An Unconventional Thanksgiving

Happy belated Thanksgiving, stateside friends and family! I think last Thursday marks the my first Thanksgiving without pumpkin pie, but that’s okay. Instead, the occasion was marked by a great trip to Ahmedabad and Udaipur with a friend from Swarthmore, Shashwati. It was nice to see a familiar face – a good change from always meeting new people on the Watson (four months of intros and quick getting-to-know-yous with everyone you interact with does get a little tiring). It was also fun to take a proper weekend trip and be more touristy than I’ve been on the Watson so far.

The Ahmedabad riverfront.

I spent Friday morning seeing the Sabarmati Ashram, founded and inhabited by Mahatma Gandhi, and the mosque and tomb complex Sarkhej Roza. Later that day, Shash and I ate traditional Gujarati food for lunch (a thali, a round platter with small portions of many different dishes, spicy and sweet), saw some more sights, and wandered through the busy market streets in town.

Gandhi’s ashram is a beautiful green compound with a small museum about Gandhi’s life and activities in the ashram.
The mosque at Sarkhej Roza.
Beautiful carvings inside the tomb complex of Sarkhej Roza.
“Ladies Not Allowed” in the actual mosque.

I found Ahmedabad a bit challenging, with the same constant and excessive honking as Mumbai, and pushy crowds in town. Also, at the comparatively very calm ashram, a woman asked to take a selfie with me. That had never happened to me before, though I’ve heard of it happening to [white and blond] tourists in China, and certainly I get some stares in Mumbai as a young white woman. But no one has ever wanted a photo with me, which felt annoying and vaguely exploitative, even though I know friends have experienced this before and had fun with it. I feel like it’s one thing to stare at someone who looks different or ask where they’re from – as many strangers and taxi drivers asked me in Ahmedabad and Udaipur, though never in Mumbai – but another thing to want a picture of them without even asking their name. I did take a selfie with that woman, but I felt weird about it, and I refused the following requests from people in the ashram and in Udaipur’s City Palace (also because those were from men, which made me feel less comfortable).

Shash and I went to a nearby village to see the Adalaj Stepwell, which is what it sounds like: a well that you reach by walking down steps. I had never been to one before, but it was beautiful (though slightly creepy to descend down towards the water!).
The bottom of the stepwell. I couldn’t help but think of the Indiana Jones snake pit scene here.

At the Ahmedabad mosque, I discovered a group of about 60 students of middle-school age on a field trip. The more outgoing ones ran up to me and asked me all sorts of questions (“I’m from the U.S.” “Wow! Are you from Ohio?” “No, New York City.” “…Do you go to the Statue of Liberty a lot?”). Obviously, they saw my white skin and assumed, correctly, that I was an English-speaking American. Still, talking to them was fun and didn’t bother me at all. A few spoke English quite well, and it was clear that they study English in school but know very little about the U.S., and I’m sure many of them had never met an American before. So that was fun for them, and I enjoyed amusing them with answers to their questions. I’d much rather do that than take selfies with silent strangers. I wish that distinction didn’t bother me, but it does.

On Saturday morning, Shash and I traveled to Udaipur, the “white city” of Rajasthan. We stayed in the central historic district, which was very tourist-friendly. The streets are cooler and more pedestrian friendly than in Mumbai or Ahmedabad, and there are some beautiful man-made lakes in the city. Shash and I filled our time there seeing all the best attractions.

Rajasthan is known for its “miniature painting” style. These paintings with tiny, elaborate detail are found all over the city as murals on walls, in shops, and adorning the palace walls.
An interior garden in Udaipur’s City Palace, the city’s main attraction.
In addition to the miniature paintings, we found a lot of colorful Belgian stained glass.
The very fancy Taj Lake Palace Hotel, floating in Lake Pichola, as viewed from the Palace.
The palace had lots of funky and colorful rooms like this, with mirrors and/or stained-glass windows.
After the palace, we took a rickshaw to Lake Fateh Sagar to watch the sunset. I loved the softly textured nature of the water here.
Udaipur is so colorful! This is a fountain at the Sahelyion ki bari heritage garden.
We took a boat trip on Lake Pichola, the main lake. This is a palace on the lake as seen from our boat!
We also saw the Jagdish Mandir Hindu temple, which had lots of beautiful intricate carvings depicting animals, people, gods, and scenes from tales.
The top of the temple.
Our unconventional Thanksgiving meal: a Rajasthani thali plate.
We took this cable car up a mountain to see Udaipur from above.
Seen from above, Lake Pichola and Udaipur to the right.

