Everyone Deserves Healthcare

An Interview with Grace Garey

Grace Garey - co founder of Watsi, a nonprofit start-up founded by a former Peace Corps volunteer, is using crowdfunding to provide health care to patients in developing countries making medical care affordable and available to people in need. Watsi is the first nonprofit funded by seed accelerator Y Combinator.

In your blog you say you are “obsessed with the idea that connecting people will change the world.” When did that obsession start?

Very young actually, I grew up in Berkeley and went to a Montessori school whose tagline was ‘education for peace’. My dad was your typical UC Berkeley peace supporter and my mom was a high-school English teacher and focused on global studies. I was brought up with the belief that people matter. There are so many injustices in the world – we should be aware of them and be vocal about trying to push towards a world where people have equal chances to live a meaningful and happy life. So I became aware of this early on in life – the idea that potential is universal across every human being but opportunity is not.

I wanted my life to be about changing that so I went to college and studied political science and global international studies. I started traveling and studied abroad in Ghana and studied refugee issues.

So how old were you when you were traveling and studying this?

I went to Ghana when I was 20, my senior year in college and lived there for about 8 months. I studied post conflict peace building and transitional justice at the University of Ghana. While I was there, I had the opportunity to assist on some research at a Liberian Refugee Camp in Ghana to determine what these refugees were doing for money, how they were educating their children, and how they could live “normal” lives in a very abnormal and difficult situation. When I came back from Ghana and that experience, I realized that some of the positive things I got out of it were to really see what a lot of brilliant and inspiring people were doing to try and solve some of the world’s biggest problems; poverty, access to capital, major conflict.

I was exposed to some of these big scary problems and was on the front lines of what could be done to solve them. So the next step was how to rally more support for these challenges; I took a quarter off from school and went to Washington DC for an internship at an international humanitarian non-profit called the International Rescue Committee where I worked in their Africa advocacy department. Their goal was to convince the US government that these are really important challenges and that we should be investing in making sure people around the world have a safe place to live, access to food, clean water, and can be assured of some basic human rights.

Again, I found myself really inspired by these amazing, really smart and motivated people who were trying to make the world a more just and peaceful place. I also felt that a lot of their efforts were trapped in an infrastructure that defined the way they could seek resources, and send them to people who needed them. It honestly resulted in me feeling a little bit helpless. I wanted to make a big impact on a lot of people and I could not see the best way for me to do that, or for anyone else for that matter to do that effectively in the systems we have set up. So the humanitarian aid world was very important to me but it felt like throwing buckets of money into a black hole. You had one amorphous group of people sending a resource to another amorphous group of people. I had the incredible opportunity to meet the people on both ends of that – they just weren’t connected to each other that felt wrong to me.

Frustrating I am sure and also something many people feel conflicted about when contributing to a non-profit or important cause; asking ‘where is the money really going?’

Yes, so I came back, finished school and graduated without knowing what my next step was going to be – I figured I should just keep trying something new. This led to another internship at an organization called Kiva which runs a website where people can fund micro-loans for individual entrepreneurs all around the world to help them start or grow a business. It was at Kiva where I got really excited about how technology could make some of these massive changes happen on a really large scale, while powered by individual people.

At the same time I became convinced that maybe individual people are actually the most powerful change agents that the world has to offer. When my friend Chase Adams got back from the Peace Corps, he started talking about this idea that was like ‘Kiva for Healthcare’. He got the idea while serving as a volunteer in Costa Rica; a woman boarded a bus he was on and asked the passengers for donations to pay for her son’s healthcare. The experience inspired him to start some sort of website or crowdfunding platform where donors could come together to fund something more fundamental and crucial than anything else – healthcare. It was called Watsi named after a very small province in Limon Costa Rica, the town Chase was traveling through at the time of this idea. I started working on Watsi with Chase and this rag tag team of volunteers that started forming around it to help. We put in late nights and weekends alongside our day jobs. We were spread out all over and kept in touch weekly through Google Hangouts.

You were all in different parts of the US?

Actually, we were all over the world where at one point we were working on Watsi across 6 continents and 8 time zones. It was pretty crazy.

Wow, that must have been fun to coordinate calls?

