Phelophepa Trains: Mobile Medicine for a Nation in Need
By Arunima Rajan
Keeping health on track for South Africa's underserved rural communities
What is a hospital, to you? Perhaps it's a place nearby, easily accessed. Maybe you have general hospitals, a teaching hospital, even speciality hospitals in the city where you live. Places with a range of medical professionals and equipment, able to respond to a variety of medical needs.
What if you live somewhere that doesn't have its own hospitals? What if a hospital wasn't a distant destination, something you have to travel to over days, uprooting yourself and putting things on hold? What if there was a way to make hospital facilities, complete with skilled personnel and a range of equipment, come to the most underserved community on a regular basis?
For thousands across South Africa’s rural communities, this is not a distant fantasy. The Phelophepa Healthcare Trains — two fully equipped mobile hospitals — are the lifeline that travel directly to those who have long been bypassed by traditional healthcare systems. For them, this is more than a visit to the doctor. It is a rare chance at wellness in a world that often forgets them.
The project, run by South Africa’s state-owned rail, port, and pipeline company, Transnet, has been operating for over 30 years, and is named for the Sesotho word for ‘good, clean health’. “Our mission remains improving access to quality healthcare services in communities where barriers exist,” says Shamona Kandia, senior manager of health at the Transnet Foundation. Kandia speaks with a clarity that matches the vision of the project: simple, effective, and lifesaving. For the many in need, these trains are not just a backup—they are the first and only stop in their long, painful waits for healthcare.
South Africa’s healthcare system is a mirror of its broader social inequalities. The divide between public and private care is glaring, with the private sector catering primarily to the wealthy, educated, and insured. Meanwhile, the majority of South Africans, often lower-income and outside of medical schemes, must rely on an underfunded public system that struggles to meet demand. As for those living in rural areas, the nearest clinic or hospital can be an unreachable dream — a day’s travel away, with costs that multiply with each kilometre.
This is where the Phelophepa trains step in, offering a practical solution that might make even the most cynical observer stop and rethink what healthcare can — and should — look like. These mobile clinics operate for 10 months of the year, stopping in rural communities for about two weeks at a time. Onboard, people can access a range of essential services: dental care, eye check-ups, general health screenings, psychological counselling, even pharmacy services. It’s a healthcare system that fits on tracks, bringing critical care where it’s needed most.
“The project had humble beginnings as a three-coach eye clinic in 1994, coinciding with South Africa’s dawn of democracy,” Kandia reflects. Back then, it was a small, ambitious collaboration between the University of Johannesburg’s Optometry Department and Transnet. The concept grew over time. From a modest three-carriage eye clinic, more coaches were added to meet the growing demand for healthcare. Today, the Phelophepa trains are fully-fledged mobile hospitals, each with 19 coaches, offering a wide range of medical services. For the patients they serve, these trains have become known as “miracle trains.”
The services provided are comprehensive. General health screenings for communicable diseases like HIV and tuberculosis sit alongside checks for non-communicable diseases such as cancers. Dental clinics offer everything from fillings to tooth extractions. In the optometry clinic, patients not only get their eyes tested, but they can also walk away with a pair of glasses made onboard in the train’s own lab. There are even counselling services for mental health — a reminder that holistic care is crucial, even in the most challenging environments.
But it’s not just about treating immediate health issues. The Phelophepa trains are also accredited as a training facility for final-year students from various health and humanities disciplines. From nursing to dentistry, pharmacy to psychology, students join the trains as part of their practical training. It’s a rare opportunity for experiential learning, and it leaves an indelible mark on both the students and the communities they serve. As Kandia explains, “We contribute to their professional growth, and they get the chance to serve their country’s most impoverished citizens.”
Yet, for all the good they do, running these trains is no simple task. Theft and vandalism of railway infrastructure are constant threats, causing delays that disrupt the trains’ tight schedules. The demand for healthcare is overwhelming — often more than the train’s staff can handle. “The decimation of rail infrastructure through criminal activity and inclement weather has impacted our reach,” Kandia acknowledges, while expressing gratitude to sponsors and donors who keep the trains moving despite challenges. “Providing quality medical services is expensive, and continuing to do so at low or no cost is a huge challenge.”
The Phelophepa trains serve an estimated 600,000 patients over 36 weeks of operations each year. Since inception, the trains have touched the lives of over 19 million people. But Kandia is clear-eyed about the future. While the trains are a vital resource, they cannot fix the deep-rooted issues within South Africa’s healthcare system. “We hope to build a surgical train, inspired by India’s Lifeline Express, and to establish permanent Phelophepa clinics in the communities we serve,” she says. The future of healthcare, she believes, lies not just in these mobile miracles but in creating lasting solutions for those left behind.
In the meantime, the Phelophepa trains keep rolling, bringing care and attention to parts of the country with no other recourse. It is estimated that the trains have provided medicines to over 3 million people, and health screening to over 2 million people. The trains have provided important first aid and HIV/AIDS awareness training to millions. They have also helped hone the future of the medical profession in South Africa with numerous student doctors and nurses serving under seasoned seniors in the trains.