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Postcard #5 - Week 5

We just wrapped up week 5 of our discovery phase and our first round of fieldwork. This time we spent a week immersing ourselves and getting inspired in Bangalore, India. We spent time researching the health care structure, mentality, patient experience and provider practices. We interviewed 2 patients who had recently taken antibiotics, 2 pharmacists, a community health worker, 3 doctors and a registered medical practitioner. We also did intercepts in pharmacies and mystery shopping where we went around asking for antibiotics,

Here are some highlights from this week.

What happened this week... 

Discovery interviews and observations with healthcare providers

Here's a summary of the best interviews and observations, with links to the short blogposts for each.

Dr Rangita - a family physician running her own private clinic in Bellendru, Bangalore. She also owns a pharmacy next door to the clinic. See more here

Shaurya - a registered medical practitioner with with no medical degree, that sees 150 patients per day and is prescribing medication. With his 38 years of experience and great interpersonal skills he has developed a great relationship with most of his patients. During our observation, Shaurya saw patients for 3 minutes on average. Due to the fact that most of his patients cant afford to lose time and money on multiple consultations, he'll give a provisional diagnosis and prescribes medication (including antibiotics) for quick relief. See more here

Dr Gautam - 65 year old veteran GP who runs his own private clinic and testing facility in the heart of Bangalore. Dr Gautam believes in the importance of utilising his lab to prescribe the right medication to his patients. See more here

Dr Samar - 29 years old GP, who has a diploma in family medicine. Dr Samar openly talked about the problem of incentives and corruption in healthcare in India. He shared stories of doctors he knows who have been approached to prescribe specific medication (including antibiotics) in return for gifts. See more here

Jaga & Reshma - patients who live in an upper middle class neighbourhood of Cooke town in Bangalore with their 2 boys and 2 dogs. They talked to us about their approach to staying healthy as well as their interactions with healthcare in India. See more here

Dr Gaurav - a senior doctor at a large public hospital in Banaglore with 26 years of experience an a very traditional mindset towards patient care - a ‘doctor knows best’ attitude. See more here

Intercepts and mystery shopping in pharmacies

We visited a total of 6 pharmacies. Pharmacies in India, are not allowed to prescribe medication. Both pharmacies we interviewed requested to stay anonymous and did not allow us to take any pictures. In those interviews the pharmacy owners told us they are doing everything by the book and they never give medication without prescription. This is something that we found wasn't the case through our mystery shopping. All pharmacies we visited would give us antibiotics without any prescription and in some cases would not be strict on giving guidelines on dosage and compliance. Here's a write up on our pharmacy intercepts and mystery shopping.

Top Quotes

“Lots of patients ask for antibiotics even for viral infections, they will have this belief, as some other provider gave it to them previously or they have a lack of awareness about the disease itself.” - Dr Gautam, GP
“Doctors are incentivised to prescribe specific medicine [even antibiotics]. Pharmaceutical companies incentivise doctors with trips or tip offs. I know someone who got offered to get his house built.” - Dr Samar, GP
“Antibiotics are the best way to deal with an illness quickly and effectively. We have a hectic family life, we can’t afford a time out. We need to kill the illness now” - Reshma, patient
“When I’m sick I self medicate, go to the store and pick up my meds. I know my body, if it feels exactly the same, I’ll take the same medication.” - Jaga, patient
“2-3 out of 5 have already taken antibiotics when they come to see me, and a mixture of them. Quacks will often give a 'masala of antibiotics' to patients in hope that one of them will cure them." - Dr Samar, GP
"Yes, you can have this (taking out the packet), it's good for a cold, a cough." - "Don't we need a prescription?" -"No, no, it's just low level, not a prescribed drug". - pharmacist in a low level chain pharmacy with 20,000 outlets in 8 states, when we asked for some antibiotics to treat a cough
“Patients are impatient, they come back in a day and say you may as well give me antibiotics” - Dr Roshan, GP
"What patients want is quick relief. They need to go to work the next day We give a provisional diagnosis, mainly because of the financial condition of the patients and the pressure on time. We give them antibiotics for 3-4 days and if there in not much relief we ask them to come back on the fourth day and we carry out further investigations. It may not be correct in general, other doctors would examine and test first and then prescribe, but we do it the other way around. For our setup and our patients it is correct." - Shaurya, registered medical practitioner

Coming up in week 6

Week 6 will be about synthesis. Synthesis is about looking back, Identifying themes and finding meaning though everything we’ve seen, gathered and observed, in order to uncover opportunities for design.

--- Did you miss our previous postcards? Have a look:

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