In a place where (seemingly) all great ideas are sprung, a few years ago during his morning shower it occurred to Dr Frank Hoffmann that perhaps tactile breast examinations could be the perfect job for blind women.
The social entrepreneur and founder of Discovering Hands, now trains and deploys blind female Medical Tactile Examiners (MTEs) to deliver breast examinations at doctor’s practices throughout Germany.
“Everybody knows that people without sight do train their sense of touch very well,” he explains. “I was sure if our system had made so much progress on the therapeutic side, we could look to improve the poor quality of the diagnostic side.”
With breast cancer the most common cancer in women in both the developed and developing world, Frank was looking for a way to improve the accuracy of the tactile breast examination. Today, DH has achieved so much more.
“Research showed that not only was the size of the tumours detected improving – with accuracy likely to be twice that of ordinary examinations, but women were becoming receptive to the time spent with our MTEs,” elaborates Frank. “Not only are perspectives of disabled people altered – because we focus on their capabilities – but they can also see that there is a professional spending 30 minutes on you,” he adds. “By answering all your questions, giving you information about breast health and convincing you that proactive preventative behaviour is better for your health, we hope our MTEs can change perspectives on breast cancer and the scary aspects of a disease that often leaves you feeling helpless.”
Previously, Frank recalls instances of only 1-2 minutes per examination being undertaken by the average MD. “You know the chance to heal breast cancer is much higher in the early stage – before it reaches the lymph nodes the chance of healing is about 90% and its drops dramatically if found at a later stage,” starts Frank. “Our MTEs can find lumps [at a size of] 6-8mm.”
As a key constituent in the first phase of breast cancer detection, MTEs play a vital, but not final role. “If you convince them that they are able to perform a better medical examination than any medical doctor because of their well trained sense of touch, we assure them that they are not responsible at the last step,” he adds, discussing the challenges in recruiting blind women. After completing the exam, the MTE hands over the results to an MD for further testing, before he or she will make a final diagnosis. “We have to remind them that they are being supported shoulder to shoulder, providing an additional and improved service to patients.” This focus on fostering their capabilities whilst also improving a process, highlights Franks hope to see MTE become a viable and obvious choice for blind women when considering their career options.
With such great results, the proof of concept only took four years to solidify, “we had a great training concept and final examination handbook, but we didn’t have any experience bringing it to market,” Frank recollects. “When you bring this idea to an MD the first questions are always – how can it work in my network? What do I need to do? Will they work in congruence or support me? And can I make money out of it or is it something I have to pay for?”
Once Ashoka (global organisation that identifies and invests in leading social entrepreneurs) approached Dr Hoffmann, and he had the realisation that he fit the bill as a social entrepreneur, he started to approach things differently. “We were asked to test the business model as a part of the Ashoka globaliser. This is where fellows are invited to undergo a process with experienced international consultants to find the best way to scale up. Perhaps through smart networking or an affiliate, or via a social franchise system,” he explains. With market conditions so different in each country, for DH, the franchise model seemed the best fit.
“The social impact we can generate is of key importance, but we also have to ensure it’s on a self-sustaining basis,” Frank expands. “We want to offer a business model which allows the franchisee to offer the program on their own, without needing to depend on grants and government – the idea being to become financially independent.”
As a result, DH sought to lease MTEs to doctors as a means to address concerns with additional expenses for practices. “We employ MTEs ourselves and lease them – they are then paid on performance,” explains Frank.
So where does the money come from?
“First of all we had to approach health insurance providers that would be willing to offer this additional improvement to early breast cancer detection,” says Frank. DH has successfully partnered with 40 health insurance providers in Germany, collectively offering over 8 million women an exam with a DH MTE once per year for free.
Now, DH patients have become the models biggest ambassadors. “Initial surveys in 2008 revealed that 17% of patients who hadn’t had an exam in the previous two years had not done so due to shyness – they weren’t body confident and didn’t want to take off their clothes in front of a doctor,” notes Frank. “With our system, this issue is eliminated. Many women liken the experience to a massage – describing it as more human and less clinical, in part because the MTEs cannot see them.”
Having stepped away from his practice after over 20 years, and starting a new career as a social entrepreneur, Frank sees DH as a platform for greater improvements to medical diagnostics, “One day, we might be able to offer exams for thyroid or glaucoma, or also consider male MTEs for prostate and testicular examinations,” he offers. “With Discovering Hands, we hope to make blind women so self evident for the field of tactile diagnostics, that they will be perceived as midwives are to giving birth.”