‘Bridgital’: An innovative ‘medical consultant’ shows that technology has a people problem in India

Nikhil Burman parked his car beside National Highway 37 in Silchar, Assam, turned on the hazard lights, and waited in the darkness. The blinking lights were for the people coming down from distant towns and villages few people could find on a map. He could not see them, but wanted them to see him; they were coming for him.

While he waited, same as every night at 8.30, a crowd grew around the car. Older women, young men and women, people of all ages, all thrust their papers and their questions at him. His phones rang endlessly. Arriving trains brought more people and more questions.

His visitors came because they were sick, and deeply in need of anyone who could help. Someone – a friend or relative in their village – had told them of a man who parked his car beside the highway, turned on the flashing lights, and answered questions. That was what brought them out of the hills, across living root bridges a hundred years old, down mountain roads that ran along ravines, and across state lines: Someone who could guide them to the right doctor.

The surprise was that Nikhil was a driver, and had no medical training at all. His expertise was in helping patients go where they needed to be.

Few patients asked him about his qualifications. He seemed to know what he was doing. He listened patiently to one caller’s lengthy list of complaints, noting them down on his other phone, an old piece that had a chipped screen and was worn at the edges.

He composed reminders to himself on SMS, typing the patient’s name and a code for which test had to be done: SABITA BHOWMIK GC, or RAJIB DAS SKD. He told the caller to not eat because the tests he needed required an empty stomach. Nikhil could not discuss the particulars of the caller’s ailments, but assured him that he would arrange the pickup from Silchar railway station, appointments with doctors, examinations and tests, and even a place to stay.

Nikhil was nearly forty, but looked a decade younger. It was his manner – firm, business-like, reassuring – that gave strangers confidence.

A man stepped out of a rickshaw and walked over to Nikhil. He introduced himself, handed over some papers and, without being asked, bowed to present his head. Nikhil assessed the nature of the lump on the man’s skull with two fingers, like a doctor would. In less than a minute, he concluded which doctor the man had to see.

An elderly villager walked up. She was tired, with worry written over her face. This was her first time outside her village. This was the first time she had been so sick. Her stomach hurt, and no one in the village knew what to do. Someone told her about a driver who could lead her to the right treatment, and gave her Nikhil’s number. Now she found herself, a nine-hour train journey later, on a dark highway, in front of a complete stranger, handing over her medical file.

Nikhil found the woman a place to stay, and prepared her for what would come next. He told her they would drive to Kalyani Hospital the next day, consult doctors, and do some tests. He explained that an operation could follow.

The woman listened, but could not stop worrying. She was all alone. To reassure her, Nikhil told her he would buy her medicines from a pharmacy, and take care of any other formalities associated with the surgery.

“But if you die here,” he remembered to tell her, “I will not send your body back to Tripura. I will arrange for you to be cremated here. Understood?”

In the end, it was a simple procedure to remove a few kidney stones. No complications. Still, Nikhil had worked with patients for a long time. She was older, and he didn’t want to take any chances.

Each evening, Nikhil met with dozens of patients to help them understand what to expect from their visit to Silchar’s hospitals and clinics. On any given day, he estimated, there were usually over two hundred calls from patients in Tripura.

Nikhil’s “career” as a full-time medical coordinator came about entirely by accident. In 2000, soon after he finished school, he began shuttling passengers across Silchar in his father’s auto-rickshaw. One of his frequent customers, a senior doctor at a charitable hospital in the town, found him dependable enough to ask a question: Would Nikhil like to transport patients between the places where they were receiving medical treatment?

Nikhil agreed.

Before long, he began to view life through patients’ eyes.

Most patients required active help on their arrival in Silchar, having only heard of the place. They arrived bewildered and clutching their medical files, not on a professional’s advice, but on the recommendation of a friend, family member, or neighbour. This meant that few doctors were referring patients to specialists, which, in turn, meant that patients spent time trying to find the right doctor all by themselves.

They wandered out of consultations and surgeries, wondering what to do next. They all seemed lost and uneasy this far from home, in an unfamiliar and imposing town that bustled with noise, energy and action.

Once they did find a doctor, there was the small matter that doctors and patients spoke different languages. Nikhil saw doctors speak in their second or third language to a nurse, who then struggled to translate complex diagnoses and prognoses to patients in a regional dialect. One could only guess how much was lost in translation.

Nikhil sensed the deep suspicion with which rural patients approached doctors in large hospitals. Beyond the question of whether patients would comply with instructions they only partially understood, he observed a deeper disconnect – of which differences in language was only the most apparent part. It was human nature to be less trusting in a foreign environment, especially if the diagnosis was of life-altering significance.

When people travelled a long way for medical treatment, the problem was probably a serious one, something that did not have a simple cure. But the shock of a diagnosis was often so great that they refused to trust anything doctors said, and refused to act on medical advice until it was too late. Most had never undergone diagnostic tests, and never been required to understand what reports said. Besides, they were preoccupied with the more mundane concerns: An affordable place to stay in town, transportation, medicine, appointments.

Nurses and doctors were ready to help, of course, but there were endless lines of patients and not enough healthcare providers. They were already doing all kinds of work to keep the hospitals running. Doctors administered injections that nurses otherwise would, and nurses filed documents, made funeral arrangements, and did paperwork for government schemes. Witnessing all this, Nikhil realized that patients longed for guidance from someone who felt friendly and familiar. Someone who could coax and cajole them, as a youth from their village might; someone who could simplify the process of seeking help and alleviate the helplessness they felt.

The entire edifice of healthcare relies on creating an environment of trust, yet trust was in short supply.

Nikhil saw the role he could play. “Patients come here thinking they know what ails them and what they might need to do,” he said. ‘When they receive a different diagnosis, they get overwhelmed. They need guidance, and need to hear their options carefully explained. Navigating the medical system itself should be the least of their problems.”

Nikhil saw himself primarily as a logistics manager; but while he was careful not to give medical advice, he frequently ended up as a de facto triage nurse, directing patients to certain facilities based on his past experience with cases like theirs. He charged a minuscule daily amount for his services, and fully expected to be haggled down. Several patients needed discounts, and one in five was too poor to pay at all. If someone could not afford even the bargained down price, Nikhil waived his fee.

Demand continued to grow, and providing guidance became a full-time business. His fleet of cars grew to seven vehicles. His relatives joined the business, doing what he did. But Nikhil was in it through and through. On occasion, he paused work to donate blood to a customer.

Seen one way, Nikhil was an entrepreneur, ingenious in finding and serving a market. Across Silchar, their lights blinking in the night, other drivers played a similar role.

But seen another way, if India’s systems worked the way they were intended, this market would not exist at all.

Excerpted with permission from Bridgital Nation: Solving Technology’s People Problem, N Chandrasekaran and Roopa Purushothaman, Allen Lane.