It's not unusual for women in Pakistan to become doctors. It is unusual for them to practice after getting married and having kids. Only 14% of qualified female doctors end up working full time, official figures show.
That's a serious problem in a country with a severe lack of medical staff, but now a telemedicine startup is trying to make use of the lost talent. DoctHERS connects stay-at-home doctors with purpose-built clinics in underserved areas, showing how the Internet can break down geographic and cultural obstacles.
"We have a lot of cultural barriers in our country," says Sara Saeed, one of three co-founders. "It's a noble thing [for women] to become a doctor—and you get better marriage proposals if you are a female doctor—but when it comes to doing duty hours, it's not accepted."
So far, DoctHERS has built eight clinics, including six near its base in Karachi and another two in the Khyber Pakhtunkhwa province in the north. They have a simple setup: two rooms, basic medical equipment, a small pharmacy, and a laptop. Patients walk in, a nurse performs an examination, and enters information on the laptop. Then, a doctor appears on the screen to offer a consultation.
The clinics are not aimed expressly at women, though women have the greatest unmet need and about three-quarters of the 20,000 patients so far have been female. The facilities offer weekly sample testing and ultrasound screenings. But, if patients need more serious attention, they're referred on to a bigger facility, Saeed says.
DoctHERS is for-profit and charges about $1 per consultation, though making money isn't the main point. Saeed says the goal is to reach rural and neglected communities where doctors are scarce, and where quacks, like shopkeepers or teachers, often put on white coats (with disastrous results).
The company has funded the first clinics from grants and prizes (including from Ashoka and USAID). But that isn't sustainable in the long-term. The startup is now collaborating with a network of 600 existing clinics and partnering with multinational corporations like Unilever and GlaxoSmithKline, which pay for the clinics as a service for their workers. Saeed says each new facility costs about $6,000, and they normally break even after 600 patients or nine to 12 months of activity.
About 120 million Pakistanis live below the $2-a-day poverty line, and 90% have minimal access to health care. So DoctHERS has a lot of room to grow. But Saeed says setting up each facility requires more than money. It has to find the right type of nurses to front each operation (the person needs both medical and marketing skills). And, more seriously, DoctHERS needs to convince communities to accept its unusual clinic concept.
"We identify and mobilize the main movers and shakers in the community in a 15-day campaign and get them on-board," Saeed says. "We say we're going to offer a qualified doctor rather than a quack. When they see that value, they start trusting the system."
Of course, in the long term, Pakistan still needs women to became full-time doctors. But, before that happens, it will need to spend on child care and change its attitude towards married women in the workplace. In the meantime, there's telemedicine, which isn't perfect, but a lot better than the alternative.
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