Originally published March 31st, 2015

"discovering hands" uses the extraordinarily well-trained tactile sense of blind and visually impaired people to improve the palpatory examination for breast cancer detection. In doing so, they've created a globally unique field of employment for the blind and visually impaired, not “despite their disability”, but because of their capabilities.

Join us as we speak with Stefan Wilhelm to take a closer look at this innovative social business and explore his wishes for Germany's social startup sector. 

Breast cancer in Germany
With about 70.000 yearly incidences in German alone, breast cancer is the most common carcinosis for women in Germany. 

Tell us about discovering hands, what was the motivation behind starting it?

The gynaecologist and 2010 Ashoka Fellow Dr. Frank Hoffmann from Mülheim an der Ruhr had the idea behind discovering hands in 2006. He’d been a resident gynaecologist for over 20 years and simply wasn’t happy with the quality of the palpatory examination of his patient’s breasts.

Since the public health care system doesn’t allow for more than a couple of minutes of examination per patient (due to budget constraints and therefore lack of time on the doctor’s side) and since there is no general nationwide standard (and thus no comparability) for the palpatory examination of the female breast in the framework of the general preventive care, Frank decided to try and develop his own, quality assured and standardized palpatory examination method.

His intention was to offer more time and better quality to his patients for the best possible diagnosis, because he wasn’t comfortable with sending patients home after one or two minutes of palpation, having made a diagnosis of the breast or not.

discovering-hands-breast-cancer-detection

The idea to utilize the extraordinarily well trained tactile sense of blind and visually impaired people to improve the palpatory examination literally came to him one morning under the shower. He did some research and was really surprised that no one had the idea before him. And ended up creating a globally unique field of employment for our blind and visually impaired “Medical Tactile Examiners” (MTEs) not “despite their disability”, but because of their capabilities.

Are “discovering” hands better than machines? Could discovering hands replace breast cancer detection machines altogether?

Actually, there is no competition between the “discovering hands” and technical devices like sonogram or mammogram. And we do not intend to replace this important part of medical diagnostics in any way. The reason for this is simple: The palpatory examination always comes first in the diagnostic process. And since the early detection of lumps in the breast helps to prevent possible tumors from growing and spreading metastases into the woman’s body, the best possible palpatory examination is imperative.

If more lumps are found in the breast earlier, there is also a need to clarify these findings. This, in turn, makes the use of imaging techniques necessary. So there is actually a need for more technical devices rather than less. In a nutshell: the “discovering hands” make better what needs to be done anyway (palpatory examination) but is in no way a replacement for ultrasound or mammography.

Another important detail: our MTEs never diagnose, they only assist the doctors, who employ them, by lending them their “discovering hands”.

How do the blind or visually impaired women react when hearing about the concept?

Most of them are thrilled by the idea. Especially because the focus lies on taking advantage of their capabilities, rather than only looking at what they can’t do. Also, our MTEs say that doing this job offers a meaningful activity in which they don’t compete with sighted people on the labor market. And they like helping people while improving healthcare and the perspective on “disability” in general. So they are “ambassadors of their own cause”, if you will.

Of course, this job is not for everyone. There are people who dislike the idea of touching patients for a living or who don’t want to deal with the risk of cancer and possible findings on a daily basis. That’s why we conduct a 5-day assessment for MTE-candidates before admitting them to the 9-month course at one of our vocational training centers. It’s important for us to know that they have the tactile abilities as well as the social and communication skills we need. Once we have clarified these details, they are ready to go and generally very happy with what they’re doing.

breast-cancer-detection-social-business

What has been the response from the other stakeholders?

Overall, the feedback has been overwhelmingly positive from all sides. Not only because the Minister of Health of the Federal State of Northrhine-Westfalia, Barbara Steffens, is our patron, but just because the idea is so simple and ingenious at the same time. It just makes immediate intuitive sense. The public and private sector as well as NGOs, foundations and fellow social enterprises all agree with us. They think what we’re doing is a really good idea. On a local, national and international level.