On Sunday night, we traveled back to Ahmedabad in a sleeper bus, which we hadn’t quite realized we booked. Neither of us had been in one before. We had two “beds” (thin padded sections of floor) side-by-side on the lower level; basically it felt like we were on the bottom bunk at summer camp! We both cracked up for a good five minutes when we saw our “seats.” I flew back to Mumbai the next morning. Overall it was a great trip and I feel rejuvenated now. This week I finally have multiple project meetings (wahoo!) and, since the trip to Udaipur was so much fun, I’m now very much looking forward to traveling around India more when my parents visit for Christmas.

Our point of view from our bed in the sleeper bus!

Health post: Welcome Cure

Last week, I met with a few people at Welcome Cure for my first project meeting here in India. Welcome Cure provides an online homeopathy service; its website is described as a portal to complete homeopathy treatment. Interested users can go to the website, register for free, get a health consultation, sign up for a health plan, and then work with one of Welcome Cure’s in-house doctors. Users communicate with their doctor through chat on the website, over telephone, by email, or via Skype. Then they receive the prescribed medicine at home, couriered by Welcome Cure.

Welcome Cure gave me its complimentary box kit to check out. It has samples of Welcome Cure’s most common treatments. This is the type of package that might be couriered to a patient.

Welcome Cure is an example of telehealth – providing a health-related service remotely using communications technology – which seems to be the focus of many of the medical technology start-ups I’ve looked at in Mumbai and Bangalore. It makes sense that remote services would be popular in a country with 1.3 billion people. Also, many of the companies I’ve seen simply offer to help people choose between the myriad of options available when it comes to doctors, hospitals, and types of treatment. Welcome Cure, however, claims to provide an end-to-end package by diagnosing and treating its users, tracking them through the scope of their illness.

Before my meeting with Welcome Cure, I didn’t know much about homeopathy, which is the treatment of a disease by giving a patient small doses of natural substances that would, in a healthy person, replicate the symptoms of their disease. It’s in contrast to allopathy, the main method of medical treatment everywhere, which treats illnesses with drugs that combat the symptoms of the illness. Though of course Welcome Cure doesn’t advertise this, homeopathy is widely considered to be a pseudo-science and a completely ineffective alternative to mainstream medicine. The World Health Organization does not support the use of homeopathy for treating any illnesses, and many scientific studies have proven homeopathic treatments to be no better than a placebo (

What’s inside the box: a list of the different medications and how to take them, as well as 3 packages with small pill tubes. The box and instructions are in English only (a Hindi option is in the works for the future).

Jasmine told me that over 100 doctors work for Welcome Cure, and all of them are experts in their field. There might be a specialist for migraines, for example, who has spent over 10,000 clinical hours treating migraines. She said that this is an advantage of using a telecommunications service over simply walking into a hospital, where you will be assigned a general doctor from the get-go. Of course, Welcome Cure does not cater to patients needing surgery or immediate emergency attention; it focuses on chronic illnesses, skin conditions, etc. that can be treated with pills over some time.

I asked about both the patients’ and the doctors’ approach to using technology in the healthcare space. The people at Welcome Cure said that the doctors have all had a positive reaction to their homeopathy software, called Hompath, as almost all doctors that practice homeopathy have used that specific platform.

The patients are more hesitant. Jasmine said that every single patient has a negative reaction to telemedicine at first. They ask “How will you treat me over the phone? How will you see how deep my rash is?” and so on. A doctor has to convince each new patient that by asking them questions over the phone and by seeing pictures of surface-level conditions, the doctor can diagnose and treat a variety of conditions. Some don’t trust that they’re talking to a doctor because they can’t see who is on the other line. Jasmine said this negative attitude towards telemedicine is often an issue of literacy and education, while others simply can’t use telecommunications technologies due to infrastructure issues such as faulty internet or electricity.

Furthermore, many people are skeptical of homeopathy as a form of treatment. Again, Jasmine said this is mainly an issue of education. Welcome Cure wants to educate people about homeopathy, as well as build a base of testimonials (the website already has such a section). Jasmine said that potential patients will be more encouraged to try homeopathy if they hear an emphatic, positive review from someone who has had success with it. The people at Welcome Cure said that since homeopathy is widely practiced in India, many people think it’s an Indian science, and seem to trust it less for that reason – so Welcome Cure is quick to tell them that in fact, “it’s a German science.” (I looked it up, and yes, a German doctor is credited with inventing homeopathy in the 18th century. However, that was over 200 years ago, and I’m quite sure that the German government does not support homeopathy today, nor is it widely practiced in Germany. I found it really interesting that Welcome Cure uses the German background of homeopathy as a way to increase its sense of legitimacy).

