Dr Lillian Cingo is the tireless manager of ‘Phelophepa’ - known to millions as South Africa’s ‘Miracle Health Train’. As guest-speaker at the London centre of Initiatives of Change on 20 November 2007, she spoke about her work on board this 16-carriage train that brings much-needed primary health care - and hope - to South Africa’s rural poor. She was introduced by Amina Dikedi-Ajakaiye from Nigeria.
‘Phelophepa’ (pronounced ‘pay-lo-pay-pa’) is a combination of seSotho and seTswana words meaning ‘good, clean health’. What started out as a three-carriage optometry unit in 1993 offering eye tests to rural people, is now 16 carriages long. It’s a vast operation that brings the additional services of an onboard pharmacy, cancer screening and education, psychology and health, optometry and dental clinics as well as now diabetes, prostate and PAP smear tests to over 40,000 people every year. The world’s first and only fully-fledged primary healthcare train, it’s run by South Africa’s state-owned rail carrier, Transnet, who cover around two-thirds of its running costs. The remainder is met by a mix of corporate sponsors, including Roche and Colgate, charities and individuals.
The manager of Phelophepa, Dr Lillian Cingo, was born in rural South Africa and trained as a nurse and midwife before coming to London in the Sixties. In the midst of Apartheid, South Africa offered no future for a young, black woman and the UK enabled her to gain a formidable array of qualifications in neurosurgery, tropical medicine and psychology. ‘The training I got in this country was a blessing…I know it was God’s plan. It’s as though every bit of my life’s learning was meant to be used fully on this train.’ Lillian arrived in England ‘a very angry woman’ from a life under Apartheid but she credits organizations such as Initiatives of Change (then known as Moral Re-armament) for helping channel her anger into constructive action.
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 an estimated 45,000 patients a year, with thousands more benefiting from the train’s outreach programmes and healthcare training. The students staff the clinics for two-week stints, creating what Lillian describes as ‘madness onboard’ at each fortnightly changeover. ‘There are three big shocks for students new to the train. The first is seeing the poverty of rural people. Many could not have imagined how desperately they need healthcare. The second is getting used to a 90-second shower to conserve water.’ And the last? ‘Seeing the accommodation they will be staying in for their time on the train! The beds are so small - if you don’t wake yourself up to turn over in the night, you fall right out!’
The train doesn’t simply pull in at any station. Phelophepa must be invited by the community and, once it is, it takes months of planning before the train arrives. ‘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.’
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.
Lillian sees the train as ‘a microcosm of South Africa’ in the way it builds bridges between different groups of people. ‘I hear 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 ten years, 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.’’' For South Africa’s university students, the impact of their two-week stint is profound. Once qualified, many go on to become permanent members of staff and some even set up clinics of their own in the very rural areas they’ve visited with the train.
While the train has been dubbed a ‘Miracle Train’ by the hundreds of thousands that have been treated by it, Lillian was quick to point out that it isn’t a catch-all solution to all her country’s ills. Thousands arrive to receive treatment at every stop and not everyone can be seen. ‘Sometimes I think; God, what am I going to say to these people? I see a young woman with a baby on her back, an old man running [towards the train]. I want to say ‘Don’t run. Please God, don’t run. The clinics are already full.’ The train clinics are filled on a ‘first come, first served’ basis and patients will sleep outside overnight if they can’t be seen, waiting for the clinics to re-open in the morning. ‘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’. I’m not there, doing all this good work on my own!’ Lillian sung the praises of the dedicated Transnet staff, the professionals onboard and the train’s conscientious students.
Examinations and screenings onboard are free but nominal fees are charged for services such as prescriptions (5 Rand - about 35p), tooth extractions (10 Rand) and spectacles (30 Rand). While the train couldn’t run without these contributions, most beneficiaries, in Lillian’s experience, actually want to pay for their treatment. ‘Payment gives people dignity,’ she explained. ‘Free services can make people feel helpless and dependent.’ Donations are put into a fund, however, to help those patients unable to pay.
The government’s Department of Health is, in Dr Cingo’s words, ‘in love with the train’. It’s proved so successful that Transnet recently agreed to fund a second one. A Phelophepa II is currently under construction and will be operational by 2009. It’s a commitment Lillian is hugely excited about. Despite the long hours and relentless workload, Lillian is incredibly passionate about the train’s work and is set to be onboard for a good while yet. ‘I trained up a great nurse with the idea she would take over from me. She was all ready to go and then …they got us another train!’
By Esme McAvoy
English