Olwel Co-founder and Chairman M M Aftab Hossain shares his journey to entrepreneurship and how he and his friends started a new type of healthcare company in Bangladesh, explains what went into building Olwel’s initial operation and challenges of building something from scratch, discusses Olwel’s services, how it operates as a company and offers insight into challenges for Olwel, state of its business today and its ambition going forward and reflect on lessons he has learned and why we have to sacrifice our comfortable present-self in order to become the person we want to be and much more. We hope you enjoy the interview as much as we did.
Future Startup
Thank you for agreeing to do this interview. Please tell us about yourself and your journey to what you are doing.
M M Aftab Hossain
I consider myself very lucky to spend my early boyhood at the delta of two mighty rivers, Padma and Jamuna near Aricha ghat, Manikganj. Later, I studied in Shibalaya Govt. high school before attending Notre Dame College in 1992. I graduated from BUET in EEE in 2001.
I began my career next year at Aktel, which is called Robi now. I worked there for five years. In 2007, I had to choose between continuing my MBA at IBA (University of Dhaka) and master’s in Radio Communications in Helsinki University of Technology (recently merged into the Alto University). I finished my MSc in 2009 with Distinction and obtained DSc in Communication Engineering from the same university in 2016. Afterward, I worked as a postdoctoral fellow at the KTH Royal Institute of Technology, in Stockholm, Sweden for a year.
I started working for our healthcare initiative during the first quarter of 2016 before submitting my DSc thesis.
Lack of a proper GP/referral system got singled out as the main issue with our healthcare system. Many of the problems in our system are because patients tend to start their treatment with a specialist and the number of specialists is limited. It has created an imbalance.
Future Startup
You studied electronics and telecommunication engineering. For you starting something in that domain would have made sense, instead, you have started a healthcare startup. Why? What was the motivation behind starting Olwel? How did you come up with the idea?
Aftab
There is a personal story to that. Living abroad has its challenges. When I’m in Finland, I get very anxious when my parents or a family member fall ill. The long-distance make it impossible for me to know the exact situation making me more anxious. My parents have aged. They routinely require medical attention.
Luckily, I have a close doctor friend in Dhaka. I would seek his help in situations when I had an ailing patient at home. However, often it would not solve the problem. It happened that in order to make an appointment with a particular doctor from Dhaka, I had to call at 8:00 in the morning, which is 4:00 AM Finnish time, keeping me up till late night. So I called in the appointment, informed my father and went to sleep. When I woke up and called to check in with my parents, they told they had canceled the trip to Dhaka. They live near Aricha ghat, Manikganj, around 85 Kilometers away from Dhaka. They are reluctant to go for the checkup, as in many cases, the journey to get treatment is more painful than the suffering due to the disease itself. They also complain about the number of diagnostic tests prescribed whenever they see a doctor. It also happened that after that long journey, wait in the doctor’s place and undergoing many tests the doctor only find out that s/he doesn't have anything serious.
During my 10 years stay in the Nordics, the thought on how to ensure proper treatment of my family members back home always played in the back of my mind. On the contrary, when we feel anything wrong with our health here in Finland, we just make a phone call and the system takes care of everything -- whether to see a nurse or General Practitioner (GP), going to a right specialist or get hospitalized when necessary.
When I started comparing, lack of a proper GP/referral system got singled out as the main issue with our healthcare system. Many of the problems in our system are because patients tend to start their treatment with a specialist and the number of specialists is limited. It has created an imbalance.
From numerous discussions with my friend Dr. Debashish Ghosh over the years, I already knew how that is also affecting the life of the young doctors in Bangladesh. On the top of that, in our current healthcare system, the patient/attendant--a layman--has to make every decision from selecting the right doctor to whether to take a test or avoid because the physician prescribed it because he is on the payroll of a given diagnostic center. It's a real struggle!
Yes, there are doctors in almost every urban and suburban towns in Bangladesh. But how can anyone be sure that they are providing the best kind of treatment? Can the patients fully trust them? That’s when we finally thought this is an important enough problem to solve.
