Healthcare for All
Sharon Allen of World Telehealth Initiative
on Providing a Philanthropic
Global Healthcare Solution
from Right Here in Santa Barbara
By Leslie Dinaberg | May 4, 2023
Picture a physician in Santa Barbara coming home after a day of seeing patients in a well-equipped, comfortably air-conditioned office. They put on comfy clothes, eat dinner with their kids, do the dishes, maybe consult on some homework and the family’s weekend plans, and then they open up their laptop and do a completely different kind of consulting. If they’re a pediatrician, they could be consulting on children in Cambodia. If they’re an oncologist, they could be helping with chemotherapy protocols in Kenya.
It may sound like sci-fi, but thanks to technology developed in Santa Barbara — and the philanthropic vision of Dr. Yulun Wang, the pioneering inventor of surgical robotics; and World Telehealth Initiative CEO Sharon Allen — physicians from all over the U.S. and beyond are now able to provide medical expertise to vulnerable communities all over the world with just a few keystrokes on their computers from the comfort of their homes or offices.
“It’s so easy; it’s just a couple of clicks, and you’re in Bangladesh, and you’re consulting,” says Allen with a twinkle in her eyes as she describes her experience shadowing a local physician doing an after-work consult.
With the World Telehealth Initiative (WTI) now providing 42 global programs to clinic and hospital partners around the world, and more than 50 medical specialties being offered, Allen, as cofounder, certainly has much to be excited about. After working more than 20 years at Aqua-Flo, including her last decade as CEO, when Allen left the company in 2017, she planned to spend “about six months” exploring new opportunities.
“I was looking into the nonprofit arena, and with Ava [her youngest teenage daughter] being adopted, I was kind of looking into adoption things. Then I was introduced to Yulun Wang,” says Allen of that fateful meeting. “I didn’t even know what telehealth was; this was long before COVID.”
Meanwhile, Wang had seen his technology, which was by then a part of Teladoc Health (NYSE: TDOC), used in remote U.S. communities and believed that it could be enabled in remote communities worldwide. But, as Allen says, “he didn’t have time to dabble in that thought.”
Wang’s vision was to be able to donate his technology and get a cadre of volunteer physicians to donate their time and expertise. Allen was invigorated by the idea, saying, “It just needed to happen. The answer is there to help fix global healthcare; 50 percent of the world doesn’t have access to care.”
Though Wang was clear it wasn’t a funded effort, Allen was undaunted. “I’m like, ‘Perfect. I don’t even know that I want to do it. Let me file for the 501(c)(3), take steps to incorporate, and assemble a board of directors who will likely want to hire an executive director — I may or may not apply.’ And so that’s kind of how it started.” She laughs. “And I did apply.” Not only that, she became the CEO and cofounder.
Though she was a volunteer in nonprofits, including the AAPLE Academy at San Marcos High School, Allen’s professional experience at that point was all for-profit. “I ran a very successful company, which was wonderful in so many ways, but not a startup. … It was a learning curve. And I wasn’t from healthcare, and I wasn’t from technology,” she says. “But you know how it is when you’re learning something new that you just love? … Once you go down that road, there’s no turning back.”
She cites being inspired by David Brooks’s book The Second Mountain, which explores what it takes to lead a meaningful life in a self-centered world, and the feeling of accomplishment and optimism that this work provides for her. “This is that: my second mountain. I haven’t watched TV for years. I mean, I’d much rather provide a healthcare visit for somebody who has no other option. Why would I watch TV when I can match this doctor with this need?”
Yes, there was a lot of learning required, as there still is, “because nobody was doing it. And so even when Yulun shared his vision, it was like, ‘Okay, well, who could we collaborate with in order to do this?’ But at that time, nobody was doing what we were doing and so, lo and behold, there’s yet another nonprofit in the world,” she smiles.
After incorporating as a nonprofit, World Telehealth Initiative’s first two partnerships were launched in 2017: Freedom from Fistula Foundation for fistula surgery in Lilongwe, Malawi; and St. Luke Foundation in Port-au-Prince, Haiti, to provide critical care in the ICU.
Since that time, due in part to the global pandemic, the U.S. adoption of telehealth has grown exponentially. According to a WTI white paper on “Transforming Care Delivery,” in 2019 only 11 percent of consumers had adopted telehealth, and in 2020, 76 percent were interested in using it, with providers reporting 57 percent more telehealth visits compared to pre-COVID, a number that has only continued to grow.
The sophistication and ease of use of the Teladoc Health technology is a big factor in enabling WTI to deliver healthcare expertise anywhere in the world that has reasonable internet access. Allen explains, “It has these dual cameras to zoom in 26 times. So on my big desktop computer, if I zoom in on an eyeball, my whole screen is the eyeball. I mean, it’s amazing clarity.”
