EP 189 – Dr. Pinak Shrikhande – Director at HealthQuad – Accessibility, Affordability and Quality of Care

• His experiences as a practicing critical care physician for almost 20 years
• Dealing with life and death situations every day
• While at Fortis Hospitals, built the first eICUs in India
• Always wanting to make a difference and be at the cutting edge of technology
• Digging deeply into eICUs
• Extracting data remotely and filling the expertise gap with technology
• How COVID created a paradigm change in the way people thought about healthcare delivery
• Some of the challenges of working across national borders
• Raising and deploying the first HealthQuad fund
• HealthQuad’s investment thesis

1. Try and Tip the Balance Towards Life
2. It’s Kind of DNA-ish
3. One Should Not Die Because of Lack of Quality Care
4. Using Technology As a Bridge to Get Quality Care

Read the best-effort transcript below (This technology is still not as good as they say it is…):

Michael Waitze 0:00
Hi, this is Michael Waitze and welcome back to the Asia Tech Podcast. Today we are joined by Dr. Pinak Shrikhande, a director at HealthQuad. Dr. Pinak, thank you so much for doing this today. How are you?

Dr. Pinak Shrikhande 0:14
Oh, I’m absolutely fine, Michael, and thanks for having invited me on this podcast. It’s a real pleasure to join you here.

Michael Waitze 0:21
The pleasure is all mine. And I will thank you online as well for making the end of my week. This is just the best way to end my week. I’m relaxed. It’s all cool. And it’s great to have you here. Before we get to the main part of our conversation, maybe you can give our listeners a little bit of your background for some context before we jump in.

Dr. Pinak Shrikhande 0:42
Sure. So Michael, I’ve been a practicing doctor for almost 20 years. I am a critical care physician. So I deal with life and death situations on I dealt with life and death situations almost on a daily basis. For almost 20 years, I was the director of critical care at the fortress group of hospitals in Delhi, as you would be aware, Fortis is one of the largest healthcare groups in India with more than 35 hospitals across the country. But I was heading three of their large facilities in Delhi for four critical care, managing about 150 critical care beds, a team of more than 450 doctors, nurses and technicians. And I did that for about 10 years. Prior to that I was at another large hospital in Mumbai called Lila the hospital. Again, in the department of critical care. I’ve done my MD from the Armed Forces Medical College, one of the most prestigious medical colleges in India. And and then my super speciality in critical care from the National Board. And at fortis, there was an interesting journey that we went through. So we were, we were not only managing these critical care beds, we were also the pioneers of something called as the E ICU in the country. And probably in this part of the world, if I’m, if I was successful, the E ICU was a unique program where we connect it to the most remotest ICUs in north India, Bangladesh and Nepal, who had very little access to quality, critical care, and power and expertise. And many of their devices were plugged into our command center. And we had a live stream video stream that was coming in from these centers into a command center. And we were providing real time critical care to doctors who are managing patients in these ICOs. And I think we manage about 650 critical care beds across about 15 locations. So that’s a brief about my background.

Michael Waitze 2:36
I want to get back to the E ICU in a second because it’s fascinating. But I want to understand why here’s a bunch of things, right, so doctoring itself, just at the core of this hard work. No matter what type of doctor you are, it’s just hard work. But critical care is like the tip of the spear, right? Because it’s in the name, it’s critical care if something bad goes wrong for like a general practice practitioner, it could be terrible. But it’s not at that tip of the spear. It’s nothing. It’s not disparaging for that. But like, it’s critical. If something goes wrong, that person could die. What drives you, at a young age to say, I want to be at the tip of that spear? Do you know what I mean? Yeah, absolutely.

Dr. Pinak Shrikhande 3:19
Absolutely. And, Michael, that’s a very interesting question. Because, you know, as, as doctors, there are always two ambitions, you know, you need to do something which is going to make a difference. And you want to be at the cutting edge of technology. And I think critical care, in a way kind of fulfills both these aspects. You know, here, you’re always in a situation where you’re on the edge, or your patients are on the edge. And, and it’s important that you in your sound, mind and wit and wisdom, make the right decisions to try and tip the balance towards life. And I think that’s, that’s what the adrenaline surge is all about. And that’s what gives you a kick.

