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November 22, 2018updated 05 Sep 2019 1:50pm

The Train of Hope: South Africa’s Phelophepa

Dubbed the “Train of Hope”, the Phelophepa travels across South Africa’s railways to provide care to people in remote rural areas, including treating patients and enrolling people in education. Operating since 1994, Phelophepa I made history when it became the first sustainable South African initiative to receive the prestigious United Nations Public Service Award for its excellence in public service delivery.

By Adele Berti

With a ratio of doctors to patients of one to 5,000, hospitals are often too crowded to accommodate everyone, but since January 1994, the Phelophepa train has come to their rescue.

Conceived by Professor Jannie Ferreira at the University of Johannesburg and Transnet, the corporate social investment arm of the state-owned transport and logistics organisation, the Phelophepa is a mobile medical facility that travels South Africa to provide basic healthcare to people in the most remote and rural areas.

Nicknamed the “Train of Hope”, in 1994 it consisted of only a few carriages with very little resources and very few staff. Celebrating its 25th anniversary in January 2019, it has now expanded in multiple directions, both geographically and virtually: its sister train Phelophepa II was rolled out in 2012 – with a third one planned for the coming years – and Transnet has extended its healthcare services to schools and geriatric centres for those who are unable to reach the train.

19 carriages of hope

Throughout its 24 years of existence, the Phelophepa project has found great approval and support around the world, becoming the first South African CSI initiative to win the United Nations Public Service Awards’ Africa Prize. Today, it counts partners such as Roche, Colgate and the Canon Collins Trust among its supporters.

“The Phelophepa Train captured the world’s imagination with its pioneering work in rural South Africa.”

The train also owes its popularity to its patrons, Archbishop Desmond Tutu and his wife Leah Tutu, two prominent international figures famous for their role in breaking down apartheid, racism, sexism and homophobia in South Africa.

In 2003, Archbishop Tutu, a Nobel Peace Prize winner, wrote a letter addressed to the Phelophepa community which read: “From its modest beginnings in 1994, the Phelophepa Train captured the world’s imagination with its pioneering work in rural South Africa. As the Train moves into the next decade of delivering health care services, our vision is that the Train of Hope will be embraced by all as a beacon of hope to the rest of Africa and the world.”

The two Phelophepa trains now move full steam ahead up and down the lands of South Africa, but the situation was quite different when it all started out. As Transnet Freight Rail senior communication and media manager Mike Asefovitz puts it: “On 10 January 1994, a modest three coaches, rebuilt from redundant stock, took to the rails.”

Some 24 years later, the number of carriages has increased to 19, making each train 480m long. As mobile healthcare clinics, the trains visit up to 70 locations across South Africa in the space of 35 to 36 weeks.

“The Phelophepa Health Care Trains comprise two locomotives that use existing rail infrastructure to deliver vital healthcare services to South Africans in remote, rural areas who would otherwise not have access to a doctor or be aware of any health problems they may or may not have,” Asefovitz explains.

Providing good, clean health to millions of South Africans

A combination of the Sutu and Tswana languages, the word Phelophepa means “good, clean health”.

The Train of Hope has helped an outstanding 23.5 million people since its first trip, contributing to “changing lives and bringing healing and healthcare education to communities in great need of care,” as Asefovitz puts it.

“The main objective of the Phelophepa Healthcare Trains is prevention and early detection of medical conditions, as well as screening and education by making people aware of the importance of looking after their own health.”

“The main objective of the trains is prevention and early detection of medical conditions.”

In practical terms, this objective is translated into six on-board clinics: the health clinic, for general, comprehensive healthcare services; the psychology clinic, which offers counselling services; a dental clinic, an eye clinic, an educational clinic and finally, a pharmacy clinic.

But dealing with such high numbers of patients is an achievement as much as it is a burden. With thousands of patients in need and only 22 permanent members of staff plus 39 rotating med students available, handling visits is no easy task. “The biggest challenge is to accommodate a large number of clients seeking help,” Asefovitz says. “Operations require meticulous planning and logistics.”

For this reason, each clinic has an outreach programme, thanks to which members of staff travel to nearby areas and schools to assist those who are not able to go to the train.

“Unemployment, HIV/Aids and violence are as prevalent in rural areas as they are in an urban environment, leading to depression and despair,” says Asefovitz. “In the areas visited by the trains, there is usually no-one to turn to for help.”

Final year students play a particularly important role in this occasion: “Residents at each stop play a major role, so when the train leaves the station, it leaves a legacy. Their task is to identify schools, retirement homes and other places that need visits from the Phelophepa healthcare workers to check on their vision and dental needs.”

Preparing for Phelophepa III

Looking ahead, the Phelophepa III will join the fleet as the first surgical train on the African continent and the world. With a capacity to serve a minimum of 10,000 patients over nine months, the Phelophepa III will feature new operating rooms to be used for the removal of cataracts, but with the potential to expand to provide other procedures.

“It is a remarkable story, an uplifting feeling that gives me great hope.”

The move builds on figures from the Train of Hope’s eye clinic, which treated 49,521 patients between January and September 2015. About 8% of these patients were diagnosed with cataracts and referred for treatment; however, data from 2016 revealed that less than 4% of the patients were operated on, meaning that the remaining 3,704 were placed on waiting lists and are gradually going blind due to the maturing of their cataracts. For them, the Phelophepa III could make a tremendous difference.

Back in 2009, the Train of Hope was featured in a documentary that gave it further international visibility. Speaking in the introduction of the documentary, Archbishop Tutu described the project with these words: “This is a feeling that captures both the desperate need of the many and the heartfelt dedication of the few who serve them. It is a remarkable story, […] an uplifting feeling that gives me great hope.”

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