Short Takes: Bringing Affordable Medical Imaging to Botswana

Nita Bhagat: But every time he was having treatment, he kept saying to me, “Why aren’t you doing this? Why are you not doing this? Why am I paying so many hundreds of pounds when I could be paying in pula?” So the question started popping up as to say, “Why not?”

Darius Teter: Welcome to Grit & Growth from Stanford Seed, the show where Africa and South Asia’s intrepid entrepreneurs share their trials and triumphs. This week we continue our Entrepreneurs in Their Own Words series with Nita Bhagat, director of Village Imaging in Botswana. Nita and her husband came to Botswana in 2002 as economic refugees from Zimbabwe. In the 20 years since, they’ve done incredible work to fill the gaps in the country’s health care system. We’ll hear how Nita went from hotelier to owner of a radiology practice and how her father’s fight with cancer led the company in an ambitious new direction.

Nita Bhagat: My name is Nita Bhagat. I live in Gaborone in Botswana. I run a company by the name of Pronto Investments, although we trade as Village Imaging. Village Imaging is a radiology practice with the first MRI scanning facility in the country. Up until 13 years ago, we didn’t have any of that. And it has grown unconventionally backwards, because normally radiology practice starts with small things like X-rays and ultrasounds and goes up to MRI. We did it the other way around and also not in a hospital environment. So we’re in community. There are no beds. So it’s an outpatient facility.

Darius Teter: So doctors refer patients to you with a scrip and you do the imaging and you send the imaging back to the requesting physician or hospital?

Nita Bhagat: Exactly. We do that. To date, actually, we have about 200 referring doctors sending patients to us. And we see in the region of 14,000 to 15,000 patients a day, which sounds like small numbers, but for Botswana it’s quite a good, busy practice.

Darius Teter: Just a quick note here. Nita actually meant to say 14,000 to 15,000 patients per year, not per day. So that doesn’t sound like a small number to me. I’m curious. Botswana’s a middle-income country. How is it possible that 13 years ago this technology wasn’t available?

Nita Bhagat: Basically, you must remember the medical background of Botswana was the fact that we were ravaged with HIV and AIDS in the eighties and nineties. So the focus was always how to prevent HIV and set up the antiretroviral program. So although we are a middle-income country, it’s also a huge country, so widely spread out. So medical services are not available to all the population, and diagnostic imaging wasn’t really at the forefront.

MRI scanning, as I said, wasn’t available here. And what was happening was, I’m not sure if you know, but Botswana is very unique in Africa with respect to medical care. So all citizens are afforded free health care in this country.

Darius Teter: Oh, my god. That’s socialism. I’m just kidding.

Nita Bhagat: Which means, literally, that if you, for instance, were living in the central district in Botswana, which is 250 kilometers from where we are, and your doctor deemed that you needed an MRI scan, you would be transported with a family member all the way to South Africa to have that scan at the cost of the government. And you can just imagine what the cost is.

Let’s say a cost of the scan is about $400, but the cost of transporting you and your family with an overnight stay with two members in an ambulance and bringing you back was just costing the country so much more. The country obviously didn’t have the expertise of a radiologist that could read MRI scanning. That’s number one. You need that. So we put together a proposal that we would service government patients to stop them having to send them to South Africa. And it was a double whammy because we knew that we would get the business, as it were, but also service those patients. So the motivation was to say, “Those government patients will come to the only MRI scanning center in the country.”

Darius Teter: So I’m curious why you started this business. Are you a doctor by training or by background?

Nita Bhagat: No, not at all. I am actually a hotelier by background and training. I happen to be married to a cardiologist. We moved from Zimbabwe to Botswana in 2000. When we came here, he just said, “Why don’t you help the front offices just like helping hotel guests, but they’re just sick, and do your front office skills in my clinic?”

So it was a very clear, persuasive way to get me into his offices and work with him. And working with him, we realized there was a niche and there was a market and there was a need for quality radiology. So I actually learned everything about MRI scanning, from what it does and who I should buy it from and who actually reads these reports. And I’ve learned more and more along the way. So I’m no longer the receptionist anymore. I’m a business owner.

Darius Teter: Interesting. Because it’s not exactly a well-trodden path from hotelier to radiologist.

Nita Bhagat: As a consequence of learning — my 13 years of learning within radiology — I’ve also learned a lot about cancer. And two reasons. One, my father recently passed away from cancer, but secondly, I was introduced to cancer screening technology for women and breast cancer that was invented at Drexel University and manufactured in India. So I started to learn more and more about cancer. Obviously, it was also to do with my father and his treatment and where he could access treatment.

Darius Teter: So, first, I’m really sorry to hear about your father. My mother also passed away from cancer and it was a long, miserable process of the disease progression. When your father had to get these treatments, so he was traveling to South Africa, or what was he doing?

Nita Bhagat: He eventually had his treatment done in the UK, and he could afford the best treatment. And that’s where we saw the disparity because, although he could afford the best treatment in Botswana, it wasn’t necessarily available. But every time he was having treatment, he kept saying to me, “Why aren’t you doing this? Why are you not doing this? Why am I paying so many hundreds of pounds when I could be paying in pula?”

So the question started popping up as to say, “Why not?” I started seeing more and more, and obviously, as you well know from your mom being ill, you start to learn and to research yourself what is available, what’s the best treatment, etc., etc. And everywhere I looked, it seemed like cancer treatment was just looking at me and saying, “Open the doors for me. I need to get into Botswana.”

