DR SAM EVERINGTON: Poverty means bad health. Bad health means poverty.
DR. GRO HARLEM BRUNDTLAND: One point three billion people live on one dollar a day!
PROFESSOR JEFFREY SACHS: You could get everybody vaccinated with all of these new vaccines- no problem!
DR. ZAFRULLAH CHOWDHURY: Most of the diseases we have in here can be cured.
PROFESSOR AMARTYA SEN: It is scandalous that curable diseases could batter the lives of so many people.
COMMENTATOR (COMM): Kwazulu Natal: one of the poorest provinces of South Africa. The government's promise to provide health care for everyone in rural areas like this is going to take time. The province only has one doctor for approximately every four thousand people. Most rural people don't have access to primary health care - they never have a chance to see dentists, opticians, or even community nurses.
LILLIAN CINGO, PHELOPEPA MANAGER: What attracted me about this train was that it was giving healthcare, affordable healthcare, to the rural people of South Africa. I am passionate about rural people. I am passionate because I know that those are the people who need most, yet they are the ones who have very little. And because they don't complain, they tend to be forgotten. In many ways I feel my whole training was centred to be used fully on this train. I think, how could I have been so lucky - every bit of my learning was made for the Phelophepa! From, from birth - I feel - it just went round and round until I finally came to help the rural people of South Africa.
LOUDSPEAKER: Good morning Phelophepa... The time is ten minutes past six on this beautiful Thursday morning. This is not a bad dream but this is your wake up call!
COMM: Phelophepa means 'Good, Clean Health'. This train spends nine months each year travelling to the most remote areas. Its role: to bring health care services to places that the government's new policy still hasn't reached.
LILLIAN CINGO: You see, patients er call this train "The Train of Hope", a magic train, a train that is going to solve everything. And I think also when you've been wanting something for years, when something like this happens you think its going to solve all your problems. It doesn't. It can't.
COMM: Lillian went to England to specialise at a time when there were no opportunities for black women to take advanced training in South Africa. She opened the Neurosurgical unit at London's Royal Free Hospital and went on to do her master's degree in counselling psychology.
LILLIAN CINGO THRO' MEGAPHONE: We know you've got no money, we know you've got no transport, and this is why we're here, to support and help you. But unfortunately we cannot see all of you. We quite appreciate that for a long time you haven't had these facilities. But we also know that we cannot see you after eight o'clock.
LILLIAN CINGO: Even in our imagination we never expect the numbers who come.
LILLIAN CINGO THRO' MEGAPHONE: If I tell you the dentist's clinic or health clinic is full and you haven't got a sticker by that time, apologies - you'll have to go home.
LILLIAN CINGO: Now remember, I am saying this to people who got up in the morning at three o'clock - two o'clock in the morning; walked for an hour, got a taxi which took them maybe to another twenty five kilometres; walked another five kilometres; ran to the train. I see people running and falling, coming to the train. And I think my god, don't run because it is already full.
LILLIAN CINGO: All the clinics are full - the eye clinic is full, apologies.
ISTER MAGDALINE NTIKINCA (HEALTH CARE MANAGER): The best thing about working on the train is the challenge, meeting the different patients and each community has its own dynamics. And the community people are human beings who are unpredictable.
NURSE: He has lost his ticket, now he is crying because he lost his ticket; he does not know where his ticket is.
COMM: There are thirteen permanent staff living on the train but it is the final year students from hospitals and universities who do most of the work and gain valuable practical experience in return.
DR TERENCE GILES: The students are indispensable on the train. Those are the people who do the real work. But they gain so much in both life terms as well as professional terms. And to see the way they change over two week is just amazing. And I think the students see the value of their chosen profession because it's very satisfying when somebody walks in being lead, or with a stick, and can, can walk out, out of the train with a broad smile on their face for seeing for the first time for many, many years.
STUDENT: Here we go. Right, here's your bag.
OLD MAN: OK.
STUDENT: Put your glasses in there.
OLD MAN: OK.