Overall, in terms of the reactions of Welcome Cure’s users, it is hard to discern the negative reactions towards technology from the negative reactions towards homeopathy. Jasmine said that Welcome Cure is constantly fighting against negative perceptions and bias towards both telemedicine and homeopathy as it engages with new users.

Some of the pills, meant to treat: “Post-vaccination”; “Sudden fever”; “Travel sickness”; “Fear”; etc. Besides this simple goal-oriented label, there is no information for what is actually in the tablets, which bothered me; the only note is that they are all “chemical free”, “natural,” “safe,” and “side-effect free.”

I was curious about all the people that don’t have access to the internet or a phone – how will Welcome Cure reach them? Well, of course, Welcome Cure can’t expect to reach 1.3 billion people with the same platform. They have four to five thousand visitors now, and they have a target user population that does not encompass all of India. They are mostly targeting people in metro areas, though not as large as Mumbai. Jasmine was telling me that Welcome Cure targets “two-tier” and “three-tier” cities, as opposed to “one-tier” cities like Mumbai, where the residents move fast and have money and walk into a hospital for quick treatment when something is wrong. In the smaller, lower-tier cities, she described that the people are slower to deal with illnesses and thus more likely to seek out alternatives such as homeopathy, though they still have access to the internet.

Also, Welcome Cure has outreach programs that don’t depend on the target group needing internet. Though they do a lot of digital marketing to get people to come to the website, they also have franchised clinics where they teach people about homeopathy and the courier medical service. They also have ads in the Times of India newspaper. Still a relatively new company, Welcome Cure is focused on building brand recall at the moment – though Jasmine said that the most excited users engage with Welcome Cure because of a word-of-mouth recommendation.

The main takeaways from my meeting with Welcome Cure were that a) the Indian government takes alternative medicine quite seriously, and also that b) India’s huge and diverse population will create difficulty for my project here. Sweden has 10 million people overall, and the cities were small and easy to manage, with similar health issues (or, rather, a high health standard) in each. Qatar’s small population of 2.3 million resides almost entirely in Doha. So it was fairly easy to learn about these small, concentrated populations and make various generalizations. Mumbai alone, however, has 18 million people and extreme economic inequality. The health standard and health issues differ greatly between various residents of Mumbai, let alone across the whole country! Also, internet connectivity and technology accessibility seem to vary far more in this one city than in all of Sweden or Qatar. I suppose the only way to deal with this form a project perspective is to make sure that whenever I meet with a company or doctor that I understand their target population or target user group and try to learn about the attitudes of that group rather than “Mumbaikars” or “Indians” as a whole (whereas in Sweden I got away with asking about the “Swedish attitude” towards such-and-such, as everyone was seen as a potential user or patient there).

Edit 11/28/16: A disclaimer. In regards to takeaway a) above, I found that the Indian government has a department of alternative medicine, called the Ministry of AYUSH: Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy. This is in stark contrast to the UK government, for example, which has publicly condemned homeopathy as a legitimate science. Clearly there is a support of homeopathy in this country that does not align with the attitude towards homeopathy in the US and Europe. Of course, the people I interviewed at Welcome Cure have a positive view of homeopathy, so they did not discuss the many revealing studies and governments that have condemned homeopathy as a viable treatment option. But I certainly don’t agree with them; this interview and this post represent their views, not mine. For my project, I try to stand back and act as an observer, writing about what I see and hear without injecting my opinion or judgment. However, a reader pointed out that by including homeopathy in my project, which is about medical technology, I am in a way legitimizing homeopathy – saying that it counts as medicine. I’m sorry to do that – I certainly do not believe that it is a legitimate form of medicine.

I do think it’s interesting that homeopathy is taken so seriously here in India as a form of treatment for illnesses, and that is certainly relevant for my project in terms of specific cultural attitudes towards health in India. However, I want to be clear that I do not support or recommend homeopathy as a form of treatment for any illness, and I do not believe it is any more effective than a placebo at healing patients.

Getting out and about

In my last post about Mumbai, I talked about my frustrations with not being able to walk all over and take photos. Well, I’m happy to say that things have improved since then! I think I just needed to talk about it and get it out of my system – writing about my frustrations had a slight cathartic effect.

