Tazin Shadid, CEO, AmarLab, Spreeha Bangladesh ; Dr. Ishtiaque Zahid, Co-Founder, AmarLab, Spreeha Bangladesh

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With the goal to transform health care, to bring technology and innovation into the services, and also to bring health care to everyone everywhere in Bangladesh, AmarLab is forging new fronts for the diagnostic lab sector. Tazin Shadid, Founder, Spreeha and Co-Founder CEO, AmarLab, and Dr. Ishtiaque Zahid, Co-Founder, AmarLab, sat down with Ice Business Time to share their visionary aspirations for the diagnostic lab sector.

Is it fair to say that AmarLab is reshaping the way the diagnostic sector operates? What inspired you to establish AmarLab?
T: In a way yes, because we are the first one to work the way we work. There are quite a few things that are new in terms of AmarLab. Currently, if any one wants to get a test done, then the only option available to them is to go to the diagnostic center, the second option is to call and insist for someone to come by, but that usually comes to fruition if there is someone nearby, then they have to bear the charge. Even if someone comes over, patients still have to make one trip to the diagnostic center to collect the report.
Whereas, through AmarLab, we are involved from the first step of collecting samples to the last step of delivering the report. With us, patients can do a price comparison, and this increases awareness of the price ranges available in the sector. I myself have experienced the advantages of AmarLab. Our services are created from our experiences. The ideas come from the problems we have encountered and solved, and this helps us notice that the problem is more prevalent not just limited to our experiences. It’s been an interesting journey. When we started discussing launching AmarLab, my grandfather was really sick, and he stayed in a building with no elevator. This fueled the inception of AmarLab even more. And I had just returned to Bangladesh where the concept of home-delivery model was taking hold, so we started thinking why don’t we apply this model to healthcare. Our initial thought revolved around our lab in Spreeha, and how can we utilize this to provide a service to people anywhere they want. AmarLab addresses a timely need. It is convenient, cost effective and saves time. We are also in turn helping other diagnostic labs by making their services more accessible. If you look at basic diagnostic only a small percentage is imaging tests, and the majority of it almost is blood sampling test – it makes up the bulk amount.

How do you ensure accuracy and reliability in the diagnostic results? Is there a set standard that the sector adheres to when processing diagnostic results?
Z: AmarLab has partnered with ISO certified organizations and with diagnostic centers that are registered with the government. The health care service in diagnostic has advanced tremendously and the technology is automated. Ten years back we were semi-auto, so when we shifted to full automation the result accuracy is very high while the margin of error is very low. Diagnostic centers are ensuring accurate results. AmarLab and Diagnostic centers ensure result accuracy. From our side we ensure that our containers are pressure and temperature sensitive, and we have custom-made them through thorough R&D. Our inspiration was the home-delivery model, but there are other factors that needed to be incorporated when applying this model to health care service. We had to take into account proper disposal methods since we are conducting tests in someone’s bedroom, and we spent a good amount of time devising the right way to dispose after completing a test. We have trained our medical technicians in this regard. We ensure quality and safety from our end when collecting the samples, and once we hand it over to the labs they take on the responsibility to ensure safety and quality in the reports from their end.

In rural and even in suburban areas, there is a mushrooming of unlicensed diagnostic centers. What sort of policy will ensure the cessation of these diagnostic centers?
Z: Bangladesh government has already taken the steps. Nowadays, Diagnostic centers looking for licensing have to approach the Department of Environment, then City Corporation, and currently the licensing process has been made tough. It is an online process and has to be renewed every six months. When you submit your papers for clearance to the Department of Environment, and once you are granted clearance only then can you apply for license. What happened before was that you could apply, but now there isn’t an option till you get clearance.
T: We never stopped to consider the environment aspect of it. I was unaware the process was so strict, and how to properly dispose the waste – that you need different types of bins for different types of wastes, then you need a partnership with a third party who are going to come and collect the waste and take it away. This is why these laws are in place. Those who have been around before the regulations came into effect, will not be able to renew their licenses because of not meeting compliance protocol. The government has taken measures to go and monitor diagnostic centers to see if they meet the standards. Spreeha Lab gets visits from City Corporation, and this ensures that we are indeed in compliance with regulation standards. Things overall are improving in the sector, and it is fair to say we are on the right track.

There is a lack of skilled medical professionals and lab technicians in this sector, does this pose a problem in ensuring quality service? What steps need to be taken to ensure the development of skilled medical professionals and lab technicians?
Z: I wouldn’t agree there is a lack of medical professionals. In Bangladesh, the professional to population ratio is much higher than in adjacent countries. However, the number of nurses need to be improved, but the doctor to patient ratio is steadily increasing. More health institutes are being established, along with increases in medical technology centers. The government is working hand in hand with the public and private sector to improve the diagnostic sector.
But if you are talking about people who draw and collect samples – they are called phlebotomists. There is confusion between medical technologist and phlebotomists in our country. Blood draw is actually the initial part, the main part is the ability to conduct the test, to operate the machinery, and how to mix the reagent. We need more phlebotomists, and right now this is an uprising sector in Bangladesh. A few local medical institutes have already taken steps for creating a pool of phlebotomists.
T: After we hire phlebotomists and medical technicians, we have to give them another level of training which is a three-month long training. Since AmarLab is still a new concept, there are things that need to be taught. Example say we hire someone who collects blood from around 400 people, but when this seasoned medical person goes to a patient’s home, they are immediately in an unfamiliar territory. Usually in a home environment, the patient’s family members are peering over shoulders and watching the process intently, and this can make the medical technologist nervous. This service is different than other home services, since most services end at the door, but over here the service begins once you enter the patient’s room. Patience is a key component in the service we provide. We have to factor in soft-skills when providing door-to-door medical services.
What sort of training do AmarLab medical technologists have to go through before being field-ready?
Z: This is a two-part process. The first part is completely clinical and the second part is dealing with situations. The most common occurrence is a patient or patient’s relative fainting at the sight of blood or vasovagal syncope – which is just a reflex mechanism. We train our medical technicians about this too. They usually are skilled in how to draw blood; we just boost their confidence. There are three phases to the training process, at first we give them the technical know-how, how to draw blood and use sample vials. The second phase is how to cope with the situation and environment, and the third phase consists of the soft skills. We teach our technicians the manners, etiquette and behavior when dealing with a patient in their household. Every family has their own culture, so learning to be sensitive to the environment and responding in the correct way is crucial to the service we provide Like within an in-home scenario, people ask a lot of questions, and sometimes even request that our technicians measure their blood pressure, and we comply, because we focus on the quality of the service, the overall experience matters definitely. Our number one criteria is that we are service first.

