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Disrupting the Pakistani Healthcare System by building a Search Engine for Doctors

Doctory is building a search engine that uses machine learning and a review-based feedback mechanism to provide patients with reliable health care information in Pakistan.

FIELFALT spoke to Maliha and her COO Talha Naveed Ashraf about how they started working on doctory, what the first challenges were and how they have overcome them and how doctory is disrupting the Pakistani Healthcare System.

If you had to describe yourself in 3 words what would they be?
Maliha: Creative, strong-headed and eager.
Talha: Empathetic, compassionate and belief in equality.

How did you come up with the idea of doctory?
Maliha: I have been very passionate about the project for the past four years. Working on it off and on, facing challenges, overcoming these challenges and moving forward. But the initial idea actually goes back to the time when I was in high school around 2008. My parents got divorced during that time period and it was very tough for me and my siblings.  To fully understand the situation, you have to know that in Pakistan divorce was an absolute taboo. You would not even talk about it and for my family it was reality. At the same time, I started experiencing fainting spells and my mother was completely clueless when it came to taking me to the doctor.  Not only with taking me to the doctor but she was overwhelmed with the whole situation. I have to mention that during the divorce it was decided that us children stayed with our mother.  My health on top of it added a lot to the entire situation. That was a time period when I saw my family being completely helpless, me being helpless to support my mom in that entire situation, my uncles were very upset, and basic questions like “What type of doctor should I be taking my daughter to?“ or “Would the doctor actually listen to us before giving a diagnosis?“ or “What times would the doctor be available?“ – there were no answers to any of these questions even though I live in the capital city of Pakistan and I have many doctors in my family. This experience stayed on with me during my entire youth and when I decided I wanted to work for the community and for the society, this experience from my childhood came up. I am working on developing the tool which democratizes the health system and helps people and especially women in navigating the complexity of the healthcare system. Because women are the primary domestic decision makers in households in Pakistan

Maliha Khalid (Photo: Amin Akhtar/ Vodafone Institute)

Was there a special moment when you knew this was something that I can create a business of?
Maliha: When I was in college I was interning for different corporate FMCG and telecom companies in Islamabad. It was during the time that I was working for a telecom company when we were sitting in the office one evening and I was just reflecting back the tasks that we accomplished as a team during the entire day. What I realized was that in these fancy fully air-conditioned offices the most important question of the day it felt was “What fancy place do we want to go and eat lunch?” or “Where do we want to go for coffee in the morning?”  And there is no actual substantial work that’s being done. It was in that moment I realized that this was not the future I wanted for myself. I want to do something for the society that has given me so much and has turned me into the person that I am. So I left and took a trip up North to the mountains on a camping trip with my siblings for 5 days. When I came back I started working on doctory and have never looked back since.
Talha: I would like to add on to something that Maliha just said. As she told you her experience goes back to 2008 and it is 2018 now, ten years later, and very little has changed in the healthcare infrastructure in Pakistan. Most of the problems she was going through then are still very real today and many people have to deal with them. There has been almost no progress and I believe that is something that really motivated Maliha to start her project.
Maliha: To be honest, it is actually easier to find the best pizza places on your phone then to find the best doctor in your area. Sad but true.

When you started working on doctory what were the first steps? How did you start?
Maliha: Most of the healthcare facilities in Pakistan are located in the big metro cities, such as Lahore, Karachi and Islamabad. People from the periphery and rural areas come to these cities just to access basic healthcare facilities. We knew this was one of the major pain points we wanted to tackle. And there is one difference we saw compared to the healthcare systems in other countries: First you go to a General Physician (GP), who gives a diagnosis and if necessary refers you to a specialist. In Pakistan the system works differently: we don’t go to a GP, but go directly to the specialist doctor. These were our two targets: We knew which cities we wanted to target and we knew that we wanted to tackle the specialists as we knew people would directly go there instead of a GP. In the first step, I went to the licensing for all the specialist doctors in Pakistan, which is called PMDC – Pakistan Medical and Dental Council – and I told them what I wanted to do. They felt it was a brilliant idea and asked me straightforward what I needed from them, how they could help. I told them that I needed data of all the specialist doctors working in the 10 most populated cities in Pakistan. They told me they sell this information and asked me to come back the next day and they would prepare the data for me. I came back the next day, I paid the fee and the person working at the office of the council handed me CD saying: “Mam, we don’t know who is dead or who is alive on this CD, if they are still in the country and if they are, which part of the country.”  They gave me the names of 40.000 doctors not knowing who was dead or alive and the disc did not have any phone numbers or email addresses on it as they only recently started filing this information. That was when the real challenge started. I went back to my office, put in the CD and the data was all over the place.