Last week, I joined a free walking tour of Dharavi slum, one of Mumbai’s largest slums (and apparently the slum that was featured in Slumdog Millionaire, which I now feel the need to re-watch). There were four of us: the tour guide, a local who lives in the area; a couple that has been here for two years; and me. The tour guide knew Dharavi inside and out – it’s a city unto itself. There are lots of small businesses in Dharavi, most of which involve producing raw materials by stripping down and recycling old, discarded products. There is also a pottery business there, where the people make their own clay by mixing sand and water.

We watched this clay-making process for a few minutes. You might be able to see the thin hose that’s bringing water to the center of the tarp. While the hose is on, this man mixes water and sand with his hands to make clay.
These pots were so uniform that I think they must have been made with a potter’s wheel.
Some of the larger pots made by Dharavi residents.
One of many murals in the Dharavi area.

In Dharavi, it’s hard to tell what is part of the slum and what isn’t. The slum is a mix of permanent concrete rooms and less solid structures. There was a lot more concrete and brick than I was expecting. The Dharavi slum was very different from the townships I saw in South Africa, most of which had very clear boundaries, uniform informal housing, and a spread-out grid layout. In Dharavi, there are lots of little lanes of varying width that connect to other streets; it would be impossible to navigate without a guide!

Some of Dharavi has electricity – you can see the wires here – but there is no plumbing anywhere. The two little rooms you can see jutting out over the river are bathrooms.

The businesses in Dharavi are varied. We saw people dyeing clothes, sewing jeans, building suitcases, creating blocks of pure aluminum from discarded pieces in trash, and selling  leather goods. It’s unclear who purchases these goods and when, but I’m sure some of them go to the same shops that you or I frequent.

Just outside the temple with our little basket of offerings.

After the tour, I hung out with the couple for a few hours. We went to the Shree Siddhivinayak Temple, one of the most popular Hindu temples in Mumbai. It was quite the process to enter. The area around the temple was fenced in with various security cameras and two controlled entrances with metal detectors. Once inside, no photos were allowed. There was a place to drop off shoes and many stands handing out little baskets of offerings – flower garlands, a tiny coconut, and a tightly closed box of sweets.

We removed our shoes and stood in line, holding the little basket of flowers. As we waited in line, we got closer and closer to the temple’s inner sanctum. This single sanctum used to be the entire temple, but the temple has been expanded and built up over the years to become the complex it is now. The inner sanctum is filled with gold. By the time we got there, everyone around us was pushing forward. We passed our flowers to the temple workers, who touched them to the statues of the gods and passed them back. Then we went out of the sanctum and eventually out of the temple. That was it!

The beach by Shivaji Park, Mumbai.
In the hazy distance, that long bridge is the Bandra-Worli Sea Link, the fastest way to travel between those two neighborhoods. It’s a breath of fresh air after the congested streets of the rest of Mumbai!
I was surprised to see this much green in the city.
A tree of hands!

That’s all for now – a day of iPhone pictures after being here for 2 weeks, as of today – but it’s certainly better than nothing. I’ve also been walking around the city more, which I like. I realized that most areas are more pedestrian-friendly than where I’m staying, so it’s good to get out and see other neighborhoods!

Health post: Doha’s patients

For my last week in Doha, I spent every day in the cancer hospital of Hamad Medical City, NCCCR (the National Center for Cancer Care & Research). I was meeting and interviewing patients there, finally cleared to do so after a lot of communication with the Hamad Medical Corporation. It was a goal of mine to meet with patients when I first designed my Watson project, but while I was in Sweden, I realized that it would be very difficult to access real patients due to legal and privacy concerns. Since I’m not affiliated with a well-established company or university, I have no established pipeline to access.

In Qatar, however, this problem was easier to navigate. It’s easier to find the right contacts in a smaller country with one central hospital system. I spoke with someone at the Medical Education Department of Hamad Medical Corporation, a department that has connections to all the Hamad hospitals and has helped clinical researchers in the past. I’m not a clinical researcher – I’m not testing any drug, but rather conducting very informal interviews – so they were a bit confused by my goal but approved it fairly quickly.

Unfortunately, I was only able to interview patients at the cancer center, NCCCR, as they are the only department that responded to my research request. Ideally, I would have interviewed a more diverse group of patients, specifically diabetes and asthma patients, to learn more about technology options for managing these chronic illnesses out of the hospital. Still, NCCCR was very welcoming and organized, and they helped me meet with a total of 15 patients.