LILLIAN CINGO: I don't like children sitting on the train like this. But they also have got eye problems. They couldn't see well in the morning. My problem is always having to balance it. If I force issues that the children are seen in the eye clinic it means the eye clinic er people have to work even longer than perhaps eight o'clock. And it also means one compromises professionalism. So one has to balance that.
We basically are a primary health care train and we do a lot of health education, preventative measures. But you know it's so difficult really - if you talk to a rural person about a normal diet, what is a normal diet when they live on pap and vegetables, when there is no money, no money for food? So sometimes it's frustrating talking about what is normal. What is normal to me is definitely not normal to the people we deal with.
DR GLENISS DENICKER, DENTIST: Well, we just finished a ten-hour shift and were filling in our quotas for tomorrow - and there were ten other patients that came from twenty kilometres away crying for treatment. They said they'd been here for three days but they weren't helped because they came too late. And I just felt that - we said we could do it and would only work an extra hour. So I asked the students if they were willing to just work an extra hour and they were willing to sacrifice.
LILLIAN CINGO: Are you coming to work? Jolly good, that's the spirit.
DR DENICKER: I find it so amazing that they're willing to wait so long, and so patiently, none of them really complain. Some of them have been living with this pain for so long and I just thought that we can, if we can help them that's the best thing we can do.
LILLIAN CINGO: Rural people are poor and I think, for me, the worry, the concern, is the fact that we are faced with people who are not just faced with not having things but even the weather ravages them. There seems to be so much that piles against them. And I think, my goodness, why do you deserve this?
LILLIAN CINGO OVER LOADSPEAKER: Morning, Phelophepa, wakey-wakey! I don't know if you heard the birds at five o'clock, the birds were singing for you. And if you look outside the skies are absolutely beautiful and blue. Is it because we are here, to serve the people of the rural areas. And even as I speak, it seems to me the wind has been silenced.
COMM: As well as the train's clinics there are visits to local schools. Here Sister Maggie and her students screen children and teach basic healthcare.
SISTER MAGDALINE NTIKINCA: When I was first allocated to work in the rural areas, I thought that it was a punishment. Because I felt that I had the expertise to work in the clinical situation.
So it was by chance, and then I loved it.
So here is red, here there is wax_ So when you look at a child, you look to the general appearance of the child, yeah? Because you might have to refer the child now for other things. Look, for example this one has got scalp sores; has got ringworm, yeah? So you have to refer even for that, yeah? Because this child was fortunate that he came to the clinic.
PHARMACY ASSISTANT: Next!
CHRISTIAAN LINTNAAR, PHARMACIST: In rural areas it is difficult to explain to patients, so really you must - you must get a feel for your patients. Basically when the patients come in it's like greeting the patients, letting the patients know you are on their level. You know - you're standing here behind this counter, yeah, and you've got this bar in front of you and you need to bridge that gap. So basically when you greet your patient, get the patient to smile so the patient can um, you know, also be in feeling with you. We dispense medication and with a product like this you need to get medicine also at a very cheap price, but you need to have quality as well. And quality is really where the pharmacist comes in. That's our role basically on the train.
LILLIAN CINGO: The reality is that this train cannot run if the patients don't contribute. We ask them to think do they want a train like this to run at affordable prices, or do they then want it to stop?
COMM: The train spends five days at each stop. On Saturdays it travels to the next.
SISTER MAGDALINE NTIKINCA: It's a challenge because you become involved with them: you bond with them and now when the train leaves you feel that at the same time you haven't done enough for them. The sad look in their eyes, er their gestures when the train moves showing you that, "I wanted to come for glasses but I didn't have money". It's a challenge and then we always feel we haven't done enough for them.
LILLIAN CINGO: I was visiting South Africa and then I heard about this train from one of the executives at Transnet. I thought, my god what is going to happen - I must work on that train! So I still then applied. There has never been a woman who is manager on a train for a start - whether black or white. So I had to be taught as to how to do the hand signals, how to shunt the train, how to check the diesel, how the check pressure on the train.