What we are trying to do is to fill up this reliability gap. We think that the whole system has turned into a mess just because the middle-layer doesn't function properly. And we are using ICT-enabled supervision to build this middle layer that can be relied upon.
Future Startup
That’s an interesting perspective. And it is true that there is an overall lack of trust in health care services in Bangladesh and people tend to start with a specialist before going through a GP. Now you have identified the problem and wanted to solve it, what happened after that?
Aftab
I am very lucky to have some of the brightest minds of our time as my friends. I started to talk to a few of them whose participation was vital for this project. They also concurred that they often get confused about the right course of action when a family member falls ill. So the thought which sprang from a very personal issue turned out to be everyone's problem. I have this friend, Mojahedul, who built the software platform as the CTO of Therap services LLC that serves half a million people 24/7 in the USA. Abdullah Faiz, another of the cohort, who opted for an MBA from IBA in marketing after graduating from BUET, also agreed to join. I spoke to Aminur Rashid who has always been the brightest one in the bunch. Similarly, Shameem Kabir who was working in Siemens healthcare in Germany also joined in.
I found them equally eager to bring a change in this chaotic sector. They recognized the challenges ahead but jumped in mainly because this initiative will help people in need. During my tenure in KTH Royal Institute of Technology, Sweden, I came across two great minds, Vilho Jonsson and Johan Bäckman who collaborated with us from Tele2 in the EU project SOOGreen. When they started their own innovation agency curlabs AB, I pitched our idea to them. They got onboard instantly believing our idea has the potential to bring a change in the way life is lived by millions when they get ill. They took the responsibility to build the partnerships with the Nordic healthcare initiatives.
Later on, our doctor friend Salahuddin Feroz who did MBBS from DMC and MD in Nephrology from BSMMU (He also had exposure to UK GP system for a year) took the responsibility to build the doctors team, training them and monitoring process. Feroz studied in Notre Dame College with me, Aminur and Mojahedul and in Govt. Lab school with Faiz and Shameem Kabir. We also got onboard Dr. Saleh Mahmood, a son of a renowned professor, Dr. Rafique Uddin. He could not resist to join us after returning to Bangladesh after finishing his MS and MPhil from University of Nottingham and King’s College London as he himself had the ambition to make sure the wellbeing of mass people by engaging doctors as home teachers.
We have an incredible team.
What we are trying to do is to fill up this reliability gap. We think that the whole system has turned into a mess just because the middle-layer doesn't function properly. And we are using ICT-enabled supervision to build this middle layer that can be relied upon.
Future Startup
You built a wonderful team. What happened next? What went into building the initial operation?
Aftab
We then conducted quite extensive research on the healthcare industry to understand the situation and design our product. Our research revealed a lot of weak links in the system. It also gave us a clear understanding of what we should aim for and issues we should address in the process of delivering services.
On the technological aspect, we have a competent team and partner. Mojahedul took the responsibility to build the systems for us. His company Dynamic Solution innovators (DSi) has been our development partner since then. DSi is an equity owner of Olwel as well.
We wanted to launch full-fledged quickly. After June, we started to build the infrastructure that we needed to provide our service. It won't be an exaggeration if I say that we have built one of the best digital platforms in our space. We are not experimenting here. We have got an opportunity to serve the mass and we are serious about it.
In the meantime, Olwel got registered in Finland. Later on, Olwel got registered in Bangladesh as a joint venture.
We first published an ad in a very popular and active Facebook group for doctors where there are over 18,000 doctors. Our advertisement made quite a stir. Some people didn't wait to find flaws and others quipped us saying whether we are doing doctors home delivery like other goods. But a big group of doctors soon began to appreciate our initiative. They supported the idea that a doctor visiting a patient at her/his home and said doctors are supposed to treat patients and see good for patients. That there is no problem with visiting patients at their home. Not to mention, to the patients, it was like a universal demand. So, this gave a strong boost to our confidence.
We put together a group of expert doctors to select doctors from nearly 600 applications. We established a rigorous interview process to assess the applicants. Many of the applicants were surprised at this because doctors who work at clinics don't have to go through such processes. However, for us, along with being an excellent doctor, one also has to be excellent at social skills and be empathetic.
