Next Station: Hope
What motivated Transnet to get the Phelophepa rolling?
S. K. : It all began in 1994. At the time, South Africa’s inequalities were glaring, especially concerning health care access. One of the country’s universities turned to Transnet to make ophthalmological care and optometry services accessible to the low-income populations living in the rural areas. Since we had the railway network at our disposal, they suggested using some of our trains to reach those remote populations and provide on-board care. And so a first locomotive with three cars set off down the tracks.
How did the project grow?
S. K. : The following year, we decided to provide an even larger array of medical services to meet the specific needs of the underprivileged populations. They were especially suffering from a lack of dentists and a shortage of basic medical supplies and drugs, overstretching the South African healthcare system. Today, we have two trains with nineteen cars each! Along with the ophthalmology and optometry car, you will find a full-service dental care center, an infirmary, a psychological center and a pharmacy. We also organize screening campaigns to detect diabetes as well as cervical, breast and prostate cancers. It is a real hospital on rails.
How do you handle such logistics?
S. K. : We are entirely autonomous: we have on-board kitchens where we cook up to 450 meals a day. We have our own laundry and accommodations for 22 crew members. We also generate our own electricity. The only external resource we depend on – wherever we go – is water. Fortunately, Transnet owns the majority of the railway network in South Africa. The Phelophepa’s movements are organized in between its regular commercial and passenger traffic.
What is the cost for the patients?
S. K. : It all depends: the infirmary and the psychological clinic are free of charge. If you use our dental car for a tooth extraction, it will cost you ten rands.1 If you have eyesight issues, the eye exam is free, but a pair of glasses will cost you thirty rands. A prescription for several boxes of medicine will cost you five rands. In order to lower the prices, the universities that have joined this effort send us interns (nurses, dentists, optometrists, psychologists, pharmacists) to give us a hand.
How do you reach populations living far from the railway?
S. K. : When the train makes a stop somewhere, people get in line and we give them a ticket to ensure they will be seen to during the day. We have a team dedicated to the populations living within a thirty to fifty kilometers radius of the station. These mobile units visit schools, nursing homes, prisons, etc. Since we started our operation, we have taken care of over 611,000 people.
Are you able to meet everyone’s expectations?
S. K. : It is a never-ending challenge. We are often unable to attend to every single person who turns up. Yet, even if we cannot provide care for everyone, the medical services delivered by Phelophepa are meant to supplement those of the state. The use of a train enables us to reach areas where the traditional health care system is not working at its best.
How do you finance the operation?
S. K. : Last year, each patient that we treated cost about eighteen rands (1.3 dollars). Maintaining a train in working order costs us around fifty million rands a year. We benefit from a lot of support from the private sector, such as the pharmaceutical lab Roche and Colgate Palmolive South Africa. Still, the largest share of the funding, at 9 %, comes from Transnet. I am very proud of this project.
What do you see for the future of the Phelophepa?
S. K. : We would like to stop the train. But that would mean that South Africa’s health system is able to provide care to everyone in the country. In the meantime, the train of hope will never stop improving itself in order to attend to the needs of the most vulnerable and marginalized populations of this country. Our goal is for everyone to be able to access medical care, regardless of their social level or their place of residence.
By Perrine Massy
1. South Africa’s official currency. One dollar is worth approximately forteen rands.