Michael Waitze 4:00
It is kind of exciting, right?

Dr. Pinak Shrikhande 4:02
Absolutely. It’s bungee jumping.

Michael Waitze 4:04
Yeah, injury. Do you come from a family of doctors?

Dr. Pinak Shrikhande 4:08
Yes, I do. I do, though. You know, my parents, my mother, or my father and my grandfather’s were doctors, right. But unfortunately, I lost them at a very young age. So sorry. So I have been brought up in the family of doctors but never seen them really working as such.

Michael Waitze 4:26
I understand. But I have to presume that there’s this feeling not of responsibility, but just like, that’s something I want to pass down from generation to generation. And you know, my father did it. My grandfather did it. Hopefully my sons and my daughters will do it as well kind of thing. Yeah.

Dr. Pinak Shrikhande 4:44
Yeah, absolutely. It’s, it’s it’s something which is so you know, as you mentioned, it’s kind of DNA ish, little Bible. I

Michael Waitze 4:51
say that. Yeah.

Dr. Pinak Shrikhande 4:53
But yes, there is this whole thought process that you know, this is this is what our family stands for.

Michael Waitze 4:59
Yeah. It’s a great thing to stand for. I want to share a story with you. I have a brother who’s a year and a half younger than I am. He’s a neurosurgeon. When he was going through his residency in Atlanta, I went down to visit him. If you saw the two of us standing next to each other, we don’t look alike. But we resemble each other enough that if I walked into the hospital, the people that were there sometimes would think that I was him. And I’ll never forget this experience I had when I walked into the hospital one day, I was there visiting him. And an older woman came over to me and thanked me for saving her grandson’s life. I couldn’t say I wasn’t my brother. Do you understand the point though, right.

Dr. Pinak Shrikhande 5:39
Absolutely. Absolutely. I can I can relate to that incident. Very well.

Michael Waitze 5:43
Yeah. And it was weird for me, because I hadn’t done anything. But I’m not going to take that feeling away. Right, because that’s the reverse of what you have. It’s this. Thanks for thank you for being there at the tip of the spear. And thanks for saving my family’s life. It’s just kind of cool. Yeah. Yeah, absolutely. I want to understand the genesis of this EIC, you I presume the E is like electronic? Yes. Can I understand better exactly how this works, though, right? Because part of the problem with the world in which we live is that in places where there’s great population density, and also, you know, high GDP per capita wealth, the access to medical care is relatively straightforward, relatively yet, it’s not perfect, but it’s relatively straightforward. But the further you get away from those capital centers, and those concentrated populations, the further away you get from actually high quality medical care, right. So if you’re deep into the countryside, and a third tier city or a suburb of a third tier city, the likelihood you can get great medical care is just lower by definition, right? Absolutely. What’s the I like? How does this E ICU work? Right? Because ICU feels to a lay person like, you kind of have to be there and touching it? Right. So how does it work?

Dr. Pinak Shrikhande 6:56
Yeah, so I think here is the you know, the key here is that, you know, there are critical care patient patients all over the country. Absolutely. And there will be is tier three and tier four city hospitals, which will continue to have patients coming in, who are very difficult to either transport to the to the major centers, or who can’t afford being transported to the major centers, right. And our thought, at that time when we started off is that one should not die because of lack of quality care. I think that was the that was the thought when we started. This is way back in 2011. When these, these things were really at that point in time not even thought of right? What we what we realized is that, you know, you can put up equipment in some of these centers, you can probably have the basic kind of manpower, but the expertise is missing. Yeah. And what we tried to do is that, you know, because there was equipment, which was compatible for data sourcing, we were able to extract data from these equipments, and channelize them back into our data command center. And at the same time, we were also able to get a live video stream of those patients coming into the command center. Now, it may not be the perfect solution, but this is where it is these people would have absolutely no access to quality care. We have now tried to bridge this with technology, using technology as a bridge to get them quality care. So that was the that was in a sense, the the kind of base that we wanted to get to.