The patients were a mix of men and women, 7 in the cancer daycare facility (with private beds) and 6 in the outpatient clinic center. Most had some type of cancer, but some of the outpatient interviewees were there for hematology issues instead, such as artery obstructions. Most of the patients spoke English, and for those that spoke only Arabic I used a family member or nurse as a translator. The age range I interviewed was 15 to 78 (average age: 44, median age: 44). Here are the questions I asked them with tallied results and a couple interesting responses (patient responses are in italics and have been paraphrased for length and clarity).

Where are you from? The Philippines (4); Jordan (2); Egypt (2); Qatar (4); Palestine (2)

Have you been to university? Yes (10); No (3, two Qataris and one Palestinian); Not yet (1)

What technology have you interacted with at the hospital – that is, what scans have you received here? MRI (13); PET Scan (10); CT Scan (7); Ultrasound (6); Echocardiogram (4); Biopsy (3); Mammogram (3); X-Ray (2); Radiotherapy (2); Bone Scan (2); Colonoscopy (1).

Note: These numbers likely underestimate reality. Most people had so many scans that they only listed as many as they remembered or found relevant, and some only referenced the more obvious ones after I asked to confirm (“Did you get an MRI, too?” “Oh, yes, of course.”).

For each scan, each interaction with technology, did you understand why it was necessary and what the benefit was? Was it explained well?

  • Yes (13)
    • It all helped, but it helped the medical team more than me because they needed to understand what was going on. They didn’t explain so much. For them it’s very routine – they just put you in there and do the test.
    • I understood why each one was necessary but not the order in which the scans happened. We did a ton of tests that didn’t confirm cancer, and then finally a biopsy that did. I wish we had done the biopsy first. 
    • I’m happy with the doctor, but I also read all about the procedure beforehand.
    • Sometimes the doctors explained too much! The full set of risks and benefits could be scary because of the risks.  
  • Mostly (1)
    • Usually things were explained well, but not very frequently. The tests were explained with their risks and benefits.

Did it ever seem like too much, like some of the scans were unnecessary?

  • No (10)
    • Doctors explained everything.
  • Not really (2)
    • I feel like I got more x-rays than necessary: 10.
    • I got a PET scan that didn’t show what it was supposed to, but that was a problem with the device and not with the doctor. [I feel like the doctor just ordered the wrong scan, but it was unclear].
  • Yes (1)
    • I once refused an MRI because I had already gotten so many, and it was ordered by Hamad General Hospital instead of NCCCR.

Did you have any fears or worries about the technology? If so, were they addressed by your doctor? Did your doctor answer all your questions about the technology?

  • Yes, but all my fears were alleviated (3)
    • I was worried about exposure to radiation, but I did the scan after the nurse explained it.
    • I wasn’t worried about the technology itself, but rather how it might affect my pregnancy. However, the doctors always explained how it might be affected.
    • I thought the lung biopsy would be too risky because the doctor kept explaining the potential side effects and risks. It wasn’t until I asked the doctor if the risks would be easy to manage and he said yes that I realized it was worth it.
  • No fears (11)
    • I was uncomfortable with the biopsy and MRI, but not out of fear. [more because they are uncomfortable procedures to begin with.]

How do you feel about the technology here – is it good? What about the technicians – are they well trained?

  • Yes, both are excellent (6)
    • However, they need to increase number of machines. There is only one PET scanner in NCCCR and only one MRI machine.
    • What they have is great, but not everything is available. We sent a blood sample abroad once for additional testing.
  • Both are good but not perfect (6)
    • There needs to be better awareness of technology. People here aren’t trained to use it entirely properly.  
    • One day the computer was working really slowly.
    • One day they introduced a bunch of new computers and it was very confusing and caused lots of delays. Now, it’s fine.
    • The technology is well-developed, but the technicians don’t make an effort to make you feel comfortable with it.
  • Unasked (2)

What made you comfortable with the technology?

