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Throughout its 24 years of existence, the Phelophepa project has found great approval and support around the world, becoming the first South African CSI initiative to win the United Nations Public Service Awards’ Africa Prize. Today, it counts partners such as Roche, Colgate and the Canon Collins Trust among its supporters.

The train also owes its popularity to its patrons, Archbishop Desmond Tutu and his wife Leah Tutu, two prominent international figures famous for their role in breaking down apartheid, racism, sexism and homophobia in South Africa.

In 2003, Archbishop Tutu, a Nobel Peace Prize winner, wrote a letter addressed to the Phelophepa community which read: “From its modest beginnings in 1994, the Phelophepa train captured the world’s imagination with its pioneering work in rural South Africa. As the train moves into the next decade of delivering health care services, our vision is that the Train of Hope will be embraced by all as a beacon of hope to the rest of Africa and the world.”

The two Phelophepa trains now move full steam ahead up and down the lands of South Africa, but the situation was quite different when it all started out. As Transnet freight rail senior communication and media manager Mike Asefovitz puts it: “On 10 January 1994, a modest three coaches, rebuilt from redundant stock, took to the rails.”

Some 24 years later, the number of carriages has increased to 19, making each train 480m long. As mobile healthcare clinics, the trains visit up to 70 locations across South Africa in the space of 35 to 36 weeks.

“The Phelophepa Health Care Trains comprise two locomotives that use existing rail infrastructure to deliver vital healthcare services to South Africans in remote, rural areas who would otherwise not have access to a doctor or be aware of any health problems they may or may not have,” Asefovitz explains.

In practical terms, this objective is translated into six on-board clinics: the health clinic, for general, comprehensive healthcare services; the psychology clinic, which offers counselling services; a dental clinic, an eye clinic, an educational clinic and finally, a pharmacy clinic.

But dealing with such high numbers of patients is an achievement as much as it is a burden. With thousands of patients in need and only 22 permanent members of staff plus 39 rotating med students available, handling visits is no easy task. “The biggest challenge is to accommodate the large number of clients seeking help,” Asefovitz says. “Operations require meticulous planning and logistics.”

For this reason, each clinic has an outreach programme, thanks to which members of staff travel to nearby areas and schools to assist those who are not able to go to the train.

“Unemployment, HIV/Aids and violence are as prevalent in rural areas as they are in an urban environment, leading to depression and despair,” says Asefovitz. “In the areas visited by the trains, there is usually no-one to turn to for help.”

Final year students play a particularly important role in this occasion: “Residents at each stop play a major role, so when the train leaves the station, it leaves a legacy. Their task is to identify schools, retirement homes and other places that need visits from the Phelophepa healthcare workers to check on their vision and dental needs.”