Michael Waitze 8:33
And were you managing the sort of caregivers and the doctors and nurses that were there through a process. So essentially, like getting a video feed of what’s happening there. I don’t understand how the data was gathered. But I’m really curious about how that happens. But it’s almost like real time you’re seeing this data come in, you’re saying okay, do this, do that look at this test that fix that kind of thing, and helping them through it? Absolutely,

Dr. Pinak Shrikhande 8:54
absolutely. This was this was exactly what was being done, live video streaming, live looking at the patient, the monitors, based on those monitors it of course, there was exchange of data, both electronically as well as verbally. But based on the inputs, then you asked the doctors at that and all the nursing staff at that end, to make the necessary changes in either settings, medications, or the therapies in it by themselves to bring about change. I want to

Michael Waitze 9:26
use a simple measurement that most people understand a heart rate, right? It’s easy. And it’s also easy to measure, right? Like I can measure my heart rate on my phone. Yeah. But are you suggesting then that something like that was connected to somebody you could measure their heart rate and that that data was getting sent to you automatically over a wire that you could then see on a machine in front of you, along with other data I presume and then you could help make decisions using that.

Dr. Pinak Shrikhande 9:49
So they were connected to that to their monitors. These are patient monitors which which are able to capture data as data points like heart rate, blood pressure, Oxygen saturation levels, respiratory rates, temperature, all of that can be measured by that monitor. But we were extracting data from that monitor and we are seeing them real time in our in our command center.

Michael Waitze 10:12
And were you able to real will you be able to analyze that data in real time, let me tell you what I’m thinking in my head, right, just so you can understand that I don’t want to equate the things because it feels mean. But in the late 90s, in the mid to late 90s, we started taking wires and splicing them and getting real time trading data from exchanges, futures, exchanges, stock exchanges, stuff like that. We could put them into spreadsheets, and then start analyzing them in real time and make trading decisions based on that data. The other thing we could do is we could then back test the data that we had gathered, and then use it to make decisions about the real time data that we were getting. And it seems to me that if you could combine all of the data that you had on the medical side in the same way back, test the old data and come up with some types of conclusions, not perfect, but good enough, and then analyze that in real time and say, Oh, this thing is definitely going to end up as that thing. Is that what you were doing as well?

Dr. Pinak Shrikhande 11:05
Absolutely. Wow, go ahead. So Michael, that that’s exactly the point one, of course, there was a live data stream that was coming in. So all that was getting captured in, in the EMR sheets at our end, right. And then we were looking at trends and analyzing those trends to make a decisions, which would change the outcomes for patients.

Michael Waitze 11:29
So this is a paradigm change in the way that medical care is given particularly remotely when you I presume you were involved in proposing this as a solution to access to medical care. Let’s just say remotely, when you first proposed this to people in the big city, were they like, Okay, you’re insane, like this is never gonna work? Or were they just like, Sure, please go ahead. Just install the stuff. This is definitely good.

Dr. Pinak Shrikhande 11:50
So I think, you know, we found great support from the owner of the chain, so of hospitals, so he was our biggest problem. And, in fact, he was the one who encouraged us to do this, because when we took it to him, obviously people at at levels below him obviously had the skepticism that you talked about. But he was one who was futuristic in his thought process. And he, he thought that, you know, if we were able to demonstrate this, it could be a game changer.

Michael Waitze 12:21
Yeah, it sounds like it was. I want to talk about changing the game with technology in 2011, which doesn’t feel like that long ago. To you and me to the technology it feels like two or three generations ago. Absolutely. Can you talk about just what’s changed at scale from the tech implementation standpoint, and the difference that it’s made over time as that Tech has changed?

Dr. Pinak Shrikhande 12:50
Yeah, surely, I think the biggest change was that first and foremost, connected devices were limited. So when when you have to get data output from some of these devices, it was difficult to integrate them or rather get output out of these devices, because they were not compliant. So that was one big challenge. Now more and more devices are compliant. And you can actually extract data from many of them. The second part was that even if they were compliant, the large device manufacturers were reluctant for us to get data from them. And we had to actually explain to them that this is for a certain reason. They used to think that we are hacking into their systems, which was certainly not the case. The third, of course, was the cost of data. And the fact that today, we have brought bands, which can, which can do far more than what we were doing at the time, because we were laying down dedicated data lines at the point where you really do get data from all of these and and at that time, it was like two Gbps per minute, right, which was like, crazy. Yeah, I mean, that with a dedicated data line, and I’m talking about this today, where we are on the broadband, you can have exponentially more data coming in.

