Cape Town - The early morning air is chilly, but already queues are forming along a section of railway track in the small town of Darling, a farming community about 75km from Cape Town.
They come from all over the town and the neighbouring communities – a class of primary schoolchildren, mothers, teenagers, and farmers from the surrounding farms.
Nthombi Pukwana, a clinical psychologist and acting train manager for the day and weekend, is host and guide and her passion and belief in the Phelophepa mission is tangible.
The Phelophepa Healthcare train, one of two owned and run by Transnet, is on its last but one stop before services shut down for overhauling and rest for the staff.
The trains travel from January to October, 35 to 36 weeks each year, visiting a different rural community every fortnight within its four selected provinces.
Both trains have 19 fully refurbished and equipped coaches, custom designed and built by Transnet Engineering, an operating division of Transnet SOC Ltd.
More than 40 permanent staff and many final-year students and community volunteers work on the trains.
Pukwana, along with two other psychologists and a team of final-year students, focus on preventative interventions for teenagers dealing with such issues as substance abuse, sexuality, anxiety, trauma and bereavement. Career guidance and family counselling are other important areas of focus.
“Teenagers are starting to examine the world around them. They can’t talk to their parents about substance abuse or their curiosity about drugs or sex. We want to be the adults that children can speak to without horror or judgement and be the safe space for them, but also, we are teaching adults how to speak to their children,” said Pukwana.
Promoting mental health awareness is one of the team’s primary objectives.
This includes removing the stereotypes around mental illness and educating people on where to get help.
“Psychology is not really known. The communities do not have psychologists,” Pukwana said.
Ahead of the train’s arrival in a community, social mobilisers are deployed to spread the word, do the groundwork and to make a needs assessment.
Working with local communities and government departments of health, social services and other partners, the train makes a two-week stop in the selected districts during which they share their services.
“They need to know about us, and they need to expect us,” Pukwana said.
The system supplements and supports existing community health facilities and builds relationships with the local health-care providers.
This way, patients can be referred and continue to receive the care they need after the train leaves. This was important for psychological care, she explained.
“Phelephepa is a supporting structure ... it’s there to fill the gaps.
We are not trying to fix anything. Being able to teach parents and teachers to be able to fill in the role and talk to young children is key. We are trying to create those spaces.”
Achona Vuta, 26, is a registered counsellor who initially joined the train as a final-year student in 2020 for two weeks. She found the experience so unforgettable that she had to return.
It was a time of many firsts – her first couples therapy session and first sex education workshop. Dealing with grief and bereavement became her favourite area of discipline, along with equipping teachers to deal with stress management and conflict, rampant in many rural areas and not just the big suburban towns.
The therapists say the experience of crossing the country brings home the universality of mental health challenges in the different communities.
For Vuta, the most important lessons from her time on the train was community.
“This train is about community work.
It’s a train for the people. It exposes you to community and to the reality of what South Africa is,” she said.
“I’ve found therapy to be a safe space – but also a fun space.”
The trains make mental health and quality medical care accessible to South Africa’s most remote communities, where there is often only a single doctor for every 5 000 people.
Solomon Quaynor, African Development Bank’s private sector, infrastructure and industrialisation vice-president, hailed Phelophepa’s innovative healthcare service which has received global recognition.
“Since 2010, the African Development Bank has invested a total of $500 million in Transnet, towards a portion of its capital expenditure programme.
The Phelopepa train, while tangential to that, is an example of how investments align with our High 5 priorities such as improving the lives of African people.”
Pukwana said that after three years, she was far from ready to quit the ride.
Cape Times