Well, it’s that time of year again. I’m about halfway through the Watson, meaning that I left home 6 months ago and that my second quarterly report is due. So far, this year has been easier, safer, and more fun than I could have ever expected (knock on wood) – here’s hoping the next half goes just as well! Anyway, here’s the report if you’d like to read it.
A week ago today, I got my cheek pinched by a spiritual master who founded the ashram where I was staying, as well as the university where I’ve been having project meetings to learn about their interesting work in medical devices. Who knew I’d ever say such a sentence!
A lot has happened since my last report 3 months ago. I finished my time in Qatar and traveled to India; I watched Trump win the presidential election; I had Thanksgiving, Christmas, New Year’s, and my birthday abroad; my parents came and visited me for the latter three events; and then they left. Now I’m halfway into the Watson and I could say the time has flown by, but I know that’s only an illusion of hindsight; those first few days in Sweden really do seem far away, and I feel like I’ve been in India now for ages (just over two months, really; in terms of the Watson, maybe that is ages). Second halves are always easier than first ones, though, and I’m sure the passing of time will seem to accelerate, though I certainly don’t wish for that.
This past quarter has been characterized by more challenging experiences than the last, including the challenge of expanding the scope of my project from one country to multiple; leaving behind the easy and comfortable life of Sweden for the unfamiliarity and activity of Qatar and India; flying nearly every week to see different parts of India; and getting direct challenges about my project from various people.
I’ll start with Doha, where most of my project meetings were at hospitals. The bulk of Qatar’s medical technology comes from purchases made by the government for the country’s hospitals, and there are very few independent medtech companies. I met with one of the few medical start-ups, an online doctor-finding service for patients organized by ratings and location. I learned that innovation in individual companies is stagnant in Qatar because of the government’s rule that any new start-up must be at least 51% Qatari-owned. Since Qatar’s population is about 85% expatriates, and they do not mix with the local Qataris that make up the remaining 15%, such business deals are unlikely (and it seems that the drive for start-ups comes from the expats rather than the locals). However, the rule certainly makes sense coming from a government trying to protect its small group of nationals.
Instead of companies, then, I met with doctors, and I also had the unique experience of interviewing patients at Doha’s main cancer hospital. I realized while I was in Sweden that it would be very challenging to gain access to real patients for my project, so I was thrilled that it worked out in Qatar. Since I had mainly interviewed people at medical device companies and researchers in Sweden, I had to adjust my questions for the doctors and patients. The technology changed, too, as I focused on the larger-scale tech and procedures that are more common to hospitals and specifically to cancer patients: MRI machines, endoscopes, CT scanners, biopsies, and more. Hardly anyone discussed the need for these devices to be well-designed and ergonomic. Rather, I found that what mattered to patients in Qatar was knowing that the hospital had access to the best (that is, the most expensive) technology in the world, and most importantly, that their doctor recommended its use. Since I interviewed mainly doctors and patients, perhaps the importance of trust in doctors seemed inflated, but it was still clearly key for patients to feel comfortable with medical technology. It also makes sense that sick patients in hospitals would be less picky about technology and more focused on a cure than medtech users outside of the hospital, who are more focused on fitness or long-term self-management of a chronic condition.
I got a sense that while the Qatari government is excited about medical technology and has the ability to purchase and import any technology, there is a lack of enthusiasm on the user end. Many doctors told me that, despite the best technology being available, it sits unused in hospital rooms with no technicians trained to operate it. Also, without independent companies making other medical devices, you see very few people focusing on their health outside of the hospital setting. From a meta-project perspective, I realized how hard it is to compare and contrast countries on my Watson when my project has to adapt for each country that I visit. If I had known in advance that I would be meeting mainly doctors in Qatar, I would have made an effort to interview more doctors in Sweden. Instead, I have mostly companies in Sweden to compare to doctors and patients in Qatar, which makes that comparison challenging.