Obviously, dealing with the German health care system and professional rehabilitation authorities for people with disabilities is not an easy task. Bureaucratic hurdles are high and there is some resistance in the medical community. We’re OK with that. Not everybody needs to like us, but most do. Also, most of the time we can get people on board if we are able to explain what we do in detail.

Really, there is no loser to our game. All stakeholders involved benefit. I’m still looking for the hair in the soup.

You’re a social business – how do you finance yourselves and how do you measure your impact?

The business model is surprisingly uncomplex: For each examination the MTE needs haptic orientation stripes that are applied to the upper torso of the patient. They are equipped with little dots that help the MTE orientate, creating a kind of coordination system which enables her to palpate every square centimeter of the patient’s breast in three depths and allows her to document possible findings very precisely.

Dr. Hoffmann invented these stripes and patented them – and our enterprise sells them. So with each examination, we get revenue: the standardized price for an examination in Germany is 46,50 EUR (the examination takes at least 30 minutes – so it’s a bargain). Out of these 46,50, 10 EUR go to discovering hands for the stripes. The rest of the revenue enables the MTE’s employer to finance her salary. The revenue we generate helps us market and roll out the model nationally and internationally.

The beauty of this system is, that we increase the social impact we generate with each examination that is being carried out. So while we’re earning money, we’re also scaling: better early breast cancer detection, creating jobs for blind women and changing mindsets towards people with disabilities. An excellent motivation to carry on what we’re doing.

Also, we’re currently rolling out internationally via a Social Franchise System. The first Franchise is Austria. There’s a different pricing model behind this idea, however.

Ever sector has its ups and downs. What was your greatest success or accomplishment up until now?

Obviously the 24 women for whom we generated employment are our greatest success. But also the expansion to Austria shows that the discovering hands system works. For Frank, becoming an Ashoka Fellow was definitely a pivotal moment, because Ashoka made him realize that he’s a social entrepreneur. He had no idea how to name what he was doing before… like most of the people with similar ideas.

What was the greatest challenge you faced with discovering hands and how did you overcome it?

Our greatest challenge, by far, was (and still is) finding MTE-candidates in Germany. Although many people talk about discovering hands, we are still a very small initiative with an extremely small team. We haven’t managed to overcome this challenge yet, but we’re looking at a lot of potential on the international market.

The German professional rehabilitation system is extremely complex and we are no experts in that field. So this remains difficult, but we’re currently working on solutions (that I cannot talk about here, because they’re still in the making). The potential for jobs is huge, nationally and internationally. Finding MTE-candidates isn’t, however. So if you have ideas or know anyone who might be interested, let us know!

What’s your wish for the social startup sector in Germany?

Three things:

  1. More and better hybrid financing possibilities (e.g. Social Impact Bonds)
  2. A legal framework that supports social enterprises according to their specific needs (also in terms of tax legislation, e.g. low profit enterprise)
  3. Progress in the definition and measurement of Social Impact (making it more feasible to use as a positive argument for Social Entrepreneurs).

What advice or tips do you have for others starting their own social business or project?

  1. Run your ideas by as many people who have backgrounds that are as diverse as possible – and don’t trust your friend’s judgment. They like you too much to tell you that your idea won’t work.
  2. Wear your shoes a size too large: Pay attention to infrastructure and reporting details before you drown in documentation chaos and still work from your grandma’s living room.
  3. Choose well, who you accept pro bono support from. There are many people with lots of good will and tons of advice. Non of which helps your organization if they don’t understand exactly what you want. If it binds resources to explain it to them: don’t do it!

What makes you a changer?

Excellent question. People have asked me many times why I work where I work under these conditions.

I have a tentative answer: Trying to effectuate positive change in society is never easy and mostly frustrating. Keeping at it, going full throttle while taking existential risks – and feeling blessed while doing so.

That makes me a changer.