So it’s the first radiation oncology center in Botswana, which will be based in the community. And we have partnered with a seasoned oncologist, who has been working in Botswana for the last 20 years himself. And we are currently looking for a third technical partner as well as a partner that may want to put in some money into the project, someone that will bring value to the business. Not just financial value, but technical value from a medical perspective, but also from a business perspective.

I think one of the things that I hear in your podcast — it’s a theme that seems to follow through — is that leaders are pretty lonely. And having a partner in a business who can really kind of poke holes in your idea, as much as you don’t want it to be done, helps in the long run of your business.

Darius Teter: And we have a saying we use a lot at Seed, that feedback is a gift. Something I have to remind myself sometimes because when you get defensive you’re like, “Okay, it’s a gift, but it just landed right on my foot.”

Nita Bhagat: So why oncology and why in Botswana at this stage, when we have such a small population? According to oncologists in the country that I’ve spoken to, they’re looking at a 20 to 25 percent increase in the number of cancer cases in the next five to 10 years. And how many radiation oncology centers do we have in this country? We only have one, and that one center has been open for 20 years. So the need for radiation oncology is now.

So the potential from a business perspective, yes, is high, but we mustn’t forget we are in the business space of treating people and saving lives. And that’s where both our government and private sector have fallen down with respect to cancer patients. Cancer patients, by the time they are actually received and have been diagnosed, they’re already in stage three or four of their treatments, at which time you’re basically just giving them palliative care.

We want to collaborate and work with institutes — like in Botswana, we have something called the Botswana Harvard Partnership. Historically, they’ve worked with HIV patients, but lately in the last six or seven years, they’ve been working with cancer. We’re doing a study for patients who have HIV and have been diagnosed with breast cancer, and we are doing a study with them on the heart because apparently chemicals that are involved in antiretroviral therapy are having an impact on the heart.

Plus, chemotherapy also has an impact on the heart. So we are actually doing a study with Botswana Harvard for 50 women before they start chemo and after they stop chemo. So we want to tie up with these kinds of institutions so that it’s a holistic approach. It’s not just a business perspective. It’s treatment as well as getting facts and research out there so that these prestigious institutions can come back and give us better treatments for this part of the world.

Darius Teter: There’s a couple of thoughts that come to my mind. The first of all is that the patients that you’re dealing with are some of the most sick and in-need people. They have HIV-positive, they have extra complications, more likely to get different types of cancers. You’re talking about a specific population of women that are both HIV-positive and have breast cancer. These are very serious illnesses. Does it give you a sense of purpose to work with these populations?

Nita Bhagat: Yes, because I’m not a medic. So for me to see a patient who looks like they’re 60 or 70, but actually are 40 years old and are really sick and are brought in on a trolley just to get an MRI scan, I’m not trained to not have empathy. As a medic, you’re trained not to look at it that way.

So for me it’s like, “Get this patient in and let’s not get them to suffer any longer.” Botswana is a population of 2.3 million. It’s criminal to not get our population well. We don’t have that many people to look after. We are a middle-income country and we should not not be looking after our people.

Darius Teter: Do you have ambitions to bring these lifesaving treatments to neighboring countries?

Nita Bhagat: Absolutely, Darius. Absolutely.

Darius Teter: So tell us a bit more. What’s the vision? Tell me a bit more about the big vision.

Nita Bhagat: Village Imaging lives in a center called Village Medical Center. Village Medical Center is just a group of medical people who work well together — dentists, psychologists, laboratory people, radiology people, cardiologists — and work well. They complement each other. The vision has always been to take this model throughout Africa, particularly West Africa.

East Africa is very well-known for their medical health sector. So East Africa’s well-populated in that. But to take it to West Africa, to take it to places like Zambia, Namibia, Mozambique, Malawi, these kinds of places. Because what happens is that, in the medical space, people think about building hospitals. Building hospitals are huge investments with huge overheads. So why take that when actually the American model is very similar to what we are doing, that you try and take the system out of the hospital and do as much as you can in community.

Because the more you can do in community, the better patients are because they can go back home, and they feel better psychologically. But we’ve always felt that you have to show that you can do it in the place that you’re living in before you can start putting it somewhere else. So there’s no point in me starting Village Imaging Kampala if I can’t show that I have done Village Imaging Gaborone.

Darius Teter: I love hearing Nita’s journey, how her personal experiences have fueled her professional life, even as an outsider to Botswana in the medical field. When she worked in her husband’s practice, she learned about radiology and she found a systemic gap. And when her father was sick and treatment options limited, she set out to build them herself. She uses her curiosity and empathy in service of her community and the results speak for themselves.

I want to thank Nita Bhagat. Since we spoke, Village Imaging has continued to fill health care gaps in Botswana. In October of 2022, they unveiled a mobile cancer screening program, housed in a truck, that brings mammograms, ultrasounds, and X-rays out of the clinic and into the community. And while Nita is still seeking investment partners for their next phase, she’s forging ahead. The new Radiation Oncology Center is set to be finished by April 2023.

This has been Grit & Growth with the Stanford Graduate School of Business, and I’m your host, Darius Teter. If you like this episode, leave us a review on your podcast app. It really helps us to share the stories of these incredible entrepreneurs with as many people as possible. To learn how Stanford Graduate School of Business is partnering with entrepreneurs in Africa and Asia, head over to the Stanford Seed website at seed.stanford.edu/podcast.

Grit & Growth is a podcast by Stanford Seed. Erika Amoako-Agyei and VeAnne Virgin researched and developed content for this episode. Kendra Gladych is our production coordinator, and our executive producer is Tiffany Steeves, with writing and production from Andrew Ganem and sound design and mixing by Alex Bennett at Lower Street Media. Thanks for joining us. We’ll see you next time.