  • Explanations from nurses and doctors (good communication) (6)
    • Cooperative staff.
    • The doctors are trustworthy, so their recommendation is important.
  • Emotional support from nurses and doctors. (6)
    • 9/10 accommodation. [I asked why not 10/10, and he said that most, but not all, of the nurses are super nice].
    • The most important factors for feeling comfortable with the technology and the hospital experience in general are: having faith in God; being surrounded by the supportive presence of family; cleanliness; and having the support of staff (friendly people, rather than just machine people). I feel pampered by the staff, like I’m in a hotel, which has been important for my emotional health.
    • Emotional support was good when it was there. Many of the nurses would smile, but with the doctors it would depend on your luck. Sometimes you have bad luck and you get a bad doctor.
    • The doctors were always good to me.
    • For the MRI, they asked me if I wanted to listen to music in headphones. I didn’t need it so I said no, but it was an attempt to make me more comfortable.
  • Knowing what to expect in advance because I read about the process (1)
  • Staff technique (2)
    • The technicians consider patient preference.
  • Upgraded tech (1)
    • The initial MRI machine was too claustrophobic, but it was replaced with a more open version that’s better. However, I don’t really care about it as long as the tech shows some reduction of the disease – that’s the goal.

Is there anything you would change in the process?

  • No (3)
  • Yes (3)
    • More non-tech options.
    • There was a lack of communication between the radiotherapy department and NCCCR, so I kept getting calls for appointments that I wasn’t supposed to go to. My cancer returned, so I needed to stop my radiotherapy, but they didn’t get the memo – so they stressed me out with calls and texts.
    • Wait time: I had to wait for a PET scan that finally diagnosed stage 4 cancer. It was frustrating because I had been to the hospital a couple times that year without the cancer getting detected. I might have been discharged too quickly in those visits, leading to the ultimate late-stage diagnosis.
  • Unasked (9)

Follow-up to above: Are there other options (non-tech) that you would try?

  • No (5)
  • Yes (1)
    • Sometimes, you should set aside the technology and take other suggestions. [This cancer patient has done a lot of reading about alternative cancer treatments because he really hates chemo. He said that he wants to try cannabis oil or a new treatment developed by a Russian doctor. He wasn’t saying that technology is bad, but that he’s tired of it and wants to try something else.]

Are you comfortable with technology in general? Do you use a smartphone?

  • Yes (12)
    • The hospital sends automatic SMS appointment reminders.
    • The hospital call center calls me and my husband automatically to remind me of appointments.
  • Mostly (1)
  • Unasked (1)

That’s all. While I’m happy that I was finally able to meet with patients (I almost titled this post “Patience for Patients”), the type of medical technology we discussed in these interviews is not exactly the type that interests me. Heavy duty hospital technologies, like MRI machines, are often not used by patients out of choice. When you have cancer and you are in a hospital, all you want is to be cured; if your doctor orders a scan or biopsy or a surgery, you do it.

So while I was conducting these patient interviews, I was worried that they were not relevant to my project. To date, I’ve tried to focus my project on a different set of technology, that which exists outside the hospital, such as devices that encourage doctor-patient compliance, support medication adherence at home, and help long-term care of chronic illnesses day to day. These are technologies that people have to choose to use, as opposed to the various technologies one is subjected to as part of cancer diagnosis and treatment. Still, PET scanners, MRI machines, and so on are types of medical technologies, and it’s important to see them in this context. Now that it’s been a week, I do think that this was a good choice for my project. I learned that, in the context of more serious illnesses, an important factor for having a positive attitude towards medical technology is the recommendation of a trusted doctor. I think for people with a serious illness, user-centered design processes become less important in favor of robust functionality and expert opinion. Most of the patients I met didn’t mind any discomforts associated with the machines, as these discomforts pale in comparison to the pain and fear that result from cancer itself.

I do hope, though, that in the future cancer patients will not have to assume that difficult and painful treatment is a necessary evil of a difficult and painful disease. I can’t get the image out of my head of the 40-something patient who was desperate to tell me about cannabis oil because he is so scared of doing chemotherapy again. Like he said, sometimes we need to set aside the technology and think of something else.

Transition #3

It’s been a week since I last posted on this blog, which is the longest I’ve gone without posting so far. I feel like I need to reach out before it gets to be much longer. A lot has happened in the past week: I said goodbye to Doha, I flew to Mumbai, I started getting settled into a completely new place (again), and I watched my home country elect Donald Trump as its next president.

The time difference between Mumbai and New York City is 10.5 hours, and for many other reasons I’ve never felt further from home. (Also, whose idea was it to throw an extra half hour in there?). I’m frustrated that I haven’t been able to take photos in a while. One reason that I was excited to post every few days in Sweden was the chance to visually show what I was seeing. I could share photos of my long walks in the different cities, of the pretty touristy scenes, of the funny exhibits in the many museums. I blended in and didn’t feel strange taking lots of photos.

