Mansehra, Khyber Pakhtunkhwa, Pakistan – The Pakistani social enterprise DoctHERs is extending affordable and quality healthcare to marginalised women in impoverished areas where it is otherwise unaffordable.
In a country where the majority of medical students are female but only a minority of registered doctors are women, DoctHERs is empowering women to fulfil their Hippocratic oath in the face of cultural and social constraints that leave many of them otherwise unable to practise medicine after marriage.
Despite the fact that 63 percent of medical students are female, according to 2014-2015 figures from the Pakistan Medical and Dental Council, only 23 percent of registered doctors are women, their data suggests.
With clinics operating in conservative areas where female patients often feel more comfortable dealing with female doctors than male ones, DoctHERs also provides a medical service with which women feel more at ease.
These doctors provide consultations from their homes over internet connections to patients in “teleclinics” staffed with a nurse who coordinates with the doctor to treat patients in person. The doctor also has access to the clinic’s diagnostic tools and can monitor her patients’ vital signs remotely.
The two founders of DoctHERs, Dr Sara Khurram and Dr Iffat Zafar, were motivated to launch the business by their personal experiences as female doctors.
“My motivation was that I was terminated from my residency as I conceived the baby. And this is just one of the issues that female doctors face in Pakistan. My co-founder was in a corporate office, she was a doctor also, but she was working in a pharma [pharmaceutical company],” Khurram said.
“She had to leave her job because she got pregnant and she couldn’t work longer hours and they didn’t give her a part-time option,” Khurram said.
DoctHERs runs consultations over medical consultancy software called MD Consults and, if the software is not accessible, they use Skype. The doctor appears on a laptop screen in the clinic and talks directly to the patient. In coordination with the clinic nurse, symptoms are checked and treatments are disbursed.
Sana Rehman works as a doctor for the company, providing consultations over the internet. She quit mainstream medicine in 2010 after she wed her husband so she could take care of her children. She said DoctHERs enables her to continue helping the sick while raising her children.
“They give the platform to work from home. I have to be home with my children,” Rehman said. But the arrangement allows her to consult the patients through Skype and MD Consults from home.
Marriage or career?
Choosing between a career and family is a dilemma many women in Pakistan still face. In a society where traditional gender roles still define the roles of women and men in a family environment, often women feel they have no choice despite their education.
Competition for medical school placement is tough in Pakistan. Rubina Tahir, a professor of obstetrics and gynaecology at Karachi Medical and Dental College, says 10 percent of her undergraduate medical students are men and 90 percent are women.
She thinks this is because medical schools in Pakistan recruit on grades alone, so the majority of medical students end up being women as they make better grades.
However, because many quit working after getting married, Pakistan is facing a shortage of doctors that is likely to get worse.
“Most of the girls, who got married, these are the ones who stopped working. Those who don’t tend to continue working,” Tahir said. Aside from quitting because of marriage, some also seek jobs in other fields such as in pharmaceuticals or hospital administration, because those jobs pay better, Tahir explained.
Saba Hussain, a 23-year-old undergraduate medical student at Dow University of Health Sciences, says she will quit medicine for her future husband.
“If he lets me work, then I’d be happy to work, but other than that, I don’t think so. Because it’s a very tough profession, it’s a never-ending race,” said Hussain.
“You always have to study more and more and get more qualifications. There is always a new job. And I personally think I can’t manage my marriage and my profession.”
But Sarah Jaffrey, a 24-year-old medical student at Karachi Medical and Dental College, says she wouldn’t quit her career after marriage.
“I’m the only one in my whole family who is going to become a doctor. And everybody forbade me to become a doctor, like ‘it’s such a tough field’, you know? It was my passion that I chose to be a doctor. I would never give up being a doctor,” said Jaffrey.
Not all married female doctors give up on having a career. Dr Amna Ali, who graduated from medical school in 2010, was married in 2012 and then had a child. But instead of leaving medicine afterwards, she carried on.
“It all depends on your family and your motivation to work. My family was supportive and my father was there to keep my child. I was able to go and able to do my education as well. I have wanted to keep my education because I studied hard for 20 years,” said Ali.
Connecting through technology
DocHERs runs three clinics across Pakistan in both rural and urban areas. With internet and power connectivity sparse and unreliable in many of Pakistan’s rural areas, running teleclinics in those areas comes with unique challenges.
“The first problem we face is electricity. There is heavy electricity shortfall in the second tier of the country, the second tier meaning there is load shedding of 16-20 hours. So we have to put a UPS, an additional device to maintain electricity,” explained Khurram, saying that this increases the costs of operation.
She explained that internet connectivity was a problem initially, as well. But, Khurram said they resolved this situation. “We have multiple connectivity providers which help us, which amend the signals.”
Five months ago, DoctHERs launched a teleclinic in Mansehra town in the northern Khyber Pakhtunkhwa province. Patients, mostly female, from the surrounding rural areas visit the clinic. With prices ranging from $1 to $12, the clinic provides an affordable alternative to other local medical services.
One of the clinic’s initial challenges was persuading the patients to trust the digital technology used for consultations. In Mansehra, where many of the poor live without internet connections, patients are not familiar with this technology. Many distrust it at first.
The patients didn’t believe that the doctor appearing on a screen was a real doctor. “Convincing them was very difficult but afterwards those who eventually came and discussed their problems, many of their reservations have been addressed. Now gradually people are understanding this system,” said Abida Haroon, the clinic nurse.
Pakistan’s public health system is underfunded and overwhelmed.
In 2013, Pakistan spent just 1 percent of its total GDP on public health according to World Bank data.
There have been repeated calls since the early 1990s to spend more tax revenue on healthcare and find alternative ways to fund it, but without success.
The lack of comprehensive public health care has given rise to a mostly unregulated private sector, with varying service quality and prices.
Poor patients often fall into debt paying for private health services.
Patients say the DoctHERs clinic provides a better service than the local government hospitals in Mansehra.
One woman who visited the DoctHers clinic thought it was a better alternative to the government-provided care. “I have found their [DocHERs] system to be better. They have checked me. [At the government hospital] the male doctor was assigned to see me,” said the 30-year-old Parveer Bibi.
“In fact they don’t even check the patients … in the big government hospitals. There is no care. People will arrive and then leave. They don’t take care of visiting patients despite charging a fee,” she said.