Web doctors prescribe health and hope for women

The power of technology is unleashing a store of unused medical knowledge to the 120 million people who go without access to healthcare in Pakistan, especially women

Lack of access to proper medical care for poor women in Pakistan is not unusual, a situation that led Dr Iffat Zafar and her partners to found Pakistan-based enterprise doctHERs. With clinics in rural and slum areas staffed by female physicians beamed in via the internet, doctHERs is using technology to let doctors see patients’ files and lab tests, and perform consultations by video link, assisted by an on-site nurse.

“There was a woman who came to one of our clinics; she said she had been infertile for many years and went to a doctor who did some surgery and after that her periods stopped. She wanted to know what was wrong,” said Dr Iffat Zafar, cofounder of Pakistan-based enterprise doctHERs. “When we examined her, we found her whole uterus had been removed by some quack, and she didn’t even know.”

Women’s reluctance to see a male doctor puts them at risk of worsening medical problems, something the doctHERs model seeks to overcome, she added.

“The communities where we create these clinics are places where female doctors are not present. Because of security concerns, women aren’t able to travel to slums and villages,” said Zafar.

Launched last year, doctHERs’ approach also serves another excluded group: female doctors. While there are some 70,000 qualified women physicians in Pakistan, just 9,000 actually practise, according to Zafar, herself a trained doctor.

“There’s a huge cultural aspect. Career options for women are very limited, so either they become doctors or teachers,” she said. Medically qualified women are even considered ‘trophy wives’. But once married, their husbands and families tend to balk at the long hours and nightshifts required: “[The family] thinks her children will be neglected if she goes out to work.”

DoctHERs lets women work from home and maintain cultural norms, while still practising medicine, said Zafar. They receive 60 to 70 resumes for every place they advertise.

DoctHERs currently operates in four clinics – three in Karachi and one in Mansehra, Khyber Pakhtunkhwa province – the first of which opened in May 2015. Each clinic has two female doctors who split the shifts. Already, some 15,000 patients have passed through their doors; and the social enterprise estimates it has reached 70,000 people through door-to-door medical awareness campaigns.

The organisation either sets up a new clinic – if a space is gifted to them – at a cost of $5,000; or they slot into existing clinics run by community health workers, at a cost of $1,000. DoctHERs charges patients a small fee: $1 for a general consultation and $3 to $5 for a specialist service such as a gynaecologist, psychologist or diabetologist. Income is split, with half going to the doctor, 25 per cent to the on-site nurse and 25 per cent to doctHERs.

Still, the cofounders ran into a few challenges at the start. Initially conceived as a tech-based model they could slot into existing networks, doctHERs had to set up its first clinic from scratch after their idea received little traction in medical centres. “But I think this was necessary to prove ourselves,” noted Zafar. The company won $38,000 in seed funding, including from Ashoka Changemakers, and further investment from one of the founders. The money helps finance a clinic’s set up and operations for one year. After that, the clinic must be self-sustaining: “[We aim for] around 750 general consultations and 600 specialist consultations per month.”

There was initial resistance from one of the communities, too, who were anxious about doctHERs’ intentions. “They thought we were associated with a foreign agency, trying to cut down our generation by vaccinating them something weird,” said Zafar.

Despite these obstacles, doctHERs has proved its model works. The social enterprise has been approached by reproductive products manufacturer DKT, who have 800 midwife-run clinics across Pakistan, to operate in five of their centres. DoctHERs’ fourth clinic is one of these pilots. If it goes well, they could scale to 80 of these Dhanak clinics in 2016.

For the women in remote and poor areas, the doctHERs service could be a life-saver; avoiding the difficulties of having to persuade male family members to take a day off work – and sacrifice a day’s wages – to accompany them to the doctor in the big city.

“Women in poor communities are very dependent on men,” added Zafar. “So they have prolonged medical conditions. They don’t even realise they are in really bad shape health-wise.” For the female doctors, too, doctHERs is a step in the right direction. “It’s a win-win situation,” said Zafar.