Dr William Mapham

Bruce: Today's guest is Dr. William Mapham. He is the founder and Chief Executive of Vula Mobile. Now, we all know that Health Care is problematic in South Africa, the delivery of healthcare to nearly 60 million people on, what is a substantial but badly spend budget is a real problem particularly when you go into South Africa's rural areas than of mechanics and of not hospitals. Often, these places are not properly managed and staffed and so, if you need specialist care in a rural area in South Africa and you don't have access to a private car to get to the nearest big city, how do you get access and we've been hearing stories for years about how technology can bridge that gap, but it's always seemed quite theoretical. Dr. William Mapham has found a solution to the problem.

William: “I would value Vula and I would work for it full-time, if it was saying more patients than I could possibly see in a day. So, in Swaziland are used to see 80 patients in a day each and there was a very slick system, all paperless and it was built that way, so it was possible. Vula is now seeing between 350 and 400 patients every day. So, I do think that I'm able to work for it full-time. I can justify that and basically the thrill I get of seeing that patients are getting specialist guided health care every day across the country in our six provinces, and I think that really means something to me.”

Bruce: I'm Bruce Whitfield and you're listening to RMB solutionist thinking

It's an app. Vula Mobile is an app like everything else in the world today that connects specialists with clinics and hospitals and facilities, health care facilities that don't have access to the sort of stuff that you might get at the Morningside Clinic or you might get at a hospital in Claremont in Cape Town, for arguments sake.

William: Yeah, that's spot on. It started off as a just for Ophthalmology. I'm an ophthalmologist and, so we decided to start with eyecare and we first designed this in Swaziland where there was one eye clinic for the whole country. It was the Vulamehlo, which means open your eyes, eye clinic so the name of the app is a harp back to where all first began. And, as the community health workers and other health workers in rural areas started to communicate with the specialists, other specialists asked if they could join the platform and we've just launched in our 20^th specialty now, so it's ranging from cardiology, dermatology, emergency medicine, even psychiatry and the latest one is TB.

So, it's really interesting to see how other people have seen the benefits and then we've helped them a larger system.

Bruce: What was your connection to Swaziland? Why was it that this idea was spot there?

William: So, goes back a long time. I think I failed ophthalmology as a medical student. I wasn't really clever at that stage. But when I was an intern, I wandered into the wrong theatre, I was there but later than usual last than in the evening and I saw cataract surgery for the first time. I can still remember that operation that really fascinated me and I always follow one day, I'll go into eyecare one day and then when I went to work in the rural Eastern Cape for the next few years, I always thought I'd go into eyecare somehow, and we organized a very rural conference then and the ophthalmologist from Swaziland came to that conference. So, I sit up please can I come and work with you? And he said sure, but we don't have a budget, so you have to work for free and volunteer and at that stage, I didn’t have that much cash. Now that one day I'll have cash to do that and I visited two or three times over the next three or four years and then I was sort of a defining moment when I was working in the field of HIV and AIDS and as she went climbing and her bad accident, we almost lost my life and I decided then literally as I got down I said to, my now wife, I'm giving up my job. I'm going to go and join John and Swaziland and the nice thing about his clinic there is little that's the only Clinic it's got a paperless based system, there's incredible technology there. It's really kind of a state-of-the-art service people get billed on a sort of grading scale according to how much money they have. So, the poor patients will get the service for free and the rich ones are known as Robin Hood patients and they get a special room and that sort of thing get treated slightly differently. But, at the end of the day that all get the same treatment so going there didn't just see how to learn how to be an ophthalmologist, I also learned to see how a system can actually a big difference.

Bruce: And, this is a private clinic in Swaziland?

William: No, that's your public sector clinic so that the chapter sizes at Dr. Jonathan puns was very clever sir. Third of its actually funded by the government third through drug sales and patients actually paying and a third through sponsorships that he's managed to raise and we one goes up. He managed to get money from the other ones. So, it's been very very clever in the way he's set it up. So, it's not completely reliant on one particular funder.

