[Music]
meet up Dooley a poor farmer from a very
mode Willett of Bangladesh about three
years ago his wife was pregnant with
their second child and in their third
trimester Abdul one night woke up
hearing a scream
he realized very quickly that his wife’s
water had broken and she was in
excruciating pain he calculated that it
would take about five hours to get to
the nearest hospital she would never
make it so he did the only thing he knew
how to do in these circumstances he
called his family doctor the doctor
picked up and before he could hang up
that person was on his way in less than
30 minutes he could hear two sets of
footsteps outside his door not only had
the family doctor come he had also
brought the local Midwife so they got
into action
they fixed us a line drip they’ve
managed her blood pressure and it was a
close encounter with death as abdul
stood by numb and in shock it was close
to dawn and after several hours of this
fight abdul could suddenly see his tired
wife beaming at him with a beautiful
newborn daughter in her arms what if I
told you that the family doctor that you
envisioned while I was sharing that
story was not a booth family doctor what
if it was someone like this a local
medicine seller who had very little
medical training if you ask any doctor
or anyone from the global health
profession they would tell you that this
person is a quack an impostor from the
dark underbelly of rural healthcare but
if you’re Abdul or his wife would you
agree this story
comes from one of these dark zones which
are devoid not only of electricity but
also of healthcare according to the
World Health Organization about 57
countries have an acute shortage of
doctors at least two billion people and
there are many estimates but about two
billion people cannot access a facility
or a doctor when they need treatment in
Bangladesh in rural Bangladesh there’s
only one doctor for every 10,000 people
compare that with 18 doctors in urban
areas so what do people do when they’re
in such circumstances I found out
personally the hard way in 2009 I was
travelling in the southern built near
the Sundarbans and I stayed for the
night to visit visit a village fair I
went to bed and about 2 a.m. in the
morning I woke up with terrible
abdominal pain I was in agony and I
could feel that I was getting very very
sick very quickly I started having
continuous bouts of diarrhea and
vomiting and I was pretty sure that it
was cholera by 6 a.m. I was so
dehydrated that I was about to lose
consciousness and I had almost resigned
my life to fate I reached out with the
last ounce of energy that I had left I
reached out for the phone on my bedside
table I took it and I texted my den
fiance that I might never see her again
luckily I survived that night and I got
married and my wife is actually sitting
right there but I survived partly due to
chance and if I was not a novice
urbanite I would have known where to go
that night and it would have been
someone like this it would have been one
of those quacks the that the doctors
would call quacks there they go by many
names they are called rural medical
practitioners they’re called village
medics and round up their political
shock you can call them anything you
like but and they come in all kinds of
shapes and sizes as well so some sit in
a pharmacy some don’t
some have private chambers some are big
wholesalers where some retailers but
what differentiates them from any other
kind of health provider is that they are
part of the community that they serve
and even unlike community health workers
these are entrepreneurs so they start
their profession pretty early in life
and they actually carried through all
the way till the end of their careers so
they have long relationships with the
people that they serve in Bangladesh
about 67 percent of people trust these
guys as their first point of care in
anywhere across the world if you look at
any developing country you would find
that 40 to 80% of rural primary care is
actually delivered by them this is
despite the fact that for the better
part of half a century the world has
actually called them quacks and made
them the villains in in the health care
system billions of dollars have been
invested in creating alternative better
providers and displacing them why is it
that they are so popular despite all of
this enemity towards them I want to
illustrate that with a with a few
stories so polish here is a village
medic his father was a legendary village
medic in the village that he comes from
polish studied as studied Bengali
literature and he wanted to become a
teacher in the local primary school but
on his deathbed
his father wished that polish continued
his legacy so he did and today polish
knows almost every one of his thousands
of patients by name as they pour in
through his pharmacy from morning to
dusk he pours them tea he chats with
them about their loved ones and even
fixes a rickshaw for his elderly
patients he’s so much a part of the
community that no local shall eat or
arbitration actually happens without his
presence people even call him to resolve
their family disputes about three months
ago in Natrona where he serves there was
a big flood for the second time this
year
and a lot of the crops were destroyed
people’s lives were at stake and what
Pollard’s started doing really startled
us he started giving away thousands of
dollars worth of medicines for free or
on credit when we asked him why he was
doing that he said if my people don’t
live what use would they have of a
doctor so it’s for this reason that you
cannot displace village medics it is
because of this that you cannot fix
rural healthcare without their help in
2013 I was a global health practitioner
and we had worked for a few years in in
the health space and we learned this
fact and I saw this big disconnect
between the language we used to describe
them and the reality on the ground so we
