Diabetes can become degenerative when a patient has it for a long time. And that is what happened to Dr Fahreen Hannan's mother-in-law.
"She was one of those people who lived for her family, she was so active, it was unbelievable. But we watched helplessly as with time, diabetes turned this extremely active person almost immobile. Her suffering was unbearable," said the doctor, also the founder and CEO of Dhaka Cast, an online diabetes management website.
"My husband suggested we do something for diabetic patients where they would be able to avail almost all the services without having to leave their home," she said.
Dhaka Cast was launched in June 2019 with three other partners including her husband, who is also a doctor.
Last year, it won "She loves Tech", a Beijing-based start-up competition, focused on women and technology.
Dhaka Cast provides services such as online appointment with specialists and general practitioners (GP), sample collection from home, and round the clock doctor's consultancy. For conducting the tests, it has business to business (B2B) arrangements with Ibn Sina Hospital and Turag Diabetic Centre.
After securing an appointment, the doctor sees the patient via video calls. Then technicians collect blood samples etc from the patient's home. The reports are e-mailed to patients, hard copies are also delivered on request. The start-up provides medicine delivery service through third parties as well.
There is a pool of senior doctors, fresh MBBS graduates, and nurses who do home visits when the patient is too ill. The general practitioners are always available, but the specialists are usually available in the evening because some of them have their own practices or attend other clinics during the day.
Payment is usually handled through bKash and Nagad.
Till now, Dhaka Cast has had nearly 5,000 patients. During the pandemic, the maximum number of patients they reached in a month was close to 1,300.
Going all in
Dr Fahreen grew up in Chattogram and graduated from Sapporo Dental College in Dhaka. She also holds an MPH from North South University. When she decided to do something for diabetes patients, she quit her full-time profession of a dentist and dedicated all her time to becoming an entrepreneur.
Why the name Cast, we asked her. "Initially, the idea was to start a podcast, but after doing some research, we understood that the market in Bangladesh is not yet ready for such a thing. So, we changed our business model to a service oriented one," said Dr Fahreen.
Before starting Dhaka Cast, she prepared herself for more than a year, almost like preparing for a battle. "I read everything I could on start-ups. I learned to speak in English at Search English. The whole year of 2018, I studied about start-ups and entrepreneurship," she explained.
She also prepared a questionnaire and started taking a survey on her own at parks every morning. She asked people who were on morning walks about what they would like from a healthcare service provider.
Usually diabetic patients have to visit the doctor multiple times to get a complete diagnosis. Blood sugar tests require patients to remain empty stomached for a long time and then give blood again after eating something. These processes take time.
Most of Fahreen's survey members said they disliked physically going to the doctors, waiting for them at the hospital, and then going again to collect reports. They did not like to be stuck on the road for hours as well.
Start-ups are not just about providing services, they are also about changing people's behaviour in a positive way. And that is what Dhaka Cast has been relentlessly trying to do
"I understood that patients just wanted services within their comfort zone. You see, start-ups are not just about providing services, they are also about changing people's behaviour in a positive way. And that is what Dhaka Cast has been relentlessly trying to do."
The pandemic has prompted many renowned clinics and hospitals to provide online services. How is Dhaka Cast differentiating itself from them?
"I believe we will be able to continue our online services as well as on-call services side by side. The pandemic has taught patients that instead of going to the hospital, it is much safer to get home services. So we are not worried about losing out."
While speaking on limitations of the start-up, Dr Fahreen said that because Dhaka Cast is still at an early stage, they do not yet have the pressure from loads of patients. But this also helps them to maintain quality, as they can give their patients more time.
She said, "We are not a monopoly, there are many others like us. We specialise in diabetes management and get most of our patients through word of mouth. Our 15 doctors can easily cater to a lot of patients. As Dhaka Cast expands, we will increase our number of service providers, it will not be a problem."
The pandemic has taught patients that instead of going to the hospital, it is much safer to get home services. So we are not worried about losing out
Tina Jabeen, managing director of Start-up Bangladesh Limited, thinks although Dhaka Cast has a long way to fully establish themselves as a prominent telemedicine service provider, it has had a good start as a newcomer.
"What we call a start-up DNA, Dhaka Cast has that, they have substance. I appreciate the fact that Dr Fahreen left her practice and delved into entrepreneurship. She is setting a good example for other entrepreneurs."
The ICT expert is also satisfied with Dhaka Cast's services, as she has availed them.
"One of my family members had an emergency case of varicose veins, and Dhaka Cast handled it really well. We did not even know how fatal it could have turned for the patient. The doctors gave us consultancy through video calls and they constantly followed up. Now, the patient is doing fine."
Tina Jabeen feels that in order to improve their services, the start-up needs to bring in more doctors.
Another user of Dhaka Cast, Farhana Ahmed's husband fell ill with Covid-19. A high diabetic patient with insulin needs, contracting the coronavirus made him very sick. At the same time, Farhana's six-year old twins and the house help also came down with high fever.
"We had such a rough time back then, but Dhaka Cast was with us constantly. We could even reach out to a doctor at 2am. Their services are reliable and affordable. A well-reputed hospital even gave a false diagnosis of my husband's report, but thanks to Dr Fahreen and her team of doctors, he is fine now."
Dr Fahreen Hannan believes that it is vital for policymakers to ensure that telemedicine services become available throughout the country. "The moment we step out of the capital, it is a completely different picture. And our dream is to provide Dhaka Cast services to rural areas."