On a brisk September morning, Thethiwe Mahlangu stepped onto the bustling streets of her South African township. The familiar symphony of honking minibuses and the aroma of breakfast stalls filled the air, but today, Mahlangu wasn’t headed to her local clinic. Instead, she was on her way to the train station, seeking a unique form of medical care. This was no ordinary train; it was the Phelophepa Train of Hope, named after the Sesotho word meaning “good, clean, health.”
For over three decades, this specialized mobile health clinic has been traveling across South Africa, providing vital medical services to individuals, particularly those in rural areas who struggle to access care at overcrowded local clinics. Each year, the Phelophepa Train touches the lives of approximately 375,000 people, offering a vital lifeline in a country grappling with healthcare disparities.
South Africa’s public healthcare system, serving around 84% of the population, is overstretched and burdened by inequalities. Only 16% of South Africans have health insurance, a luxury beyond the reach of many in a country struggling with an unemployment rate exceeding 32%. In an attempt to address this, President Cyril Ramaphosa signed the National Health Insurance Act into law earlier this year. This legislation aims to provide healthcare access to millions currently uninsured by funding it through the private sector. However, the act has sparked debate, with details regarding its cost and funding remaining unclear. Economists predict potential tax hikes, while critics argue that the system, still in its planning stages, might be susceptible to corruption. Many believe the government should prioritize improving the existing public healthcare infrastructure rather than focusing solely on a new system.
For individuals like Mahlangu, who rely on the train for free healthcare, the reality of local clinics often paints a stark picture. Long waits, medicine shortages, and unwelcoming staff are common experiences at clinics like those in Tembisa, east of Johannesburg. The health train, which began in 1994 with a single three-carriage unit, has since expanded to two 16-carriage trains, managed by the Transnet Foundation, the social responsibility branch of the state-owned Transnet railway company. The service has evolved from its initial focus on eye care to address a broader spectrum of health needs. Now serving Pretoria and Johannesburg, the train spends two weeks in Tembisa alone, addressing the growing healthcare needs of these major urban areas.
Despite the expansion and increases in the healthcare budget—Gauteng province’s health funding has surged from 6 billion rand ($336 million) in 2000 to 65 billion rand ($3.6 billion) now—public health expert Alex van den Heever criticizes the ruling African National Congress for allowing corruption to erode the public healthcare system.
For many South Africans, the arrival of the health train is a symbol of hope. Mahlangu, now equipped with new glasses, and other patients like Jane Mabuza, who received a comprehensive checkup and dental care, eagerly await its return, grateful for the crucial services it provides. The Phelophepa Train of Hope, a testament to the power of human compassion, continues to serve as a beacon of light in a system struggling to provide equitable access to healthcare.
