THE STUDENTS have said to me that they learnt more here in two weeks than all the years that they spent at university. But I don't say that to their professors," says Lynette Coetzee, following it up with her trademark hearty laugh.
This is one of many anecdotes which Coetzee, a portfolio manager for health at Transnet, proudly shares about the experience on Phelophepa, the health care train owned by the parastatal. The train was Coetzee's brainchild 16 years ago.
Phelophepa is a Sotho and Tswana word mix for "good clean health", and that is exactly what the train delivers.
The students Coetzee is referring to are doctors and pharmacists in training who come from different universities around the country. She calls them the backbone of the train because there is no way that the 20 permanent staff can manage to attend to the more than 40 000 patients they register and treat a year during the 35-week operational period.
Some patients arrive at the train station as early as 3am, even though the clinic opens its doors at 7am. The consulting can go on until 9pm depending on the day. The 18-coach train houses a general health clinic, dental clinic, optometry clinic and a pharmacy. Its professionals include a psychologist and counsellors.
The train is a public-private partnership between Transnet, Roche and other private investors, and has the characteristics of both the public and the private health care systems. The hours are long, the service is free for children, and adults are only charged a minimal amount. The best technology is used on the train, which is efficient and clean.
"In the first year, we treated 33 000 people with 13 coaches. But we are not chasing numbers, we treat everyone with dignity and respect," says Coetzee.
Coetzee and her team work closely with both the Department of Health and the Department of Education. The team consults with the Health Department before it moves to the next stop. It stops predominantly in rural communities. The psychology team works with the schools in the area, where it does outreach programmes.
This week the train was at Saldanha Bay for the second time. It generally stays with a community for a week, although it has stayed longer when necessary.
Though the train is with one community for just a week, the impact goes far beyond the five days. Over and above medical and pharmacy students who learn on the job, there are catering students who help to prepare the meals for the staff, and volunteers and community workers who are given basic primary health care training.
The volunteers who are trained continue with outreach programmes when the train has left.
Coetzee compares coming to the train for help to going shopping at a mall where you can move from one shop to the next because of all the services that are available.
"There is a tent outside where we register people who are looking for identity documents, birth certificates. Even if you came for an eye check-up and we pick up that you are diabetic, we refer you to the general health clinic before you go home. Even our students know that they must look at patients with a holistic view and not just concentrate on the one part of the body," says Coetzee.
All this is achieved with a budget of approximately R2.8 million a month. Since its inception, Phelophepa has attended to about 18 million patients.
Leslie Galane, the dental clinic manager, is a former student on the train. Galane came back to the train to take up the position about two years ago. The clinic has five dental chairs and services offered are scaling, polishing, restoration and basic extractions.
"I came back because of the technology available on the train and because I love to train other professionals," Galane says.
At the general health clinic, all the primary health care services are available, including health education on things such as how to take the medication properly and cancer screening.
Siyabulela Mankayi, the health care manager at the clinic, says their priority is to stabilise a patient and sometimes refer them to the municipal clinic or a hospital if a patient requires more attention.
"We have an ambulance to take patients who need to go to the hospital because sometimes, like when we were at Mtubatuba (in KwaZulu-Natal), the district hospital was 50km away," says Mankayi.
Through the outreach programme, the clinic identifies juvenile diabetes and teaches the importance of compliance.
Another innovation for the health train is the education material the staff has come up with to assist illiterate patients. They use signs especially on medicines, which patients use to recognise things such as side effects of the medicine.
Generally, the train goes to rural areas where there is a high poverty rate and every cent counts.
Inevitably, some of the work started by Phelophepa staff, particularly by the psychology team, is not continued when the train leaves. There are too few psychologists and psychiatric facilities in rural areas and in most instances they are too far away for the patients to afford follow-up visits.
Onke Mazibuko, the psychology clinic manager, says they check the available resources before they go into an area.
For example at Saldanha Bay, the nearest psychiatric facility is in Cape Town, which is a two-hour drive away. Mazibuko says they try to do as much as possible through the outreach programme.
Terence Giles, the optometry clinic manager, was with the train at its launch but left for a while to go back to teaching. Then he returned because the train offered him an opportunity to do both teaching and practicing.
Spectacles are ready within an hour after an eye test. Giles says they are able to do this because the frame shapes are not complicated and the lenses are already surfaced. Sometimes patients are referred to hospitals for surgery.
Coetzee asserts her authority with warmth and sensitivity. The train's staff don't bite off more than they can chew. Though the supporters behind the initiative have deep pockets, the staff is always aware of the financial reality that delivering quality health care is not cheap.
This is probably why Coetzee turned down a suggestion from one of the former health ministers that the train should offer services for free and politely informed the politician that "nothing is for free".
Children up to the age of 14 are not charged. Adults pay R10 for consultation and R5 for each medication prescription. A pair of spectacles costs R30. This is a lot of money for most people in the rural communities, many of whom are unemployed.
"We give people 14 weeks notice using various marketing tools. We distribute pamphlets so that they can also be aware of what services the train offers and we give them time to raise the R5 or the R10 because sometimes we come in the middle of the month," says Coetzee.
Vuyo Kahla, the group executive in the office of the Transnet chief executive, this week announced that the company would spend R82m to build Phelophepa 2. This will enable the service to cover eight provinces. At the moment, Phelophepa can only visit four provinces a year. Gauteng is excluded from the programme.
The staff stays on the train for nine months during which they get six weekends off before the three-month break. The salaries are market-related.
Coetzee sums it up perfectly when she describes the staff: "The people who work here are the best, they are special."