South African transport utility Transnet’s healthcare train, Phelophepa, has entered its seventeenth year of providing South Africa’s poor rural com- munities with primary healthcare services, while the State-owned enterprise accelerates plans to significantly expand the long-running corporate social responsibility (CSR) initiative from the beginning of next year.
‘Phelophepa’, which combines elements of Sotho and Tswana to roughly translate to mean ‘good, clean health’, has proved successful to the point where Transnet announced in 2009 that it would spend R82-million on a second healthcare train, with the Transnet Foundation planning to introduce the so-called ‘Phelophepa II’ from January 2012.
At present, 172 Transnet employees are working, when required, on the construction of the train at Transnet Rail Engineering’s (TRE’s) Salt River workshop, in the Western Cape.
TRE Phelophepa technical project manager Peace Kopper tells Engineering News that Phelophepa II will have the same layout as its predecessor, with a few improvements.
TRE is currently busy with the refurbishment of the first ten coaches – including four accommodation coaches, the health clinic, the dental clinic and the power car. All 18 coaches will be completed by the end of September 2011.
“All the coaches for Phelophepa II are refurbished coaches donated by Transnet Freight Rail (TFR) and reused. The coaches are stripped and redesigned and then moved to be equipped with high-technology medical equipment by the suppliers that we work closely with,” says Kopper.
TRE started the production in August 2010 and is currently working on the first ten coaches.
One of the significant changes that Transnet plans to implement on Phelophepa II will be the improved on-board communications system and vacuum ablution system.
Transnet Foundation portfolio manager: health Dr Lynette Coetzee says that currently Phelophepa I has a communication system with vast room for improvement. The new system envisaged for Phelophepa II will enable students to continue their studies and research while on the train and away from class.
The power car will be refurbished from an old parcel coach, and will generate electricity in the absence of a locomotive, which is provided on a timetable basis by TFR.
The power car will hold two 250-kVA alternators and two diesel tanks that carry about 9 000 ∙ of diesel each to provide a constant supply of electricity.
Coetzee says the trains should be almost identical in appearance to avoid comparisons between the old and new versions.
“Phelophepa II will be a replica of Phelophepa I, right down to the clinic equipment on board. We are also thinking of rotating the staff between the trains to further avoid the idea that Phelophepa II is a newer, better version,” she explains.
When the trains are not running, they will be housed at the Salt River workshop, where they undergo the necessary maintenance and upgrades.
Running for 35 weeks every year through eight provinces, excluding Gauteng, Phelophepa I covers a total of 15 000 km of railway track, and treats about 46 000 patients in its on-board clinics during this time.
In addition, 200 000 adults and learners are reached through outreach programmes such as counselling workshops, healthcare education, visual, oral and health screening, and education; this number could be doubled with the launch of a second train.
The train has an on-board dental clinic, a primary healthcare clinic, an optometry clinic, a pharmacy and a counselling service to help patients deal with issues such as suicide, depression, abuse, parenting, conflict and violence.
Coetzee says that the cost of treating each person that comes to the train adds up to about R74.
The cost of each procedure varies, just as it would in an urban practice; however, the cost for Phelophepa patients to receive treatment is significantly less and some procedures are offered free of charge.
The charge for a pair of spectacles is R30, dental procedures can cost as little as R10 and medication costs R5 for the dispensing of a script.
All procedures for children are free, while health screening, examinations and tests such as diabetes and cancer screening, eye screening and counselling sessions for adults are also free of charge.
Transnet Foundation head Cynthia Mgijima says that Transnet has undertaken such a large CSR project because the need to extend the reach of healthcare is just too great for government to tackle alone.
“We align our CSR projects with the areas that put the most pressure on government. We want to see a return on our investment and witness the positive outcomes from the money that we put into South Africa and, through a campaign that deals with primary health, we are able to achieve this,” she says.
She also mentions that, through its CSR projects, there are many areas where Transnet is making a difference in people’s lives.
Coetzee explains that a project such as Phelophepa is not a solo programme run only by Transnet.
In reaching so many people and offering the services that it does, the train needs partnerships with experienced companies and individuals in the medical profession.