That sounds like a great challenge – how did you overcome and manage it?
Maliha: It was just summer break and we knew students would be looking for summer internships – we got a group of University grads who joined us. We created two groups and we started going through every doctor and every hospital in Islamabad and then to Peshawar and on to Lahore. What you need to understand at this point is that we needed a proof of concept whether this was going to work in Pakistan. At the time we started the concept of Google had not been heard of. Our idea of using Google or creating a website to use for searching for medical support had not been heard of. We needed to know whether the doctors would actually be interested in something like this and if the patients would be willing to use this. We decided to approach this “Chicken and Egg“ problem from the doctor’s perspective and  started talking to the doctors. While we were doing that we got around 5,000 doctors registered on our platform. And at the same time users from all of Pakistan, and also Kashmir, started using the website. They started approaching us to help them to get access to the doctors who were listed.  We only later realized that for a doctor by picking up the phone and speaking to a patient for 5 minutes he would earn less money than consulting him personally for 30 minutes. Of course, they would rather not take the phone calls. That is how we started and we gained very positive feedback from both sides.

Was there a highlight moment?
Maliha: When we started getting doctors on board there were a lot of challenges when going to hospitals and talking to them. And somewhere in between we changed our strategy and started going to different medical conferences that were happening at the time. And this was actually another challenge because getting a booth at these conferences is very expensive – it can easily cost you $6,000. And as you can imagine we did not have that kind of money. So instead we would talk to the organizing hospital and we would offer them our services in return for a booth at the conference. We did that with a couple of different hospitals and went to a couple of conferences for different specializations of the doctors and it was amazing. We did not have any money but we would get a booth in the best location and talk to all these doctors and introduce our solution.

Talha Naveed (Photo: Amin Amhtar/ Vodafone Institute)

How did you and your co-founder meet each other?
Maliha: My co-founder, Ayyaz Kiani, comes from a public healthcare background and he initially had the idea for doctory but I came on board very soon and took over. His reasons for starting are also very interesting. He had this epiphany moment in the U.S. when he visited a doctor’s clinic with a friend.  He told me that the staff was very friendly and asked them to wait while the doctor was still with a previous patient. And once he was done with the patient he welcomed Ayyaz and his friend and talked to them, gave them a diagnosis and a prescription, answered all the questions and once they were done, he actually walked them to the car and waved them goodbye. Ayyaz’ first questions after they drove off was „Are you a VIP in the United States?“ And his friend laughed and told him, he was not. Ayyaz asked him what was wrong with the doctor for being so friendly? Because in Pakistan, if a doctor smiles at you and talks to you for more than 5 minutes he is considered a very good doctor. And in the U.S. you get all this service?  What is the reason? And his friend’s answer was eye opening: He got the appointment via an online platform and he was going to write a review. Of course, any doctor would want to receive a positive review and that was why he was so friendly and attentive. In Pakistan, people go through all sorts of trouble for complaints about doctor’s negligence and in the U.S. there was a simple online platform where patients could write a review. It seemed so easy, regulating the industry from the consumer’s side. This was his reason to start. Mine was completely different but then we decided to join forces.
Talha: In Pakistan, still to this day, it is very hard to find a female fronted or a female owned business. Especially in the startup sector. That is very, very rare. It takes a very particular kind of persistence and business acumen to be a female founder and a female CEO. There is a lot of hesitance for female participation to be honest and there is a lot of barriers that you have to break. I feel that is a very important thing to know about Maliha. The other thing I would like to point out is that even though she got involved in doctory at a later stage, she has been the face of the company ever since. She is the one making the business decisions, she is the one running operations, she is the one that manages it. She is holistically the face of the company. And that is also very rare. I think that is very important to emphasize and I give her a lot of credit for putting herself out there and not choosing a traditional career path. Also, she taught herself a lot of skills along the way because she didn’t come from a tech background. And she also has not been drawing a lot of money from her work – she does what she does because she believes in it. That, in my opinion, gives her a lot of credit as well.

What did your family and friends say when you decided to leave your telco job and start your own company?
Maliha: The reason why I am here today, actually goes to my mother. She is a very strong woman. Especially after my parent’s divorce, she has been at the forefront of our family who has shielded us and protected us, she has brought us up and given us the education so we could do what we are doing today. She is my superhero in a lot of ways. My mother has always been supportive of what I do and now I have also reached a point where my whole family is supporting me as well. It was tough but my family is indeed very supportive. My friends initially thought I was a bit crazy but after about a year into the project they realized I was serious about it. And now they are all very supportive as well. Actually, whenever we need something as a team we just need to reach out and somebody is always there to help and support us.

If you could give a tip to other women from a female founder perspective, what would you say?
Maliha: There are always moments where you feel that what you are trying to achieve in your life is not possible. And that is not true. We have to constantly believe in ourselves, even if nobody else around us does, because that is the only thing that keeps us going. In the end, if it’s not us doing our work, who else is going to do it? Who else is going to create that impact that we are working on so hard. And I think the way women create impact, nobody else can do it. We are amazing when it comes to multi-tasking – I actually know that often men are amazed about how we are able to handle so many tasks at the same time. We are amazing at it and we are amazing at creating impact. We just need to believe in ourselves and I think that is key.

What’s next for doctory?
Maliha: We are going to continue growing doctory as a product, as an impact, and we are working on growing and being able to raise funds for our project.

Talha Naveed & Maliha Khalid (Photo: Amin Akhtar( Vodafone Institute)