provided medical care to more than 429,000 indigenous people living in rural areas and some of the remotest regions of South Africa.

Since it first went into operation in 1994, Phelophepa has expanded from three coaches that provided only eyecare to its present day composition of 16 coaches offering a wide array of basic healthcare services, including general medical treatments, dental care, prescription drugs and even psychological counseling -- nearly all of it free of charge or for a minor fee.

Although the services offered by Phelophepa are focused primarily on relieving physical ailments, the indirect emotional and psychological healing it brings about may be more important, said train manager Lillian Cingo, who is also a nurse.

"This is crucial for a country like this because people are really very traumatized," Cingo said, referring to the emotional scars left over from the apartheid government, which oppressed indigenous peoples, denied them services and separated them from the white minority.

Governmental services to rural areas have improved since the fall of the apartheid system in 1994, but many people still struggle and some still live a primitive lifestyle, with limited or no access to electricity and running water and few opportunities for employment.

The train offers prospects of hope -- directly via psychological counseling, and indirectly by showing the people help is available -- that are vital to restoring these beleaguered communities, Cingo said.

Carey-lee Vermoter, the psychology clinic manager on Phelophepa, told United Press International one of the most common psychological problems the clinic sees is "depression and a sense of hopelessness that stem from financial problems."

Many of the rural people are not familiar with the concept of mental or psychological problems, so they often will first complain of pain in their body, such as their back, head or heart, Vermoter said. It is only after an examination turns up nothing physically wrong with them that doctors can begin to suspect their pain may be psychosomatic and refer them to the psychology clinic, which generally sees about eight patients per day.

The individual counseling is only a small part of the work done by the psychology clinic, Vermoter noted. Most of their service focuses on leaving the train to interact with the local communities through outreach programs, she said.

Phelophepa offers a variety of these programs, covering everything from psychological counseling to school screenings to basic health education. More than 684,100 people, including more than 530,000 children, have taken part in these workshops over the course of Phelophepa's 10-year existence.

On a recent morning in East London, where the train was stationed for seven days, more than 100 people, young and old alike, were lined up waiting for treatment. In remote regions, it is not uncommon for people to have walked more than 18 miles to reach the train.

On board, the eight coaches that offer clinical services were bustling with activity. Every examination room was filled, and the medical staff seemed to have no problem navigating back and forth along the narrow passages on the converted trains as they dispensed medication and treated what appeared to be an endless supply of patients.

The conditions and equipment on the train are surprisingly clean and sophisticated and do not appear to be much of a drop-off from a modern medical clinic -- albeit in cramped and limiting quarters.

More than 60 staff personnel live on the train, which operates nine months out of the year, visiting 36 villages in four provinces -- Eastern Cape, Northern Cape, Northwest province and Limpopo -- and treating about 130,000 patients in that time. The staff includes 15 permanent crew, a rotating group of 37 final-year medical students and 11 security personnel.

The patient load and the less than ideal conditions did not seem to faze the physicians or medical students. In fact, all of the staff, who live in quarters barely large enough for a small bed and often do not have enough water to shower, seemed to be fully absorbed by and enjoying their exhausting work, which can begin at 7:30 in the morning and go on until 8:30 at night.

Many of them find it extremely rewarding, Cingo said. She noted the medical students frequently tell her their experience on the train has changed their whole perception about life. Some find it so rewarding they apply to stay on the train after their two-week stint is up and some former students have become permanent staff, she said.

Phelophepa's management places great emphasis on involving the local community in the train's operations while it is stationed in a town. They consider this to be essential to instilling basic health practices in the community that will continue to be applied after the train leaves.

"To make this project sustainable, we must train people in the community," Cingo said, and added local residents assist with everything from marketing, cleaning and kitchen help to being responsible for handling the money and acting as interpreters.

In addition, 25 local residents of each city the train visits undergo a five-day training course in basic principles of hygiene and healthcare with the hope they will pass on what they learn to other members of the community.

Having a positive impact on local populations is one of the most rewarding aspects, Cingo commented. "For me, the excitement is seeing what we can do for real people."

Although many patients the train sees have contracted AIDS, Phelophepa's staff generally do not treat them, referring them instead to clinics where they can get the long-term care they need.

The train provides a variety of medications, including antibiotics, eye drops and arthritis drugs. Roche Pharmaceuticals provides financial support for buying these medicines, which, in some areas, may be available only from Phelophepa.

Freddy Mohlala, director of the pharmacy clinic, told UPI although there may be a medical clinic in some of these rural areas, "most don't have medicines, so the patients don't go there and come to the train instead."

Most services are free of charge, but Phelophepa charges 75 cents for medications. Another advantage the train offers over hospitals and medical clinics is the medical equipment it has onboard, Cingo said.

"The train is better than most hospitals with equipment because we have companies and supporters helping us," she said. In addition to equipment, many of the supporting organizations donate other items, such as eyeglasses.

Colgate, the U.S. toothbrush and toothpaste manufacturer, has donated an entire coach for dentistry. It is been fitted with six dental chairs, drills, an X-ray machine and other dental quipment. The dental clinic offers screenings and education for free, and for the equivalent of $1.50, patients can have a cavity filled or a tooth extracted.

The bulk of the funding comes from the South African company Transnet, which provides about $2.3 million per year to keep the train running. A variety of other companies, universities and international organizations also provide funding and donations. Nevertheless, there never seems to be enough funding to provide all the healthcare needed by the poor of South Africa.

Asked if there was one area that needed more money, Cingo could not narrow it down to a single Phelophepa clinic or program. She just shook her head in frustration.

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