Running a homemade relief effort in response to India’s COVID-19 crisis from afar
Doctors for India (DFI) is a volunteer-based initiative that connects doctors around the globe with patients in India who aren’t able to get medical advice due to the strain on the healthcare system. We are three designers living in Munich, Germany, with strong ties to India (2 of us are Indian, and 1 of us is married to an Indian) who started the initiative in the wake of the deadly second wave of COVID-19 in India.
DFI was always designed as a pop-up, an initiative with the goal of reaching zero patient requests. Over the past month, we have processed about 75 patient requests and successfully facilitated medical consultations for about 55 patients & their families.
As we were running it, we realized that our homemade model of connecting families in India with doctors around the globe could be helpful in any country as a response to a public health crisis. So here, we lay out some of the questions we had to answer, processes that we put in place, and challenges we still haven’t overcome in our month-long journey.
How it began
In late April and early May, as India faced the deadly second wave of COVID-19, access to oxygen and medicines became a logistical nightmare, and doctors were overwhelmed and unreachable. We heard many such stories from family and friends who were desperate for help. So, while feeling helpless and frustrated at not being able to do anything from afar, we asked ourselves, could we connect patients in India to doctors in Germany to get essential medical advice?
“Doctors in India are overwhelmed, but doctors in Germany might have capacity to help?”
Our thinking was that specifically for COVID-19 — since it is a globally spread disease — many doctors would be familiar with it and could provide advice on understanding test results, managing symptoms, and treatment paths.
Our initial approach was simple: we would facilitate consultations via email. We set up two Google forms — one for doctors to sign up, and one for patients to request consultations. Once a patient sent us a request, we would share their information with a doctor via email and ask them to contact the patient when they had some availability in their day (ideally within 8 hours of receiving the request from us). This approach, we hoped, would provide an alternate option for families to turn to and alleviate some of the burden on the healthcare system.
Getting it off the ground
Since the situation was highly time-sensitive, we chose to dive in headfirst without a masterplan, knowing that we would learn and course-correct along the way.
Can we legally do this?
The first doubts we encountered as we set out to launch the initiative were the legal and ethical aspects of running such a service. First, we would be sharing people’s data with doctors and amongst the team, using 3rd party services such as email and WhatsApp. Secondly, we needed to clarify the medical side of things: could we have doctors who practice in different countries provide remote medical consultations to patients in India? These questions in themselves felt so daunting that we were close to not launching the service on day zero itself.
Luckily, we consulted with a few lawyers in our network. As a result, we learned that since we intended DFI to be strictly volunteer-based with no monetary exchange, we could launch the initiative by making two key decisions in addition to adding a standard non-liability clause:
- Explicitly ask people for their consent to process and share their data when they send us a patient request
- Our doctors would not be able to provide prescriptions to patients. This factor was a considerable limitation of our service but necessary to stay in the legal realm.
Testing the waters
Once we felt comfortable and confident with the legal and ethical framework, it was vital for us to first launch at a small scale. First, we needed to make sure that we were providing enough value to patients and their families despite the limitations of our model. Secondly, we needed to see if the backend system that we had hacked together (a combination of cloud-based services and manual labour) would hold to serve the demand. Third, we needed to understand if the operations were feasible for the three of us to handle on the side — outside our day-to-day lives.
We decided to run the service till we processed ten patient requests. We would then regroup, take stock of how things have gone, and iterate on our strategy, tooling, processes, and communication. We processed nine patient requests at the end of day 1 — which was a strong signal that our service was valuable and gave us enough insight to make it better over the next few weeks.
Finding and working with doctors
We started with a simple call for doctors willing to volunteer among our personal networks. Doctors could sign up using a simple Google Form. We posted this call on social media, and the first few doctors who signed up were personal contacts and recommendations from friends and co-workers. Most doctors were willing to spend up to 30 minutes a day (we had set a minimum limit to 15min/day — it wouldn’t make sense to have shorter consultations than that).
