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 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 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1874503/).
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.
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.