Bruce: It keeps everybody honest and keeps everybody working hard, I suspect. It was there that then you came across this idea that you could use digital technology in order to deliver healthcare in a non-traditional way. You as an ophthalmologist don't need necessarily need to be in a remote clinic to give advice to a local doctor. You can diagnose using a cell phone camera whether somebody has a cataract or simply an eye infection. I wouldn't know.

William: Yes. We can soon teach you. What's amazing is to see how people have actually used it. And one of my favourite examples is Sister Elise Mantoonisen. She works at a clinic and Vredendal, which is 5 hours up the West Coast and I think it's hit the highest temperature for South Africa ever. So, it's pretty hot place. There's a huge community that there's basically reliant on this clinic and she used Vula to chat to us and to send patients through over a couple of years to Tygerburg and then she stopped sending patients and we’ve kind of got to know her, so we thought that she had moved and so we wanted to see where she had gone. So, we phoned her and said yeah, congratulations on your new job. You know, where is it? And she said no, I just know what to do now and then she raised money from the Department of Health. She built an eye clinic in Vredendal. She takes referrals from her area from other health workers and now specialist go once a month to operate for her. So, I think the long-term effect that we've seen when Vula's used is incredible because it actually takes healthcare to where it's needed and kind of an evidence-based and reliable manner.

Bruce: The theory being, with great digital technology is and I don't know if it does happen yet. We see TV ads like this where the specialist is able to use technology here, so effectively be working operating equipment 5,000 kilometres away and actually doing the surgeries themselves is that science fiction or science fact?

William: No, it’s starting to happen, but it's not really happening in South Africa at the moment, especially in, we've got areas that don’t have the best connection. And so, we discovered was that rather than trying to have a direct connection all the time. We used a chat system that uses between twenty to a hundred times less data than WhatsApp, so it works in deep rural areas or even inside the bunker of a big tertiary hospital and that's the best way to communicate because if it's asynchronous and it's chat, the doctors can reply between their own patients rather than having to both be online at exactly the same time. It's actually quite hard to organise.

Bruce: Give me a practical example. Somebody is struggling to see, and they are in Kumga in the Eastern Cape, it's very remote small village, there's an Old Mission Station there, not much else but there's a clinic and somebody comes in and they've got a massively swollen eye and they and they decide that they need to get hold of Dr. William Mapham. How would they do it?

William: Yes, it's amazing. Actually, it's very close to a real example, where a young kid was actually hit on the head of the stick a lot of swelling and they'll he needed to be sutured up. So, the surgeon sutured has wound up and because he had the vision test on the ruler app. You thought I might as well test the vision as well. He tested the child's vision and the child can see in that I he couldn't see what the problem was, but when he sent the photographs through with the information on the app, we could see there's actually a laceration through his cornea, all five layers of the cornea and so he asked him to be transferred directly to us. We switch them up and the child went back being able to see. So, I think it's not just about I care. It's also the fact that other specialties now are all involved and everyone's able to do the right test for the right people.

Bruce: Who talks to whom? I mean, you've got somebody in a rural clinic and somebody comes in showing me complaining of chest pains and you've got cardiologists on the platform. And is it as simple as a one swipe and you can then pick between ophthalmologist cardiologist and knee specialist? Yeah, essentially so that's all used by health workers. It's not used by patients. So, your clinic nurse or clinic doctor would say, oh I need to get an opinion here and click on new referral and the little specialties is there, you choose the one that you need from the list of current 20, if it's chest pain, it could be TB, or it could be a cardiology problem. And so, then they click on that, it tells them immediately who's on call and that area for that specialty. So, no phoning around trying to get hold of a doctor or anything like that, they get put in contract directly with the right person at the right time and then we do publish the response times to the specialists and generally they seeing patients are between the normal patients when they make a reply and the average response time is about 15 minutes.

style="font-family: 'Arial',sans-serif; color: #3c304c; border: none windowtext 1.0pt; padding: 0in;">William: So, this is incredible if you take Cape Town for example right now, if you go to any private GP here and you say right, I've got a skin problem, I think it might be cancer. What should I do? It'll take about a month to get an appointment in private or if he's on Vula, so Vula on power GP in a way, he can click on dermatology. It's got Red Cross, Tygerberg and Groote Schuur on there, directly with the doctor on call, the dermatologist on call and they'll give you an answer within 15 minutes. So, I think the real future for South African health care, if you look at in terms of the national health insurance and initiatives like that, if we can make the public health system so good that people actually start using it or using it more, there’ll be more room for collaboration with the private sector.