LYNETTE COETZEE: The train started in 1994, January. It really was a nightmare, but a very nice nightmare. I didn't really have to ask any permission because the then government was busy preparing to leave and the new government really wasn't in place. That was the nice part. The not so nice part was Lillian not being there.
LILLIAN CINGO: And then I met Lynette, and somehow this woman was not what I had thought an Afrikaner woman would be. And we just hit it.
LYNETTE COETZEE: The disadvantage I had growing up during the famous old South African system of Apartheid: I never had the opportunity to know black people - never - and Lillian is my first black friend. But she's not black; she's Lillian. She's my friend.
SISTER MAGDALINE NTIKINCA: I have got three children of my own and two adopted ones. When this challenge came I discussed this with them and then they said to me, "Mummy, do you want this job?" And then I said, "Yeah, but I can't take it, I'm afraid of leaving you." And then they said, "If you want the job, take it." I manage to talk to them over the phone sometimes. Sometimes I have to scold them for doing nonsensical things at home when the eldest reports them. I have to act on the phone and pretend as if I'm there.
LILLIAN INTO INTERCOM: The interpreters are late, perhaps in another ten minutes I'll bring them down. If we are lucky!
LILLIAN CINGO: I get my strength from knowing why it's so vital that this train continues. This train must not stop and I also know that I have got to be strong for the staff to be strong, for the students to be strong, for the patients to also be strong. So somehow I have to continuously keep this up. I know the communities we visit call this a train that gives them vision in various ways. And so it does, but I also know that we've got our limitations. The reality is that the need in South Africa is enormous. It's been a need for so many, many years that whatever we put is only a drop in the ocean. But again my belief is that an ocean is made out of drops.
CHRISTIAAN LINTNAAR: We are like a big family and you know in families you do get to fight and in a small space like this you get to see the person you fought with five seconds ago! The whole day - you sit with them at breakfast, lunch and supper! So it gets to you. But you know we, we are all professionals and I think that the respect we have for each other is very nice. We can work out things, we can talk about things.
1st STUDENT: It's fun.
2ND STUDENT: It's something I could do when I've finished my course.
3RD STUDENT: One learns that actually we are a multi-professional team and that we are not functioning as individuals or as one profession on its own. So it's nice seeing that we actually need each other to interact and function in proper nursing or proper health care for all our patients.
LILLIAN CINGO: Well, our living conditions are not exactly what one would want. I've always liked space, but if I can't have space it doesn't really matter. "The three things I missed" I said, "A big bed, a bath and going the theatre." Lynette said, "I can't do anything about your theatre, not much about the bed, but I can try something about the bath." And I got my bath. And it's written 'Only' as you can see. And there are no compromises here, this is my bath, and my bath only. You are free to photograph this one! After a hard day's work I come here I soak, I think, I reflect, I feel better.
LILLIAN CINGO: Good morning - I'm coming just now! I expect you also to treat each patient with dignity and respect. I don't want you to shout at them because most of the patients have been shouted all their lives and the last thing I want is for you to be shouting at them.
COMM: People from local communities receive basic health training at each stop. Before the train leaves they get a certificate and a healthcare manual. This year Phelophepa staff have seen over one hundred thousand people.
NURSE: It was just that like your one lens is thicker than the other.
PATIENT: You're a star!
NURSE: So I had a bit of a problem. But as long as you can see with them. Now, what I'll do, I'll just_
PATIENT (WILSON MAMELE): As long as you can tell me if you're married, I've got three sons who are looking for a girl.
NURSE: You're embarrassing me!
PATIENT (WILSON): OK! OK, thanks! When people are sick the hospital is miles away from this place. The clinic - we have got no clinic here. I think it came at the right time, when the people need it.
COMM: Until South Africa's dream of health care for everyone comes true, Phelophepa will go on providing services and hope for rural people.
LILLIAN CINGO: This train is about working together, but for me it is actually like a mini South Africa a new South Africa, where men and women come together to give their best to build South Africa. Because I find to my disappointment - and sometimes absolute anger - people say, "Well why don't they do this; why don't they do this?" Who is they? The majority of South Africa must themselves do something, because they is me - and whoever is in South Africa.