By the end of week 1, we saw an overwhelming amount of medical practitioners—including people outside our immediate networks—signing up to volunteer with us. The initiative gave doctors worldwide—many of them from the Indian diaspora—a platform to use their expertise to provide direct help to families in need. This was heartening but also prompted us to make modifications to our intake process. Some of these were:
Onboarding & verification: We didn’t have a standard way of onboarding doctors who signed up with us initially. We quickly realized that we would need to provide a clear overview of how the initiative works and what is expected of them. It was also crucial for us to verify their medical credentials at this stage to ensure a high quality of care to our patients. We wanted to do this respectfully, so we opted to personalize the onboarding. When a doctor signed up with us, we did not send them an automated message. Instead, one of our team members personally reached out to them with a message containing essential details about the service and asking them for their credentials. It felt more friendly and less awkward to do this in a two-way conversation instead of through a form. The doctors would also know that “we were for real” before having to share their information with us.
Flexibility for doctors: One of the key tenets of our service and the mechanism that made it attractive for doctors to volunteer with us is that we didn’t ask them to provide specific time slots when they could volunteer. Instead, our default was to ask them to reach out to the patients whenever they had some time during their day as long as it was within a reasonable time window of receiving the request. This decision was based on the insight that patients would be much more flexible with their time than the doctors unless it was an absolute emergency (in which case, we were most likely not going to be very helpful anyway).
In total, we had about 39 doctors sign up to volunteer, but we could only realistically work with about 18 of them. It was incredible to see so many doctors and medical practitioners from around the globe stepping up to help.
Reaching patients and gaining their trust
Once we had a few doctors willing to volunteer with us, we needed to let people know that we’re open to taking patient requests. We did this through social media, using Instagram and LinkedIn as our primary channels of outreach. We also shared a message on WhatsApp with family and friends that eventually found its way into different groups and spread quickly. We saw that most of the incoming requests were from younger family members or caretakers on behalf of their parents and relatives.
Although we were seeing a constant influx of requests and positive feedback on people’s experience in the first few days after launching, we were also getting the sense that our service was not very:
Trustworthy: People weren’t sure who our doctors are and if they can provide relevant advice as they primarily practice outside of India
Accessible: The Google Form to send a request for consultation was cumbersome and hindered some people from reaching out to us
To address the first issue, we launched a dedicated Doctors for India Instagram profile where we created a series of posts highlighting our doctors. We also posted feedback we received from patients, started a FAQ section both on our webpage and Instagram (through videos), and published weekly statistics, both as a way to provide transparency into our operations and to celebrate the work we were doing.
To make our service more broadly accessible, we set up a WhatsApp Business account and used that to take in patient requests. People could drop us a message there, and we would coordinate their full consultation on WhatsApp itself. It made our service quite personal — we were a well-wisher with a strong network who could find you help. The downside was that WhatsApp Business doesn’t allow for multiple users — resulting in a bottleneck when the team member with the device wasn’t available. This was definitely not a recipe to serve patients at scale, but we didn’t have the scale yet, and we decided we’ll cross that bridge when we get there.
The nuts and bolts of our operation
We’re all fans of building just enough tech and putting in place just enough process to provide the service. Our focus was on facilitating the consultations between doctors and patients — not building a tech solution that could automate the operations (although that would have been nice).
We strung together Notion, Gmail, Google Forms, Sheets, WhatsApp, Instagram, Zapier, Trello, and Slack to run Doctors For India. We didn’t build any tools, and spent a total of 10€ on our tech (a SIM card to create the WhatsApp Business account).
Patient requests which came in through our Google form were automatically sent to a Google Sheet, and a Zapier automation took that new request and created a new card with all the information in our Trello board. When a request came through WhatsApp or Instagram, we manually added the request to our Trello board.
Our Trello board started simple but got quite complex towards the end. We had lists tracking both patient requests (new, assigned to doctor, consultation completed, no response) and doctor status (new, onboarded, idle, active). When a new request came in, we assigned it to one of us. The appointed person was then responsible for all communication with the patient and doctor and tracking the request’s status until the consultation was completed. This overview and process helped us stay in sync and be as efficient as possible.