Bruce: And become, theoretically anyway, self-funding because if you can scale the costs in the same way as if you are somebody with Medical Aid, here the Medical Aid rates and that rate is paid into the public rather than the private sector the public sector ends up getting financial support from the public from the private sector and that way become sustainable.

William: Yeah. It's very exciting to see what's going to happen. I think if you look at South Africa where she blessed with health resources, we worked and every single town is a private hospital next to a public hospital in many cases, which means that there's so many resources at most places that we just not making the most of it and I think that with systems like Vula we can help people really make the most of the local resources and make a difference.

Bruce: Is there a commercial advantage to medical professionals to the specialist being on the platform, if they are willing within 15 minutes between patients to give a diagnosis will give advice or going to create the referral system that is needed? Is there a commercial incentive for them to do this?

William: This is a common question. In the public sector we work in teams. So, the Tygerberg hospital were ten of us on call and we rotated the person on call is always someone available. So, it's our job to help patients in the public sector and when people either phone in or write to us or Vula, we are the ones that make the response and that's our job. We’re paid the salary to do that. So, we're not paid per referral. It's just our job.

The private sector is different because often the aren't teams the individuals, so you could have 20 specialist cardiologists at hospital, but they don't work as a team and there's not one person on call all the time, on Christmas day or near as people go on holiday. So it is a bit different in the private sector and we busy looking at ways of how could possibly work because what we've seen with Vula is in the public sector that saves 30% of referrals physical referrals coming through and it's a huge saving for patients and the system and will be exciting to see the same savings and in the private sector too.

Bruce: How hard was it to get public sector acceptance of an app like this because it does break the mould, it does challenge the status quo, it changes the way in which public healthcare works for the better, but often to get through bureaucracy can be challenging. No.

William: Yeah. It's a very good question. So when I first made it, you've got the money in 2013 and we launch the app and July 2014 and I just really believe that it was going to suddenly kind of take-off and everyone doesn't want to and that does not happen that one little bit it was only in about October that we managed to get people in one department and one Hospital starting to use it and it sort of trickled through and then the following year there were two departments and then three and in the 2015 we were asked by other departments if they could start using Vula. So, let's actually took almost 18 months two years before any already took me seriously.

Bruce: Is there a legal risk associated with it? I mean, I'm not sure that you can necessarily do this in the United States in a more litigious environment than perhaps, South Africa. Is there an issue with potential litigation?

William: Sure, so health care is very important to make sure everything is regulated. One of my uncle's happens to be a medical malpractice lawyer. So, we get a lot of advice free from him. I will have our own lawyers and it's very important to make sure everything is saved.

One of the most important things the records don't go missing and one of the best things about Vula is the records are there in stone time stamped for any kind of legal reason in the future. We've just been made our system GDP our compliance that's being able to be used in Europe. We've had a request from one of the countries there. We haven't decided on America. My passion is rural Healthcare and Healthcare in Africa and other countries that are similar to our environment. So, I don't think we're going to America very soon, but it's always a good idea to be ahead of legislative change and perhaps we'll make our system legal to be used there, at the very least.

Bruce: How do you evolve this application? Because the moment it sounds all fairly altruistic and it's in the public sector. Is it something that you earn money off?

William: Yeah, so the beginning of last year. We raised a little bit of money from small Equity raised but we had no business model and we had no idea of how we could even earn money. So, treaty was scraping the bottom of the barrel and we survived by winning prize money and various other initiatives.

Bruce: It's amazing how many small businesses bootstrap themselves through entering competitions? It's the SAB Kickstarter competitions and others many others. You won a couple of high-profile ones in order to get the funding you need to get the thing built.

William: Yes, and that's our version of early-stage equity sales. I guess compared to the States where it's sort of a big thunder coming in last year was pretty hectic. So, the middle of last year kind of really broke down and it's totally exhausted and we had no money. I was determined to make this work. So, I mean I could have just gotten worked as a private ophthalmologist, but something has kept me going. My wife was very supportive. She had a really nice car which we sold to pay rent.