There’s also directional audio, which is very important, for example, “when we’re in Bangladesh; they have a corrugated metal roof. And in monsoon season, it’s super, super loud. So it muffles the surrounding sound, and it just picks up wherever you’re pointing. It’s as if you’re in the room looking at one another.”
It’s also diagnostic-enabled, she explains: “If you plug a stethoscope in, and the provider on-site applies it to the patient, in my headphones I hear that heart sound or bowel sound or whatever else. Or we use ultrasounds in a lot of our maternal health care programs, so I can see the live ultrasound feed on half of my screen. And then on the other half, I see the provider and how they’re manipulating the probe. … You really can be anywhere in the world to do a lot of medical interactions — not everything — but quite a bit.”
She explains that the WTI model is not taking over the patients’ care but working with local providers to care for more of their own communities and build the capacity of their local healthcare systems for generations to come. What that looks like on a practical level is often providing consultations with specialists. For example, there might be a general practitioner with a rheumatology question and WTI helps them get a rheumatologist to consult with.
“I just got back from Kenya, and that program is fairly new,” explains Allen. “It is very typical when we’re in the initial assessment phase — we ask what types of medical expertise would be helpful.” It turned out they were doing chemotherapy but didn’t have an oncologist, and they were doing dialysis but didn’t have a nephrologist — and now they have ongoing access to both specialties.
“For me, coming from the for-profit world, the more successful you are, the more people want your product, the more revenue you have coming in, and you want to grow and provide what you know,” says Allen. “But with a nonprofit, the more successful you are, the more products and services people want, you have to turn around and invest in that to be able to provide it.”
They went in knowing that “in order to make the organization sustainable, recurring revenue was going to have to be part of that model,” but as Allen says, “the interesting thing was how it came together.”
Like any nonprofit, WTI focused on the impact they were making on their onsite partners, which now include programs in Argentina, Ecuador, Haiti, Puerto Rico, Guinea, Togo, Nigeria, Malawi, Kenya, Ethiopia, Bangladesh, Ukraine, Kashmir, Bhutan, Vietnam, and Cambodia. “But all the while, we were hearing from our supporting providers things like, ‘This is the best part of my day,’ and ‘This is why I went into medicine,’ ” says Allen.
Boardmember Ron Werft, president and CEO of Cottage Health, suggested, “All you have to do to recruit providers [is] say ‘Save a life, no EHR [electronic health records]’ because they all hate that.”
He was right, says Allen. “We heard all these incredible things from the supporting providers, but we didn’t really think of quantifying it. And then Ron was saying that the biggest challenge for any health system CEO right now is workforce wellness. You’ve probably seen the statistics; 30 percent of them are going to retire by 2030. They’re just flocking out of healthcare.”
She cites studies that show “a small amount of meaningful volunteering reduces physician burnout and increases job satisfaction,” acknowledging, “It’s kind of counterintuitive, like ‘Wait, if I do a little more, I’m gonna feel better.’ But studies after studies show that, and that’s what we were hearing.”
In response, WTI now offers memberships to a program — Cottage Health is a member — “where they pay us a small amount, and then we, in a very organized way, offer their physicians — and now we’re expanding to nurses too — an opportunity to have these engagements.” The interface is a very simple profile: “ ‘I only want to work Tuesdays from 2-4 p.m.,’ or ‘Call me and I’ll respond if I can,’ or ‘This is my specialty,’ or ‘I only want to work in Haiti, because I’m a diaspora of there.’ … And then our matching platform sends them opportunities that coincide with their requests, and it’s basically swipe left or swipe right.”
In terms of selling points for institutional partnerships on the volunteer side, Allen explains that in the health system, it costs anywhere from half a million to a million dollars to replace a physician, “so, if they’re paying $25,000 a year, it’s a small cost to them to have this engaged workforce. We’ve gotten a huge response; lots of health systems are lined up. And it’s great, because it feeds us. We have over 1,000 providers now and it represents over 50 medical specialties.”
A lot of their critical emergent high-acuity care is being done in Ukraine right now. “They wanted neurosurgery consults; they’re having a lot of head wounds. Our volunteers are from all over the U.S. and beyond,” Allen says. “And so a Mayo Clinic neurosurgeon is consulting with these Ukrainian nerve neurologists. … It blows me away. It’s so amazing for me to even witness this. I’m in a privileged position to be able to witness what could happen with this platform and with this technology, and what it would be like. … I get really excited about just how inspirational it is, the humanitarian nature of physicians.”
She continues, “The doctors that have a heart for this work are the cream of the crop.”
Asked about language barriers, Allen explains that most of the programs have in-country physicians that have gone to medical school in English. “For example, in Bangladesh, the providers go to medical school in English. Not all of the patients speak English, but the provider has that relationship with the patient, and our supporting providers are just there to consult with them.”
In Ukraine, where they currently have a large response effort going on, Allen estimates about half of the providers speak English comfortably. The other half usually speak both Ukrainian and Russian. “But out of just word of mouth, we have so many Ukrainian speakers that have heard of this opportunity and want to help.” They also do have a 126-language medical translation service available, she notes.
