The disrupted life of refugees keeps them from having good medical records. Med student Senan Ebrahim decided to do something about it and made headway. Listen to the story of Hikma Health and of its promising founder.
Senan Ebrahim grew up in Silicon Valley but he experienced the Syrian refugee crisis via his grandmother. When he became interested in the problem of refugee health his initial solution was laughably unsuited to real life. Contact with health care workers serving the refugee population allowed Senan to zero in on a high-impact solution that is now serving 50,000 displaced people and is set to grow.
Transcript of, “Hikma Health”
GUEST: FOUNDER, SENAN EBRAHIM
Sal Daher Introduces Senan Ebrahim, Med Student & Founder
Sal Daher: Welcome to Angel Invest Boston, conversations with Boston's most interesting founders and angels. Today, we have a really special founder that I think you guys are going to be hearing from a lot more in the future. His name is Senan Ebrahim. Welcome Senan.
Senan Ebrahim: Thank you so very good to be here. Thank you for having me.
Shout Out to Agustín Lopez Marquez for Introducing Sal to Senan Ebrahim
Sal Daher: I am very grateful to Agustín Lopez Marquez for connecting us. Agustín is your, your buddy. He spoke very highly of you. He said "Saleh you've got to meet this guy" and I think very highly of Agustín. I'm an investor in SQZ Biotech [SQZ on the NYSE] where Agustín was the founding president, I guess. And is the first person at SQZ that I talked to. I called them, I said, are you guys raising money? And someday I'll tell the whole story, but anyway, I'm very grateful to Augustin for connecting mw with Senan about whom you will be hearing a lot more because this is a young man who has a very, very interesting ideas and a very brilliant future. So, Senan tec ll us a little bit of your background, just like a mini mini background. We're going to get more to that in the second half of the podcast, but right now, just a quick background and then tell us the problem that you're addressing with Hikma Health.
Senan Ebrahim: Absolutely. Thank you again, Sal for having me on here, I'm a fan of the Angel Invest Boston podcast and listening to it for a year now. So it's a real privilege and a treat to be here with you.
Sal Daher: The privilege is really mine, I mean, I'm very honored to have someone like Senan Ebrahim listening.
Brief Bio of Senan Ebrahim
Senan Ebrahim: Likewise, and shout out to Augustin as well for putting us in touch. I remember, I worked with him at nference [nference.ai]. As you know, for about a year and learned a lot from him. He told me that you're one of the folks who in addition to investing in SQZ was someone who is always great to bounce ideas off of and learn from as well. So, yeah, I'll tell you a little bit about the Senan Ebrahim story, but excited to get into the Hikma Health story. But yeah, so I was born and raised in San Jose, California son of immigrants as well. My mom is from Syria. My dad is from Pakistan and, you know, growing up there, it was, it was a really interesting time in Silicon Valley, right? It was pre dot com and I saw the dot com bubble collapse. Even as a kid, I had some exposure.
Senan Ebrahim: My parents were joining. Startups are kind of weighing the options and I had the sense that technology could be used for amazing things that transformed the world we live in at scale. And my mom actually still till this day is working at Apple. So I had this sense of like what technology can do. And in my own hands, I can see its power, but as I grew older and I got to college, I started thinking more and more about how we can apply some of these amazing transformative technologies, innovations, discoveries that I was working on in the lab to folks around the world. And it was actually in college that I first started learning about machine learning technologies. And at that time it was very preliminary, very in the R and D world. But as I got on and, you know, after I, I went to Harvard for college, I studied neuroscience.
Senan Ebrahim: There went all in on neuroscience, really wanted to do the MD/PhD was really excited to start my PhD in the lab of dr. Sydney Cash at Mass General. And Dr. Cash was an awesome mentor because he really pushed me to think at scale, you know, what can we do with this really cool applied machine learning to time series data work that you're doing? How can we do that throughout epilepsy? Not just one epilepsy type, and then how can we do it in sleep? How can we do it for all kinds of neuropsychiatric disorders? So that kind of big thinking, really my grandmother was actually impacted by the Syrian civil war. My grandma was still living in Damascus until 2016. So that was, yeah. Thank you. I mean, it was, it was a tough time for our family, but we're relatively fortunate, relatively financially privileged that, you know, my, my grandma, when she finally agreed, we could just pick her up and get her to come to Beirut, which thankfully even after the blast and everything she's been safe, but for a lot of families that are not so fortunate. And, I had been to Syria up until 2008. I'd seen what life there was like. And then more recently, you know, as part of the MIT accelerator, I went to Jordan and met with refugees there. And I just knew we had to do something, given all the benefits that we've had here, all the cool innovation we've been doing here, I wanted to transform the way that care is delivered for refugees based on the technologies that we're building here today. And that's how Hikma Health was born.
Sal Daher: Excellent. Excellent. So what is the problem that Hikma Health is addressing?
“Quite simply Sal, there is no way to record in a refugee camp what people's health conditions are. You have folks that have had diabetes for 20 years that may or may not have a recollection or a record of it.”