Bruce: And it's a happy laugh and it's like well-done you guys but it's a real thing. People think people make up stories about how hard it was and here you are, you're a medical doctor. You're a specialist. Yes, you're in the public not private sector but specialist get paid well. You had to sell the luxury car to fund the business and you managed to convince her that she should.

Bruce: The payback is going to be huge…

William: She’s still making my for my shirts for me. That's fine. But luckily now, we do have an advertising contract with very supported by a pharmaceutical company called Sanofi. It's a French one. We won the competition last year in Paris. And so that led to a contract with him. We also got a tender now with the Western Cape Department of Health. We've partnered with a couple of companies that we believe really add value to healthcare workers. So, financial services company called Life Check which basically helps professionals develop a financial profile better, but they don't take any commissions from any products that they sell. We're trying to find ethical advertisers not just releasing our advertising space…

Bruce: And there's also a huge amount of collaboration, Goodwill collaboration tat is creating its own military ecosystem.

William: Yeah, that's really interesting and I we get approached by people saying oh you doing this can we help, or you talk about the expansion of systems we adding a system now where you can take a photograph of an x-ray and it tells the health worker whether the patient's possibly got TB or not. So even before they made a referral to a specialist, they're getting some feedback. So, it's amazing to meet people are doing these incredible things and helping them work together.

Bruce: How are you changing the world? It seems we for anybody looking for a real practical way of doing it. How are you changing the world?

William: Yeah. I said that I said, I would I would value Vula and I would work for full-time if it was seeing more patients than I could possibly see in a day. So, in Swaziland are used to see 80 patients in a day or each and there was a very slick system, all paperless and it was built.

Way, so it was possible rule is now seeing between 350 and 400 patients every day. So, I do think that I'm able to work full-time. I can justify that and basically the thrill I get is saying that patients are getting specialist guided health care every day across the country and now it’s in six provinces. And this is the made that thing that really means something to me.

Bruce: How does it go from 400 to 4,000 to 40,000 to 400,000 because across this continent that's feasible?

William: Yes, we have so and that's nice little bit you have a runway of money. Now, we've never really had a good in-house tech team before. So now we've managed to get a bit of money. But some revenue we bring our tech team and house which means we can make features that can help us expand. So, I'm really excited about the future for us.

Bruce : How do you make revenue? I mean, how do you actually make money out of this thing? Yes, I get the grant funding is to get the prize money if it gets a private equity backing, but how does it earn money?

William: So, we've got some advertising. That works very well. The government tenders not the biggest amount of money, but it helps us to we get commissions for organizing doctors’ meetings. So, we get to paid per introduction and that works very well as well. And then we just negotiating a research contract with one of the universities which will also help us produce better data. So, for example orthopaedic department used our data to show where the specialist post should be in the country as opposed to just shoot outs loudest in the allocation meeting. So, I think the value over time's going to prove the data will become one more valuable and people willing to pay for that too.

Bruce: What's the endgame for Vula?

William: I guess I would like to see that everyone is able to get access to a specialist as the main goal. I mean, if you should be in any way you are and, the health worker that you with should have specialist guidance. I still believe that people are the most important part of health care what you really want as a health care worker who cares for you and we’re there to support that person whoever that is.

Bruce: But there's also no reason why a private sector GP who rather than waste to specialists time by making a referral for a six hundred rand consultation is simply can't take a photo of the problem to in the specialist can either say yes, they must come and see me and therefore generate the fee or say no, actually that's just a cloudy day or whatever the case might be… you've causing the reflection.

William: No, you're special and so we do have 20% of our users. Although we never targeted them are in private and many of them are private GPS who actually use the public sector specialists as a resource for learning those things. What should be referred, or can they manage cases on their own and I think the next logical step is to involve the private specialists and I'm looking forward to doing that.

Bruce: Dr. William Mapham is the founder and Chief Executive of Vula Mobile, an ophthalmologist by day, a tech entrepreneur in the three hours he's got spare once a week but building this incredible application to revolutionize healthcare provision, not only in South Africa, but looking across our region and the continent, with a license to go into Europe at some point in the future, too.