had some experience in technology and we
decided that telemedicine might be a
great way to help them serve their
community better how did we do that the
idea was pretty simple so they have
these deep trusting relationships with
their clients what if we gave them some
a tablet with some application and some
medical equipment and gave them the
training so that they could facilitate a
consultation with an urban doctor over
the Internet
this way we leverage both the trust and
the acceptance of the village medic and
and the skills and capacity of a doctor
so the process went like this a patient
would come in about 15 minutes walk away
to the nearest pharmacy she would
explain her complications and the person
would be trained to capture all of that
in the tablet they would gather some
vitals and the blood pressure let’s say
or some physical examinations there
would be the eyes and ears of the doctor
on the ground and then they would send
all of this information to the doctor
the doctor would review this he would
form a hypothesis call back have a video
call with the patient and type out a
prescription and send it back within a
few minutes the prescription would be
printed
and the medicines would be dispensed
this entire process would take about 30
minutes as we roll this out
we had many learnings and many
challenges of course and what really
stood out was the fact that not only did
village medics do a great job at being
the eyes and ears of the doctors on the
ground they actually also learned from
the practices of the doctor and
translated that into their own practice
so we saw them actually improving the
way they serve their patients as a
result of this service I also wanted to
share one really inspiring story that
that moves eludes me to this day
Ozma was this 11 year old girl who was
really bright and she stood first in all
her school exams she had a skin
infection and because of that she
started losing her hair and because of
the bullies at school she actually
decided to drop out now imagine what
that means for a girl her age that might
mean that she would get married at 13
that might mean that she might get a
baby at the age of 15 and lived the rest
of her life in a very different way than
she would have if she was educated and
self empowered so our doctors found her
and she was given only a few hundred
taka worth of ointments and it resolved
her condition and she was back in school
in two weeks
now this isolated incident of one girl
or even 10,000 patients that we’ve
served through the telemedicine platform
is not enough because there are tens of
thousands hundreds of thousands of
village medics out there and millions of
patients that are taking service from
them how do we make village medics a
part of national healthcare policy and
why are they not there yet I think the
reason partly is that doctors who tend
to control the healthcare policies in
our country Harbor a deep distrust and
disdain for village medics whom they
call quacks and I feel that back when I
started there was I did not have the
ammunition to kind of combat some of
those criticisms that they have they
have some legitimate concerns but today
after having worked in this space for
about four years I feel ready to at
least try to defend the village medics
against some of the criticisms that come
in because nobody is actually being
their voice in in the national landscape
so three of the most common concerns
that come up the first one is they over
prescribed they misdiagnosed patients
and they give a lot of drugs that
actually makes it much harder later on
and makes the patient’s condition worse
now this is partly true I’ve personally
seen many cases where village medics
have given wrong treatment but you have
to understand that they’re part of a
broader system and their product of that
system so what do I mean by that
consider the fact that if you’re a
village medic most of your clients are
poor rural patients and for them a day
off of work might mean the difference
between having food and not having food
so for them getting a drug that actually
resolves their problems within a day and
gets them back to work is actually a
great drug so there is a strong pool
from the patients of these strong
medicines that you and I would not
consume on a daily basis on the other
end we have
one of the most competent pharma
industries in the country in the world
but there are also because of some
relaxed regulatory structures there’s
also really low-quality pharma companies
that are engaged in a lot of malpractice
and selling counterfeit medications what
that means is there’s a lot of perverse
incentive to actually push drugs as well
so it’s a market that both demands and
rewards drug pushing combine that with
the fact that the village medic does not
really know any better because for them
the last training they have often
received is twenty years ago and the
only workshops that they get new
information from is run by guess who
those same pharma companies so the
government sitting in this nexus it’s
really hard for them to also regulate
this massive infrastructure because
they’re so decentralized it’s in every
nook and cranny of the country and it’s
really hard to monitor what’s happening
there the second question that often
comes up is they exploit patients for
money by sending patients for
unnecessary treatment and surgeries now
if the first point was a half-truth the
second one actually is quite inaccurate
it’s almost a lie because in our own
research as well as secondary research
that we’ve come across we’ve seen that
only about 3% of patient cases that a
pharmacy sees are referred to upstream
hospitals and diagnostic centers and
even among those 3% more than 50% are
actually sent to government facilities
because when we ask village medics why
that is the case they say if I send a
patient to a private clinic and the
patient gets bad treatment it would come
back to hurt my own reputation they