In Doha, I had only one city and one museum to show you. There was hardly anything touristy to photograph, and I felt strange toting my fancy camera around. Furthermore, I was more stationary, staying in the same house for 4 weeks and not being able to use walking as a mode of transportation. Not only was I frustrated by the lack of exercise, but I wasn’t making fun detours down interesting streets, which also served as material for future blog posts. I met with doctors and patients, which provided less of an opportunity to take photos than my meetings with medical device companies and research institutes.

Now, I’m in Mumbai, where it would be unwise to take out my camera on the busy streets – I already stand out enough as is. Also, while far more people walk here, the city is still nothing like the calm, pedestrian-friendly Gothenburg. In this much larger and hotter and less safe city, I will not be venturing out for 12-mile walks through various neighborhoods and tourist destinations. I know far less of Mumbai after a week than I knew of Stockholm after a few days. I’m tired of not taking photos and not having them for the blog. I need to find a way to make this blog interesting for myself and its followers regardless of how challenging my environment is. I will be here in India for 3 months, and I need to make it work.

But so far, my time in Mumbai has been good. My host here, though now away on business, gave me a warm welcome by taking me out to great cafés and restaurants and introducing me to his friends. We all went to see Doctor Strange together at the movie theater nearby, and I went with his friends to a small wine festival over the weekend, which was a breath of fresh air after conservative Doha. I found an expat event where I could watch the election live, and I’ve already tried yoga here (it was incredible).

I don’t want to delve into the election here, but suffice it to say that I was disappointed, though not shocked. This is a historic moment for the United States, and it’s strange to be an expat as it unfolds. I’m not sure what to expect for the future, and I feel like I can’t say anything until after Inauguration Day. By the time I come home, Trump will have been active as President for a full 6 months, and by then we’ll have a sense of what our country looks like in his hands.

For now, I’m trying to focus on setting up project meetings for Mumbai. There are lots of interesting companies, startups, hospitals, organizations, and research institutes here, which all seem great for my project. But so far I have no meetings planned, and I’m trying to work on that. I’m also working on an article about my last project experience in Doha, so there’s plenty to do. Still, what has preoccupied my mind in this latest transition is what it feels like to keep moving further away from home while being unable to deny how much is happening in the United States right now. This is not the easiest time to be by myself without friends in a very foreign place. How much of myself did I leave behind in Doha, and how much of myself will I have to create here in Mumbai?  There is still so much of the Watson left – I’m less than a third of the way through – but I’m also beginning to feel like I’ve been away for a long while.

Health post: Meddy, a start-up in Doha

Nearly all of my project meetings here in Qatar have been at hospitals. In Sweden, most of my meetings were with independent medical device companies of all sizes. I’ve missed getting that innovative, gadget-focused opinion. So, I was thrilled when I found a medical start-up here in Qatar, where there are hardly any start-ups at all! (I read about it in the ‘news’ section of the Carnegie Mellon University in Qatar webpage). Last week, I met with Haris, the co-founder of Meddy, a website that helps people find the best doctors in Qatar. It allows them to search by location, specialty, and rating; for example, you could use Meddy to find the best dentist close to the Al-Hilal neighborhood. Each doctor on Meddy (only doctors who agreed to be on the site are there) has a starred rating and a list of real patient comments – a bit like Yelp for doctors.

First, I asked Haris what it was like to have a start-up in Doha. Ever since the QSTP talk I attended, I’ve been aware that while the government is excited by start-ups, there aren’t many here in Doha. Meddy is housed in QBIC, the Qatar Business Incubation Center, a new start-up incubator. Similar to QSTP and Education City, QBIC was created and funded by government agencies (Qatar is still far from from having venture capital investment and private accelerators).

I learned that it’s difficult to do start-ups in Doha because of the regulations here. There’s a minimum amount of capital that a company needs to get started. However, it’s the requirement that at least 51% of the company is Qatari-owned that turns people away. As the Qataris are ~13% of the population, that’s not easy, though I completely understand the desire of the Qatari government to include the local population in innovation. Luckily, Haris co-founded Meddy with his classmate, who is Qatari. However, since the local Qatari population already has a lot of money (mostly due to oil), it’s possible that many Qataris wouldn’t want to be so heavily invested in a small, risky start-up. With so much money in oil and real estate, especially without the need to work for it, there is very little drive for Qataris to come up with start-up ideas. This came up at the QSTP chat, too, where they discussed the lack of a risk-taking culture.

What I found interesting is that the creators of Meddy never intended it to be a start-up, or at least didn’t go into it with such innovation in mind – perhaps because of the culture here. Meddy was the result of a senior project for a start-up class at Carnegie Mellon University in Qatar. A member of the press came to the project presentations and wrote something about Meddy, leading to the idea “blowing up” as many people learned about Meddy and became interested.

