The train 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.

Phelophepa travels through 70 communities over a two-year cycle and sees an average of over 45,000 patients a year In addition, it reaches a further 100,000 children and adults annually through the Outreach Programmes. It is staffed by 19 health professionals and up to 40 student interns preparing for careers in a variety of health-related fields. Each one of them 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 is 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 Phelophepa Health Care Train operates 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.

The arrival of the clinic 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 million individuals have been reached since 1994 – including many women and children who would otherwise have had no access to basic medical services. The Transnet Foundation, the main sponsor of the train of Hope, has received the 2008 > United Nations Public Service Award in the category 'Improving the delivery of services' for its Phelophepa Health Care Train.

Roche's support of Phelophepa dates right back to its beginnings, when Roche South Africa started to fund the salary of a nurse to work in the train's general health clinic.

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.

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's support of 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.

The success of Phelophepa will be extended to a second train, expected to be put into service in 2012.

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Converting an old train into the train of Hope

From its humble beginnings as a modest 3-carriage ophthalmological clinic, the 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.

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 train grows to its current length of 18 coaches

2009 – Cancer health awareness service is established, including screening, staff training, patient counselling and education

2010 – The Roche Health Clinic undergoes a full refurbishment

Phelophepa at a glance - facts and figures

• The train is 340 metres long and has 18 coaches
• It travels for 36 weeks of the year and visits a different community every week
• The train is run by 19 resident staff, supported by up to 40 student interns
• The train's pharmacy coach dispenses 26,000 prescriptions every year
• The Health Clinic team visits around 25,000 schools a year, providing screening and health education
• Each year close to 600 local volunteers selected by their communities are educated on general health
• About 20,000 students, doctors and nurses have had the opportunity to their skills to date
• Phelophepa sees an average of over 45,000 per year
• Including two large-scale HIV/AIDS education programmes, over 5 million individuals have been reached

Visiting the train 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 Phelophepa Health Care Train 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 were seen and treated during the train's annual journey.

Health Clinic

Recently refurbished to include vital health screening, 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 Train. It has some 100,000 items of medicine in stock and fills 26,000 prescriptions every year.

To overcome the problems in communication and avoid any possible confusion when explaining how to take the medicines, the Phelophepa staff has 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 recognized, 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.

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.

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 45,000 patients register for treatment through Phelophepa each year and over 600,000 people have been treated since the train's inception in 1994. A further 1.3 million people have been able to take advantage of the screening, health education and counselling services that the train provides.
Furthermore, over 5 million people have benefitted from 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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