Senan Ebrahim: Quite simply Sal, there is no way to record in a refugee camp what people's health conditions are. You have folks that have had diabetes for 20 years that may or may not have a recollection or a record of it. You have seven-year -olds like Hisham who have Type 1 diabetes that, you know, they're showing up with constitutional symptoms, they've got fever and chills and aches and pains. And the doctor says, Oh, I think it's a cold. Just go home. And one day this poor kid, Hisham al-Abrash real story that was written in the New York times three or four years ago. He ends up in an emergency room in Jordan because the doctors, his parents, nobody knew his story. Nobody knew that he had Type 1 diabetes, thankfully in Hisham's case, he survived. And the physicians realized he had Type 1 diabetes and reversed his diabetic ketoacidosis.
“…the current electronic health record systems just do not work in a low-connectivity, low-resource setting, like a refugee camp, where interestingly, you also have multilingual practitioners.”
Senan Ebrahim: But at the end of the day, it should have never gotten that far. He should have been chronically taken care of and every single person in his life, especially his parents should have known that he had the disease. So we talked to physicians and realized that the current systems that were out there, the current electronic health record systems just do not work in a low-connectivity, low-resource setting, like a refugee camp, where interestingly, you also have multilingual practitioners. And I know you'll appreciate this Sal, given your background, being a multilingual person. There, you got these teams where someone is speaking Arabic because they're a local nurse practitioner and you've got some international surgeon coming from France. And another one from the, from the US so having a multilingual team, that's actually writing notes and recording data in different languages, presented additional challenges as well.
Sal Daher: Tremendous. So basically you created kind of a lightweight, highly versatile electronic healthcare record system that was very accessible, very easy for people to use, but also with technology adequate to the particular need and appropriate technology to the setting, not a lot of bells and whistles, but something that's robust and accessible and easy to use in the correct setting.
Senan Ebrahim: That's exactly right. So this was, this was textbook less is more, right? The bells and whistles that actually no disrespect to the makers of EHR in this country, but you simply cannot digest the information that's needed to take care of a patient in a refugee camp within one minute, which is what the time they have to look up the information before spending only five minutes with the patient, right?
Sal Daher: You may not want to disrespect them, but I do. I mean like these are, these are monopolists. They've produced C-R-A-P ware. Raul will take out the unspelled version of that. It is because they have, you know, they're incumbent, but you don't have to nod. Senan Ebrahim is not nodding. He's shaking his head like this in silent disapproval. I can mouth off you can't. So anyway, so please continue.
“Honestly, we all know that basically EHRs [electronic health records] in this country have been solving a very different problem and they've had a captive market.”
Senan Ebrahim: Honestly, we all know that basically EHRs [electronic health records] in this country have been solving a very different problem and they've had a captive market.
Sal Daher: They're for billing, they're for billing.
Senan Ebrahim: That's right, exactly. They're built around billing. They're not built for outcomes. So while it was an immense challenge in a lot of ways, and most of it was a systems challenge, but also big shout out to Sam Brotherton, my CTO and our technical team for solving the offline sync, which was actually a very challenging technical question. But aside from that, it was largely a systems challenge. Besides the challenge aspect, I was really excited about it in that it's actually a huge opportunity where for once billing doesn't matter, right? You kind of have the opportunity to work with these folks that really all they care about is health outcomes. They're there to help the refugee patients. They're not going to get anything out of it.
Senan Ebrahim: The organization's all treated as a loss. They either provide free services or very, very cheap services. So at the end of the day, all they care about because it's sort of value-based care. They're the ones that are, they're the only care provider in the area. It's in a way it's a mini single payer. So we have an opportunity when we talk to them, they're not sitting there telling us about ICD codes for billing reasons. And who's going to do the medical coding after the EHR note is written. They're just asking, all right, how quickly can I pull up the right information about Hisham? So it was perfect alignment of values and incentives to build a product that actually moves the needle forward on people's health. And that's why I'm so excited about Hikma Health to this day.
Sal Daher: Excellent, excellent. Hikma Health. How did you get the resources that you needed to build the system?
Senan Ebrahim: So we were very fortunate that we started out of MIT, which gave us a lot of access to immediately, right within that accelerator, before we even knew exactly what we were doing product-wise.
Sal Daher: Which accelerator is that?
Senan’s Starting Point Was the Refugee Learning Center at MIT’s Media Lab
Senan Ebrahim: So, the MIT Media Lab ran an accelerator. That was the Refugee Learning Accelerator. Yeah. So it was sort of a, it was because of the Syrian refugee crisis that they really launched it. And I believe they did a few cycles of it. And it yielded actually a number of very successful groups, um, that are moving the needle on mostly educational-related issues in the refugee setting. But we actually pivoted through that experience because as part of that, in addition to some seed funding and some access to technologies, they actually took us to Jordan. So that story I alluded to at the beginning, Sal, going to Jordan was actually thanks to MIT saying, "Hey, we understand that you as the founders and the creators need to actually see with your own eyes and talk directly to refugees, to their caregivers and to their educators."