Once we launched our WhatsApp number, it became more sensible to assign requests amongst the team based on the channel they came through to accommodate that only one of us had access to the Whatsapp Business account at any one time. This is one of the main tech-related things that we would upgrade (using WhatsApp Business API) if we were to scale. It would be relatively straightforward to have multiple volunteers process incoming requests and facilitate consultations.
One of the main operational challenges we faced was that we couldn’t figure out a smart way to know if and when the consultations were done or not. We needed this information to understand if a particular doctor was available again, or in case a consultation hadn’t happened, to know if we needed to find another doctor. This meant that we manually checked in with both doctors and patients via email and WhatsApp after roughly 8 hours of assigning the request. It increased overhead, and we probably came across as annoying, but our doctors were fantastic and showed no signs of being bothered by us.
Lastly, one of our early assumptions was that doctors wouldn’t be comfortable sharing their contact details with patients. We thought this would be a deal-breaker. We were already looking into multiple avenues to facilitate consultations without exchanging personal details but realized that it wasn’t as big of a problem as we had assumed. Although a few doctors ended up not volunteering with us for this reason, most doctors were willing to communicate using their email or WhatsApp. Some of them (based in India) were also fine with patients directly reaching out to them. If we were to scale, we would need to find a solution to protect both patients’ and doctors’ privacy. However, it’s hard to deny that WhatsApp’s ease of use and the gravity of the situation trumped privacy concerns by far at this critical point in time.
Either we scale, or we stop
As our initiative gained traction, we had venture capitalists reach out to us, offers from acquaintances who could get us funding, and individuals wanting to contribute in whatever way they could. At the same time, we saw our patient request numbers decrease by 50% in the second week. This was a good sign — India’s COVID-19 cases were declining, and the healthcare system started to breathe again. However, India is still posting about 150,000 cases today (June 4th) so many patients still need medical care. We knew if we wanted to increase our reach and serve more patients, we could acquire the resources, but we’d have to be committed to carrying the initiative full-time. Our personal reality simply does not allow for that.
Nonetheless, one avenue we pursued to increase our reach was to look beyond the urban centers. We explored the option of partnering with NGOs who were doing tremendous work on the ground. However, we ran into a few challenges here that would need more thought, time, and resources to overcome. These are assumptions that we haven’t tested, so we might be far off with our assessment:
- The context and living conditions of families living in urban slums and non-urban areas are quite different from the audience we catered to so far. Our doctors might not be familiar with that environment (e.g., many people sharing a single room, making it difficult to self-isolate). Hence, their advice might not be beneficial here.
- Our model worked well because we offered a lot of flexibility to the doctors. They could get in touch with patients when they had a few minutes. However, to serve a larger group of people, we would need to ask the doctors for regular recurring time slots, which might lower their interest and participation in the initiative.
- We would require language translation to facilitate consultations as most doctors volunteering with us were comfortable speaking in English. In contrast, most non-urban populations would prefer to consult a doctor in their local language.
Signing off
As patient requests started to decline and eventually hit zero, we started to run out of gas and decided to ramp down our efforts by the end of May.
If we’re completely honest, we ran Doctors For India to help patients and their families as much as to help ourselves deal with our helplessness of being mere bystanders. So, we’re sharing our story and the things we learned, hoping that it inspires you to turn your anxiety into action. It’s not the only way to deal with difficult situations, of course, but it’s the way that worked for us.
In retrospect, the idea itself wasn’t new. There are many telemedicine services out there that are way more sophisticated. We used our strengths, leverage our unique position of having a network outside India, and responded to the need in a timely fashion. What worked for us was that we were small, approachable, and created a brand that made people want to join us on the journey. We don’t want to be unique—the opposite, in fact.
We hope to see many offshoots of Doctors For India as and when required. We are always happy to help if you want to do something similar and leverage our experience.
Doctors For India is Sanya Rai, Barbara Franz, and Akshan Ish. We’re reachable via email at teamdoctorsforindia@gmail.com or through our Instagram page.
