William Mapham How the Vula app is revolutionising the South African healthcare system

[Music] good morning good morning morning or as we say in fossa well we're in the other follow bond versus one of South Africa's eleven national languages it's a language spoken by Nelson Mandela and most commonly spoken in the Eastern Cape where I'm from and where this picture that you see behind me is from when I was at medical school one of the professor's said to me nothing good comes out of the Eastern Cape I'm not sure if he was referring to me or if he didn't know Nelson Mandela but anyway it sort of put the impetus into my mind that I should actually go and do something about that so this road is near gumbo which is actually where Nelson Mandela's birthplace and home is and I drove down this road to my first job as a real doctor at mud way Leone Hospital it's a very rural Hospital it took an hour and a half round trip to fill up with petrol so it's like kind of driving to a - to fill up with petrol so we really were kind of out there this was my road to to work so I loved driving to work and there wasn't that much traffic apart from cows and sheep and it was interesting because our first hour sort of theme our motto at the time was a quote by Helen Keller where life is either a daring adventure or nothing at all in 2004 I saw a patient with an eye condition one of his eyes was badly affected I didn't really know what it was it looked very serious so I wrote this letter and I said please please please go to him Tartu hospital it's the nearest specialist hospital it's only two or three hours away I think you can get there in time and that's the last I saw of him seven years later I went back to volunteer as a specialist the same patient came back with his letter saying now I can see a specialist I had never been to him Tata actually in his life the tragic part of the story was that he'd gone blind in that eye and I realized then we actually had the medication he needed the first time I had seen him so this is a very personal moment when I realized that a small piece of specialist information really could have changed his life once I started specializing I realized the problem wasn't just in the rural areas the problem is with the scarcity of specialists you may not know but South Africa's essentially got two health systems if you're sitting in these expensive seats it probably means you've got medical aid and you probably part of the private healthcare system the private healthcare system looks after about eight million people and there's one doctor per one thousand five hundred people so it's a shame to see one doctor for all of you in this theatre there's also one specialist per one thousand five hundred people so essentially you've all got access to a specialist in the public sector however there's one doctor for every four and a half thousand people which is three of these theatres and there's one specialist for every 18,000 patients which is twelve art escapes so you can see that specialist skills are exceptionally scarce and we really have to maximize the availability of those you can see I'm seeing one patient I have to teach to students at the same time there's another patient waiting with a crying baby in her arms and the phone the landline phone in the yellow circle is ringing off the hook with people like I was in the rural areas trying to contact me and invariably the thing that gets missed is the is the phone call so we had to solve that problem and probably one of the few people that says guys I bought this built this great app please do not download it it's only for health workers you welcome to like the Facebook page you're welcome to look at the videos like the one from the BBC on our web page but please do not try and register it's going to really annoy us so essentially we started off with I care but very quickly a lot of specialists wanted to join and it's now available 15 specialties now I'm going to scare you a little bit I qualified from medical school with very little specialist training we had a very good general upbringing but I hadn't done neuro surgery you might be thrilled to know that I didn't know much about ophthalmology I didn't know much about dermatology and I hadn't treated any patients with cancer so there was providing a general service I couldn't really help patients who needed specialist attention so the way the app works is the rural doctor or the rural nurse would click on the specialty that they need every specialty has a unique form and this is where it's vital to have excellent design and I'll show you how that happened later so that the specialist receives exactly the right information they need to help the rural doctor make a decision or how to manage the patient the other nice thing is we built chat into the system it sounds so simple but combining all these things has made a real difference you can now send pictures and the asynchronous nature of chat conversations means that the rural doctor can send the information and get on with her job and the specialist can then reply between patients when she's got a time rather than being interrupted by the landline phone call so our vision is for every health worker to have access to specialist advice we would like specialist healthcare to be delivered at a primary level to take you back for whatever history lesson this is me volunteering in Swaziland it's the Voula metal eye clinic which means that open your eyes eye clinic it's the only eye clinic in the whole country and dr. Jonathan pons invited me there and he said well it should take you about three months to train you and basic eye care in how to do a type of surgery called cataract surgery I have to admit I was a bit of a slow learner it took me 10 months volunteering without a salary essentially meant that I lived on cultures and vegetables that we picked from the garden but in a way it was lucky that actually I spent more time there because we ended up doing outreach to all the clinics often four hours drive there in back and the rural health workers actually had really good mobile phones so then I thought well why don't we create an app everyone else is making apps why don't we kind of thing and said well if we connect the rural health workers with the specialists in the eye clinic maybe we can stop doing all this driving so obviously I'd read a bit about design I practiced for a while I really made a big effort to learn how to design properly and I thought sure I've done by my medical knowledge with all my design knowledge and I managed to make the first version of Villa perhaps some of you could have done a lot better you'll see it's very very specific for eye care it suited my needs even very specific buttons for specific eye conditions a cataract is basically when the lens of the eye goes white the patient then goes blind then I hit gold because I got a small bit of money from the Shuttleworth Foundation they gave me fifty thousand Rand and I thought wow now I can make their app into a real thing so fifty thousand Rand I think it's about it was about four thousand dollars at the time so I found all these developers and I was so excited I said I'd like an Android app an apple app and a server in the background and they said what 50,000 Rand and they just laughed and they said like things I can tell you what I build you a button would you like red or blue so as a bit stuck and then I managed to get a hold of Deborah Barrett Deborah Barrett is one of South Africa's top user experience designers and she happened to be on holiday at the time at a place called a galas which you can see behind me you may not know but a galas is actually the southernmost tip of Africa it's where the Indian Ocean meets the Atlantic Ocean and in a way it