[laughs] Yeah! I was working at Kiva in a marketing role while I was working on Watsi on the side. At Kiva, I ended up launching an education outreach program that is now called KivaU. This was a really big confidence building experience for me. Kiva was an organization I really admired and loved but I had never really done anything before and didn’t have any real experience since I was fresh out of college. I wanted to make an impact but didn’t know what I was supposed to do so I took a moonshot and proposed creating a program that supports the idea of helping a lot of people around the world AND start businesses in the process. I pitched it, and to my surprise, people at Kiva were really excited by it! So I was allowed to pilot this KivaU program that has now been running for 2 years by a full time staff and has generated millions of dollars of loans on Kiva platform.

That must have felt like a great sense of accomplishment…to take a risk and have it play out like that?

Yes absolutely. So after launching KivaU I sort of ended up sort of all over the place. This is where if I could give one piece of advice is that it is OK to have a non-linear path. I mean for me, I went from Kiva, to Watsi on the side, and then got a fellowship to live in a hospital in India for four months over the summer to build out the micro insurance program there. At one point I was waking up 5am in India, to get on these Watsi Google Hangouts to plan how we wanted the website to look, reaching out to hospitals we thought might want to partner with us…it was a crazy time in the early days.

Sounds like it was hard being all over the world and trying to do a lot of different things. Did it feel like you had a purpose and a goal that kept you going?

The one thing looking back, was that I believed Watsi should exist in the world – that everyone deserves healthcare and that it’s going to come down to individual people to create the world we want to live in for the next 100 years. Technology has made it possible to do that. We can connect with humans on the other side of the world and an aggregate of that can make an unprecedented difference. I latched onto this idea and vision that this is going to happen for healthcare. Where in the next 5 to 10 years the entire world is going to come online and it’s going to change the way we think about everything. Somebody is going to use this to change the way people get access to healthcare in the world and I wanted to be a part of making it happen, and shape what it looks like because I think that is really important too.

“…everyone deserves healthcare and that it’s going to come down to individual people to create the world we want to live in”

What a great vision, Grace, and I agree about the importance of being involved to influence it.

Yes, so once we sort of decided that, we didn’t have any money to work on this and no one is going to pay us to do it so we had to find a way to make it work. SO we sort of worked backwards – this was going to happen, and we are going to find a way to make it happen. Whether we were on 6 continents, or 3am Google Hangouts, or working sneakily while we were supposed to be working on other things for our day jobs, we were just going to make it happen.

Other than meeting Chase and discussing it, was there a certain thing that attracted you to Watsi and got you motivated to keep working on it on the side?

I think it was the idea that we could connect people in a different way and the fact that it could have a really big impact. The second I heard about the idea while I was at Kiva, I wrote Chase this really embarrassing message on LinkedIn telling him who I was and that Watsi was exactly something I was looking to start and would he meet me for beers. So we met up for beers in San Francisco one night and ended up talking for 4 hours. I convinced him that I needed to be a part of doing this with him.

Beyond the funding you provide for medical care in developing countries, are you guys involved in connecting the medical personnel or assisting medical agencies to the regions in need?

We learned about some of the ways we were helping these health systems in the areas where Watsi works and grows tangentially. One of the things I asked when I first visited a Watsi hospital partner was ‘should we be doing anything else? We are covering the cost of care for your patients where our donors are funding healthcare; should we also be funding infrastructure projects? Buying a new ambulance or surgical wing? How can we be the most helpful?’ I was really surprised that the heads of these hospitals told me ‘No, don’t do anything else, you are funding the core product of our hospital.’

Most hospitals in the developing world have a dual mission. First, is to provide high quality healthcare, and second is to provide that healthcare to people who really need it. [The trouble is] if you are providing healthcare to people who really need it, it’s unlikely they can pay the fair market price for it. If people can’t pay the full price of the healthcare, you can’t afford to provide them with high quality healthcare. So these hospitals get caught up in this really nasty cycle where they are either in the red covering the cost of care for patients who can’t afford to pay themselves, so they can never invest in growing more hospitals in their health system OR they are just turning patients away all the time. So Watsi is displacing all this money that they used to spend on being able to just say yes to patients and allowing them to invest in things like infrastructure.