Without such partnerships and the valuable skills on board the train, from the permanent staff to the students that volunteer from training institutions all over South Africa, the train would not function.
“This is a huge partnership where everyone contributes. We all learn from each other and share our ideas on how we can achieve the best solutions to aid the less fortunate in rural communities,” she says.
The train’s major external partner is international pharmaceuticals company Roche.
This company has been involved in the project since its inception in 1994 and has extended its financial support to Phelophepa I to the end of 2013.
The pharmaceuticals giant sponsors the train’s pharmacy and health clinic, which was renamed the Roche Health Clinic in 2001, and provides services that include basic health education, screening and examinations, cancer screening and education, minor ailment treatment and diabetic screening and education.
Roche South Africa CEO Steve Hoerter says that the company’s long-standing partnership with Transnet has helped to bring primary healthcare to millions of South Africans.
“Phelophepa is an important part of Roche’s CSR investment in South Africa, and we are very proud of the positive impact this initiative has had on the lives of so many South Africans. When our partners at Transnet approached us about introducing a second train, we were happy to increase our level of support, being aware of the significant impact Phelophepa II will have on delivering primary healthcare to South Africans living in rural areas,” says Hoerter.
Roche was one of the first companies to provide external founding for Phelophepa.
The train not only provides practical experience for final-year nursing, dental, psychology and pharmacology students, but also attracts catering students, from the Walter Sisulu School of Technology’s hotel management department, needing an opportunity to practise their skills.
“The majority of training institutions in South Africa send their final-year students to the train and, through these institutions, we also receive international students to work on Phelophepa,” says Coetzee.
One of the suppliers of students to the train is the University of the Witwatersrand (Wits), which sends volunteer final-year students from its dentistry department, nursing school, department of pharmacy and pharmacology and department of psychology to work on board the train for a two-week period.
Wits School of Oral Health Sciences public oral health specialist Dr Ahmed Bhayat says that the aim of sending dental students to the train is to expose them to rural communities and to allow them to render primary oral health services away from the confines of the dental school in real-world circumstances.
In the process, students carry out basic dental procedures under the supervision of a qualified dentist.
He explains that each university is allocated a certain number of two-week blocks, depending on the number of students enrolled at the university.
“Wits usually has three two-week blocks on Phelophepa during June and July, and we send six final-year dental and two final- year oral hygiene students on each block,” he says.
About 18 final-year dental students and six final-year oral hygiene students go on the train each year and are credited with each procedure they perform.
A qualified dentist, an infection control nurse and an oral hygienist manage the dental clinic, which is partially sponsored by personal care brand Colgate-Palmolive.
Professional bodies, such as the Health Professions Council of South Africa, the South African Nursing Council, the South African Optometric Association and the South African Dental Association, are also supportive of the initiative.
Most of the students are drawn from urban settings and working on the train teaches them how to administer high-quality care in a different environment.
“The most common feedback that we get from the students is about the value system that is instilled in them by working on the train in such conditions,” Mgijima says.
Qualified pharmacist Chantel do Cabeco worked on the train in 2007, when two final-year pharmacy students were chosen from the Rhodes University faculty of pharmacy for a one-week block.
“Working on the Phelophepa is a prestigious thing among the final-year students. It’s hard work throughout the day but it teaches you basic skills and respect for people from all walks of life, many that can’t even read or write. It was an honour to work on the train,” she says.
When the second train is introduced, students will, where possible, be sourced from training institutions in the areas along the trains’ route.
There are 21 permanent staff members, 14 contracted security officials and 39 students on board the train, all reporting to the on-board Phelophepa manager, Onke Mazibuko.
“There is still a lot of planning required around the logistics of the two trains but we are as positive about the second train as we are about Phelophepa I, and all that ultimately matters is how we can enhance the quality of people’s lives with the project,” says Coetzee.
By September 2011, Transnet hopes to have signed off on the second Phelophepa train and have it on a test run before setting out in January 2012 to offer poor communities an expanded service that has emerged as something of a South African corporate responsibility icon.
by Mary-Anne O’Donnell for Engineering News