Dr Sara Khurram is a young doctor from Karachi. In 2012, she got pregnant, and this led her to quit her residency and stop her medical career.
Sara’s story is common among Pakistani female doctors. While 80 percent of medical school graduates are women, only 25 percent ever practice medicine. Pakistan being a conservative country, many have to stop working once they get married or start having babies. That’s how an estimated 9,000 trained female physicians end up staying at home.
Pakistan’s medical crisis
This home restriction phenomenon puts an additional pressure on Pakistan’s collapsing medical system. With only 0.74 doctors for 1,000 people, active physicians are overwhelmed, and of course, this has a negative impact on the population’s well-being.
Pakistan is still struggling with poliomyelitis as well as with a high rate of stillbirth and tuberculosis cases. Moreover, the examples of malpractice and medical negligence are numerous. In Lahore, for instance, a toddler with a small burn on her hand passed away after a doctor injected her with too much anesthesia. A teenager had his appendix removed when in fact he was suffering from colon cancer. And every day, newborns with jaundice symptoms are misdiagnosed, making them either deaf or brain-damaged.
The main victims of this predicament are the 56 million Pakistani who earn less than three dollars per day. Whenever they get sick, they are left with three choices: get no treatment, go to an insalubrious public hospital, or visit the often unskilled local doctor. For pregnant women living in poverty, the situation is even more dramatic, as many refuse to be examined by a male doctor. Therefore, 95 percent cannot access quality health care; and in the countryside, 1 in 5 mothers dies every day, because she delivers at home, in an unsafe environment.
Bridging the gap between female doctors and female patients
While expecting her baby, Dr Sara Khurram had to spend most of her time on bed rest, and she was doing a lot of thinking. In particular, she thought about her own situation and the current medical crisis.
One day, she came up with a clever idea to circumvent Pakistan’s main socio-cultural barriers: she would open a telemedicine clinic! Thus, female physicians could stay at home, and yet, provide poor women with primary and OB/GYN cares. To lower the risk of misdiagnosis and enhance the human interaction, the young woman decided to rely on Lady Health Workers.
In Pakistan, there are about 90,000 of these community-based women, and they play a key role in preventive health care. Dr Khurram, therefore, thought she could hire some of them and train them further to assist the physicians.During an ante-natal visit, for instance, the nurse would conduct the patient’s examination, and since the entire consultation would be video-conferenced, the doctor would not only supervise her assistant. She would also see in real time what appears on the monitor, and thus, give accurate medical counsel.
At the time, considering opening a virtual clinic was a bold idea. For sure, telemedicine had been spreading across the world for a while. But it was far from having reached Pakistan, and it is well known that many people in the country are wary of ICTs. On the other hand, mobile penetration was already high (85 percent), and Dr Khurram believed mobile and video consultations were workable in most regions.
“On the seventh day, one patient came in”
It did not take long for the young woman to take the leap and give her ‘DoctHERS-in-the-House’ project a try. To test its feasibility and sustainability, she decided to start a pilot in Naya Jeevan‘s health center of Sultanabad, a conservative slum of 250,000 people in Karachi.
In May 2013, everything was ready, and Dr Khurram could open her virtual clinic, the first telemedicine facility in Pakistan. “For six days, she said, not even one patient came in; […] but on the seventh day, one patient came in.” Since then, the clinic has always been full, encouraging the young woman to hire more doctors and replicate her model throughout Pakistan.
It has turned out that video-conferencing is not an obstacle for the female patients. In fact, since DoctHERS-in-the-House started, women have been thrilled by this new type of consultation. For sure, they are happy to pay 50 percent less than they would do for an in-person visit. But what satisfies them the most is the good quality of the care they receive. In Sultanabad only, DoctHERS-in-the-House have provided 500 women with ante- and post-natal care. For 14 percent, they anticipated medical complications and sent their patients to a hospital, where they could get a safe delivery.
And this has certainly saved a few lives!