We were able to select 16 doctors in the first batch. We finally launched our service in November 2017.
Future Startup
As you mentioned earlier, there is a huge demand for doctors’ time in Bangladesh. The doctor-patient ratio is nowhere near. Why should doctors care? How do you plan to attract more doctors as you grow?
Aftab
Like patients, we believe the existing medical setting creates challenges for the doctors as well. When doctors are forced to endure hardship from the early days of their career, they lose the emotional touch with their patients. For many young but competent doctors, who finished medical school a few years back and pursuing PG courses, it is hard to get patients whereas well-known doctors could not manage time to see all the patients come to them a day. This makes the lives of young doctors very difficult.
So we are building a system that also helps doctors. We have built our system in such a way that doctors who are pursuing Postgraduate courses can treat patients in their spare time. That's why we introduced two 7-hour shifts, one from 8 am to 3 pm and the other from 3 to 10 pm.
Future Startup
Now you launched the service, how many calls did you receive on day one?
Aftab
We wanted to test the waters first and see how the market responds. We distributed some pamphlets detailing our service at mosques and inside daily newspapers in mostly Mohammadpur area. The first day went by without any call. We received our first call on the second day asking for a home visit.
A few weeks into the business, the number of calls started to grow. Initially, people mainly called for information. When people came to know about our service, it felt too good to be true. They wanted assurance that we were authentic. People will trust you if you provide good and quality service. Just like our first caller who was so thankful to us that he personally asked for our pamphlets which he wanted to hand out among his friends and family.
We got around 17 calls in total in the first month. Our promotional activities were mostly confined to off-line means until then. In the second month, we included Dhanmondi to our coverage areas and began advertising on Facebook. The response was quite good. The number of calls doubled in the following month.
Future Startup
That's an interesting story. How does your operation work?
Aftab
We have spent more than a year to build our system. We have three types of doctors here: senior doctors, doctors who visit our patients and doctors who answer queries and follow up the patients after a visit.
We are running a digital hospital where anyone can access our service through our mobile app or using our website or just a phone call. The call center doctor first triages the patients, i.e., advise the emergency patient to go to the nearest relevant hospital as we do not have a well-equipped ambulance to treat the emergency patient at home. Otherwise, our central system chooses and dispatches the nearest registered and trained a doctor to the patient’s place.
A doctor spends a minimum of 20 minutes with a patient, which is our minimum duration. We particularly emphasize two things: collecting the complete medical history of the patient, and clearly explaining the situation and provide proper counseling to the patient. We need a proper medical history so that we can reduce the number of tests. We advise our doctors to be as open to the patients as possible, i.e. explaining to them why you're prescribing this particular medicine, and how they will be benefited by the suggested tests. An honest relationship makes a remarkable contribution to the patient's recovery. Counseling is sometimes all an ailing person needs.
After a doctor finishes seeing a patient and giving a prescription, he uploads the necessary documents electronically to our central system., Then the call center doctor immediately checks the prescription to see if anything is wrong. Our call center also reaches out to the patient to get feedback and to check whether the visiting doctor has given enough time and provided proper counseling. Afterward, these prescriptions are again reviewed by our senior doctors. We have built these three layers to ensure checks and balances. We are confident that our mechanism would allow a very limited margin of error.
We maintain the medical history of all our patients. As for the medical data, we have not yet made it accessible to the patients. But we will be able to do so over the time. At present, when a doctor accepts a request for a visit of an old patient, he also receives a copy of the patient’s previous history.
What we really want is to give people the benefits of having a family physician. It has been highly appreciated by our customers. There was this one patient, a 60 years old lady, who had a leg injury. Her children were out of the country and she was living with her 82 years old mother.
Her initial treatment was fine but she was neglecting follow-ups due to the cumbersome journey to hospital. She started suffering from other symptoms (e.g., sleep deprivation) due to the frustration of being bedridden. Giving her counseling and few more calls from both ends prevented her from further deterioration. She did not receive only physical treatment, knowing someone is there on the other side of the phone gave her mental peace too. There are many cases where Olwel kind of service can make a big difference.