Michael Waitze 14:10
And want to go back to the, to the people that actually owned the hospitals. Yeah. So you’ve when you first proposed it, they’re a little bit more visionary than maybe the people that were below them. And they said, Hey, this is a great idea. As it progressed over time, was this feeling amongst the people that were involved doing this, like, wait a second, we may actually be changing the way medical care is delivered, not not just here, but in places we hadn’t even considered yet.

Dr. Pinak Shrikhande 14:37
Yeah, so I guess it was a very slow process at that time. You know, it was it was not accepted enough to actually the code hit me once once COVID hit. It was a totally different paradigm shift in the in the way people thought about all of this. It was it was Very slow. We were converting one person at a time maybe till that time,

Michael Waitze 15:04
I understand. And was that were there any surprise places where now because this is such a force multiplier, right? Those are your words, are there places now where you can put, I don’t want to say full scale hospitals because in a way, they’re great, but not necessary in this case. But where you can put things now, because of the connectivity, that the devices are connected, that the bandwidth is higher, and the data storage is cheaper. Now, you can put facilities in places where you may not have been able to serve people before.

Dr. Pinak Shrikhande 15:34
Certainly, so I’ll give you a very classic example. You know, we were served serving hospitals in Bangladesh. And now this was a at that point of time, it was a unique challenge, because we were crossing international boundaries with data cables. At that point in time, if something happened to the data links on the international boundary. And we have had those situations at least twice in our, in our work with them for six years, at least twice that we had, you know, data cables going down in no man’s land, it was a terrible task to get those cables up and running.

Michael Waitze 16:12
Because now you’re dealing with two with two different absolutely, yeah, authorities. Right.

Dr. Pinak Shrikhande 16:17
Yeah, two different service providers, two different authorities and and then requesting people to get into the moment slide.

Michael Waitze 16:25
Yeah, really fascinating. And is, are there problems with getting data from one country to another country just to begin with? And I’ll tell you why, again, back to the trading thing. When I first joined Goldman Sachs in Hong Kong, when I moved there to kind of build a business, one of the businesses we had it was in Korea, but the servers were in Hong Kong at the time, we had to move them to Korea, because they want to protect their own country’s data, this is common for countries globally, India, does this obviously, the US does it every country does this, where there are issues initially getting that information from Bangladesh, into India, then to be able to analyze that data and provide the care.

Dr. Pinak Shrikhande 17:04
Yes or no for for the simple reason. I don’t think people have that evolved thinking about data by that, in that in that era, got it. In fact, you know, this was discussed with the hospitals, whom we were working with, right. And we it was actually, you know, their responsibility to get the permissions necessary. But you will be surprised that when they went to talk to talk to the authorities there, the authorities did not even understand what we are talking about,

Michael Waitze 17:39
right. You know, I told you this story earlier that when I walked into the hospital, when I was visiting my brother that this old woman came over to me and thanked me for saving her grandson’s life, I have to presume that in these third tier cities, anywhere in the world, that most people feel like if there’s a critical issue, that they’re kind of out of luck, right, just because they feel so far away from where proper and modern medical care can be given. Was there this sense of magic? In the patients, you know, what I mean? Where they would say, like, wait a second, we survived that that’s not possible kind of thing, you know, what I mean?

Dr. Pinak Shrikhande 18:16
Yes, yes. And that that used to happen, you know, in the middle of the night, you had a ventilator alarming off and alarming all the patients around and, and the nurse at that point in time used to be really out of a witch trying to understand what was wrong, right. And you had this constant communication channel, and, and, and she used to, you know, panic at that time in that center there. Sure. And, and that would obviously be noticed, by the relatives of the patients, these, these ICUs are not the very sophisticated in terms of access control, and all of that. So, you know, you

have the relative right there, right? And, and suddenly, you

have this call going there and saying, Please do this right now. And she does that and suddenly, you know, things settle down, the patient is quiet. And you realize that at the end, they are looking out of you can see those people around looking out of the blue to understand what happened just you know, and where did this phone call came from come from? And what how did this change? So it was it used to be very, very fascinating. And we used to see that live, you know, because it was it was coming live stream.