END
DR. GRO HARLEM BRUNDTLAND: One point three billion people live on one dollar a day!
PROFESSOR JEFFREY SACHS: You could get everybody vaccinated with all of these new vaccines- no problem!
DR. ZAFRULLAH CHOWDHURY: Most of the diseases we have in here can be cured.
PROFESSOR AMARTYA SEN: It is scandalous that curable diseases could batter the lives of so many people.
COMMENTATOR (COMM): Kwazulu Natal: one of the poorest provinces of South Africa. The government's promise to provide health care for everyone in rural areas like this is going to take time. The province only has one doctor for approximately every four thousand people. Most rural people don't have access to primary health care - they never have a chance to see dentists, opticians, or even community nurses.
LILLIAN CINGO, PHELOPEPA MANAGER: What attracted me about this train was that it was giving healthcare, affordable healthcare, to the rural people of South Africa. I am passionate about rural people. I am passionate because I know that those are the people who need most, yet they are the ones who have very little. And because they don't complain, they tend to be forgotten. In many ways I feel my whole training was centred to be used fully on this train. I think, how could I have been so lucky - every bit of my learning was made for the Phelophepa! From, from birth - I feel - it just went round and round until I finally came to help the rural people of South Africa.
LOUDSPEAKER: Good morning Phelophepa... The time is ten minutes past six on this beautiful Thursday morning. This is not a bad dream but this is your wake up call!
COMM: Phelophepa means 'Good, Clean Health'. This train spends nine months each year travelling to the most remote areas. Its role: to bring health care services to places that the government's new policy still hasn't reached.
LILLIAN CINGO: You see, patients er call this train "The Train of Hope", a magic train, a train that is going to solve everything. And I think also when you've been wanting something for years, when something like this happens you think its going to solve all your problems. It doesn't. It can't.
COMM: Lillian went to England to specialise at a time when there were no opportunities for black women to take advanced training in South Africa. She opened the Neurosurgical unit at London's Royal Free Hospital and went on to do her master's degree in counselling psychology.
LILLIAN CINGO THRO' MEGAPHONE: We know you've got no money, we know you've got no transport, and this is why we're here, to support and help you. But unfortunately we cannot see all of you. We quite appreciate that for a long time you haven't had these facilities. But we also know that we cannot see you after eight o'clock.
LILLIAN CINGO: Even in our imagination we never expect the numbers who come.
LILLIAN CINGO THRO' MEGAPHONE: If I tell you the dentist's clinic or health clinic is full and you haven't got a sticker by that time, apologies - you'll have to go home.
LILLIAN CINGO: Now remember, I am saying this to people who got up in the morning at three o'clock - two o'clock in the morning; walked for an hour, got a taxi which took them maybe to another twenty five kilometres; walked another five kilometres; ran to the train. I see people running and falling, coming to the train. And I think my god, don't run because it is already full.
LILLIAN CINGO: All the clinics are full - the eye clinic is full, apologies.
ISTER MAGDALINE NTIKINCA (HEALTH CARE MANAGER): The best thing about working on the train is the challenge, meeting the different patients and each community has its own dynamics. And the community people are human beings who are unpredictable.
NURSE: He has lost his ticket, now he is crying because he lost his ticket; he does not know where his ticket is.
COMM: There are thirteen permanent staff living on the train but it is the final year students from hospitals and universities who do most of the work and gain valuable practical experience in return.
DR TERENCE GILES: The students are indispensable on the train. Those are the people who do the real work. But they gain so much in both life terms as well as professional terms. And to see the way they change over two week is just amazing. And I think the students see the value of their chosen profession because it's very satisfying when somebody walks in being lead, or with a stick, and can, can walk out, out of the train with a broad smile on their face for seeing for the first time for many, many years.
STUDENT: Here we go. Right, here's your bag.
OLD MAN: OK.
STUDENT: Put your glasses in there.
OLD MAN: OK.
