A Conversation with Dr Sara Saeed Khurram – CEO & Co-Founder of Sehat Kahani

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19 May 2021

The Faculty of Remote, Rural and Humanitarian Healthcare (FRRHH) are proud to be a global home for remote, rural, and humanitarian healthcare professionals. It is always a pleasure to connect with organisations who are dedicated to setting the standard and ensuring high quality healthcare for patients as well as providing support for healthcare professionals living and working within remote and rural communities.

FRRHH spoke with Dr Sara Saeed Khurram, CEO and Co-Founder of Sehat Kahani to find out what the main inspiration was behind setting up the organisation and how they have enabled many female practitioners in Pakistan the opportunity to balance both a career and family life whilst creating potentially life-saving solutions for patients living in rural areas through the use of telemedicine.

The main inspiration…

Dr Khurram relates that “In Pakistan, I’m solving the problem of healthcare access in the country through technology. Pakistan has a huge population of more than 200 million and at least 50% of these people never get to see a doctor in their lifetime. They might be going to a clerk or a midwife or a dispenser but they’re not going to a qualified doctor.

It is considered to be extremely noble in our culture to become a doctor, so if you are female and you are a doctor, you’re a figure of nobility, your social status inflates but unfortunately only one-fourth of our doctors go from graduation to formal practice. This means a high number of female doctors get their medical degree and then become homemakers or mothers or they’re not allowed to work due to the cultural barriers in hospitals. I think a lot of people in our country end up not having proper healthcare because the majority of our workforce is female and the majority are not working, therefore a lot of patients miss out on the opportunity to see qualified doctors.

On top of that, we have a large number of doctors who go out of the country for better work opportunities so in the end we have only 90,000 doctors for 200 million people. This equates to just one doctor for 1700 people, a big supply demand gap. 85% of these doctors live and work in urban areas and only 15% go into rural areas. Imagine if you’re living in a rural area of the country (and 60% of our population does live in the rural areas), you’re only likely to get access to a midwife, nurse, dispenser or a clerk and that’s where malpractice can happen. By the time the patient reaches a tertiary care hospital and can be seen by a doctor, most of the time they are at an advanced stage of the disease, the doctors can manage it, but they cannot prevent it from getting any worse.

I think the issue of Pakistani doctor brides and the inability of patients reaching doctors is so interconnected, I can also relate to the issue of being a doctor bride and being unable to work. After my marriage I moved to a new city with a new-born baby and I couldn’t work. I started doing consultations for a clinic I used to work in prior to my move as in that clinic, they couldn’t find a doctor to replace me. I began doing on call consultations and then video consultations and that propagated this concept to challenge why female doctors end their career at a very early stage because of the inability to work physically.  Can’t we instead use this untapped, underutilised force of female doctors and connect them to patients who need healthcare using a telemedicine-based platform and audio video-based platforms so that we can fill the gap of these doctors in low income communities using technology.”

The advantages of technology in healthcare…

Dr Khurram further explains the benefits of technology stating “We connect a large pool of female doctors from their places of comfort to patients who need healthcare using a telemedicine solution. We work across markets, so in low income communities where people don’t have access to quality healthcare or doctors and they don’t have smart phones or the internet, we upgrade traditional clinics into telemedicine centres. The patients will go to a nurse who will connect them with an online doctor available within their system or connect them to a laptop. We also have a product for the masses, we have a mobile application that people can download themselves or through their employers and they can get access to a qualified doctor 24/7.

Ultimately what we’re trying to do is connect patients to qualified doctors through technology, through our mobile app, so they can get quality healthcare, which is affordable, cost effective and easily accessible.”

Providing alternative opportunities for female practitioners…

Dr Khurram shares that “A lot of female doctors come in, a lot of them go out and a lot of them disappear. I don’t think we’re seeing the numbers get better, they will only get better if we develop policies that will allow more flexibility in the system, so we really need to understand why they leave the system. 

I think one reason is there’s a cultural reference for female doctors who become doctor brides and don’t work, so one action that needs to happen is an increase of awareness. There needs to be public level policy awareness schemes that normalises the working of a female doctor and emphasises the importance of them working because a lot of people in Pakistan still don’t connect the dots as to why there is a health care problem.

The second thing is, I think there needs to be more flexibility. A large reason why a high number of female doctors finish their career early is because they can’t commit to the long hours of training whilst raising children and focusing on their marriages. There needs to be more flexibility for the female doctors to be able to work and manage the demands of their families as well.

Third is, a lot of female doctors don’t go into low income communities to work because of the concern for lack of security and poor quality of life it offers for themselves and their families. These are some integral operational changes that need to be made to ensure that female doctors feel safe and secure in such an environment that gives both them and their families a lifestyle they would have anywhere else.   

What Sehat Kahani offers these female doctors is an alternative solution and we’re showing them this is also a way that they can still practice. I think the world has really changed since COVID-19. I think now when we talk about online consultations and virtual consultations it is more accepted and more of a standard option in providing care.  

A lot of female doctors now feel they can become part of the system and think that it’s acceptable to provide online consultations because whenever they provide a consultation, they are paid for it and able to give back to their families. So, it’s not just a social purpose that they’re getting back to work but they’re making something for themselves and at the same time not losing years of their practice.”    

We thank Dr Khurram for taking the time to speak with us and sharing the hope which female practitioners and patients now have through the advancements in healthcare within the rural communities of Pakistan.

If you found this article interesting and would like to learn more about Sehat Kahani and how their E-Health Clinics are enabling more patients living within rural and low income communities to receive quality healthcare click here

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