Another way we are helping them, is we do really deep dives with all of our hospital partners on the cost of care they are providing. So they are looking at their own operations and efficiency in a really different way. They’re thinking about things differently, like patient follow-up. For many of them, we are the first electronic “medical record” they have ever had, so they are able to look at things like when they treat a cardiac patient how many have to come back after heart surgery because of complications, and how they can do better on that. We have had hospital partners ask us for introductions to other partners in our network who have a certain expertise they don’t have. So there is also this information sharing going on, creating networks of health systems where they didn’t exist before, which is really exciting.

That’s fantastic and goes back to your idea of connecting people all over the world and getting the right resources where there is a need. Leaving a paid job to go to work for a non-profit must have been a risk? Did you have any doubts about making the move or were you always confident that Watsi would do well?

I always believed Watsi would do well and was important in the world. But in the early days it was sort of this abstract belief. It was something we constantly hammered away at and it was on the back-burner of all of our lives. When we finally launched Watsi we sent out a link to Watsi.org to all of our friends and family and posted on social media and we were so excited that this idea is out there and it’s going to be great… and nothing happened.

Right, the famous cricket sound…

Yes, I mean like my mom donated and Chase’s mom donated and we were like, ‘hmmm, ok, this is it,’ and then we posted a link on a website called hacker news, not really expecting anything, and we shot up to #1 and stayed there all day where we saw about 19,000 people on our site. People fully funded every single medical treatment we had posted. I was at my day job at the time in New York and had to leave work sprinting through Manhattan to get home because we were out of patients on the website and trying to contact all of our medical partners to tell them.. ‘hey, this thing is working, we think we can fund more of your patients! Please send them to us!’ At that point, every single patient profile on Watsi was hard coded into the site. Hospitals would send me a word document with a photo attached and I would write a patient profile. Sometimes in the early days when things were going crazy, I would write patient profiles from the bathroom of my day job, send them to Jesse – our engineer – so he could hard code them onto the site where people could donate.

“hey, this thing is working, we think we can fund more of your patients! Please send them to us!”

That’s great. Some sites are so automated it feels a little impersonal. It sounds like a lot of what you were doing early on was very manual and labor intensive which made all the difference I imagine?

Oh completely. It was a choice we made too. I think there are two ways you can create something that has never existed in the world. You can sit on it for a long time and wait until everything is perfect. You have these really robust systems in place, and everything is automated and polished, then release it and hope it succeeds. We took the opposite approach and wanted to build the minimum viable product (MVP) in the world, put it out there and see if anyone is interested in this thing. [Then we could] get feedback and build from there, knowing we were building the right things. No matter how manual things were in the early days – and in many ways they still are – if you had asked me to design the perfect system and build the perfect Watsi two years ago when we first launched it, I would have done everything wrong. We made all of the mistakes we made because we had to make them.

Credit: Lisa Wiseman

Is there a big difference working for a non-profit vs a profit company? For example, you’ve had some amazing investment. If you received that investment for a company that was designed to make profit and you didn’t get investors a return on their money then potentially the startup could close. So is working for a non-profit more relaxed or is it actually more stressful because of the importance of the work?

That’s a good question. We are a non-profit and that’s in our legal structure and I think that is where the definition really ends, besides the fact that we have a social mission at our core. We really run Watsi like a startup. That is something that we hold ourselves accountable to, both internally and with all the people that have donated as part of Watsi’s overhead. One of the things that makes us really different is that 100% of every donation on the website funds healthcare and we don’t take a cut, so that was really interesting in those early days when we were processing lots of donations, none of those donations were going to pay our costs, or salary, we were all sort of trying to hang onto this thing as volunteers despite the fact we were succeeding. So Paul Graham was the first person to write us a check, he was the founder of Y-Combinator. He sent us an email out of the blue one day just asking us if we wanted to meet, wrote our first check and invited us to be the first non-profit to join a startup accelerator he founded called Y Combinator.

That was when I quit my job in New York, Chase quit his job in San Francisco and Jesse quit his job in Portland and the three of us moved into an apartment together in Mountain View to do this startup accelerator and go all in with Watsi.

That’s a great startup story.