Michael Waitze 19:29
It must seem like magic. My grandfather was when he was much older was I guess, summering somewhere in the Blue Mountains. I can’t remember where maybe in Virginia. I honestly don’t remember where and he had a heart attack and he was airlifted to a hospital I want to say in either North Carolina or South Carolina. I honestly don’t remember. And I went down from New York to visit him because I was really afraid he was going to die. But I remember being in his hospital room. So it’s not an ICU per se but I remember being in his room and obviously he was hooked up to all this machinery and just so fearful that Something would happen on the machine, this is what you’re describing, that I didn’t understand. And all you want to do is like press that button to get the nurse or the caregiver to come in to fix it. But now you’re remote. So again, it just must have felt like some, you know, super powerful being from somewhere else just going, Do this, do that do this to that. And then everything stabilizes. And everyone’s like,

Dr. Pinak Shrikhande 20:22
Absolutely, that’s that’s exactly how it was to work.

Michael Waitze 20:26
Wow, it is also must make the doctors like you and the other doctors that are performing these operations, not operations. But these these exercises, just feel so much better, because you can feel the fear in the families. I want to talk now about health quad, because we haven’t even mentioned what it is and what it does. Can you just give us a sense of like, how would you describe what health quad is?

Dr. Pinak Shrikhande 20:48
So while it fortes, you know, what we were realizing is that, you can call me a cynic. But that’s what, that that’s how, you know, things change. So, unless and until you’re cynical about things, things don’t change, right? At 40s 40s was was catering though we were doing this EIC program but Fortis was actually catering to the three or 4% most affluent people of India understand in terms of their affordability to care for this was a most people would not afford care at Fortis hospitals understood, also, the fact that, you know, after a certain point in time, there is a kind of, you know, feeling that you have as the director of the critical service, that, you know, most patients coming into your ICUs are 86 years old, and you’re just helping them to reach 87, maybe at a timestamp. And you know what I mean? I’m not, I’m not saying that that’s wrong. That’s right now, again, is saying that you’re not making the difference to the people who matter. And there is a huge population of people who are at a much younger and much more productive ages of their lives, right, have absolutely no access to health care, right. This is not only a problem with India is a problem across the globe, everywhere. And all the low and middle income countries suffer from that challenge. Right. The the idea of health court was to try and see if we could set up a healthcare transformation Fund, which was leveraging technology to make health care affordable, accessible, and improve the quality of care. Okay, and that was the whole genesis of health one.

Michael Waitze 22:32
When did that start? It started in 2016. Okay, that’s a while ago as well. Yes. And can you talk about like what the progress is and what Health Cloud has been trying to do? Maybe some of the investments that you’ve made? And is this a, an LP GP fund? So I should say, a GP LP fund, so your general partner, but there are people that invest in the Fund, and then you invest in the companies? Yeah,

Dr. Pinak Shrikhande 22:53
that’s right. GP LP structured as a GP, which is formed this fund, it’s regulated under the Indian F category two rules, the Securities and Exchange Board of India. And what we did was we, you know, we were testing what was at that time, we really see the at that, at that point in time, the whole focus of healthcare investments in India was go big, invest in hospitals, diagnostic chains, pharma companies, you know, that was the focus. And at that point in time, there was a lot of skepticism around the fact that whether technology is going to be such a game changer in the future, everybody had, you know, there were a lot of companies that were mushrooming that were leveraging technology, but most had, at best a pilot, or a little more than a pilot in place. So there was in terms of traction, it was not such a big play at that point in time, what we decided to focus on, and hence we raised a very small fund, it was a $13 million fund, we ended up investing $35 million. But that’s that’s because as we started investing, more and more people gained confidence, right? In those models, and hence, we were able to, you know, kind of invest more. Our thesis was that we were leveraging technology to solve for these three fundamental challenges, accessibility, affordability, and quality of care. And we realized that, you know, if we were to make an impact only, there were two ways we can make an impact. One is we start bottoms up, where we invest in models, which were really targeting the most, most difficult sections of society, if I was to say to certain terms of their, in terms of their affordability or in terms of the accessibility, right, and then work our way up towards the top tiers. Now, that is one aspect and then the other aspect is how we start start with the top tier populations. But we make, you know, continuous improvements in technology to make it more and more affordable to reach the lower tiers. And I think with these two approaches, That is how we started looking at companies. And if there were models, which could help in either of those two ways we would invest in them.