guard their reputation very very
strongly the third point is that we
doctors have to fix the mess that
village medics create now this argument
is a bit circular and kind of derives
from the first two but it’s a bit
circular like my son who his five years
old and he refuses to go to school one
day and the next morning he has it in
himself to come back and complain about
the fact that he got a punishment as a
result
because doctors are not ready to go live
in villages but they are complaining
about the shitty care that people
receive as a result so if I have been
able to convince you that village medics
are here to stay and they’re very much a
part of the rural society I hope I can
start to show you the enormous Vista of
opportunities that I see in my work so
consider the fact that there’s at least
140,000 village medics in the country
and they see at least 18 patients a day
according to some research that means
about two and a half million patients go
through these pharmacies every single
day imagine the kind of health care we
could deliver like up those daughter or
asthma if we were able to connect them
to doctors and hospitals like through
the telemedicine that we did or or
otherwise what if we could build their
skills and knowledge there’s been
research in India that shows that if you
train a village medic the difference
between them and a doctor in identifying
common illnesses can actually be
significantly reduced we can equip them
with technology today this is the
century of biomedical sciences there are
many innovations happening in medical
artificial intelligence rapid
Diagnostics which could potentially be
channeled through village medics to the
last mile and reach millions of people
but we cannot see them in isolation
because they’re not an isolated island
unless we increase patient awareness
which about these strong drugs and what
harm it does in the long run unless we
are able to control the counterfeit
drugs market and the unholy nexus that
happens in there unless we are able to
introduce laws that protect the
patient’s against mal practices not just
at the quack but at doctors hospitals
and everywhere else in the healthcare
system this problem will not be solved
in other words even if we simplify the
problem significantly and have blame it
all on quacks the solution is actually
far more complex
Abdul’s daughter the
story story has started with in the
beginning she must be about three years
old by now she’s about the same age as
my own daughter I want them to grow up
in a world where they have a decent shot
at a healthy and productive life whether
they live in the city like my daughter
or in the village like Abdul’s for that
we must go beyond the black and white
narratives the scapegoating of village
medics and utilize every single resource
we have at our disposal it’s often in
those grey areas that the solutions lay
hidden waiting for us to find them
thank you
you
meet up Dooley a poor farmer from a very
mode Willett of Bangladesh about three
years ago his wife was pregnant with
their second child and in their third
trimester Abdul one night woke up
hearing a scream
he realized very quickly that his wife’s
water had broken and she was in
excruciating pain he calculated that it
would take about five hours to get to
the nearest hospital she would never
make it so he did the only thing he knew
how to do in these circumstances he
called his family doctor the doctor
picked up and before he could hang up
that person was on his way in less than
30 minutes he could hear two sets of
footsteps outside his door not only had
the family doctor come he had also
brought the local Midwife so they got
into action
they fixed us a line drip they’ve
managed her blood pressure and it was a
close encounter with death as abdul
stood by numb and in shock it was close
to dawn and after several hours of this
fight abdul could suddenly see his tired
wife beaming at him with a beautiful
newborn daughter in her arms what if I
told you that the family doctor that you
envisioned while I was sharing that
story was not a booth family doctor what
if it was someone like this a local
medicine seller who had very little
medical training if you ask any doctor
or anyone from the global health
profession they would tell you that this
person is a quack an impostor from the
dark underbelly of rural healthcare but
if you’re Abdul or his wife would you
agree this story
comes from one of these dark zones which
are devoid not only of electricity but
also of healthcare according to the
World Health Organization about 57
countries have an acute shortage of
doctors at least two billion people and
there are many estimates but about two
billion people cannot access a facility
or a doctor when they need treatment in
Bangladesh in rural Bangladesh there’s
only one doctor for every 10,000 people
compare that with 18 doctors in urban
areas so what do people do when they’re
in such circumstances I found out
personally the hard way in 2009 I was
travelling in the southern built near
the Sundarbans and I stayed for the
night to visit visit a village fair I
went to bed and about 2 a.m. in the
morning I woke up with terrible
abdominal pain I was in agony and I
could feel that I was getting very very
sick very quickly I started having
continuous bouts of diarrhea and
vomiting and I was pretty sure that it
was cholera by 6 a.m. I was so
dehydrated that I was about to lose
consciousness and I had almost resigned
my life to fate I reached out with the
last ounce of energy that I had left I
reached out for the phone on my bedside
table I took it and I texted my den
fiance that I might never see her again
luckily I survived that night and I got
married and my wife is actually sitting
right there but I survived partly due to
chance and if I was not a novice
urbanite I would have known where to go
that night and it would have been
someone like this it would have been one
