John Matshikiza
‘We go anywhere in South Africa where there is a railway line,” says Lynette Coetzee, senior manager of Transnet’s Phelophepa health-care train project.
“In fact, we sometimes even go where there is no railway line. One time, when we were going to Qamata [in the Eastern Cape] it turned out that the line had disappeared, for some reason [someone had probably come along and pinched the tracks for scrap metal].
“The man from the technical department told me it would take several weeks to lay new tracks, so the train would have to wait. So I told him he was now going to be very proud of himself, because he was going to make sure that the line was back in place in exactly one week.
“And even though he shouted and protested that this would be impossible, the new line was indeed in place in exactly one week, and the train was able to make its appointment in Qamata.”
Coetzee is one half of the formidable duo at the heart of the extraordinary Phelophepa enterprise. Lillian Cingo is the other half. The absence of a little bit of railway track is nothing more than a passing irritation to be dealt with, compared with the scale of what these two extraordinary women have set out to achieve.
Coetzee and Cingo come from backgrounds so vastly different that they might as well be from different planets.
Cingo grew up in the Eastern Cape, trained as a nurse and later as a midwife in Thaba ‘Nchu and Durban, won gold medals for being the best nurse in South Africa in 1956 and 1961, and then left South Africa to pursue further studies and continue her outstanding nursing career in London.
She was twice nominated as British Nurse of the Year in the 1970s, and was presented to the queen as the best neurosurgical nurse in London. She received the Probe Dental Award from the British Dental Association in 1998 (this time for her work on the Phelophepa train), has a permanent place in the American Biographical Institute’s Hall of Fame, and has been recognised by the International Biographical Centre at Cambridge, England, as “one of the 2E000 intellectuals of the 20th century”.
Coetzee grew up in an Afrikaans-speaking environment in Germiston, left school as a teenager, and joined the railways.
“I started with Transnet at the age of 17,” she says, “so basically I grew up with these guys. That’s why they can’t really try to tell me anything [she is still referring to the episode of the railway tracks].”
She started off doing basic clerical work – “They used to call me a punch- donkey,” she says – then became the company’s librarian, a position that taught her the fastidious filing and organising skills that she brings to the job of managing this complex health-care project and its mission to far-flung places. In 1990 she was moved to Transnet’s social responsibility portfolio.
Phelophepa translates as “good, clean health.” It started as a relatively modest project operated by the department of optometry at Rand Afrikaans University (RAU), seeking to bring basic eye-care to remote communities, while at the same time giving the university’s optometry students hands-on experience with real patients.
“Professor Jannie Fereira phoned us and asked us if we would supply him with two coaches for his optometry project,” Coetzee says. “He’d been inspired by the Lifeline Express in India, which specialised in soft-tissue operations and took eye-care to remote regions. We refurbished the coaches, and they would be hauled behind a regular passenger train and then unhooked in various sidings around the country to provide a basic eye-care service.
“Then one day, somewhere out near Brits, the bogey started giving trouble,” Coetzee continues, “so the coaches had to be brought back to Braamfontein [where Transnet’s main Johannesburg sidings are situated].
“The train was already quite well-known. So somehow people all over Johannesburg heard that ‘the train that gives spectacles’ was in Braamfontein. Before we knew what was happening, 2E000 people had shown up at the sidings. I got a call from one of the operations people saying that ‘these people’ had shown up asking for spectacles. You know exactly what kind of people he was referring to when he used that expression ‘these people’. Anyway, he said ‘these people’ have shown up, and we don’t have any spectacles to give them.'”
The demand for cheap and accessible eye- care had simply overwhelmed what the RAU operation was able to supply.
“I don’t know whether I’m devilish or just passionate,” Coetzee continues, “but when I heard about this, I saw an opportunity. If RAU couldn’t pay for all the eye-care that was needed out there, why shouldn’t Transnet take over the train – in fact, why not build a complete train that was dedicated to more than just giving spectacles? So I actually stole Jannie Fereira’s idea, and made it work as something bigger.”
The new Phelophepa train, now expanded to 13 carriages pulled by their own, dedicated engine, rolled out in January 1994.
Basic medical care was provided by groups of final-year and postgraduate students from various institutions (no longer just from RAU), supervised by full-time instructors. The train also had two managers, who would alternate the work of running the project on the road.
The trouble was, they were excellent train managers, but they had no medical skills – nor did they necessarily have the kind of people management skills Coetzee regarded as essential for the running of the project.
