Mr. Harmon Returns from One Place to Another

Demedicalizing Medicine

February 13, 2010

Originally published at AshokaTech.

Photo: BBC World Service Bangladesh Boat, CC license

I had an interesting discussion earlier this afternoon with an Indonesian medical doctor named Bachti Alisjahbana. In a great visual illustration of the concept of social enterprise, he handed me two business cards — one for Pakar Biomedika (.com) and one for Frontiers for Health (.org) — and said, "I'm working on getting all of this onto one card."

In short, Dr. Alisjahbana is working on making medical supplies more available to rural villages in Indonesia, with a hesitant eye toward expansion. Having heard a fair amount of talk about medical supplies in the past few days, I was curious to get the perspective of a physician working in social enterprise. Yesterday, I heard David Green and Anita Moura both use the word "demedicalize" in describing their distribution models. By going through nontraditional vendors of medical supplies, they're able to keep the prices down — not to mention bringing their tools to people who don't have access to traditional medical care.

"Demedicalizing is very important," Bachti said. He explained to me that in Indonesia, doctors typically stay in a community for only a year before leaving for a more prestigious post (the equivalent of residencies in the US), whereas nurses and widwives stay for their entire careers. "The nurses know the patients much better," he said. "They're better at counseling patients than doctors are." Legally, they can't counsel patients, but he laughed, "When you get into the rural villages, the law doesn't matter as much."

One of the big points in yesterday's discussion on economies of scale was the question of whether scaling means growing a centralized system of distribution or replicating the smaller distribution in new regions using local materials and talent. "I'm more interested in the latter," Bachti said. "Getting things through customs in Indonesia is very difficult. That's why Indonesia has the most expensive medicine in the world. And besides, we've developed a system that works for Indonesia. When we move somewhere else, we want to make a system that works there."

I appreciate that perspective a lot. I think there's a danger in taking a system that developed organically in one community and imposing it onto another. Or as Tim Prestero said in a panel earlier this week, "Saying you’re going to build a global product is like saying you're going to build a car that swims and flies. You're forcing people to pay for features that they're not going to use."