of those quacks the that the doctors
would call quacks there they go by many
names they are called rural medical
practitioners they’re called village
medics and round up their political
shock you can call them anything you
like but and they come in all kinds of
shapes and sizes as well so some sit in
a pharmacy some don’t
some have private chambers some are big
wholesalers where some retailers but
what differentiates them from any other
kind of health provider is that they are
part of the community that they serve
and even unlike community health workers
these are entrepreneurs so they start
their profession pretty early in life
and they actually carried through all
the way till the end of their careers so
they have long relationships with the
people that they serve in Bangladesh
about 67 percent of people trust these
guys as their first point of care in
anywhere across the world if you look at
any developing country you would find
that 40 to 80% of rural primary care is
actually delivered by them this is
despite the fact that for the better
part of half a century the world has
actually called them quacks and made
them the villains in in the health care
system billions of dollars have been
invested in creating alternative better
providers and displacing them why is it
that they are so popular despite all of
this enemity towards them I want to
illustrate that with a with a few
stories so polish here is a village
medic his father was a legendary village
medic in the village that he comes from
polish studied as studied Bengali
literature and he wanted to become a
teacher in the local primary school but
on his deathbed
his father wished that polish continued
his legacy so he did and today polish
knows almost every one of his thousands
of patients by name as they pour in
through his pharmacy from morning to
dusk he pours them tea he chats with
them about their loved ones and even
fixes a rickshaw for his elderly
patients he’s so much a part of the
community that no local shall eat or
arbitration actually happens without his
presence people even call him to resolve
their family disputes about three months
ago in Natrona where he serves there was
a big flood for the second time this
year
and a lot of the crops were destroyed
people’s lives were at stake and what
Pollard’s started doing really startled
us he started giving away thousands of
dollars worth of medicines for free or
on credit when we asked him why he was
doing that he said if my people don’t
live what use would they have of a
doctor so it’s for this reason that you
cannot displace village medics it is
because of this that you cannot fix
rural healthcare without their help in
2013 I was a global health practitioner
and we had worked for a few years in in
the health space and we learned this
fact and I saw this big disconnect
between the language we used to describe
them and the reality on the ground so we
had some experience in technology and we
decided that telemedicine might be a
great way to help them serve their
community better how did we do that the
idea was pretty simple so they have
these deep trusting relationships with
their clients what if we gave them some
a tablet with some application and some
medical equipment and gave them the
training so that they could facilitate a
consultation with an urban doctor over
the Internet
this way we leverage both the trust and
the acceptance of the village medic and
and the skills and capacity of a doctor
so the process went like this a patient
would come in about 15 minutes walk away
to the nearest pharmacy she would
explain her complications and the person
would be trained to capture all of that
in the tablet they would gather some
vitals and the blood pressure let’s say
or some physical examinations there
would be the eyes and ears of the doctor
on the ground and then they would send
all of this information to the doctor
the doctor would review this he would
form a hypothesis call back have a video
call with the patient and type out a
prescription and send it back within a
few minutes the prescription would be
printed
and the medicines would be dispensed
this entire process would take about 30
minutes as we roll this out
we had many learnings and many
challenges of course and what really
stood out was the fact that not only did
village medics do a great job at being
the eyes and ears of the doctors on the
ground they actually also learned from
the practices of the doctor and
translated that into their own practice
so we saw them actually improving the
way they serve their patients as a
result of this service I also wanted to
share one really inspiring story that
that moves eludes me to this day
Ozma was this 11 year old girl who was
really bright and she stood first in all
her school exams she had a skin
infection and because of that she
started losing her hair and because of
the bullies at school she actually
decided to drop out now imagine what
that means for a girl her age that might
mean that she would get married at 13
that might mean that she might get a
baby at the age of 15 and lived the rest
of her life in a very different way than
she would have if she was educated and
self empowered so our doctors found her
and she was given only a few hundred
taka worth of ointments and it resolved
her condition and she was back in school
in two weeks
now this isolated incident of one girl
or even 10,000 patients that we’ve
served through the telemedicine platform
is not enough because there are tens of
thousands hundreds of thousands of
village medics out there and millions of
patients that are taking service from
them how do we make village medics a
part of national healthcare policy and
why are they not there yet I think the
reason partly is that doctors who tend
to control the healthcare policies in
our country Harbor a deep distrust and
disdain for village medics whom they
call quacks and I feel that back when I