“I knew from the beginning that I was in trouble here – this couldn’t work,” says Coetzee. She needed someone with skills that could cover all aspects of the health train’s operation. So she put out the word to various employment agencies, who found her description of the kind of person she was looking for rather baffling.
“‘What are you looking for?’ they asked me, ‘an angel or a matron?’ I knew I didn’t want a matron type of person – matrons scare me. So I didn’t know what I was going to do.
“Then one day the phone rang, and this beautiful voice said ‘I hear you’re looking for someone.'”
The voice, rich, melodious, with a constant hint of friendly laughter just beneath the surface, belonged to Lillian Cingo.
Cingo had by that time made several visits to South Africa, looking for a suitable niche in the new dispensation after 30 years of exile. One night, at a cocktail party in Cape Town, she had a chance meeting with a senior member of Transnet, who mentioned the corporation’s involvement with the Phelophepa train.
“It sounded like exactly what I wanted to be doing,” she says. And so she made the call.
The two hit it off from the word go. But there were still a few obstacles to get past. The biggest would be getting the approval of Coetzee’s colleagues at Transnet for the idea that a black woman from London was to be appointed to manage their train.
Coetzee approached the task with her usual directness: “I said to them, ‘Guys, I want you to relax and just listen to what I’m about to tell you. I’ve appointed this woman who is all the fairy tale things that I’ve been looking for. She’s a nurse, she’s a psychologist, she’s had a wonderful medical career in England, the only thing is, she knows bugger-all about trains. But guess what: you’re going to give her a six- month course in train management, but it’s only going to take two weeks, because I need her to start on the train right away. And guess what else: you’re going to teach her in English.'”
It was a lot for the masculine, Afrikaner culture of the country’s railway system to take on board, but as usual, Coetzee was determined to have things her way.
Cingo, the highly honoured neurosurgical nurse and widely recognised intellectual, had to learn how to take charge of every aspect of the train’s operation.
“I don’t think Lillian could even change a kettle plug at that stage,” says Coetzee, eyeing her colleague with a sideways smile. “But sure enough, there they were: this white Afrikaans male and this black woman, standing on the railway tracks, the one teaching the other how to shunt a train.”
“I had to learn everything,” Cingo recalls, laughing. “For example, if there’s a problem, you have to know how to protect the train. If your train breaks down, you have to know how to set off detonators on the track to warn oncoming trains that there’s an obstacle.”
Cingo, with her usual dedication to all kinds of learning, passed with a mark of 95% at the end of the crash course. She was now ready to fly to the Eastern Cape and take charge of the Phelophepa train.
Without even thinking much about it, she packed her precious detonators in among the rest of her possessions, and headed off to Johannesburg airport. The metal detectors were not pleased with what they discovered in her luggage.
“Within minutes, I was surrounded by about 10 policemen, who were certain I was a terrorist. ‘What else are you carrying?’ they demanded. ‘Where are the AK47s?'” It was a somewhat dramatic start to her new career.
She arrived in a health-care environment that had already had to make vast adjustments to the nature of the country and its legacies – both in terms of a poor health infrastructure, and in terms of what people were prepared or not prepared to do to access the benefits that the Phelophepa train was bringing. The train’s first year of operation, under Coetzee’s guidance, had been an eye-opener.
“You must remember that we started operating before the 1994 elections,” she remarks. So, for example, when the train first arrived in the Free State, thousands of people had heard about it and wanted to be seen. But they automatically formed themselves into two queues – one white, one black.
Coetzee was having none of it. She personally supervised the merging of the two queues into one. Service was to be on a strictly “first come, first served” basis. And yet it was still hard to break old habits.
“A white patient would say that they didn’t want to be seen by a black dentist. It was terrible. When I saw these things, I felt so ashamed – ashamed of being white, just ashamed as a person.”
These were realities that had to be confronted. In the process, everyone concerned, both the train’s staff and the people they were serving, had to find new ways of relating to each other, and face up to the demons within themselves.
Cingo’s arrival added another dimension. She had to stamp her authority on every aspect of the train’s life immediately, without losing sight of the principal task of compassionate service to all members of the community.
The crucial thing, she says, is that she had no illusions about the background of the people she would be serving. She understood their inherited mindsets and knew that she would have to deal with them.
“I have to make it clear to them that I am going to be humane and fair with them,” she says. “I’m not going to treat anybody differently from anybody else.”
Her presence, her professionalism and her warmth – and the unwavering support of Coetzee – have steered her through a potentially daunting process.
Five years down the line, Cingo’s management of the health train has produced remarkable results, and built a team whose dedication to the project (and to Cingo herself) is quite extraordinary.