A few weeks into the business, the number of calls started to grow. Initially, people mainly called for information. When people came to know about our service, it felt too good to be true. They wanted assurance that we were authentic. People will trust you if you provide good and quality service. Just like our first caller who was so thankful to us that he personally asked for our pamphlets which he wanted to hand out among his friends and family. Till today more than 34% of our home visits are repeated, i.e. from the home already visited earlier.
Future Startup
How many doctors do you have on your platform now?
Aftab
Currently, we have 28 home visit doctors working with us. We have another group of doctors, comprises of 10 female doctors, who run our call center. They do not go to patients’ home.
I would also like to add here that there are plenty of doctors who are very keen to see a change in the current chaotic sector. They are very much willing to provide as much time required for the patients, if the system allows them. In fact, the determination and fortitude our doctors showed to serve people during those initial tumultuous days was highly inspiring for us. It often happens so that patients ask for the same doctor, especially after taking our service first time fearing that other doctors would not be this good!
Future Startup
How do you work with doctors? How do they get paid? Do they work full-time with you or get paid based on the number of patients they see per day?
Aftab
Doctors are paid based on the number of shifts they have worked in. For every home visit, we charge BDT 800 including transport costs. They get paid for the shifts they work regardless of how many patients they attend during a shift. We are also piloting different modes.
Let me quickly note one thing here, all of our doctors are MBBS and have at least three years of experience. On an average, our doctors have experience of seven years. Majority of our doctors finished their degree from government hospitals (a healthy percentage is from DMC) and the rest are from reputed private hospitals who performed better than many of the doctors from government medical colleges.
Future Startup
How has been the response so far? What have you done to grow the business?
Aftab
Fortunately, we have already been able to build trust among our clients. Word-of-mouth has worked well for us. And many of our patients are now demanding for more advanced services (e.g. specialized doctors). Some want doctors regularly visit them at home. These are really good signs.
We have started by providing our service around the Mohammadpur area. Gradually we have grown to other neighborhoods in the capital. At present, our service can be availed from Kalabagan to Pallabi. Other than that, we can also accept doctor requests from areas near which any of our doctors live. Very recently, we have started our operation in Gulshan, Banani, Baridhara, Niketon and surrounding areas.
Future Startup
Your doctors’ visit patients at home but what happens when they need a test? Do you also offer on-demand test facility?
Aftab
We have been facing such an issue with the medical test which is often necessary to make a better diagnosis. For that, we have gone into partnership with Thyrocare Bangladesh, an Indian diagnostic centers chain having an operation in Bangladesh. They have made the test procedure easy. They collect the test samples (e.g. blood, urine) from a patient’s home, take them to their test center, and brought the result to the patient's home. Everything's done by their people. They send the softcopy of the report to our system and our senior doctors go through them before changing/adding medicine based on the test results.
Our intentions have matched quite perfectly with Thyrocare. They are even giving a 25% discount to Olwel's patients on medical tests. We also have partnered with Ural EMS and EPharma so that our patient can get connected to the nearest ambulance and get medicine delivered to home. We are becoming a one-stop solution for needed healthcare services of a family.
To sum up our current operation, our doctors now visit patients at home. They recommend tests, if necessary, which the patients can get done from our partners at a discount. If the patient needs medicine or ambulance, Olwel also provides them through its partners.
Future Startup
How do you reach out to your customers? What are you doing in terms of marketing?
Aftab
Since this is a new service, we are primarily concentrating on creating awareness among people as to why they need a doctor to pay a home visit. We are not pushing for sales yet.
As for channels, social media is our major focus. In offline, we have designed posters and bumper stickers for cars.
The name Olwel is mainly derived from our ultimate vision to help people ‘live well’, i.e, lead a healthy, stress-free life. We have had plans of doing things to that end from the very beginning.