Yeah we went through Y Combinator and grew Watsi significantly in the first 3 months and for the first time we could all go all in. In the first couple of months we grew to 10 medical partners, processed tens of thousand of dollars in donations, and started to automate some things. At the end of those 3 months we looked around and were accompanied by all these for profit startups and we had been growing alongside them really aggressively. We knew they were about to go out and raise millions of dollars. So we were like, ‘well, why can’t we can’t do that too?’ Most non-profits live this life where they are sort of perpetually fund-raising and you can never completely focus on your mission because you are constantly worried that you’re going to die. So we decided to try raise what we called a philanthropic seed round. We would fund raise for a distinct period of time, then we would stop and get back to focusing on making Watsi great and on helping as many patients as we possibly could.

Seems like you guys had a well thought out strategy in place. Looking at the list of people who have invested in Watsi, it’s quite an incredible group. Why do you think Watsi captured their interest?

I think a lot of it comes back to the same things that originally inspired me to work on an idea like this. These are people who have grown up and spent a lot of their lives on the internet and they are excited about the idea that technology can introduce a layer of transparency in our lives and make the world a lot smaller and enable us to really get to know the people on the other end of our support. A lot of them have had this want to do something really important and positive in the world for a long time. Talking with a lot of these people, they just really didn’t know where to start. They could give a lot of money to X organization, or Y organization, but how do I know where it’s going to go and that it’s helping people? I think that the way we have run Watsi answered a lot of those questions for them.

Another thing I think they liked is that what we pitched to them was the same pitch they heard from for-profit companies. I mean, this was working… there are people all over the world who want to donate and who want to help other people get access to healthcare and all we need from you is help to scale this. I think that was a really attractive idea to them – that they could be a part of scaling social good the same way they would scale a for-profit venture.

How do you make money or fund operations? Is there a model where at some point it will allow you guys to self sustain Watsi?

Being self sustaining is really important to us in the long term. Right now, when you donate to a patient on Watsi, you can give an optional tip to our overhead. So right now, with very little optimization we are getting about 8% in tips to fund our overhead, which is great. Kickstarter, as a for profit, get 5%. So I think that what is says is that if you are really open and transparent with people about where the money is going, then they actually want to support the organization. There have been a lot of really worthy conversations in the non-profit community how it’s really not fair to skewer a non-profit for taking a cut of donations to pay for their salaries. It’s important for a non-profit to do that and I completely agree. Our rational to always have 100% of every donation support a patient is that we are not just about funding healthcare for as many people as possible.

We are about connecting people, and it’s important if you donate $5, $50 or $500, that every single cent of that donation goes to the actual person you look at on Watsi. I think people appreciate that and they turn around and want us to be able to do more of this. So at scale that will be enough to sustain us so we can maintain that 8% and maybe drive it up a little bit.

You have been at Watsi for a little while now – does it satisfy your goal of “changing the world by connecting people” or do you have bigger plans?

That’s a good question. The exciting thing about working on Watsi is that I feel like my job changes every week. Everything I’ve done in the last couple of years working on Watsi is something I’ve never done before. What I am asking of myself and of each other is fun and we keep sort of transcending. One of the things I love about Watsi is that it is unequivocally good. I feel like I can scoop everything out of myself and pour it into this because every single additional patient we are willing to help means so much to me.

That is awesome Grace, what a huge motivator!

I can see myself doing this for the rest of my life because I know that it will never be the same thing. I think that what gets really exciting for me is the idea that pretty soon all of these patients will be coming online too. A lot of my job right now is to understand both sides of the groups of people who are coming together. We want to understand the people we hope will donate on Watsi, and understand the patients and the hospitals, and act as a connecting force between them. What I am really excited for is when we are facilitating a connection between two groups of people and we don’t have to do so much storytelling and communication because [the patients] can just do it themselves. That is something that is going to really change my day to day in the next couple or years and it’s really exciting to me.

I can hear it in your voice. Finding your passion and loving what you do – finding happiness in your work seems rare these days. People want that and say that but to actually live that every day is a great opportunity.

Has there been a specific experience or really memorable moment you have experienced at Watsi that stands out?

There have been so many. Something that I think everyone tries to do when starting a company or organization is you decide how it’s going to work and sort of decide on “the rules”. Then the idea moving forward is to keep these rules in line, so when X happens we do this and when Y happens we do this. We have this sort of ideal process for every patient that comes through Watsi; we post them on our website, they are funded, they receive treatment successfully and send out an update to all the donors and that is just how it goes.