It doesn’t surprise me that this start-up is the result of a class at an American university, especially Carnegie Mellon. However, a class about start-ups seems like it could easily fall into the trap of creating a solution where there’s no need. I’m thinking of the CMTH fellowship program in Sweden, during which participants had to identify many hospital and medical needs long before even thinking the word “start-up.” Still, the Meddy co-founders did their work to find a real need. Their initial idea for the class was essentially “LinkedIn for doctors” so that doctors could network with each other. However, after telling doctors about the idea, they realized that doctors didn’t have need for a personalized networking platform nor the time or energy to maintain a profile. Instead, the Meddy group found that they were discussing where to find good doctors in Qatar. They realized that the problem was on the patient end; people are always looking for good doctors and trying to avoid bad ones.

They validated that this was a real need by talking to many friends, family members, and professors. When someone in Doha needs a doctor, dentist, dermatologist, or some other specialized doctor, they ask their friends and family for specific recommendations. However, since many of the doctors are expats that are only here for, say, five years, the list of “good doctors in Doha” is always changing and thus hard to keep track of. Similarly, patients come and go, so you might ask around about a good sports medicine doctor only to find out that none of your friends have been to one since they arrived in Doha. Basically, there’s no constant base of people here, so when people seek doctor recommendations from their social circles, those social circles are always changing. Favorite doctors come and go. Therefore, migrating all of this information to a website – with lists of Doha doctors rated by real patients – creates a constant base that can be accessed by anyone at any time.

In the United States, you might be referred to a specialized doctor by your general practitioner or family doctor; in Qatar, it’s not as common to have such a doctor, especially for expats that are only here for a few years. Also, in New York City at least, you could find a doctor via independent rating agencies that publish lists such as “The 10 Best Doctors of 2016,” “The 10 Best Dentists of 2016,” and so on, every year. That’s not the case here in Doha.

Haris asked me if I had heard about Zocdoc and was surprised when I said no. As it turns out, it’s a doctor-finding service very similar to Meddy that was founded in New York City in 2007 and is still based there (hey, maybe I’ll send them my resume!). Zocdoc also has iOS and Android apps, whereas Meddy is entirely web-based (for now). Harris said that Zocdoc is one of many doctor-finding services throughout the United States. If he had tried to launch Meddy there, he said, he would have been crushed almost instantly by the competition. In Qatar, however, Meddy is one-of-a-kind and thrives.

As to whether or not Meddy can make people healthier in Qatar, its target is people who are already looking for a doctor. While Meddy makes it easier to find doctors, people still have to self-motivate to use the service. It also targets people who can afford to shop around without considering the price of treatment – rich Qataris and expats here on salaries with private insurance benefits. Meddy is good for people on private insurance because it connects patients to doctors at private clinics. If you don’t want to make a choice, or if you can’t afford a private doctor, you can show up to the general hospital owned by the governmental Hamad Medical Corporation, where you would be assigned to the next-available doctor in the necessary field.

Once the co-founders of Meddy had their idea, they started building it as their senior project for their start-up class. They had to encourage doctors to join the site, some of whom were hesitant at first. However, they currently have a 100% retention rate – no doctors have removed their profiles. While building the site, they did usability testing to make sure it was user-friendly. They also asked people to start adding reviews. When they presented it as their senior project, as I mentioned, it became their jobs. I asked if any of the patients had privacy concerns about leaving reviews. Haris said that there’s a stereotype that patients are very privacy-focused (all over the world, but especially in Qatar), but that it’s not true. In fact, Meddy had to edit down some posts because patients shared too many personal details when reviewing their doctors.

I was impressed with Meddy, but Haris was very modest about it. “We’re just solving a basic need,” he said, emphasizing that Meddy is mainly an aggregator of opinions. The site gets 50,000 visits per month, however, and an Arabic version was recently released, increasing the site’s popularity. Haris thinks that Arabic versions of health services and startups in general could influence the locals to be healthier and engage with startups – it’s important to reach them in their native language. For example, an “Arabic WebMD” would be useful here. Meddy predicts even more growth in the future since employers of expats continue to offer the benefit of private insurance to new employees in Doha, giving them the freedom to choose any doctor they want. This is especially important considering the wait times at Hamad Medical Corporation; the city’s main healthcare provider is getting increasingly crowded.

Check out Meddy’s website at: