Better Design, Better Health: Bringing Telemedicine to Rural India
26-year old Rinku has been bleeding for days. It is a thick, persistent and painful blood that terrifies this mother of four. So she did what many village women in rural India do when health problems reach a certain level of severity; she made the multi-hour trip to a private hospital in the district town of Muzzafarpur hoping for high-quality, if expensive, healthcare.
India is administratively organized into state towns, district towns, block marketplaces, and then villages. Healthcare, as such, is distributed along that supply chain with each level of infrastructure offering a lower standard of care. Rinku's home state of Bihar in northeast India may be the country's fastest growing region, but 85 percent of its 100 million residents live in rural areas and therefore have only immediate access to healthcare at the bottom end of that chain.
This has profound implications on the lives of people, and especially women like Rinku, who have to travel long distances for curative care, much less preventative care. It is these people that Gopi Gopalakrishan, founder of World Health Partners (WHP) and recent recipient of the Skoll Award for Social Entrepreneurship, is trying to reach.
His big idea? Build an ecosystem atop the existing private sector. WHP is essentially trying to connect every level of the system from rural health practitioners to pharmacists, drug wholesalers, diagnostic centers and what WHP is calling LMO's, Last Mile Outriders. These are the entrepreneurs delivering medications that last mile from the block to the village level.
When Rinku arrived at the private district hospital, doctors told her she needed to have her uterus removed, saying cancer was most likely the cause of the excessive bleeding. Rinku was not so sure. So she went back to her village health practitioner, or quack, as India's unlicensed doctors are called.
Dr. Viresh's medical practice lies off the main road in Nariyaar, just a few miles from Rinku's home. He is one of the 433 quacks in WHP's network of telemedicine practitioners in Bihar. About one year ago he decided to invest in setting up an online portal that connects him with WHP doctors in the state towns of Patna and Delhi. For about $1000 he purchased a laptop, set up his own Wifi network, and bought a solar panel and battery to power it all.
The system allows his patients to have access to licensed doctors when the medical problems surpass his abilities. This saves time, money, and in some cases can save lives, for rural families that would otherwise have to travel hours to larger cities. The line outside Viresh's office is a testament to the impact he is having on his community. He says he's seen a 50 percent increase in patients since he added the telemedicine component to his practice.
On a sunny, blistery December day, Rinku visited him. Viresh hooked her up to a remote diagnostic device where the licensed doctor in Patna could read her vital signs, ask questions and look at her through a camera. Within a few minutes, Rinku learned that she had an STD and that the bleeding was most likely the shedding of her uterine lining after the recent delivery of her youngest child.
It had nothing to do with cancer. "The doctors in the city work for cash," Viresh explained. "They may have recommended the surgery just to make more money."
A woman's uterus in exchange for rupees seems an exorbitant price for anyone to pay. This is what technology and good systems design can prevent.
WHP's system is not perfect. Technology breaks down often. The distribution system for WHP's Sky Med pharmaceuticals can be inefficient at times. And importantly diagnostics at a village level is a nut they have yet to crack. But during a time when women throughout India's urban cities are demanding justice, it's worth reflecting on the injustices facing rural women when it comes to their health, and the people determined to change that.
Cris Valerio is an Innovator-in-Residence at IDEO.org where she most recently worked on a pro-bono project with World Health Partners.
Images courtesy of World Health Partners. Rinku is not pictured for privacy reasons.