Interview: Suzanne Garber, Founder, Gauze

Suzanne Garber, CEO, Gauze
Unravelling global healthcare

Director of the GAUZE: Unravelling Global Healthcare documentary and founder of Gauze, a company that digitises information on global hospitals, Suzanne Garber, highlights her dream of a healthcare system that provides full transparency, quality outcomes, and a fair price, and reveals how she is seeking to fulfil this

Could you tell us about your background?
Having grown up in seven countries on four continents and having had the opportunity to learn and practise various languages, I always knew I was destined for a career in the international sector. That came to fruition during my tenure at FedEx – where I spent almost 15 years – culminating in the role of Managing Director, South America based in São Paulo, Brazil.
From there, I became the chief operating officer at International SOS, which enhanced my skills and desire to make a difference in the world of international healthcare.
Fast forward five years and I directed and produced a documentary about international healthcare (GAUZE: Unravelling Global Healthcare), and set up a company that digitises information on global hospitals to be accessible to the 1.2 billion international travellers who may find themselves sick abroad, also named Gauze.

What led you to found Gauze?
I got sick abroad. Of course, that was bound to happen, given that I’ve lived outside of my home country almost half my life, as well as travelled to more than 100 nations. In most cases, I received excellent care and, in a few, not so excellent care.
One of the more concerning moments for someone sick outside of their home country is the inability to communicate, as well as the lack of knowledge surrounding quality – where should I go, what should I do?
I wanted to create an easy-to-use service that would provide information immediately to those who may not know where to go or what to do when sick in a foreign country. The current modes of accessing care abroad use antiquated telephonic connectivity; today’s traveller wants access to information and care at their fingertips. That means an app for immediate, confidential and accurate information.

What do you find most exciting and rewarding about your work?
Knowing exactly the thoughts that go through someone’s mind when they are in a land where they do not speak the language or have knowledge of the healthcare system, I can totally place myself in that person’s shoes. Being able to help alleviate someone’s fears about whether the quality of care is adequate or finding translation services, or worrying about cost and payment is quite extraordinary.
I find being able to save and enhance lives in a small way to get them the care they need to be very gratifying. We had one case where an ultra-high-net worth individual asked us to put in place a report listing all of the hospitals for an upcoming vacation by chartered yacht that detailed facilities that had a doctor on staff who spoke English and, for a developed nation, it was surprising to see that none of the facilities on his itinerary met his requirements. He was able to hire multi-lingual staff to assist him throughout his holiday; being prepared gave him and his family great peace of mind. We were delighted to have facilitated a successful journey.

As the world’s first and only global database of hospitals outside of the US that is vetted by professionals, can you discuss the importance of Gauze?
With over 1.2 billion international travellers, and determining that between 10 and 45 per cent of them become ill while travelling, we knew that our idea would make a huge impact to a large number of the global population. Our focus is on the international traveller, although organisations that are trying to vet and source information on foreign hospitals can also utilise our system. We focus on three key areas that differentiate us from other organisations that also place patients in hospitals.
1) Confidential. What that means is that individuals can access our database of more than 20,000 hospitals and determine the nearest centre of medical excellence or adequacy that meets their needs.
2) Immediate. There’s no need to ring a call centre in California when calling from Cartagena. Patients can simply look up the app for hospitals within a certain distance from them. They will never be placed on hold, receive a busy signal or voicemail, or be told someone will call you back with a vetted provider.
3) Accurate. With over 20,000 hospitals in our system, the information provided on hospitals has been vetted by academics in each country. We detail information on nearly 40 categories including specialities, languages spoken, clinical trial availability, board certification, staff trained abroad and more. We know that giving access to information is one of the most empowering tools someone can have.