Here in India, I spent my first four weeks in Mumbai and have been jumping around ever since. I’ve now visited 7 states and I’m visiting my 8th next week, which has been a bit exhausting but fascinating. My project meetings started erratically; I only had one meeting over my first three weeks, and I found it very hard to convince people to talk to me. But these things snowball, and I made connections that led to other contacts, so that by the time I went to Bangalore, I had 14 meetings over 8 days! In my last report, I mentioned that 2 meetings a week is my ideal pace. I haven’t hit that pace once in India; though I had a slow start, I’ve now far surpassed that mark. I never want to say no to a project meeting, and that’s the part of the project I love most – talking to as many people as possible, even if I do have the occasional lackluster conversation. But when I have meetings every day, I don’t have as much time to process what I’ve learned and write about it.
India has been challenging for my project because it’s a much bigger country, with far more diversity and people, than either Sweden or Qatar (both of which were homogenous and small in comparison). Many people here have told me that I could spend my whole Watson year in India, treating the states as different countries for the project. My methods, and where I’ve chosen to spend my time, have been directly confronted by various project contacts. I’ve been asked more than once why I don’t yet speak Hindi, and I’ve also been told many times that I’m not seeing the “real India.” That last point, which I heard from multiple corporates in Bangalore, bothered me the most. Of course, anywhere in India is part of the real India, but I knew what they meant; with roughly 70% of the population living in rural areas, talking to English speakers in Mumbai and “the Silicon Valley of India” (Bangalore) meant that I was only interacting with a tiny fraction of the population. Since then, I’ve traveled a lot more within India, seen more rural areas, and pushed myself to seek out more diverse opportunities here. While it would take far longer than 3 months to understand the intricacies of each state, I feel like I’ve gotten a much better picture of “real India.”
In terms of my findings here, I’ve learned a lot from meeting with a variety of companies (mostly in Bangalore) as well as researchers, faculty members, and doctors (mostly in Kerala and Mumbai). I’m trying to have a diverse set of meetings so that I can more easily compare my experience here to the other countries I see this year. In all my meetings in India, people have said that the number-one barrier to acceptance of medical devices is cost. It’s the headliner of the three “As” of acceptance: affordability, access, and awareness, which I keep getting as answers to my big question of “What factors lead to acceptance or rejection of a medical device in India?”. The device has to be affordable; it has to address the fact that a majority of the population has limited access to healthcare; and people have to be aware of it and its benefits, especially if it’s competing with alternative medicine, which is prevalent here. Also, since the population is so diverse, I think that anyone making a medical device here would have to have a clearly defined target user group in mind ahead of time – even just to know which of the local languages, if any, they should use for the device.
Personally, I’ve had more ups and downs this quarter; I started missing both home and Sweden while in Qatar, and I entered into a slight funk when I arrived in India. The frequency with which I posted on the blog took a dive, which bothered me a lot at first. I simply wasn’t inspired, and I felt like I wasn’t taking enough photos or having enough meetings to justify posting. Then I started having loads of meetings, and no time to write about them! I decided that, as long as I’m still having project meetings and keeping my own notes, it’s okay to leave the blog for a while if I’m not feeling inspired to put a post together. I also realized that another reason I haven’t posted so often is because I’ve been spending more time with new friends, which is a good thing – I feel less of a need to post and reach out when I’m spending less time alone.
I’ve been thrilled to be able to make a group of friends here, partially as a result of spending so much time in India (and, miraculously, finding a group of Mumbai swing dancers). A few weeks ago, I was at a friend’s house for a get-together and met someone new. I told her about the Watson and my experience so far, and her response was, “Have you always been so extroverted? I think you would have to be really extroverted to do that.” That meant the world to me, as I haven’t always been so extroverted but always wanted to be seen as outgoing. I feel like I’ve finally learned the lesson that part of being confident is simply acting like it, and the Watson makes self-confidence a necessity. Well, that’s enough for now. All I can say is, once again, I owe much of my success to the kindness of others, and for that I am eternally grateful.