LILLIAN CINGO: I don't like children sitting on the train like this. But they also have got eye problems. They couldn't see well in the morning. My problem is always having to balance it. If I force issues that the children are seen in the eye clinic it means the eye clinic er people have to work even longer than perhaps eight o'clock. And it also means one compromises professionalism. So one has to balance that.
We basically are a primary health care train and we do a lot of health education, preventative measures. But you know it's so difficult really - if you talk to a rural person about a normal diet, what is a normal diet when they live on pap and vegetables, when there is no money, no money for food? So sometimes it's frustrating talking about what is normal. What is normal to me is definitely not normal to the people we deal with.
DR GLENISS DENICKER, DENTIST: Well, we just finished a ten-hour shift and were filling in our quotas for tomorrow - and there were ten other patients that came from twenty kilometres away crying for treatment. They said they'd been here for three days but they weren't helped because they came too late. And I just felt that - we said we could do it and would only work an extra hour. So I asked the students if they were willing to just work an extra hour and they were willing to sacrifice.
LILLIAN CINGO: Are you coming to work? Jolly good, that's the spirit.
DR DENICKER: I find it so amazing that they're willing to wait so long, and so patiently, none of them really complain. Some of them have been living with this pain for so long and I just thought that we can, if we can help them that's the best thing we can do.
LILLIAN CINGO: Rural people are poor and I think, for me, the worry, the concern, is the fact that we are faced with people who are not just faced with not having things but even the weather ravages them. There seems to be so much that piles against them. And I think, my goodness, why do you deserve this?
LILLIAN CINGO OVER LOADSPEAKER: Morning, Phelophepa, wakey-wakey! I don't know if you heard the birds at five o'clock, the birds were singing for you. And if you look outside the skies are absolutely beautiful and blue. Is it because we are here, to serve the people of the rural areas. And even as I speak, it seems to me the wind has been silenced.
COMM: As well as the train's clinics there are visits to local schools. Here Sister Maggie and her students screen children and teach basic healthcare.
SISTER MAGDALINE NTIKINCA: When I was first allocated to work in the rural areas, I thought that it was a punishment. Because I felt that I had the expertise to work in the clinical situation.
So it was by chance, and then I loved it.
So here is red, here there is wax_ So when you look at a child, you look to the general appearance of the child, yeah? Because you might have to refer the child now for other things. Look, for example this one has got scalp sores; has got ringworm, yeah? So you have to refer even for that, yeah? Because this child was fortunate that he came to the clinic.
PHARMACY ASSISTANT: Next!
CHRISTIAAN LINTNAAR, PHARMACIST: In rural areas it is difficult to explain to patients, so really you must - you must get a feel for your patients. Basically when the patients come in it's like greeting the patients, letting the patients know you are on their level. You know - you're standing here behind this counter, yeah, and you've got this bar in front of you and you need to bridge that gap. So basically when you greet your patient, get the patient to smile so the patient can um, you know, also be in feeling with you. We dispense medication and with a product like this you need to get medicine also at a very cheap price, but you need to have quality as well. And quality is really where the pharmacist comes in. That's our role basically on the train.
LILLIAN CINGO: The reality is that this train cannot run if the patients don't contribute. We ask them to think do they want a train like this to run at affordable prices, or do they then want it to stop?
COMM: The train spends five days at each stop. On Saturdays it travels to the next.
SISTER MAGDALINE NTIKINCA: It's a challenge because you become involved with them: you bond with them and now when the train leaves you feel that at the same time you haven't done enough for them. The sad look in their eyes, er their gestures when the train moves showing you that, "I wanted to come for glasses but I didn't have money". It's a challenge and then we always feel we haven't done enough for them.
LILLIAN CINGO: I was visiting South Africa and then I heard about this train from one of the executives at Transnet. I thought, my god what is going to happen - I must work on that train! So I still then applied. There has never been a woman who is manager on a train for a start - whether black or white. So I had to be taught as to how to do the hand signals, how to shunt the train, how to check the diesel, how the check pressure on the train.
LYNETTE COETZEE: The train started in 1994, January. It really was a nightmare, but a very nice nightmare. I didn't really have to ask any permission because the then government was busy preparing to leave and the new government really wasn't in place. That was the nice part. The not so nice part was Lillian not being there.