How does your company connect patients with hospitals around the globe and why is this important?
Individuals and organisations can access the Gauze network of hospitals via an app download, as well as tailored, written risk reports. Our goal is to put the power of information in the hands of those outside their home countries in need of access to healthcare, when they need it. The best way for me to summarise the importance of having confidential, immediate and accurate information is by giving an example of a case study recently completed.
‘Kelly’ travelled to China for a business trip. Having been there only once prior and speaking no Chinese, ‘Kelly’ knew the importance of having a risk mitigation tool like the Gauze network as she had once before fallen ill in a foreign setting but waited to return home in order to seek treatment. She had requested a written report with a number of reputable hospitals in the cities she was to visit. Incidentally, ‘Kelly’ succumbed to food poisoning while on her trip and handed the taxi driver the written report she’d received from Gauze. There was no way she would have been able to correctly pronounce the hospital name or address of where she needed to go in order to be seen by an English-speaking doctor and was thankful to have both the written English name and Chinese characters to hand to her driver. She was immediately seen and discharged; no one from her company knew she was sick and she was able to carry on her professional duties. Upon her return, she sent a thank you note to Gauze for letting her continue with her trip without interruption or concern from her employer.
This confidential and immediate access to care is certainly important to patient consumers of any age; it will become even more so with the millennial population who prizes privacy. Furthermore, there is no need for your employer to know when you have visited a hospital when you are at home; why should they know when you are abroad? Gauze facilitates the access to care by helping patient consumers make educated decisions.

What do you see as the key challenges facing the healthcare sector and, in particular, cross-border care?
Transparency in healthcare is a major challenge that affects many healthcare systems, and not just those in countries that are deemed politically opaque. For example, the New York Times newspaper ran a recent article citing that Singapore’s healthcare system could not be a best-in-class system due to its lack of transparency with regards to overall population health numbers as reported by the government. Similarly, the US lacks transparency with pricing and quality outcomes. In fact, a 2016 study by Johns Hopkins stated that the third leading cause of death, if death certificates were coded correctly, would be, ‘medical error’. Other systems, particularly those in Latin America, lack transparency in terms of hospital bed availability, wait times and quality.
In terms of cross-border care, access to accurate information is key. Where does one look for objective, current, and relevant information?  Whether seeking placement at a healthcare facility for a medical evacuation or evaluating providers for an elective procedure, there is truly no panacea in healthcare transparency. Hospitals have become adept at marketing and those with the best websites and business development personnel may reap the rewards of increased international patients who both self-pay and pay list price.

What tools do you think internationalists require to make informed decisions about healthcare abroad?
I once collaborated with a woman who was spearheading a project on the dangers of travelling to Mexico after she lost her son who travelled there for holiday. I’ve lived, worked, and spent many a holiday in Mexico. I have many friends there and feel very at home there. But, the first time I went, I was very much on my guard and on the lookout for possible dangers.  
Internationalists are a unique breed – and I count myself among them – for we have been everywhere and seen it all. Sometimes we become complacent about our travels, letting down our guards in areas we know are crime-laden and thus falling victim to scams we would have otherwise been alert to if we were experiencing a locale afresh. This complacency can spread out into our own health as well. I know many people who will spend hours researching restaurants, shopping and shows prior to embarking on a trip but never once think about if there is a lifeguard on duty at the hotel pool or beach, if the hotel has use of a defibrillator, how far the hotel or meeting venue is from an emergency room or if the hotel or meeting site is serviced by ambulance. Further, does the healthcare system in that particular country offer care for foreigners and, if so, do they demand to be paid in cash up front or would the hospital even dare reject treatment if payment could not be made? These are realities of healthcare in many countries.

My vision has taken on a more public healthcare policy footprint in lobbying US government officials for more transparency in healthcare pricing, improving access to care (and methods of financing) for more Americans, and educating others on the risks and rewards in cross-border care

One’s view of healthcare while travelling can mirror both our lackadaisical attitude toward our own healthcare whilst at home, or our cavalier impression of travel overall. In either case, healthcare should not be taken lightly, nor should choosing a healthcare facility or physician be determined by a third party. While insurance and assistance companies have networks primarily comprised according to the discounts they have been extended by healthcare facilities, Gauze lays bare all possible facilities, along with information that is important to an international traveller such as languages spoken, insurances accepted, specialities, and more. Being armed with key information with which to make an informed decision will help an internationalist who finds himself needing healthcare in any country around the globe.