Michael Waitze 25:09
So back in 2016, when you started, and it’s kind of a weird question, but were there companies already that existed? You said some of them had pilots, but were there enough companies there that were just waiting for people to notice that they were trying to solve this problem? Or did the existence of the fund itself encourage people then to take the risk to then build those companies in which you could invest? Or was it more like a combination of both, you know, what I mean, a combination of both of those things.

Dr. Pinak Shrikhande 25:34
So I think it was a combination of both of those things. So we were the first kind of health tech focused fund. So we there were many generalist funds, we also had a health tech arm, right, which were kind of primed to invest into such companies. So the ecosystem was very nascent at that point in time and was just starting to, you know, build out, I would not say that there were no companies there. Obviously, there was a pool of about six 700 companies, which were trying to, you know, wait, wade into the health tech waters. But, you know, none of none of them had shown scale, or none of them had shown the real proof of the pudding.

Michael Waitze 26:12
Right? You made an interesting point. And I just want to be really explicit about this, right? I believe you have to attack this from both sides. If you take the top 3% of wealthiest people that are getting sick, you can use that money then to develop very effective, like very sophisticated machinery and equipment to be able to serve them. That’s great, right? Because they can afford to pay for it, the big hospitals, the big clinics can afford to pay for it. But on the flip side, you have to then be able to take that technology. And I’m just going to use miniaturization as an example. Right, but miniaturize it so that then it becomes super affordable. So then the lower end of the spectrum can also be served. And somewhere in the middle, you’ll meet so that then everybody can get served. Does that make sense?

Dr. Pinak Shrikhande 26:54
Absolutely. You’re spot on Michael. Yeah.

Michael Waitze 26:57
And so have you raised the second fund and a third fund? And maybe how can you characterize like what the successes have been in the six years now that you’ve been running health quad.

Dr. Pinak Shrikhande 27:07
So the second, we’ve raised a second fund, we’ve already done an interim close of about 100 and $50 million, and we expect to be around 200 to 50 million by the end of the fund. I mean, by the end fund closing, which is in March of this year. And you will be surprised, you know, we started off with an expectation of a $75 million fine, right. And our first close was at 68 million. So we said, Okay, we’ll go to one 20 million, and we had such overwhelming interest that we had to take it to one 50 million, and at one 50 million now we have, you know, request to take it to 250 we have to put a stop at around 200. Because then it just becomes too tempting after that,

Michael Waitze 27:50
too. Why was there so Why was there so much interest? I guess there really two questions there. Why did the team think okay, we’ll do all these 70 as a proxy for 68? Because it’s the same number, right? But why was there this idea? Like we’ll stop at 70. But there’s this pent up demand for this right? Where’s all this demand coming from and why?

Dr. Pinak Shrikhande 28:09
So I think, you know, his health tech has been, you know, a sector which did not get the same attention as a FinTech in India. Yeah. Or, or ed tech now that you’ve seen that Health Tech has has kind of lagged behind FinTech in its in its ability to draw capital. The reason for that is that, you know, people were not seeing scales in Health Tech. Right. Now, what changed was the pandemic, the pandemic actually crunched about four years into six months. And and suddenly people realize that, you know, technology is the force multiplier, right? Technology can reach people where, even without physical barriers or any manpower challenges, you know, you use technology, and you can reach the right audience. So, that’s what, you know, drove the entire interest in health technology. But I think what also did help was the fact that we had demonstrated from our first fund that companies could scale,

Michael Waitze 29:17
right? What have you because you’re a doctor, right? And that’s a great thing. But like, you weren’t trained to be an investor, which is a completely different world. What kind of things have you learned from 2016? In the first one, which was 30 to 35 million. Now to be running a fun, that’s, I don’t know, 200 to 250 million, you know what I mean?

