Patients wrapped in coats and blankets against the bitter cold crowd together, thrusting prescriptions through the train's window.
Inside, PhD pharmacology student Freddy Mohlala takes the slips one by one and hands back medicine to each patient who has come from miles around for cheap medical attention.
"I think everybody who's in the health profession has to come and get this experience", Mohlala said.
we do we're not even touching the tip of the iceberg'
Since its first journey in 1994 a few months before South Africa's first democratic elections, Phelophepa has provided healthcare to the country's poorest areas, helping those priced out by a public health system in crisis.
This is an unusual stop for a team more used to rural stops.
"It's quite urban ... Phelophepa is known for visiting rural villages, where people don't have access to basic healthcare services," said the project's founder, Lynette Coetzee, who lives on the train for 9 months a year.
Away from towns, some patients wake at 3 o'clock in the morning and walk up to 30km to get to the train, funded mainly by Transnet.
Phelophepa's staff, including 39 university students, treat more than 1 200 patients a day.
"When we went to the Eastern Cape, in Swartkops at 4 o'clock in the morning we had more than 2 000 people waiting outside", Coetzee said.
The reason is simple: even poor people can afford Phelophepa.
"I came here because it's much cheaper than a normal clinic," said 21-year-old John Leppen, waiting at the eye wagon where he will pay just R10 for a sight test - a fraction of the normal cost.
Optometrist Thabo Nabe makes up spectacles to prescription.
"It's my second year on the train," he said. "It's a very satisfying and rewarding job. I would do it forever if I could."
Phelophepa's manager, Lillian Cingo, describes the first decade as an "absolute success," but wishes there was another train. Although Phelophepa spends a week at each stop, in some areas this is simply not enough.
"Whatever we do we're not even touching the tip of the iceberg," she said.
Cingo said Phelophepa would do well in the rest of Africa.
"We complain a lot in South Africa for our needs, but let's face it, the rest of Africa is worse than us, particularly in health problems."
The train's eye, dental and health clinics treat an average of 40 000 patients a year. Every week R9 000 is spent on salaries for local people - many of them hired as interpreters in a country that has 11 official languages.
It also offers a free counselling service and educational programmes including one on HIV and Aids, which affects more people in South Africa than in any other country.
Aids has added to the burden on a healthcare system already struggling to recruit skilled staff in rural areas as doctors and nurses leave in droves for better paid jobs abroad.
South Africa has an ambitious programme to give life-saving anti-retroviral drugs to HIV sufferers, but the train is unable to provide adequate monitoring to distribute the drugs.
Medical students from South Africa's rich cities volunteer to serve two-week stints on the train to see the desperate needs of patients in rural areas. Some even pay their own way.
"You gain a lot of experience...These patients are so needy of the treatment you give them and so appreciative," said 24-year-old Yoemna Khatib, who is spending two weeks helping in Phelophepa's dental wagon, paying for accommodation on the way.
For Rosa Marais, a 22-year-old medical student from Johannesburg, working in the eye wagon is great training.
"In our clinic you don't see all the different diseases that you see on the train," she said. "And of course it's very nice to see people smiling in the end if they can see something".
Students are key to the train's success, Coetzee said.
"They're fresh every two weeks and they come prepared. Every patient gets absolutely 100 percent attention and that's why they love it so much", she said. "Without students we would not be able to run this project."
Another advantage is the feeling that Phelophepa belongs to the whole community.
"We never had problems. We once had a TV stolen from the train and the next day it was back."
was originally published on August 02, 2004
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