Community Based Initiatives

The Phelophepa Train of Hope serviced by UKZN’s School of Health Sciences since 1994

Since its inception in 1994, the Phelophepa Train of Hope project has been supported by UKZN’s School of Health Sciences and has become an annual community engagement activity for its students. Phelophepa, which means good clean health derived from Tswane and Sotho, is the initiative of Transnet. There are two Trains that utilize the rail infrastructure in South Africa, to deliver vital health care to under-served areas. These trains have come to be known as the Train of Hope to the 14.5 million people that it has helped thus far.

The Phelophepa started off as a thirteen coach carrier which included an eye-clinic, an edu-clinic and a pharmacy clinic, and has today grown to a 16-coach carrier, now boasting a health clinic, a pharmacy, a dental clinic, and offers psychology, optometry and a catering department—all staffed by students from various training institutions.   The train is manned by permanent staff members and numerous volunteers providing educational programs and primary health care to the poorest of the poor. Health Sciences students from the disciplines of pharmaceutical sciences, dentistry, nursing and optometry; are amongst the volunteers that have helped in the train since its inception. The train operates for 36 weeks in the year. The past decade has seen many other universities come on board as volunteers.

According to academic leader of Pharmaceutical Sciences, Dr Panjasaram Naidoo, two students leave on a Sunday and work from Monday to Friday in the Pharmacy section of the Train under the supervision of a pharmacist to provide the pharmaceutical services to these indigent patients. The role of the pharmacy students on the train involves compounding, dispensing and counselling patients with regards to use of medication. In addition they are involved in pre-packing of medicines and capturing of patients’ prescriptions for the day onto the Unisolv computer system.

‘They work for a week at a time. Pharmacy is normally the last of the services that is provided to the patients, hence our students work long hours starting at 8am and finish as late as 6pm in some cases, depending on the number of patients that visit the train on that day. The pharmacist on the train including the management of Transnet are very pleased and grateful for the assistance rendered by the students from the Discipline of Pharmaceutical Sciences at UKZN.’

‘Students normally prepare a report on their activities and experiences. Some highlights from a few of their reports are as follows.’

‘Thanks to Phelophepha I now, know more than ever before, the crucial role of pharmacy out there and how bad people of South Africa need us, health professionals. Not just qualified health professionals but people with a passion for their work who will serve the patients with a great deal of compassion,’ said Khethukuthula Nhlangothi.

‘In conclusion, I am very grateful that I was afforded the experience to participate in a project that strives to uplift the poor and South Africa as a whole’, said Sarusha Naidu.

The eye clinic aboard the Phelophepa, at any one time in the year, is staffed by undergraduate optometry students from the four disciplines of optometry in South Africa, two qualified optometrists and an optical dispenser, who supervises the clinical work of the students. The train provides the students with an opportunity to learn how to develop and modify optometric equipment for rural settings. Currently, optometry students from the University of KwaZulu-Natal complete a two week rotation aboard the Phelophepa during the second semester in their final year of study. All expenses (such as travel, food and accommodation) are fully paid for by Transnet. Each institution has a co-ordinator/s who liaises with Transnet regarding these rotations. Annual meetings with all participating institutions is held at the Transnet Head Office in Johannesburg.

Although students are given documents such as an “Open letter” and “Guidelines” before they leave for the train, an orientation programme is facilitated by the train staff on the students arrival. Students are expected to adhere strictly to the policies and procedures on the train. After each rotation a student assessment form (report) is completed by the eye-clinic manager and sent to each institution.

The dental clinic on board the Phelophepa train is staffed by dental students from the five dental schools in South Africa. Fourth and fifth year Dentistry students from Universities of Western Cape, Witwatersrand, Pretoria, Limpopo as well as final year Dental Therapy students from University of KwaZulu-Natal rotate to ensure continuity of care of patients on board the Phelophepa; taking oral health services to the rural communities who had no access to or were unable to afford dental treatment. These services are provided to underserved, disadvantaged communities throughout the nine provinces of South Africa ranging from as far as Colesberg in the Northern Cape to Marikana in the North West to Newcastle in KwaZulu-Natal wherever there is a presence of railroads and train stations.

Dental students work as team to take in patients (administration duties), educate them while waiting to be attended, examination and diagnosis of the patient and provide various dental treatments including tooth extractions, restorations and scaling and polishing. The dental clinic has three dental cubicles fully equipped with modern dental equipment and technology. There is a great demand for dental treatment as patients sleep over at the station waiting to be seen the next morning. The dental team on board work throughout the day, taking staggered lunch breaks until late in the evening to ensure that all patients ere attended to for the day. The students are also responsible for sterilization of instruments and maintenance of infection control to ensure a high standard of care is delivered to the patients. The students are supervised by a resident Dentist on board the Phelophepa who assists and guides them. Students are also assessed by the supervisor on criteria such as professionalism, punctuality, communication with patient, ability to adapt to a rural setting, competence in exodontia, administration of local anaesthetics, restorations and scaling and polishing. The assessment sheets are sent to the coordinators from the various universities. In addition to work carried out on board the train students are also taken on outreach programs to the schools in the areas where they perform oral health education and dental screening. Children with dental problems are then encouraged to visit the train for treatment.

UKZN’s academic leader of Dentistry, Dr Shenuka Singh said, ‘The Phelophepa Health Train offers an excellent platform for community based training. It takes the student from an ideal clinical setting at the training sites of the university and allows them to adapt to a rural setting. It exposes them to the oral heath status of the various communities they engage with as well as get to see for themselves what their oral health needs and demands are. The clinical exposure they get on the train can never be matched at any designated training site. They get so see several patients a day compared to seeing maybe two or three in one clinical session at the training site. They get to relieve pain and suffering from a toothache by extracting them. There is also a great demand for scaling and polishing of teeth which is not otherwise available to the patients. The students have done some excellent work on board especially in areas where there is a high fluoride content in water resulting in a number of patients presenting with stained teeth (fluorosis). Students have placed a special type of restoration (veneers) over these teeth, not only restoring their patients’ smiles but their self confidence too’.

Professor Sabiha Essack, Dean of UKZN’s School of Health Sciences whose previous Faculty of Health Sciences were the first academic department in South Africa to support the Phelophepa train commented, ‘The Phelophepa is a unique clinical training site as it exposes the students to communities and conditions that they are unlikely to encounter either at their discipline based clinics or external clinic sites in close proximity with their institutions, as many of the sites that they visit in their rotation on Phelophepa are outside of their native province. This gives them as much variety as possible in clinical experience’.

‘Another advantage of working in such a setting is that students are exposed to the responsibilities of other health care professionals, and have the opportunity to work in a multi-disciplinary team, which is often not the case with either the internal clinics or external sites. In recognition of the service provided, Transnet Phelophepa health care train has been granted a United Nations award for improving the delivery of services to disadvantaged communities’.

Dentistry Students                                                        Patients

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