In addition, to provide curative care when someone is ill, we are more interested to keep a family healthy by regular checkup and comprehensive management. The target group for this are the elderly and chronic patients, pregnant mother and young children. And from that, All is Well attitude, comes Olwel.
Future Startup
Have you raised any fund? Do you plan to raise money in the near future?
Aftab
So far we are self-funded. DSI, who is also our development partner, has also invested seed money in addition to bearing the cost for the technical platform. We are talking to a few local and foreign investors. We are also arranging a crowdfunding round for our mother company in Finland.
Future Startup
Do you have a board? How does it look?
Aftab
Yeah, we are actually operating as a joint venture with our Finish entity. Our Finnish part is helping us to bring the latest technology, training and best practices to Bangladesh, raising investment and making a partnership with Nordic digital healthcare initiative. We are already in advance stage to introduce Doctrin (a Sweden based initiative), an AI-enabled backed chat based healthcare solution and Medicheck who are giving us access to the experts from Sweden over a video call.
Future Startup
How does your revenue model work?
Aftab
We charge our patients BDT 800 for a home visit and BDT 1000 if the patient is under our long-term care packages as our expert doctors need extra time to ensure the situation is not deteriorating for chronic patients. We try to keep a margin in the process. Our doctors work both on-demand-basis and on a shift basis
Frankly, this is a small amount compared to the value of our service. Such an attractive rate is mainly promotional in order to establish a new thing and build the habits of our users.
Future Startup
What are the challenges for Olwel now?
Aftab
We have three main challenges to overcome. We need to expand our doctors pool maintaining the current quality. Similarly, we need to convey the robustness and quality ensured service to the mass people. As we are more concerned to build a quality healthcare initiative, our growth sometimes does not seem very attractive to the usual VCs - which brings the challenge to find out the right kind of investors for us.
Future Startup
What are your plans going forward?
Aftab
We plan to cover both Dhaka and Chittagong soonest possible. Subsequently, we want to spread to other divisional cities in 2019.
Although we are still largely urban-centric, our ambition is to take our services to the villages and remote areas of the country where health care services are most needed. It's especially important to serve the rural populace because the availability of qualified doctors and proper treatment are much bigger issues there. A different sort of solution is needed for that and we are working toward that.
Clearly, providing consultation is the main vertical we are working on now. But why are people getting sick? We want to focus on that too. Preventative health care would be a vertical we will be working heavily in the future. For example, to prevent the spread of non-communicable diseases such as diabetes, cancer, hypertension, we are thinking of launching awareness campaigns, health screening and comprehensive management programs. We have an expert professional heading these projects. You will see something in these areas from us fairly soon.
People usually have two lives: the one which he lives and another that he aspires to live. The day one give up working for the life he aspires for, he fails. In order to live the life of your aspiration, you have to commit to that life and sacrifice your current life. I would say commit and never give up.
Future Startup
Building a company is a very stressful job, how do you deal with stress and challenges that come with being a founder?
Aftab
Stress and challenges are a part of life. Some of them are natural, and some are unexpected. It is wise to deal with them as they come along, prioritize and resolve them accordingly. I try to control my mind and take the decisions that would be beneficial in the long-term. The right decision--that's what matters now.
We can divide our life into multiple chapters. Every chapter offers unique opportunities and new challenges. The five years I worked at Aktel was one chapter in my life. Then, I went abroad for higher studies--that's another chapter. Now I have started Olwel and it's a completely different phase in my life.
I am lucky to have a great team to manage our operation. They are good friends and very committed individuals. They relieve me of half of my stress.
Future Startup
What advice would you give to people who are trying to build companies?
Aftab
I'm afraid it's too early for me to advise anyone. But I've learned that if you are trying to do something you need to go as deep as you can. You can't hope to achieve anything by staying on the surface. The depth of knowledge also prepares you for future challenges.
People usually have two lives: the one which he lives and another that he aspires to live. The day one give up working for the life he aspires for, he fails. In order to live the life of your aspiration, you have to commit to that life and sacrifice your current life. I would say commit and never give up.
Update 01 on January 2, 2019 at 5:24 PM: This interview has been updated with new information for clarity