As quickly as the WTI program is growing, it’s definitely designed to be scalable. The technology is there, and there are many physician organizations in the U.S. that would like to be involved, Allen says. “That is not the shortfall. It really comes down to WTI’s operational staff to coordinate this and train all the providers. Everyone that comes in, either as site personnel or as a supporting provider, we do a live simulation training with them. And most people are familiar with telehealth now. This is high-end, very, very, very easy to use, but it is robust, and we want them to be 100 percent comfortable, so the technology just kind of melts away.”
“The doctors that have a heart for this work are the cream of the crop.”
The real need is for personnel to do training and onboarding. “Our limitation is really having the resources to grow our team to get more doctors trained, scheduled, and all of that,” says Allen. The team right now is 10 people, including three software engineers who are developing and refining the matching platform. “When we started, we just did it by spreadsheet and the site would email me, ‘Hey, do you have a cardiologist?’ and then I’d be looking at the spreadsheet and so that would not be scalable,” says Allen.
There are three other staff members on the programs’ team, and then the others focus on communications and development.
In terms of selecting programs, they prioritize by the impact they could have on the community. “For example, Kenya, our recent onboard — they had so many needs, and we need an onsite champion, somebody that will be our liaison right on the ground, and especially in COVID, when we’re traveling, that person is very critical. Then we also do an initial technical review to make sure their internet is stable,” Allen says. While the specs are very low compared to other technologies, “we have this assessment that we go through, but then it kind of comes down to where we make the most impact. And we do have a schedule; we’ll have 25 more programs by the end of this year. So yes, they are coming to us.”
WTI also collaborates with a lot of other non-governmental organizations. For example, the Goleta-based nonprofit Direct Relief helps ship their machines to various clinics around the world. Sometimes there are networking opportunities between groups. For example, with a certain medication that a physician was trying to get to one of their patients, “this physician from Seattle said, ‘I work in another program in Kenya; they have the source that they get it from Nigeria. Let me connect you.’ Or they need a new microscope for their lab. And so one of the health systems we work with, Providence Health, they have all this equipment from their hospitals, and we’re able to get those,” says Allen. “That’s not our sweet spot, but we certainly facilitate introductions and to really get them the robust healthcare that is out there.”
It typically takes about three months to set up a program, but the site sets the pace. Allen usually visits at least once in person to get to know the parties that are involved. The situation in Ukraine was a little bit different from most. “It was definitely a rapid response,” she says. “The Ministry of Health actually reached out to us and gave us eight devices and then they needed 10 more and so it was different than the usual way things work.”
During a recent visit to Kenya, Allen saw a single robotic device wheeled up and down in a multi-floor hospital. “We’re in the labor ward, with OB-GYN consulting, and then we’re in a ward where there’s a neurological problem … and they go to the lecture hall, and a provider’s giving a didactic session on ischemic stroke.” She describes seeing maternity wards with “two random mamas and two random babies all in one bed,” and asking the women if they knew each other. “And they’re like, ‘We do now.’ ”
She adds, “The patients I get to meet, I mean, it’s life-changing — 100 percent.”
With such a whirlwind start, what does Allen know now that she wishes she knew at the beginning? “So much,” she smiles. “I was aware that there’s lots of cultural differences everywhere, but how important that is.” She shares the story of a provider in the U.S. who was irritated when they beamed in at 9:55 p.m. for a 10 p.m. session and waited 20 minutes, then grew annoyed that the person on the other end in Kenya was a no-show. So he disconnected. Meanwhile, the physician in Kenya started out an hour early because they were so excited for their consultation, but the road was washed out, so they had to abandon their transportation on the side of the road and hopped on the back of a friend’s boda boda, but that couldn’t make it up the hill in the rains. So he walked up the hill, and then the device wasn’t in the room, so he had to go get it. Finally, he logged on at 10:25 his time and the person wasn’t even there.
Rather than be discouraged by this story, Allen feels encouraged. “Now that we understand how this works … that’s exciting, too, because it’s like, we can solve for this! You know, it feels like we’re worlds apart, but we’re not. And that’s part of what WTI does. In all of our training, we have a little cultural humility section that we review because many of the providers do have global health care experience, but many don’t. And that’s part of the beauty of working with colleagues on the other side of the world is having that shared understanding or figuring out those glitches.”
Still smiling, she says, “I tell my family that … I feel like a fairy godmother; like I have all the pieces and then I just sprinkle the fairy dust and magic happens.”
And what if her fairy godmother showed up with tons and tons of resources? Would she know what she wanted to do?
“Absolutely,” says Allen, not missing a beat. “We would speed up the platform development and establish many, many, many, many more programs. We can really dramatically affect global healthcare … and we are working on it. So I do think that is an eventuality. In the meantime, we need to keep doing what we’re doing and sharing our metrics and our impact.”
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