symbolized the meeting of design and medicine and she proved instrumental and still actually works with us to make villas a success what one of the first things she did was said look youth you thinking of this only as an eye doctor you need to think outside that middle box think of yourself community health worker she called these personas think of yourself as a nurse think of yourself as a specialist and it's very appropriate that I'm here in kind of a theatrical stage because I really had to kind of step out of my shoes into other people's shoes that work out how they would use the app what what would they be looking for and what would they actually in hope to achieve we then got even luckier because her company donated two hundred thousand rounds worth of design time whenever other designers spotted a competition it's nice to see that Leroy also enters competitions and we won we won a million rand and then we could build more than a button [Applause] so I also had to learn more about design and Debray kind of school B as we went you'll see the logo the yellow one for the first version of ruler version one you'll see it's still only focused on eye care then the eye thing in the middle of a chat bubble we're very lucky to get the logo all design for us but then more and more specialties started coming to us and we realized we only really had a skateboard what if we had something better and then one of the designers said what you've got is one special team and it's always like one bead and a necklace and if you join up a whole bunch of beads like different specialties suddenly but a very elegant network and that proved great because suddenly we went from ophthalmology to 15 specialties we've now got a push scooter we're looking forward to building the bicycle the motorbike and perhaps one day a Mercedes Ruehl is used all over South Africa now every color is a different type of health worker so you can see how instrumental the different personas actually helped us as she make the system the response time you might say well why would a specialist respond but we published their response times to each other doctors get competitive and the average response time is less than 15 minutes so as a rural doctor while I'm with the patient I'm getting the help that I need and what's interesting is it's always the least tick literate person that ends up is the fastest because they paranoid about being seen as the the slowest and what's even better is that one in three patients are now managed in the rural areas without having to travel and they the junior doctor then learns case by case and that's remarkable that other two out of three tend to get appointments or referred for urgent conditions if you compare what I had in 2004 with sister Elise Mantua nursin who's in Freeland I'll are you probably don't know freedom doll it's four hours up the west coast of South Africa but it's got a global record it recorded the highest temperature ever on planet Earth 48 point four degrees Celsius and closer hottest issue sure and if it's very very hot it's a liquor pen cleanse eeeh Manzini which means that is so hot the fish are coming out with the water Elizabeth then learned case by case over two years but then she stopped referring and I thought oh maybe she's moved on but I'd like to give her a phone call to see how things are going so I gave her a call and I said Elizabeth it's been wonderful working with you and teaching you remotely I had actually met her at that stage and she said oh no hadn't moved on I know what to do now and essentially she had been ket trained case by case remotely she then raised money from Japan and a Japanese diplomat came out to open her eye clinic that's the difference that Buddha's made from where I was in 2004 to Ailey's Mears now she's the real star she should really be here says my job really is to do social good my job is to make sure the medical side works the medical side is accurate more specialists come on board I'm not very good at design obviously and I'm also not very good at monetization so brought in another colleague will Greene who actually focuses on building partnerships between Villa and companies that want to access our network of almost 4,000 doctors now and we've also realized that actually Villa is seeing 3,000 patients a month it's about one every eight minutes so while we speak patients are being seen and helped and Google yesterday released a statement saying that they can diagnose medical conditions from 1200 pictures we put over eighty thousand imagine if we built tools that can help our rural health workers even better one of the buzz words at the moment is disruption however I prefer sin Francis's quote where if you find a difficult problem don't try and break it just bend it with gentleness and time I think it's exceptionally dangerous to just disrupt health care if you're an ICU you do not want to be disrupted in fact going viral is not such a good thing in medicine either so essentially we really need to be careful with the way we do things and I was really inspired by the architecture of the art gallery we said they took the grain silos and they didn't construct anything they deconstructed they took things away and made it into a beautiful functional space that it is today and it made me realize that perhaps that's what we've done with Villa we've taken away the fax machine we've taken away the telephone landline we've taken away the frustration and we reduced the time it takes to access a specialist so it's nice to carry the other speakers and to reflect on the different ideas that come up in terms of the bigger picture Bruhl is growing very very fast 10% of our you is actually joined since the beginning of this year and this court should be almost going to double the figure of the last quarter from last year so that's the bigger picture you'll see that it only really started growing at about 2016 and that was because it was me on my own up until then I guess in medical terms you'd call it a flatline but I was doing my best as bad designer would do then Debray sold her company to Deloitte digital and came on board full-time with Lula and their sudden growth almost sort of exponential as thanks to design I think that I would love some of you to get inspired imagine if designers can do this across across different healthcare systems you are the ones that can help health care workers make a difference in their own world but make the systems so much better so let's take you back from the big picture down to one patient if you threw a dart at a map of South Africa you would hit the middle of the middle of nowhere and they would find a town called two are now two eyes got no specialists there and a colleague of mine volunteered to go there for a weekend to offer eye surgery to the patient's venom gob is one of the top surgeons now in Cape Town and at the time we were living in Port Elizabeth so it wasn't too far I think it was about an eight-hour drive to get there and so he set up camp we had all the equipment we needed we operated on 40 patients and the surgery we were doing was called cataract surgery which I mentioned earlier it's where the lens of the eye as white as you may remember and if you remove it and put an artificial lens in the patient should be able to see the next day so unlike Simon where blindness is permanent there are some forms of blindness which are curable what we didn't expect was on the sunday villain video the room of the patients because we had to prove to our wives that would actually been doing something useful we hadn't just been on a on a road trip and by sheer fluke we caught the reaction of one of the ladies [Applause] okay okay so no penny yourself lay me [Applause] [Music] you [Music] [Applause] [Music]