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Mahlangu woke early on a cool morning and walked through her busy South African township, where minibuses were calling to pick up passengers and smoke hung in the air from snack stalls on the sidewalk. Her eyes were bothering her. But instead of going to her nearest health clinic, Mahlangu headed to the railway station for unusual care.
A passenger train known as Felophepa – or “good, clean, health” in the Sesotho language – was converted into a mobile health facility. It travels around South Africa all year round, providing medical assistance to sick, young and old people who often struggle to get the care they need at overcrowded local clinics. For the past 30 years – since South Africa broke away from the former racist system of apartheid – the train has carried doctors, nurses and optometrists on an annual trip that reaches the most rural villages, providing primary healthcare to around 375,000 people each year.
How the health train offers hope to patients like Mahlangu
The free care it provides stands in contrast to South Africa’s overburdened public healthcare system, on which about 84% of people rely. Healthcare reflects the country’s wide inequality. Only 16% of South Africans are covered under health insurance plans, leaving them beyond financial reach for many in a country with over 32% unemployment. Earlier this year, the government began addressing that gap. President Cyril Ramaphosa signed the National Health Insurance Act in May, which aims to provide funding so that millions of South Africans without health insurance can access care from the better-provisioned private sector.
But the law has been divisive. The government has not said how much it will cost or where the money will come from. Economists say the government will have to raise taxes. Critics say the country cannot afford it and warn that the system – which has yet to be implemented – will be open to abuse by corrupt officials and businessmen. They say the government should instead overhaul the public healthcare system. For Mahlangu and others who look to the train for a rare source of free treatment, the state of local health clinics is frustrating.
Patients are eagerly waiting for the return of the health train
Long queues, lack of medicines and rude nurses are just some of the challenges at the clinics that serve thousands of patients a day in Tembisa, east of Johannesburg. “We are not treated well there,” said Mahlangu. “We are made to sit in the sun for long hours. You can sit there from 7am until 4pm until the clinic closes. When you ask, they say we should go and ask the president to build a bigger hospital.”
The Health Train has grown over the years from one three-carriage train to two, 16-carriage trains. They are run by the Transnet Foundation, the social responsibility arm of state-owned railway company Transnet. When the train began in 1994, many black people in South Africa still lived in rural areas, where they had little access to healthcare. It was a period of change in the country. The train began as an eye hospital, but it soon became clear that the needs were much greater than that.
Now both trains serve the growing populations of South Africa’s capital, Pretoria, and nearby Johannesburg, the country’s economic hub. Two weeks would be spent in Tembisa alone. “The major metropolises are really struggling,” said train manager Shemona Kendia. But the traveling clinic is not the solution to South Africa’s health care problems.
Public health expert Alex van den Heever said health care budgets and public sector employment of nurses and doctors had grown substantially since the country’s first democratic government in 1994. The health department budget in Gauteng province, which includes Pretoria and Johannesburg, has grown from 6 billion rand ($336 million) in 2000 to 65 billion ($3.6 billion) rand now.
But Van den Heever accused the African National Congress, in power since the end of apartheid, of allowing widespread corruption to undermine the public sector, including the healthcare system. “This has led to a rapid decline in performance,” he said. For South Africans who have seen the decline firsthand, it may be a relief when the health train comes to town.
Mahlangu — with her new glasses — was one of hundreds who returned satisfied with its services and is waiting for the train to come again next year. Another patient, Jane Mabuza, received dental services as well as a full health check-up. She said she hoped the train would reach many others. “Here on the train you never hear that something has been completed,” she said.
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