The trains of Hope

In rural South Africa, there is one doctor for every 5000 patients. The network of railroads, built 100 years ago, owned and operated by Transnet, gives access to remote rural communities. The Transnet Phelophepa health care Train is a unique mobile clinic that has been bringing basic affordable medical care to the villages since 1994. It is fully equipped to provide general health, dental and eye care, health and hygiene education. In addition it offers cancer, diabetes and hypertension screening as well as individual counseling sessions and group workshops to help people cope with psychological such as stress and depression.

In 2012, a second mobile healthcare train, Phelophepa II, was launched to bring healthcare to an even greater number of patients each year. Phelophepa II is equipped with specialised wheelchair accessibility and enhanced technology, to bring the best possible service to patients in South Africa.

Phelophepa I and II each travel through 70 communities a year over 117,000 miles and see an average of over 45,000 patients a year. In addition, they reache a further 100,000 children and adults annually through the Outreach Programmes. Both trains are staffed by 20 health professionals and up to 40 student interns preparing for careers in a variety of health-related fields. Each intern serves 10 days of volunteer services and many return to the train as resident staff. In addition to this, the train employs local people for tasks such as translating, cooking and construction work.

Phelophepa I and II are owned and operated by Transnet Limited – South Africa's biggest state-owned freight transportation and logistics company and started its life in 1993.

Preparing for the visit

The Transnet-Phelophepa Health Care Trains operate between January and September every year, with the remaining three months used for maintenance. Only 36 stops with 5 working days at each location are possible in one year for each train.

The arrival of the clinics on rails is preceded by a lot of preparations. Nothing is left to chance: a meeting of national, regional and local representatives is held to decide exactly where the train is needed most and where it will be accessible to the largest number of people.

The local community is responsible for deciding on who will work on the train and the best people to participate in training courses.

The students

Health care student interns from South African educational institutions have been integral to the way in which Phelophepa runs, right from day one. Up to 40 students, under the leadership and guidance of the clinic's permanent staff, assist with many of the basic healthcare services provided by the Roche Health Clinic. They also play an important part in vital community education and outreach work. Each one of them serves 10 days of service and many return to the train as resident staff. The doctors and nurses of the future have not only the education and skills that they need, but a sound understanding of the realities and challenges.

Recognition of an invaluable service

Over 5.5 million people have been reached since 1994 - including many women and children who would otherwise have had no access to basic medical services. Over 600,000 patients have been treated at the train’s clinics, while over 25,000 schools have been visited and provided general screening and health education. The Transnet Foundation, the main sponsor of the train of Hope, received the 2008 > United Nations Public Service Award in the category 'Improving the delivery of services' for its Phelophepa Health Care Train initiative.

History of Roche's commitment

Roche has a long-standing commitment to find solutions for health challenges in developing countries. Rather than simply providing donations, our approach is to foster lasting change through establishing long-term partnerships. Roche is proud to be the main external sponsor for Transnet-Phelophepa Healthcare trains, bringing healthcare and education to remote communities throughout South Africa. With the launch of the second Phelophepa train in 2012, almost double the number of people can now benefit from this essential service.

Roche's support of Transnet-Phelophepa dates right back to 1994, when Roche South Africa started to fund the salary of a nurse to work in the train's general health clinic. From this small start, Transnet and Roche went on to build a true long-term partnership which, in tandem with the train, has grown and evolved over the years. Today, Roche has full responsibility for the continuing operation of the general health clinic and, in recognition of this, the coach was renamed the Roche Health Clinic in 2001.

In 2010, the coach was fully refurbished to increase the space available for examinations, and install new and upgraded equipment.

In 2012, a second mobile healthcare train, Phelophepa II, was launched to bring healthcare to an even greater number of patients. Phelophepa II is equipped with specialised wheelchair accessibility and enhanced technology, to bring the best possible service to patients in South Africa.

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Converting old trains into trains of Hope

From its humble beginnings as a modest 3-carriage ophthalmological clinic, the first Phelophepa Health Care Train has grown to hold 18 fully refurbished coaches fitted with special healthcare equipment.

All compartments have been equipped with air-conditioning units to regulate temperatures inside > the train. In addition to this, the train carries its own power supply, satellite communications and accommodation for all staff.

In 2012, a second mobile healthcare train, Phelophepa II, was launched to bring healthcare to an even greater number of patients. Phelophepa II is equipped with specialised wheelchair accessibility and enhanced technology, to bring the best possible service to patients in South Africa.

MILESTONES

1993 – The 'Eye Train', with three carriages, makes its first journey

1994 – 'Phelophepa' takes to the rails and Roche steps aboard as a main sponsor

2001 – The health clinic is renamed the Roche Health Clinic

2003 – HIV/AIDS awareness programmes initiated and reach millions of people

2008 – Phelophepa receives UN recognition for improving delivery of services

2009 – The first train grows to its current length of 18 coaches

2009 – Cancer health awareness services are established, including screening, staff training, patient counselling and education

2010 – The Roche Health Clinic undergoes a full refurbishment

2012 – Phelophepa II is launched in South Africa, doubling healthcare capacity

Phelophepa I and II at a glance - facts and figures

• Phelophepa I is 340 metres long and weighs 600 tons, while Phelophepa II is 400 metres long and weighs 750 tons
• Each train has 18 coaches
• Both trains travels for 36 weeks of the year, over 117,000 miles and visits a different community every week
• Each train is run by 20 resident staff, supported by up to 40 student interns
• About 20,000 students, doctors and nurses have had the opportunity to their skills to date
• Each train’s pharmacy coach dispenses 34,000 prescriptions every year
• The Health Clinic team visits local schools, providing screening and health education, with over 25,000 schools visited to date
• Each year close to 600 local volunteers are selected by their communities and are educated on general health
• Phelophepa I and II each see an average of over 45,000 patients per year, with over 600,000 patients treated since inception in 1994
• Each year, around 375,000 people are reached through the trains various services
• Including two large-scale HIV/AIDS education programmes, over 5.5 million people have benefited since 1994

Visiting the trains of Hope

Patients travel long distances, sometimes in very difficult weather conditions to visit Phelophepa.
The journey is often followed by queues and long periods of waiting under the canvas tent that runs along the train.

