United Press International - April 7, 2004
Steve Mitchell, United Press International

Many indigenous people who inhabit the more remote areas of South Africa have only a limited education at best and are not familiar with the concept of germs causing disease. This is the situation described by Lillian Cingo, manager of a train called Phelophepa that delivers medical care to poor and impoverished communities, during a recent briefing for reporters.

"Something as simple as learning to boil water can be vital" in preventing disease in these regions, Cingo said. That is one reason a primary goal of the Phelophepa is to make sure patients understand why they got ill so they can prevent it from happening again, she added.

This general message also extends to efforts at fighting AIDS, which has infected nearly 40,000 of the 130,000 patients the train sees each year, Freddy Mohlala, manager of Phelophepa's pharmacy clinic, told United Press International.

The train stays in one location for only one to two weeks, so it cannot provide the long-term treatment AIDS patients require. The disease is so prevalent and devastating in the rural regions, however, Phelophepa's staff is working overtime to prevent it and in that vain they have launched a variety of outreach programs aimed at educating people in local communities.

One of the outreach programs focuses on proper dental care, which is severely lacking in rural South Africa.

Cingo said she was surprised when she recently learned of "something that is really awful" -- a family of 10 sharing one toothbrush.

"And in a country with HIV/AIDS!" she exclaimed in disbelief and noted this is not an uncommon occurrence. The concern is if a family member develops mouth sores due to AIDS, blood could get on the toothbrush and potentially infect other members.

To help prevent the spread of the disease via shared toothbrushes -- and to improve oral hygiene -- one of the dental outreach programs works with schools, giving them toothbrushes, which they store and label with the name of the student to whom it belongs.

The dental clinic staff teaches them proper oral hygiene in the hope that not only will the individual kids learn, but they also will pass on their newfound knowledge to their parents, Cingo said.

Phelophepa's staff also offers programs on board where volunteer members of each community visited by the train are taught the symptoms of AIDS, the concept that seemingly healthy people can actually be carrying the disease, the importance of getting tested and other information. In a recent class, a small teaching room on the train was packed with about 25 teenagers and young adults from East London, where the train was docked that day.

The severe rate of unemployment -- over 40 percent -- is a contributing factor to the spread of the disease across the countryside, Zukile Khambi, an independent tour guide who works with the Eastern Cape Tourism Board, told UPI.

Many of the men from the indigenous villages travel to the bigger cities, such as Johannesburg and Cape Town, in search of work, Khambi said. There, they often will engage in sex with prostitutes, contracting AIDS and bringing it back to their villages. The disease then propagates among people who have little or no access to medical care and who will not be able to afford drugs to treat it.

Ensuring people in the rural areas have a proper diet is another crucial factor in Phelophepa's anti-AIDS strategy.

"Even with the best medicine in the world, especially with HIV/AIDS, you need to make sure the patient has a well-balanced diet," Cingo said. Without that, the patient may die from malnutrition or be too weak for the drugs to help.

For that reason, the train offers a program that teaches people how to cultivate a vegetable garden, so they can have nutritious, fresh vegetables available.

Although AIDS medication can help slow the progression of the disease, they can be difficult, if not impossible, to obtain in South Africa. Some areas have no medical clinics, and those that do often lack medications, particularly those useful in treating AIDS, Mohlala said.

The South African government is just beginning an ambitious plan to dole out, free of charge, AIDS drugs to residents who need them. Advocacy groups, though, have complained the government has not put in place the infrastructure and personnel to ensure all people who need the drugs will get them.

"It would help a lot," Mohlala said, if Phelophepa could distribute AIDS drugs. Currently, the train cannot, despite seeing "quite a lot" of patients with advanced symptoms of the disease, he added.

The train's staff is negotiating to gain the right to distribute the medications. So far, at least one South African pharmaceutical company, Aspen-Pharmacare, has pledged to donate AIDS drugs if the train can obtain the OK to dispense the medications, Mohlala said.

Steve Mitchell is UPI's Medical Correspondent. He is on assignment in South Africa. E-mail sciencemail@upi.com

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