LILLIAN CINGO: And then I met Lynette, and somehow this woman was not what I had thought an Afrikaner woman would be. And we just hit it.
LYNETTE COETZEE: The disadvantage I had growing up during the famous old South African system of Apartheid: I never had the opportunity to know black people - never - and Lillian is my first black friend. But she's not black; she's Lillian. She's my friend.
SISTER MAGDALINE NTIKINCA: I have got three children of my own and two adopted ones. When this challenge came I discussed this with them and then they said to me, "Mummy, do you want this job?" And then I said, "Yeah, but I can't take it, I'm afraid of leaving you." And then they said, "If you want the job, take it." I manage to talk to them over the phone sometimes. Sometimes I have to scold them for doing nonsensical things at home when the eldest reports them. I have to act on the phone and pretend as if I'm there.
LILLIAN INTO INTERCOM: The interpreters are late, perhaps in another ten minutes I'll bring them down. If we are lucky!
LILLIAN CINGO: I get my strength from knowing why it's so vital that this train continues. This train must not stop and I also know that I have got to be strong for the staff to be strong, for the students to be strong, for the patients to also be strong. So somehow I have to continuously keep this up. I know the communities we visit call this a train that gives them vision in various ways. And so it does, but I also know that we've got our limitations. The reality is that the need in South Africa is enormous. It's been a need for so many, many years that whatever we put is only a drop in the ocean. But again my belief is that an ocean is made out of drops.
CHRISTIAAN LINTNAAR: We are like a big family and you know in families you do get to fight and in a small space like this you get to see the person you fought with five seconds ago! The whole day - you sit with them at breakfast, lunch and supper! So it gets to you. But you know we, we are all professionals and I think that the respect we have for each other is very nice. We can work out things, we can talk about things.
1st STUDENT: It's fun.
2ND STUDENT: It's something I could do when I've finished my course.
3RD STUDENT: One learns that actually we are a multi-professional team and that we are not functioning as individuals or as one profession on its own. So it's nice seeing that we actually need each other to interact and function in proper nursing or proper health care for all our patients.
LILLIAN CINGO: Well, our living conditions are not exactly what one would want. I've always liked space, but if I can't have space it doesn't really matter. "The three things I missed" I said, "A big bed, a bath and going the theatre." Lynette said, "I can't do anything about your theatre, not much about the bed, but I can try something about the bath." And I got my bath. And it's written 'Only' as you can see. And there are no compromises here, this is my bath, and my bath only. You are free to photograph this one! After a hard day's work I come here I soak, I think, I reflect, I feel better.
LILLIAN CINGO: Good morning - I'm coming just now! I expect you also to treat each patient with dignity and respect. I don't want you to shout at them because most of the patients have been shouted all their lives and the last thing I want is for you to be shouting at them.
COMM: People from local communities receive basic health training at each stop. Before the train leaves they get a certificate and a healthcare manual. This year Phelophepa staff have seen over one hundred thousand people.
NURSE: It was just that like your one lens is thicker than the other.
PATIENT: You're a star!
NURSE: So I had a bit of a problem. But as long as you can see with them. Now, what I'll do, I'll just_
PATIENT (WILSON MAMELE): As long as you can tell me if you're married, I've got three sons who are looking for a girl.
NURSE: You're embarrassing me!
PATIENT (WILSON): OK! OK, thanks! When people are sick the hospital is miles away from this place. The clinic - we have got no clinic here. I think it came at the right time, when the people need it.
COMM: Until South Africa's dream of health care for everyone comes true, Phelophepa will go on providing services and hope for rural people.
LILLIAN CINGO: This train is about working together, but for me it is actually like a mini South Africa a new South Africa, where men and women come together to give their best to build South Africa. Because I find to my disappointment - and sometimes absolute anger - people say, "Well why don't they do this; why don't they do this?" Who is they? The majority of South Africa must themselves do something, because they is me - and whoever is in South Africa.
END