The cost of diagnostic tests is rising steadily, which is a huge burden especially for the middle and low-income demography – what can governments do to keep rising costs in check?
T: Government and diagnostic centers are working on it to reach a standard pricing. I think there will always be slight differences based on location and the services being demanded and provided. But we should have a generic standard in the sector and it is happening. Bangladesh is a country, where the out-of-pocket cost is so high for everyone and very high compared to neighboring countries. Another thing related to this, and we hope to work on it in the future and tackle – is health insurance. This is a challenge which is pervasive across classes. People sell off their lands to bear medical costs in the country. Health insurance is a necessity.
There are two fronts to work on. First is that we need a policy on pricing which dictates the price range, and alongside we need insurance so that the load is removed from patients. In Bangladesh, a good thing is that we have public health service where the costs are considerably cheaper, but they can’t cater to an unofficial population of 2 crore people in Dhaka. In BSMMU and in Dhaka Medical, they serve people beyond the capacity limit, but at least they are getting treated. So the government is providing the service, but now the question is how do we make it accessible to everybody, and for that we need a health insurance plan, be it government provided, so health care will either be free or subsidized through that program. We need a program like that.

How did you approach diagnostic centers to establish partnerships? What was the response you received? How is AmarLab providing a win-win situation for both patients and diagnostic centers? Can you give us an example?
T: It was easier than we anticipated, because we are not competing with them. It’s a win-win situation with AmarLab, because people want the test, the diagnostic centers have the tests, we are the bridge connecting these two fronts providing both ease and efficiency to the service. In fact, one of our partners asked us if they could transfer some of their patients to our service, because while they can send their medical service provider to a patient’s home, it also means they have to forgo the cue of patients standing at their counter. We are saying to them is don’t worry about it, we’ll collect the samples and bring them to you.
Since it’s a new concept, the challenge was making them understand the nature of the service. It was hard for most to understand our role as the third party, and it’s pretty common in any innovative service for this to happen. Our vision is that eventually everyone will be our partner. It is still growing. We conceptualized this much earlier, but we started full-fledged operations in February 2018. It’s been a year, and this is our year to scale up. The first year for us was polishing and testing the concept, because we have learned a lot in the one year in terms of understanding the challenges, starting from the right etiquette to operational challenges. We’ve learned a lot in one year, and we are now in a position where we are ready to scale up.

How do you see the diagnostic sector evolving in the coming years?
T: For me what I see in the diagnostic sector is that the health care sector here is very reactive, we are not proactive. We don’t go to the doctor until we are not at the end of our wits. We don’t practice regular checkups. When I was in the States, I was used to annual health-checkups, and after coming here I went to one of the most prominent diagnostic centres, and requested their executive health checkup, they asked me who referred me which no one had – the lady at the reception couldn’t process it. It is a foreign idea to them and this needs to change. Diagnostic centers need to be proactive also, and need to encourage behavioral change in patients.
Plus, we also have a lot more information available now, so people know more about the screening process. My guess is that in the next 5 years there will be a huge change in this sector where people will be more proactive, and this will open up the space for AmarLab. We are pushing in the corporate sector because people are so busy and despite having health insurance don’t get regular checkups. So we want to encourage that people go to the doctor on their own volition. With our food habits and environment issues, a lot of new health-related issues are arising and this needs to be monitored with regular checkups. AmarLab and Diagnostic centers will play a huge role in the behavioral change.
Z: Bangladesh’s diagnostic center is still dependent on adjacent countries for certain sensitive tests. However, things are changing here with Diagnostic Centers bringing in new technology and innovation. I strongly believe, within a few years’ adjacent countries will be sending over tests here to Bangladesh, because our health care is already evolving.
T: This is just the beginning. We have been working together for almost 13 years now, and we are both very passionate about health care. We think it is a very timely problem that we are solving. We are focused on understanding people and their problems, especially the compassion and empathy part of it also since we are providing health care directly through our clinic, and we see us changing health care in many different ways. Our goal is to make healthcare easily accessible to everyone everywhere. We think that the education and health care sector needs to catch up with the fast-paced progress of the country. We need more people to come in, more investments, and more innovators. We actually would love to have a few more competitors, because a lot of times when the concept is new people are hesitant to try it out, but if there are more competitors then people would be more encouraged to give it a go. Our goal is more than business, and we focus on the social aspect of it, changing the behavior, bringing healthcare to everybody. The more people join the better.

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