started there was I did not have the
ammunition to kind of combat some of
those criticisms that they have they
have some legitimate concerns but today
after having worked in this space for
about four years I feel ready to at
least try to defend the village medics
against some of the criticisms that come
in because nobody is actually being
their voice in in the national landscape
so three of the most common concerns
that come up the first one is they over
prescribed they misdiagnosed patients
and they give a lot of drugs that
actually makes it much harder later on
and makes the patient’s condition worse
now this is partly true I’ve personally
seen many cases where village medics
have given wrong treatment but you have
to understand that they’re part of a
broader system and their product of that
system so what do I mean by that
consider the fact that if you’re a
village medic most of your clients are
poor rural patients and for them a day
off of work might mean the difference
between having food and not having food
so for them getting a drug that actually
resolves their problems within a day and
gets them back to work is actually a
great drug so there is a strong pool
from the patients of these strong
medicines that you and I would not
consume on a daily basis on the other
end we have
one of the most competent pharma
industries in the country in the world
but there are also because of some
relaxed regulatory structures there’s
also really low-quality pharma companies
that are engaged in a lot of malpractice
and selling counterfeit medications what
that means is there’s a lot of perverse
incentive to actually push drugs as well
so it’s a market that both demands and
rewards drug pushing combine that with
the fact that the village medic does not
really know any better because for them
the last training they have often
received is twenty years ago and the
only workshops that they get new
information from is run by guess who
those same pharma companies so the
government sitting in this nexus it’s
really hard for them to also regulate
this massive infrastructure because
they’re so decentralized it’s in every
nook and cranny of the country and it’s
really hard to monitor what’s happening
there the second question that often
comes up is they exploit patients for
money by sending patients for
unnecessary treatment and surgeries now
if the first point was a half-truth the
second one actually is quite inaccurate
it’s almost a lie because in our own
research as well as secondary research
that we’ve come across we’ve seen that
only about 3% of patient cases that a
pharmacy sees are referred to upstream
hospitals and diagnostic centers and
even among those 3% more than 50% are
actually sent to government facilities
because when we ask village medics why
that is the case they say if I send a
patient to a private clinic and the
patient gets bad treatment it would come
back to hurt my own reputation they
guard their reputation very very
strongly the third point is that we
doctors have to fix the mess that
village medics create now this argument
is a bit circular and kind of derives
from the first two but it’s a bit
circular like my son who his five years
old and he refuses to go to school one
day and the next morning he has it in
himself to come back and complain about
the fact that he got a punishment as a
result
because doctors are not ready to go live
in villages but they are complaining
about the shitty care that people
receive as a result so if I have been
able to convince you that village medics
are here to stay and they’re very much a
part of the rural society I hope I can
start to show you the enormous Vista of
opportunities that I see in my work so
consider the fact that there’s at least
140,000 village medics in the country
and they see at least 18 patients a day
according to some research that means
about two and a half million patients go
through these pharmacies every single
day imagine the kind of health care we
could deliver like up those daughter or
asthma if we were able to connect them
to doctors and hospitals like through
the telemedicine that we did or or
otherwise what if we could build their
skills and knowledge there’s been
research in India that shows that if you
train a village medic the difference
between them and a doctor in identifying
common illnesses can actually be
significantly reduced we can equip them
with technology today this is the
century of biomedical sciences there are
many innovations happening in medical
artificial intelligence rapid
Diagnostics which could potentially be
channeled through village medics to the
last mile and reach millions of people
but we cannot see them in isolation
because they’re not an isolated island
unless we increase patient awareness
which about these strong drugs and what
harm it does in the long run unless we
are able to control the counterfeit
drugs market and the unholy nexus that
happens in there unless we are able to
introduce laws that protect the
patient’s against mal practices not just
at the quack but at doctors hospitals
and everywhere else in the healthcare
system this problem will not be solved
in other words even if we simplify the
problem significantly and have blame it
all on quacks the solution is actually
far more complex
Abdul’s daughter the
story story has started with in the
beginning she must be about three years
old by now she’s about the same age as
my own daughter I want them to grow up
in a world where they have a decent shot
at a healthy and productive life whether
they live in the city like my daughter
or in the village like Abdul’s for that
we must go beyond the black and white
narratives the scapegoating of village
medics and utilize every single resource
we have at our disposal it’s often in
those grey areas that the solutions lay
hidden waiting for us to find them
thank you
you
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