From Stanford to Indian Hospitals

How did an American end up launching an NGO in India?

E. E. : I met the people I founded Noora Health with five years ago, when we were students at Stanford University. Each of us came from different disci­plines. I was studying global health and foreign policies, Shahed Alam and Jessie Liu were to become doctors, and Katy Ashe was completing a master’s degree in Engineering. We were however fol­lowing a common course that we were passionate about: “design for extreme affordability”. We then met Professor Devi Shetty, the founder of Narayana Health1, a chain of low-cost hospitals in India. He invited us to his country and suggested we use design thinking (see box) to solve some of the problems he was facing. He was our first contact with India and its healthcare system. After that, everything happened quite fast.


What problems did you identify at that point?

E. E. : First, we visited many public and private hospitals, starting with Dr Shetty’s. We then realized that in all of them – this applies to the United States as well – the patient and his or her family don’t really know what they are supposed to be doing once they get back home. In India, families travel far to get to a hospital and they live there for five to ten days while their relative is being treated. They wait for hours, praying and eating in hallways. So we asked ourselves how to mobilize these relatives that want to be helpful, but do not know how. This idea gave birth to Noora Health. After getting started in the Y Combinator2, we moved to Bangalore, India.


How did design thinking help you?

E. E. : Once the problem was identified, we swiftly went on to experimenting. We started working with a nurse who has since become head of training programs at Noora Health. Together, we developed educational materials that healthcare workers could use to teach family members some health gestures. These tools were designed with and for relatives. We also liste­ned to doctors, of course, to be certain to include the right content. Today, we have set up many training courses for different types of diseases. Our core work remains the same: we go to hos­pitals, train nurses, with the help of videos for instance, then they in turn train patients and their families for the purpose of caring for the patients at home.


Can you give us a few examples of what you teach families?

E. E. : Noora Health covers cardiology, oncology, neonatal care, maternal health and diabetes. For instance, after a heart surgery, we train families to recognize the warning signs of a heart attack. This leads to a 70 % reduction in post-surgical complications. We also train them to check vitals such as tem­perature or blood pressure. We focus as well on administering medication. They are simple things, but knowing them improves the care that patients receive at home and their healing process.


What is Noora Health’s impact today?

E. E. : We are working with twenty-five hospitals and should soon intervene in twelve more, thanks to a partnership with the States of Karnataka and Pun­jab. In total, we have trained 90,000 relatives of patients. It is a lot, but it remains a drop in the ocean of India’s 1.3 billion inhabitants. We want to develop our model and our programs so that other organizations and govern­ments can adopt them. We also hope to be part of several pilot programs out­side of India.


In India, languages vary from one state to the other. How do you successfully communicate with all families?

E. E. : We work on all educational mate­rial with our teams of experienced designers. Whether we develop videos or printed documents, we favor a visual communication that doesn’t require literacy. With regard to more complex information, videos can easily be dubbed.


How do families react to your work?

E. E. : Last weekend, for instance, we faced a tough story. A woman had given birth to a sick baby and did not know how to react. Because he wasn’t treated fast enough, the child became blind. It was only afterwards that he was diagnosed with jaundice. “If only I had been informed, I would have known how to react,” the father regretted. Every day, we see how much impact our programs have. When given the right information in the right way and at the right moment, the family beco­mes an extension of the health system. Inversely, failing to instil them with a few basic health reflexes can cause a lot of damage.


How do you finance your programs?

E. E. : At the moment, we mostly rely on philanthropy, but we hope to develop our own economic model. We already have a team of paid instructors for some private hospitals that we partner with. Our objective is now to collect data to quantify the impact of our inter­ventions. We have to show that Noora Health diminishes the risks of complica­tions and readmission. When we prove that we reduce the cost of the health system, we will be able to work more closely with the government. We are involved in a highly technical environ­ment that we are trying to make more simple. The challenge is to avoid getting sucked in by bureaucracy, and to remain flexible in order to accompany the deve­lopment of healthcare in India.


By Côme Bastin

1. Read Krishna Udayakumar, p. 82-83.

2. This Californian start-up incubator is considered one of the most demanding and prestigious in the world.