Dr. Pinak Shrikhande 29:38
Yeah. So I think a couple of things that we learned suddenly is that you know, one is the market has to be really large for the for the product has to be you you can’t play on on a small market. Second point that we learned was the promoter team. I think the passion and the and the enthusiasm of building a large business has to be promoted driven. And we really, really, you know, go into the details of, of all of that before we invest. So that passion needs to be really demonstrated by the founders because I think great businesses are built by founders. Yeah, agreed. And lastly, lastly, you know, we took some early bets very early bets in our first fund. And we realized that, you know, those companies were not ready to receive our kind of ecosystem or our help at that point in time, because they were just, I mean, there was just a big gap between what we were bringing to the table and what they want to take out a table. Yep. And and hence, we realize, you know, that there needs to be a certain, you know, at least traction, whether it’s revenue, traction, whether it’s its market, adoption, traction, that needs to be in place before we start looking at it from an investment perspective.

Michael Waitze 30:59
It’s really interesting. Once you again, gather all this data and get all this experience, the market starts to look very different to you. Right. And, and again, they’re equivalencies everywhere. Like, the way you looked at your 100th critical care patient was different than the way you did your first one. Because absolutely, you know what I mean, right? I still remember my first day. I was, I was shooting books. What do I do? Yeah, yeah, it can get pretty scary. Are there? Is any of this transferable outside? Because you mentioned before, right, Bangladesh, Nepal and northern India, I’m presuming you’re still investing in those geographies. But you said before, you know, Africa, the most of the content and of Africa, Africa is gonna have this problem anywhere where there are emerging market economies where there’s lack of access to what, you know, what are the words use, where medical care is not accessible? It’s not affordable, it’s not quality, right? Because you can have medical care accessible, but it could be terrible. Absolutely, you have to solve for all three of these things, other other places where you can then implement this model, or at least partner with people that are trying to build the same thing. And at least educate them about what you’ve learned over time.

Dr. Pinak Shrikhande 32:10
Yeah, so Michael, go in. This is an India focused fund. Yep. Our investments are in India. But what we believe is that the companies that we are investing in right now have applications or the products and services of those companies have applications across the lower and mid middle income countries, because the healthcare challenges remain the same. Yeah, they are not different. But I would go one step even further to say that they could actually also be applicable to the most developed nations, including the US because cost of health care, at 18% of GDP is non

Michael Waitze 32:46
sustainable. It’s it’s actually I was hoping you’d say nonsense. But yeah, non sustainable and nonsense, please go ahead. Yeah.

Dr. Pinak Shrikhande 32:53
So So, all of the companies that we are looking at, are looking to either or have already done so are looking to expand into new geographies outside India, because those models have hapless across the globe. I’ll give you a very small example. We we invested in a company called neuro synaptic communications, it basically, you know, if I was just describe you, that you had about 10 point of care diagnostic devices, which are Bluetooth enabled. And they measure physiological data in a suitcase, along with 30 Point of Care tests that you can do anywhere, and take it into the most remotest part of the country, or in the remotest part of Africa, where you get a 2g signal, right, and you will be able to actually have a full fledge video consultation on the platform because it is compatible for 2g consultation. Yeah. And the data from these devices can be uploaded onto the, onto the cloud. And it can be viewed remotely by a physician from anywhere across the globe. Right? So the company is already making its presence felt in Panama, in Peru, in Senegal, across across Philippines, Vietnam. So it only has a, you know, wide distribution Come on. But we’re looking at,

Michael Waitze 34:16
that’s the real paradigm shift in the way medical care and Critical Care is just going to be the things you said accessible, affordable and high quality. Look, I want to let you go. But I want to also have the opportunity to talk to the founders of some of these companies in which you’ve invested because it’s the best way for me but also for other people to learn about some of these changes that are taking place in the healthcare field. I mean, to be fair, you hear all this stuff about you know, FinTech and Agrotech and stuff like that. But, you know, health is something we deal with on a day to day basis. And, you know, you can die from it. Basically, I just love to have more conversations about this if you don’t mind. Dr. Pinak Shrikhande, a Director at HealthQuad. This was awesome thank you so much for doing this today

Dr. Pinak Shrikhande 35:03
it was my pleasure Michael and thanks for giving me the opportunity thank you