Dr. Kongkiat consults with hospital staff in Phuket, Thailand.
Hospital OS
Kongiat Kespechara is an internist and the founder of Hospital OS, whose open-source management software for hospitals and clinics is in use around the world. He is also the CEO of Bangkok Hospital Eastern Group. As Covid-19 spreads across Thailand, he is raising an army of volunteers to prepare the health infrastructure for the battle of a lifetime.
Dr. Kongkiat, when did the coronavirus show up in Thailand?
In January, we noted the early cases in Wuhan, anticipating 1-5 million Chinese tourists would fly in for the lunar new year. By February, we saw Thai tourists and overseas workers coming home from Japan and Korea as those countries faced outbreaks. Epidemiologists helped us analyze the pattern of the outbreak and came up with a predictive model for Thailand, pointing to a looming crisis. Thailand hasn’t seen an outbreak like this for many decades, and we’re not ready. Frankly, some doctors are afraid for their own safety. They know that Thailand lacks sufficient equipment and systems. My first priority became to protect and prepare our medical staff.
That’s a huge task. How did you begin?
We created our own world, separate from the government’s policy debates, press conferences, and daily updates. We are only interested in practical solutions. We set up a Facebook group called Thai Co Care—Co meaning collaborative. People of all backgrounds began to volunteer. For example, I found some industrial engineers. Normally, it takes three months and $150,000 to set up a negative-pressure room. I gave the engineers the specs and tasked them with designing a room that can be set up in two weeks for a tenth of the cost, and they did it.
We also developed apps to make the quarantine and reporting processes easier. Self-quarantine was cumbersome, requiring several phone calls and reports daily. We invented an app for self-reporting that feeds into a central dashboard.
Hospitals are complex organizations. What kind of support do you offer them?
Hospitals need practical solutions and action, not theory and statistics. Using Facebook, we created a video course on personal protection and patient management. It got 300,000 views in two days. We offered refresher courses for nurses on subjects like operating ventilators. We started a blood drive. Hospitals must continue to care for non-virus cases, like traffic accidents, workplace injuries, cancer, so we have to collect blood before infection is widespread. We’ve created a dashboard for the Ministry of Health to see the real-time status of every bed in the country dedicated to coronavirus patients. We produced it in three days.
By now, everyone has heard the phrase “flattening the curve.” What does the curve look like in Thailand?
We are at a junction, and it can go either way. The doubling of cases went from ten days to five days, and yesterday it hit three days. If we double every two days, we will face the same crisis as the U.S. Social distancing and quarantine are critical. But Thai has no word and no concept of social distance. These are new rhythms we all have to learn, a new normal. Some apps for medical staff we are adapting for the general public, like guidance and tracking on handwashing, social distance, quarantine.
So, there is also a need to educate the public…
Yes, but I don’t go before the cameras myself—I’m an introvert, not very good at public relations. I feed information, I consolidate and translate medical information for the public—this is often what I’m doing late into the night. Others can take the stage or appear on TV better, and I support them.
The 2004 tsunami killed 8,000 people in Thailand. Does Covid remind you of that event?
The tsunami was a huge disaster for Thailand, especially here in Phuket. But it was a single event that touched only half the southern coast. Covid is ongoing, widespread, dynamic, long-lasting. The government can’t begin to imagine how to deal with it. In Thailand, Laos, Cambodia, resources are scarce and the gap between rich and poor is very large. Poor countries will suffer.
Do you see any ways that Thailand will come out of this crisis stronger?
It’s possible. Thailand depends on tourism—20-30 million arrivals each year. The outbreak forces us to improve our infrastructure for sanitation and hygiene. I am reaching out to the hotel and restaurant associations. Sooner or later, even if it takes two years, the tourists will return, but we shouldn’t just slide back into old ways. Second is the volunteer spirit. I see many young people taking part—not just criticizing government, which accomplishes nothing, but finding ways to help.
Your email signature says, “Rise and rise again until lambs become lions.” What does it mean?
It comes from Robin Hood. We don’t have much money or authority, but we have the power to try and keep trying. We never seek donations of money; never say, donate first, then we will do something. I believe everyone has a good heart and the potential to make things better. Sometimes I sit in the conference call without saying anything, just listening and trying to support others’ positive energy. That’s the power of this other world we have created—it runs on people’s energy and ideas, not authority. I am happy to see that.
Dr. Kongiat Kespechara is an Ashoka Fellow since 2009. You can read more about his work here.
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