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Phelophepa, the South African 'Miracle Health Train' is providing services to over 45,000 people a year
2008-05-11
Phelophepa: South Africa’s Miracle Health Train
On a recent visit to London, Dr Lillian Cingo, the Manager of Phelophepa, pronounced ‘pay-lo-pay-pa’ and known in South Africa as the ‘Miracle Health Train’, was a guest speaker at the London Centre of Initiatives of Change where she spoke about this innovative 16 carriage train that is used to deliver much needed primary healthcare to South Africa’s rural poor.
Phelophepa is a vast operation that reaches around 45,000 people per year in rural South Africa, offering services that include a pharmacy; cancer screening and education clinics; psychology, optometry and dental clinics as well as diabetes, prostate and PAP smear testing services.
The world’s first and only fully fledged primary healthcare train, Phelophepa is run by South Africa’s state owned rail carrier, Transnet, who cover around two-thirds of its running costs; the remainder of the costs are met by a mixture of corporate sponsors, including Roche and Colgate, charities and individuals.
The train’s entourage
The train travels from January to September, spending a week at each stop. Nineteen permanent staff and 36 final year medical students are onboard and together they treat the estimated 45,000 patients a year, with thousands more benefiting from the train’s outreach programmes and healthcare training.
Local ownership
Phelophepa must be invited by the community and, once it is, it takes months of planning before the train arrives.
Dr Cingo explained that ‘We speak to the village chief, the healers and officials. We ask them to nominate three local people that will lead the preparations and marketing.’ A further 15 local people make up a Phelophepa steering committee, responsible for deciding who will work on the train and the best people to participate in training courses. ‘We put the community in charge,’ states Lillian. ‘That’s why it works.’
Edu-Clinic
Phelophepa also plays a vital role in rural health education. ‘We cannot deal in the expensive, curative measures available in the West. We must impart knowledge of prevention to rural villages to continue our work once we’ve moved on.’
This sustainable approach is encapsulated in the train’s ‘Edu-Clinic’. Sixteen people are nominated at each stop to complete five-day courses in basic health and hygiene. The train’s staff also visit selected schools, offering health screening and education for pupils and teachers.
Bringing people together
Dr Cingo sees the train as ‘a microcosm of South Africa’ in the way it builds bridges between different groups of people. She hears patients saying, “The way he treated me. I never knew a white person could be so caring. I never thought I could matter to a white person.”
‘Students say, '‘I never knew a person could wait for 20 years just to get spectacles.’' They’ll say, '‘I’ve never worked so hard in my life!’' but also, '‘I’ve never felt so needed.’’' Once qualified many students have gone on to become permanent members of staff with the train and some have even set up clinics of their own in the rural areas that they have visited.
Phelophepa: not a ‘miracle’
While the train has been dubbed a ‘Miracle Train’ by the hundreds of thousands that have been treated by it, Dr Cingo is quick to point out that it is not a catch-all solution; thousands arrive to receive treatment at every stop and not everyone can be seen.
‘If a bus full of people arrive and it’s their only chance to see a doctor but we are fully booked up, I have a meeting with my staff to ask them '‘What can we do for these people?” It’s about working together and teamwork. That’s what makes it a ‘Miracle Train’.
Charges
Examinations and screenings onboard are free but nominal fees are charged for services such as prescriptions (5 Rand - about 35 pence sterling), tooth extractions (10 Rand) and spectacles (30 Rand). Whilst it wouldn’t be possible for the train to run without these contributions, most beneficiaries, in Dr Cingo’s experience, actually want to pay for their treatment. ‘Payment gives people dignity,’ she explained. ‘Free services can make people feel helpless and dependent.’ Any donations are put into a fund to help those patients who are unable to pay.
Future
The South African government’s Department of Health is, in Dr Cingo’s words, ‘in love with the train’. It has proved so successful that Transnet have recently agreed to fund a second one. A Phelophepa II is currently under construction and will be operational by 2009.
Article source: http://www.uk.initiativesofchange.org/newsroom/5675.html
Phelophepa website: www.mhc.org.za/