For you, what does the ‘best in healthcare’ mean?
In filming my documentary, GAUZE: Unravelling Global Healthcare, I was able to interview over five dozen international healthcare experts. I asked this question and found that the responses, although varied, really came down to three areas: quality, affordability and accessibility. This can best be summed up by a healthcare journal editor from Portugal, who stated: “I think the best healthcare system in the world is still yet to be created. But overall, the best healthcare system would be one that would offer transparent healthcare, high levels of patient safety and quality all at a good price. That is still waiting to happen.” I completely agree with him.

In your experience, where can this be found?
The utopian healthcare system does not quite exist. However, there are a number of better systems out there. I point to the leaders in Switzerland, Germany, France, Singapore, and South Korea as offering a smorgasbord of options for their citizens. One of the questions I asked every interviewee during filming was exactly this question. The head of benefits for the AFL-CIO, the largest union of mostly government employees in the US said it certainly wasn’t the US, for how can a country be considered the best when one-quarter of its citizens (at the time of filming) were without access to quality care? But, I would be remiss in simply lumping entire countries as ‘best’ or ‘worst’ when, in fact, high-quality care can be found in many individual hospitals, departments, or physicians in some – what others might consider – surprising locations.

What will be the key goals for yourself and Gauze in the coming five to 10 years?
We continue to add hospitals to our database and hope to ultimately be the authority in objective healthcare rankings. We refuse to take money from hospitals, in order to retain our fair approach and make a plea for hospitals to be transparent in their information reporting as well as to become more transparent in their pricing and quality outcomes. The triangle of quality, accessibility and affordability really does determine the definition of ‘best’ in healthcare.
We will also partner with other companies who may focus on a more complete view of healthcare – we only catalogue information on hospitals – or those who take a more in-depth look at hospital data apart from those categories that are important to an international traveller. There is no truly global data repository for healthcare systems and we know that it will take a lot of collaboration amongst various parties to achieve it. This will be for the betterment of global healthcare as a whole.

More broadly, can you share some of your hopes and dreams for healthcare?
I initially began my journey in creating Gauze – both the documentary and the company – with the goal of helping those who found themselves in need whilst sick overseas. I was creating a solution to something that didn’t exist when I found myself in that exact situation. Today, my vision has taken on a more public healthcare policy footprint in lobbying US government officials for more transparency in healthcare pricing, improving access to care (and methods of financing) for more Americans, and educating others on the risks and rewards in cross-border care.
Currently, I am working on gaining 10,000 signatures on a petition to mandate transparency in US healthcare pricing so that the patient receives an estimate for total costs prior to undertaking a procedure. US hospitals require patients to sign financial responsibility forms that put the entire burden of cost on the patient consumer and yet give no estimate for how much those costs might be. In any other industry, one knows the cost of an airplane ticket, a new or used car, a cup of coffee or even a stock trade on the NYSE; why is American healthcare any different? It is time to give the patient consumer full visibility into the true costs along with the risks in order to make a well-rounded decision. I dream of a healthcare system that provides full transparency, quality outcomes, and a fair price. It will take some work to get there but it can be accomplished.

On a personal level, which country have you enjoyed visiting most and why?
Such an unfair question when I’ve been to over 100, worked in 42, and lived in eight! There’s no clear ‘winner’ although I have to say living in Brazil spoiled me. The people are lovely, the cuisine is so fresh, and the scenery is just breath-taking. Although, most of my dearest friends are from when I lived in the Dominican Republic or worked in Mexico; I am partial to Latin America. From a purely touristic standpoint, I was awe-struck with Antarctica and brought to tears by the haunting majesty of its vastness. I also loved Iceland, Egypt, Thailand, and the Galapagos Islands … although, truth be told, I’ve loved most places I’ve visited! Every place has its own special qualities.