FRANK HOFFMAN and STEFAN WILHELM DISCOVERING HANDS GERMANY, ASHOKA FELLOW 2010 https://www.ashoka.org/fellow/frank-hoffmann http://www.discovering-hands.de/
PROBLEM Breast cancer is the most frequent cause of death for women between 40 and 44 and is the most common type of cancer for women between 25 and 74. There are 58,000 new cases and 18,000 deaths every year in Germany alone. One out of ten women suffer from breast cancer within their lifetime.The mortality rate from breast cancer depends largely on early detection. Halving the time between the emergence of cancer and its detection typically doubles the survival rate. In Germany, preventive breast cancer diagnosis is either offered through mammography—which is expensive and therefore only routinely available for women over 50—or a superficial manual breast examination available to all women, performed by doctors who do not employ a standardized technique. As a result of the impersonal and often stressful experience, many women choose not to undergo preventative diagnosis, increasing the risks and the treatment costs.
IMPACT More than 24 Medical Tactile Examiners have been trained and are currently working in various clinics around Germany using Frank’s system. Preliminary qualitative research on 450 cases shows that MTEs detect 30% more and 50% smaller tissue alterations in the breast than doctors (5-8mm vs. 10-15mm). Over 10,000 examinations have been carried out to date. At 30 EUR per breast exam, Frank’s model costs four times less than a mammography. Yet, Frank does not propose his model as a substitution of mammography, but as a complementary, cheaper and less harmful (radiation free) tool. The 30-minute breast examination, as compared to the usual 1 to 3-minute medical exam, gives women more time to ask questions and feel reassured about their health. MTEs’ role goes beyond detection as they accomplish other daily tasks of a full vision medical assistant, including the maintenance of medical records.
ROADMAP FRANK HOFFMAN
SOLUTION Frank is tapping into the neglected resource visually impaired women have: a far better sense of touch. He pioneered a diagnostically superior, personal, low-cost breast examination method by training blind people as skilled diagnosticians, or Medical Tactile Examiners (MTEs). Their superior sensitive touch gives them a higher precision rate and enables them to detect breast cancer earlier than the average doctor. In 2006 Frank designed and patented a standardized system of orientation for breast examiners based on braille strips. It consists of five adhesive strips placed around a woman’s breast with both braille and color coordinates that allow any abnormality/lump to be pinpointed by two dimensional coordinates. This allows blind women to carry out breast examinations with complete autonomy. Then, the MTE reports to the doctor as an assistant, not a replacement, and their examination feeds into the doctors ultimate diagnosis. When an abnormality is located, the doctor proceeds, most often with ultrasounds and mammography. The training curriculum includes a 9-month theoretical and practical program. The examinations can be paid through the existing health insurance system, thus making it profitable for every doctor able to return license fees to Discovering Hands®. In addition to enhancing women’s health care experience, Discovering Hands’ approach fostered an unprecedented integration of blind women into the primary health care infrastructure, opening an entirely new professional path.
VISION Frank has always looked for opportunities to improve existing systems that solve social and health problems. His aim is to raise awareness and spread preventive health behaviors in order to improve the quality of life of patients and raise the effectiveness of the health care system. Through his program, he goes beyond labor market inclusion
of sightless women and the promotion of prevention as a tool to fight breast cancer. Frank also helps full vision patients become aware of blind people’s unique capacities, turning blindness, often considered a disability, into an asset.
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ROADMAP FRANK HOFFMAN SCALING STRATEGY The scale up model of Discovering Hands® follows a social franchise model. The strategy has already been piloted in Austria and is currently being implemented in Colombia, and Frank and Stefan are in conversation with partners from other countries in view of further expansion. This scaling strategy involves transfer of knowledge, training of trainers, continuous follow-up and support, as well as provision of the methodology to be used by franchisees. SHOWCASE
FIND PARTNERS
SCALE
MEASURE LOCAL IMPACT
SCALING DISCOVERING HANDS Following a series of meetings with interested potential partners, Stefan also participated in Ashoka Spain’s event “This Works” held in the Spanish Parliament on March 9, 2015. On that occasion, he discussed with ONCE Foundation, an ideal potential partner who also showed interest in the model. They are currently waiting for the results of the clinical studies to be published in summer 2015 in order to continue the conversations and create a local roadmap from scaling the model in Spain.
SCALING DISCOVERING HANDS On 26th February 2014, Discovering Hands participated in “Innovate to Restart” event, an international conference organized with the support of the Robert Bosch Foundation and other local partners. Stefan was matched with Italian advisors from the Impact Hub (Marco Nannini & team) and Ashoka Italy (Samir De Chaderavian), who helped them to find local partners and collaborators to replicate Discovering Hands in Italy. Initial discussions were held with a Milan based training centre and the San Raffaele Hospital. The team of advisors are also in contact with other potential partners, such as AIRC, ASL Milano and counselling centres, Lega Italiana per la Lotta contro i Tumori, Gruppo cooperativo CGM, Istituto Clinico Humanitas, Dialogo nel Buio, Istituto dei Ciechi di Milano, Lega Tumori, Fondazione Pangea Onlus, Mangiagalli, Associazione Italiana Terapisti Occupazionali, Istituto per Ciechi Sant’Alessio, Rome, I.Ri.Fo.R. To study the demand and the needs of the Italian market a feasibility study will be completed by a Master class SDA student at Luigi Bocconi University by fall 2015. In parallel, Discovering Hands will also publish the results of the clinical studies conducted at the universities of Essen and Erlangen in Germany to analyse the strength and impact of the model. The team will reconvene in the fall to analyze the results of the feasibility study, and create an action plan for a pilot project to be launched in 2016. Should you be interested in helping Frank and Stefan to scale in one of these countries or partner with them, write to Ashoka Spain – comunicacion@ashoka.org or Ashoka Italy - italy@ashoka.org!
With the support of