Deutsche Bahn’s DB Medibus Solution Is Bringing the Doctor to the Appointment

If you ask a group of people what they value in life, you will get a variety of answers. For some, the only thing that really matters is family. For others, a successful career is the only way to care for that family. Understanding a person's values can oftentimes be the best way to get to know that person.

However, stated or unstated, there is always a common thread underneath. Without health, none of our other values can be realized. We need health to care for our families. We need good health to strive in our careers or social goals. Maintaining our health is in fact a fundamental value of life. But even before COVID-19 changed the health landscape in Germany and throughout the world, we faced a different kind of health challenge.

Over the past several years throughout Western Europe, there’s been a widespread migration to urban life. Young people are leaving rural areas in droves, and choosing to live within cities. Unfortunately, that leaves elder residents stuck in increasingly empty small towns.

As a product of this trend, many communities are becoming medical deserts. Aging physicians find that they are unable to retire because they lack replacements. Medical school graduates almost always choose to settle into urban areas. Older residents often lack the financial means to move to cities and therefore find themselves trapped without health resources. As with many problems caused by demographic changes, without intervention, it only gets worse over time.

If Not Us, Then Who?

Anecdotal evidence of a problem is great for general conversation, but the facts best speak to the real issues. In Germany, by 2018, people over 65 used nearly half of all medical services. At the same time, doctors working in rural Germany had an average age of 56. Around 39% of all general practice professionals were already over 60.

Under normal circumstances, aging doctors would naturally be replaced by younger physicians. However, grueling long hours, low pay, and extra administrative burdens were all part of small-town medicine. New graduates found higher pay and better conditions in larger clinics or pharmaceutical companies. For most new doctors, the rational choice was to focus on serving urban areas. As a result, in 2018 nearly 10,500 general practice offices were left vacant. Each of these offices meant a population unserved.

Helping an Aging Population

Deutsche Bahn is the second-largest transport related company, and the largest rail infrastructure owner in Europe. In 2016, we moved more than four billion passengers, and nearly 300 million tons of goods via railway. Although we started with a focus on German railways, today we operate as a general logistics company with over 330,000 employees around the world. We are proud to be a world leader in transportation, and we happily lend our expertise to a variety of countries in Europe and the world as consultants.

In Germany, our role of connecting people meant we were one of the first to notice the extent of the demographic problem. Since I work as a project manager for the company, it is part of my job to remain in touch with the needs of the various communities. We have a fleet of about 13,000 regional buses, so I have a keen understanding of many of the issues facing rural Europe. Typically, I use this knowledge to develop new business ideas and growth strategies for Deutsche Bahn. In this case, however, we noticed a community-wide need for greater medical access.

Employees and residents in nearly every community had personal stories about elderly residents suffering from sickness or injury. Most of these residents were isolated in countryside homes that they perhaps owned for generations. We also heard stories about young families who would prefer to raise children with access to fresh air and wide-open spaces. From this desire to accommodate aged homeowners and potential small-town families alike, we happened upon an idea: What if we placed a doctor's office on wheels?

Sometimes You Can't Walk The Journey Alone

Having an idea is only the first step. While our company was an unparalleled expert in moving people and products, we were completely new to medicine. Before we could approach our leadership to request large amounts of funding, we knew we needed to prove that this concept could work. We started by taking one of our older bus, which was about to be decommissioned and began a retrofit. We removed all the internal structures necessary for people transportation. Eventually, the result was an empty shell that was full of potential.

Since we had no idea what kind of facilities medical professionals needed, we were careful to involve a variety of doctors, hygiene experts, and engineers in the building enterprise. Through a joint effort, we were able to make the most of the relatively small area inside a bus. 

By the time we finished the prototype, a Berlin Hospital named the Charité was already interested. As one of the largest hospitals in Europe, they were dealing with the influx of refugees. They loved the idea of a mobile clinic. Before long, they were using our prototype to provide vaccinations and treat refugees in facilities throughout the city.

This experience of providing medical service to refugees was powerful in three ways. First, the commitment to the mobile facility demonstrated by the Charité was unmistakable evidence that this concept could work. Our side project suddenly became the hospital's primary method of providing service to abate the emerging refugee influx.

Second, we almost immediately realized the need to overcome the language barrier. The refugees spoke a variety of languages not traditionally spoken among Berlin medical staff. That often meant stumbling through a patient interview like an awkward game of charades, or waiting for hours for a fifteen-minute translated discussion. We realized pretty quickly that some kind of video conference-based translation services would be helpful.

Third, with the video conference potential came other ideas. In addition to translations, we could use teleconferencing for consultations with specialists. Since many of the villages were incredibly remote, providing a recommendation to visit a specialist simply was not feasible. Properly serving a customer meant providing as complete a medical examination as possible during one visit.

While teleconferencing worked in Berlin, taking the show on the road would be different. Teleconferencing in remote areas throughout Germany required stable high-speed internet services. That was a challenge we were not prepared to meet.

Finding the Right Partner

Cisco joined our effort initially to implement the IT foundations and Webex DX80 units needed to provide translations via teleconferencing. The response to this technology was profound. For the first time in months, many of the refugees were able to talk with a doctor in their native language. 

The hospital shared a number of emotionally moving stories about mothers surrounded by family realizing they were actually able to communicate with the doctor. For the refugees, these interactions were a powerful statement about the hospital's commitment to service. They created wells of trust that spread throughout facilities.

By the time we began our national test, we knew teleconferencing was essential. The second stage of the DB Medibus project was providing vaccinations to school children throughout the country. Cisco's partnership was incredibly vital during this stage because of the need for a constant, reliable internet connection through rural areas. The Cisco solution would provide the technology to easily switch between different mobile channels as the bus moved through the countryside. That was a powerful tool that enabled us to stay connected.

We know the vaccine tour was a success because the German Ministry of Health currently had a major vaccination campaign happening using one of our DB Medibuses. It travelled from school to school helping to keep kids healthy. It is a wonderful feeling knowing that our project is contributing to the health and learning of future German leaders. None of this would have been possible without our medical partners and Cisco.

The Future Of Mobile Service

We all want to believe that our contributions to society matter, and recognition from your community can be a potent motivator. We are happy to see that so many embraced our vision so fast. 

Today, we have seven Medibuses that travel regular routes throughout the country. Medical professionals board the buses in the morning and visit some scheduled towns each day. They are back within their urban communities by the end of the evening shift. By keeping regular staff and travel schedules, doctors are able to serve remote communities without opening an isolated practice. The standardization also means the same doctors visit the communities, allowing them to establish relationships with their patients. That was a vital step toward building trust among residents accustomed to visiting the same doctor for decades.