At any one time there are 57 people living and working on the train. The complement is made up of the full-time staff who head the various departments (dental, optometry, the general clinic, the psychological unit, the basic health education and counselling outreach units, the pharmacy and the all-important catering unit) as well as the advanced level university students who rotate at two- weekly intervals, providing health-care and gaining invaluable experience.
In addition, there is a complement of students who are studying catering and hotel management, who spend three to six months on the train, working under the guidance of catering manager Colin Boucher – formerly employed as master chef on the prestigious Blue Train.
“We live and work together 24 hours a day,” says Cingo. “You can’t afford to have conflicts. Everybody has to get on.”
For the students, it is a first experience of the real world of South Africa. Many of them have never had to share their lives and their experiences with students of other races. On the Phelophepa train, they not only have to work together, they have to share the tiny sleeping compartments, eat together in the narrow confines of the dining car, and be supportive of each other. It is a transforming experience for all of them. They stay in touch with Phelophepa, and with “Ma Lillian”, long after they have finished their stints.
Some, like resident psychologist Lynette Kotze and assistant optometrist Hlanyane Hlongwane, leap at the opportunity of rejoining the train as full-time staff members when positions are advertised.
It is a commitment that demands huge sacrifices. The full-time staff members spend nine months of the year living on the train, covering 15E000km of rail, examining, treating and giving advice to some 45E000 patients, and liaising with local health authorities. The Easter weekend is the only time they can get away from the train – all except Cingo and catering manager Boucher, who insist on remaining on board to keep the train and its essential technical staff in perfect working order.
Those with families (including Cingo herself) have to weigh up their responsibilities to their spouses and children against the tremendous challenges of life on the train. But none of them would exchange the life they have chosen for any other.
“I feel completely fulfilled,” says Cingo, “because, unlike most people, I’m doing something I really like. I was born in a rural area, I understand the needs of the people, and I am aware that in the rural areas, nothing much has changed.
“My education and my experience, both in this country and internationally, are being used and challenged in every way. But it wouldn’t have worked if Lynette and I didn’t share the same vision – the passion, the caring for the students and the staff and the patients.”
“We do disagree at times,” interrupts Coetzee. “We must, we’re different people. Sometimes I feel like drowning Lilly in that bath of hers!”
“Oh, you mean that bath you organised for me!” Cingo rejoins.
The bath in question is another symbol of the kind of battles they have had to fight to make small changes to the world that can help to make their lives a little easier.
“If you live on a train for nine months of the year,” Cingo points out, “it’s nice to know that there’s someone out there who still remembers you’re a woman. These trains were designed for men.”
They set about altering some of the masculinity of the train’s environment by having the women’s showers painted pink, while the men’s showers were painted blue. Stereotyping? It seems to have made a difference to the women working in the cramped, metallic environment of the train.
“But I have thrombosis, I suffer from poor circulation,” adds Cingo, who spends more or less the whole day on her feet, from the time she summons everyone to rise at dawn till lights out late at night. “A shower is no good. I have to relax in a warm bath.”
And so, two years after Cingo joined the train, Coetzee moved mountains, once again, and had a small, private bathroom (all in pink, of course) installed for her friend, adjacent to Cingo’s tiny but homely compartment. Every time she visits the train from her office at headquarters in Johannesburg, Coetzee makes sure to bring along a little gift of bath oils or toilet soaps for Cingo – a small concession to comfort in these starkly functional surroundings.
The idea of a health train staffed by 57 people, covering four provinces each year and attempting to bring better health care to millions of people, would seem to be impossibly daunting – a drop in the vast ocean of poverty and need in South Africa. But Cingo takes her cue from the statement by Mahatma Ghandi: “Be the change you want to see in the world.”
“It’s a humbling experience,” she says. “When you see the conditions under which people live here in the rural areas, and you see how the students who come to gain practical experience on the train take to conditions on the train, you say to yourself, ‘What have I got to complain about?'”
Cingo and Coetzee smile affectionately at each other across the tiny table in the restaurant car where they are taking a brief moment away from the stresses of life on the train, to be pampered with tea, cakes and savoury snacks by neatly uniformed catering students.
“At the beginning, people thought it was just two women playing,” says Cingo. Coetzee smiles in agreement.
They don’t have to complete the thought. The dynamic results of the Phelophepa health-care train, calmly continuing its work in a rain-swept siding outside the quaint rural settlement of Stutterheim, before moving on to face new challenges further down the track, are their own testimony.