Every morning, the train manager explains the rules for the visit and how much the treatments will cost.

The newly arrived patients are registered, assessed and screened. The Transnet-Phelophepa Health Care Trains staff fix bright stickers to people's clothes to show which clinic they need to visit.

After the first assessment has been completed all patients over 14 years are checked for diabetes and high blood pressure. Then, they are directed to the clinic they should visit.

Eye Clinic

The Eye Clinic plays an important role in the diagnosis and referral of cataracts, glaucoma and damage of the eye's retina caused by hypertension and diabetes, which can lead to blindness. Early diagnosis and management of these conditions is essential to avoid irreversible blindness.

While the train does not have the facilities for any eye surgery, the staff refers these patients to local hospitals. Phelophepa carries a huge stock of spectacle frames and each patient has a choice of two styles.

The Eye Clinic is staffed by a manager, optometrist and optical dispenser, and several optometry students undergoing their practical training.

Dental Clinic

The Phelophepa Dental Clinic, partially sponsored by Colgate, provides onboard consultation and treatment as well as a massive outreach dental screening and education programme.

Staffed by a dentist, dental infection control nurse, and a dental educator, over 13,000 patients are seen and treated during each train's annual journey.

Health Clinic

The Health Clinic is often the first stop of the Phelophepa visitors. Most of the diseases the staff observes are related to the meager living conditions, including eye and respiratory problems partly caused by the fumes from wood fires. Many children have worm infections.

In recent years, the work of the Roche Health Clinic has been expanded to include more specialist services with a focus on screening and prevention. Today, in addition to receiving medical care for existing ailments, people visiting the clinic can be screened for diabetes, hypertension and certain types of cancer. Free PAP smears and prostate checks can be carried out in a special tent set up on the railway platform at some stops.

Roche has the full responsibility for the continuing operation of the general health clinic and, in recognition of this, the coach was renamed the Roche Health Clinic in 2001.

> Learn more about the Health Clinic and
Roche's commitment

Pharmacy

The Pharmacy coach is a vital part of the Phelophepa Trains. It has some 100,000 items of medicine in stock and each train fills 34,000 prescriptions every year.

To overcome the problems in communication and avoid any possible confusion when explaining how to take the medicines, the Phelophepa staff have developed a drawing board with easy to understand symbols. When dispensing the medicines, the Pharmacist points to the symbol and ensures the patient has correctly understood what it means.

EduClinic

One coach of the train is dedicated to educational resources for staff and outreach. The important role that traditional healers can play within rural communities is recognised, by extending course invitations to both representatives of the community and healers. The sessions which are held in accessible community settings are designed to give participants a good basic knowledge in nutrition, health and hygiene, encouraging them to share their knowledge widely. Over 600 volunteers selected by the local communities receive education each year.

The emphasis that Phelophepa places on educating rural communities complements Roche's focus on supporting initiatives which empower people and drive long-term results.

Outreach programme

School visits are an important part of every stop made by the train. For example, by visiting schools to provide diagnosis and treatment of common childhood ear problems, the Phelophepa team makes a real difference.

By examining the children and providing appropriate medicines the team is able to treat these problems early with the aim of preventing lasting damage. Before leaving the school, the clinic staff explains to the teacher how to continue the treatment and the teacher passes on this important information to the children and their parents.

With the aid of puppet shows children are taught about good hygiene practices in a fun and friendly way.

Since 1994, over 25,000 schools have been visited, with the children receiving screening and health education.

Looking beyond immediate health needs

In recent years, the work of the Roche Health Clinic has been expanded to include more specialist services with a focus on screening and prevention.

Today, in addition to receiving medical care for existing ailments, people visiting the clinic can be screened for diabetes, hypertension and certain types of cancer. Free PAP smears and prostate checks can be carried out in a special tent set up on the railway platform at some stops.

Health protection through education

Hand-in-hand with screening for disease goes education to enable disease prevention.
Roche has sponsored the development of cancer education booklets in both Zulu and English.

These booklets are distributed to visitors of the train and shared with people in local communities.
In this way members of each community can share their knowledge and help to expand the reach of the train well beyond the tracks on which it runs.

Impact

More than 90,000 patients receive treatment through the Phelophepa trains with over 68,000 prescriptions written each year. Over 600,000 people treated since the train’s inception in 1994.

Each year around 600 local volunteers are provided with basic health education and roughly 375,000 people are reached by the train’s services. A further 1.3 million people have been able to take advantage of the screening, health education and counselling services that the train provides. This includes over 20,000 student doctors and nurses that have received skills training while on-board the trains.

In total, over 5.5 million people have benefitted from Transnet-Phelophepa’s health outreach programmes, awareness initiatives and counselling services to date. This figure includes people reached through two large-scale awareness programmes designed to educate men, women and children in rural communities about HIV and AIDS.

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