The first time we were really forced to break out of that pattern and I really got put on the spot to think about what Watsi’s role was in all of these connections was when we funded healthcare for a boy named Aman in Kenya. He had a brain tumor he needed removed and it was very serious. It was one of the most memorable stories we have ever posted on Watsi because he spoke very candidly about what his hopes and dreams were for the future and what he was scared about. His parents had been trying to find a place where he could get treated for months and they kept getting turned away because they couldn’t afford to pay. So finally we posted him on Watsi and dozens of donors from around the world fully funded his healthcare and he received surgery. When they went in to remove the tumor the Doctors realized it was a lot more serious than they thought and were worried It might be inoperable. So they closed him back up and his Doctors came back to us and said they didn’t think it would have a good outcome.

Normally on Watsi we post cases where there is a relatively high chance of success,and we had never posted a patient twice on Watsi before. So we thought about this and said that this really wasn’t how Watsi works and we were not quite setup at this stage. We are a bunch of twenty something kids just trying to connect donors and patients around the world. We were not setup to commit to funding people’s healthcare for life. Would donors even fund this if there is not a good chance that Aman is going to survive a second surgery? [Were we] building this shiny, perfect, very grown up organization, where we make rules and stick to them and just try and grow OR do we really treat every human being as a human being (of course we do but this was a challenging circumstance). Every donor is coming from a place where they have a story and a reason they are connecting. Every patient is coming from a place where they have a history and a future – should we just leave it up to them to connect with each other and hopefully change each others lives?

We decided we were going to take the humanistic route and so I told Aman’s doctors that if they thought there was a chance if they operated on him again he will be OK, we would post him again and will cover the cost of it no matter what the outcome is. So we posted him again and emailed all his donors and told them how his first surgery went and it’s looking a little scary but we think that like anyone else in the world he deserves a chance. He had the second surgery and it was this miracle moment – it went well. It’s now a year and a half out from that and he’s finishing high school and living a normal life in Kenya. That story has become one of our values now when we are presented with decisions that seem overwhelming.

“We are a bunch of twenty something kids just trying to connect donors and patients around the world.”

Credit: Lisa Wiseman

Not only are you this entrepreneur with a passion for this but you are also an advocate to help someone you may never meet to make a difference. Has the Ebola outbreak placed more pressure on Watsi?

We haven’t funded any Ebola patients. None of our hospital partners have submitted them and I don’t know how hard they have been hit. The thing that struck me most about this crisis is how important it is to invest in health systems that are prepared to handle something unexpected and catastrophic like this. Somebody has to be willing to step in and say we can help you out, but it would also be great if we made this ongoing commitment that there would [always] be somebody there to help you. I think the scary thing about the Ebola situation was that people were going for help and there wasn’t anyone who could help them. There wasn’t enough funding to enable these clinics to treat patients and stop outbreaks because there hadn’t been any commitment made beforehand.

This is something we believe is important and you can’t build a health system in a day. If issues come up today and you want to fix them tomorrow, you have to start building now. With these issues we’re going to see in 5, 10, 15 years, I think that investment [now] is really important.

I agree. It amazes me when you watch the news, the difference between care in the US vs Africa where you see Ebola patients in tents with no running water and laying next to each other on cots and dirt, mud floors. And we fly a single person back on a private plane, private ambulance ride and have a quarantined room at a hospital. It’s quite a contrast.

Yes, the difference is unbelievable and I remember asking a doctor at our hospital partner in Cambodia why he thought it was important that everyone has healthcare, even if they can’t afford to pay for it, and he looked at me and said, “because they are human.” We are all people and that is where we have to start from.

How can our readers get involved? We are trying to connect people with people, causes and events that are doing inspiring things and making a difference?

The most direct action anyone can take is to support a patient on Watsi. You can donate as little as $5, and 100% of that goes to the patient. It can make an enormous difference in their life. The second thing is to help us spread the word. We are still a really new organization and it feels like we have done a lot so far going from $0 to $3M raised for patients in two years. This is great, but we need people who think this is a good idea and that this matters to tell their friends and their families and help us think of creative ways to get the word out.

OK, we can definitely do that. We are not huge but seeing some growth and this is something we want to let our fans know about.

Thank you so much Grace for your time and your story. What you have done is so inspiring. Excited to share this and tell more people about Watsi.

No problem Christian, thank you as well. Look forward to hearing more about you guys too, and any help with Watsi would be awesome.

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