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A screen grab of Noora Health website.
A screen grab of Noora Health website.

Noora Health: from college project to one of world’s most innovative firms

Noora Health trains family caretakers of patients recovering from a major surgery or going through a chronic medical condition

Bengaluru: It’s a familiar scene. In the hospital corridor, the patient’s caregivers pace up and down. Loving and well-meaning, but with little idea of how to help. At the end of the day, they head for home, anxious till the next day.

For the four graduate students from the Stanford Design School, the disengagement of family members in India from the patients they care for came across as odd. Two to three family members accompany every patient, but they find themselves to be of no use but to sit around. Why? And was there a way to fix this?

At a college project on healthcare, the four—Shahed Alam, Jessie Liu, Edith Elliot and Katy Ashe—set to work. Alam and Liu have a medical background. Elliott has a degree in public policy and Ashe is an engineer.

Thus was born Noora Health, a care companion programme which trains and educates family caretakers of patients recovering from a major surgery or going through a chronic medical condition. Launched in January 2014, the Bengaluru-based non-profit organization, in February this year made it to the list of world’s top 50 innovative companies released by Fast Company, a US-based business magazine that focuses on technology, business and design.

“We were all graduate students at Stanford and were interested in healthcare," said Alam, one of the co-founders.

For half a year, they played with ideas, in partnership with hospital chain Narayana Health, on what they could do with the health system in India.

“We spent a lot of time talking to people in these hospitals including patients and families, chairmen, doctors, nurses, even security guards," Alam said. “What really struck us was the disengagement of the family members from the process of healthcare delivery."

“No one cares as much for the patient as the family does. But often they don’t know what to do. So we thought, why not use this compassionate pool and help them take care of the patient," said Alam, who saw his mother struggling to look after his grandmother when he was a child. “She is an extremely intelligent, capable person but it was very hard for her. And I’m sure all of us have stories like that," Alam added.

Currently, Noora has 25 hospital partners in 15 cities across India and has trained 45,000 family members so far.

Ravichandran Natarajan, group head, corporate social responsibility at hospital chain Narayana Health agrees. “In India, the average number of in-patient attenders is 2-3, but their time spent in the hospital is either wasted or underutilized," he said.

That is where the Noora Health Program came in. The project was piloted in Narayana Healthcare, Mysore, between 2012 and 2013, “We learnt a lot in terms of how complex the healthcare system is here but what really motivated us was that once the basic engagement with the family member was in place, it took off like magic," said Alam.

“We decided to give them a structured training of not more an hour a day where we could dispense information on things including medical management, bandaging and post-operative care," said Natarajan.

The training now comprises of a theoretical session with content in form of a video demo, followed by a practical session. There is also print material to disseminate information.

“We found people leaving the hospital were less anxious (after the training), six times less, really and more prepared to go home," Alam said.

“We take a Train the Trainer approach where we identify staff at hospitals, provide them with the necessary tools and impart skills to them. And our trainer is a doctor herself; so, she is very clued in to the scene," said Anubhav Arora, who heads operations for Noora Health. “They, in turn, pass on this knowledge to a patient’s family."

Heera Pinto, a senior nursing supervisor at Manipal Hospitals, is one of them, “We train relatives on hygiene, how to recognize warning signs, how to give medication, diet etc. Our focus is mostly on pre- and post-operative care for cardiac patients," she said, adding that classes are held every day, alternaty in Kannada and Malayalam.

“Typically, when the patient gets discharged, the doctor gives medication and asks them to come for a check-up. This way, they leave with a lot of additional information and don’t need to depend on anyone for the basics," Natarajan added.

In addition to the brick-and-mortar type training, Noora Health also leverages technology. “We have developed an application that can used on smartphones and tablets. There are voice messages for those with basic mobile phones," said Arora.

The programme which started with focusing on post-operative care for heart patients today also addresses diabetes mellitus, cancer and neo-natal care. It has been developed in multiple languages as they hope to reach more people.

“We want to make this a part of normal hospital work-flow," said Natarajan, “This is a low-cost, high-impact, value addition tool we provide and currently 45% of our patients have benefitted from it. Our ultimate aim is 80%," he said.

Though the hospital did invest some money in its development as part of its CSR expenditure, the rest is simple, “All we need is a nurse to spare an hour of her time, and a meeting room," said Natarajan.

Noora Health was incubated at the Silicon Valley-based start-up accelerator Y Combinator, which has launched ventures like Reddit, Dropbox, Airbnb and Weebly. “We learnt a lot being in that accelerator but we realized how much is needed to be done in India," says Alam. However, Noora plans to expand to the US as well. “We have a few partners there who have exhibited interest, but let’s see," Alam said.

The non-profit is funded by foundations, individual donors and trusts. “We have a source of revenue in private hospitals for the services we provide. We hope this will help us sustain our work in the place where we want to work for: government and trust hospitals, which carter to a majority of the population at the bottom of the pyramid," said Arora.

“On the face of it, they are addressing an important need. Caring for patients at home and educating the families to do so, is an important part of total care of a patient," said Dr. Jeremy Levin, chief executive officer and chairman of Ovid Therapeutics Inc in New York. “Given that care at home is a growing factor in medical treatment, this is potentially an important growth area," said Levin, who is also on the board of Biocon Ltd.

But how is Noora they different from existing systems of disseminating information to patients and caregivers, including doctor-patient interaction, online material and brochures of pharmaceutical companies? “We engage the people and families with their own health. We talk to local stakeholders, understand the best practices and give feedback. Also, we take feedback very seriously. We have a basic monitoring evaluation system and are planning to develop a robust one," said Alam.

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