Senan Ebrahim: And in those conversations, it became very clear that the chat bot for kids with diabetes who need to learn more about it was quote, unquote, cute. That is what the terms that the physicians on the ground were using. But at the end of the day, they couldn't even tell us who has diabetes. We were putting the cart before the horse and thanks to MIT. We got that nipped in the bud early. And then from there, once we pivoted and said, all right, we're going to build this EHR system. Harvard was also very helpful. We won the Harvard Business School competition, which really put us into kind of front and center. So very, very grateful to the Harvard Business School Social Ventures competition.
Sal Daher: Excellent.
“…we're in the process of raising a much larger fund to basically scale the work we've been doing from the 50,000 patients we serve today to 200,000 in the coming years.”
Senan Ebrahim: You know, from there, we got a grant from google.org. We got, we're lucky to get a lot of support. Fast forward, as an amazing tech nonprofit accelerator in the Bay. So we basically raised about a quarter million, which was kind of the seed fund we needed to really execute on this product. And that has basically carried us up to this point. And now we're in the process of raising a much larger fund to basically scale the work we've been doing from the 50,000 patients we serve today to 200,000 in the coming years.
Sal Daher: Oh, that's really wonderful. I was going to ask you about traction on this. So would you like to talk a little bit about how much people use it?
Senan Ebrahim: Absolutely.
Sal Daher: What are the measures that you have for that?
Senan Ebrahim: So for, in terms of engagement, we actually don't have the metadata. We don't take any use data or any medical data at all. It all lives within a self-contained server. It's basically entirely under the direction of our clinical partner. So they're the data owner and the data controller. So we do not look at any of that without any of their permission, but we are getting basically reported, use statistics where, how many users they have, how much time those users are spending on the apps. And then one other key metric is basically how many times for an individual patient, they are using the same application. So we have like multiple workflows in there where, you know, there's a patient that they might've been seen chronically, and they have a whole bunch of chronic medical issues and prescriptions in there. But for the first time in April, 2020, they filled out the COVID screener for them.
“…on average, every time that the clinician is seeing the patient 90 plus percent of the time, they are using the app.”
Senan Ebrahim: Uh, so that's an additional metric as well. And basically ballpark on average, each time the physician is using the app, they use it for about one to three minutes, which is about spot on for what our A/B testing was showing and what they told us they wanted to be spending, given that they're only spending five minutes with the clinician. And in terms of the, in terms of the actual, like how many instances per patient, our first deploy, we've only been live for a little less than a year. So we don't actually have like a complete picture, but it seems like on average, every time that the clinician is seeing the patient 90 plus percent of the time, they are using the app. And so far, it's been an average of like 1.5 to two X, just because that's the frequency, they see their patients. And most of this data is coming from our preliminary deploy in Lebanon, where we work with an amazing group called Endless Medical Advantage. The other partnerships with Nicaragua, we launched just literally two, three months ago. And, so that, that data is still coming in from there.
Sal Daher: This is wonderful. It's just beautiful to see coming together that way, because these are populations that have, I have a lot of, a lot of sympathy for the case of Syria. I mean, Nicaragua, I mean, all of these places have a lot of hardship, but I mean, Syria, you know, hundreds of thousands of people died, you know, when the civil war, you know, my family left, uh, the Middle East in the 1890s. Think about that's 130 years ago. And it's like the same movie right now, you know? And they left basically for similar reasons. It was the dying days of the Ottoman Empire when empires die, what happens is they die from the extremities, the same thing with the Soviet Empire, you know, like the center doesn't control the edges. I don't know. It's a little bit like a poor circulation. So they get a sclerotic they don't control. And then local fiefdoms develop. You end up with chaos and local warlords take over turf wars and massacres. And it's still the same movie, sad to say.
Senan Ebrahim: In any way you slice it Sal. It's absolutely a human tragedy. And, you know, obviously the Syrian cause is very near and dear to my heart. The 13 million refugees there, you know, I've mentioned my grandmother was displaced, but at the end of the day, this is truly a global problem. There's 70 million refugees around the world. And that number is only going to skyrocket. It's not just now refugees from direct conflict from civil wars. It's also going to be refugees from climate change and economic changes. And when you factor those in, we're talking about hundreds of millions, literally by 2050,
Sal Daher: Right? So 50, 000, 200,000, you know, maybe the next one is 2 million. And eventually you're going to be serving a very, very large population of refugees and making their lives a little bit better.
Senan Ebrahim: That's the idea. And, you know, for us, it's always that very difficult optimization, which, you know, as well from your work as an investor faces in the for-profit world as well, but even more so in the resource-constrained non-profit world with X amount of resources, how can we do Y amount of good per person for Z number of people? And for us, it's always at Hikma Health, you know, our North Star is doing right by our patients. So whatever it is that we're doing, we want to be scientifically validated, technically rigorous. The product just has to work that's non-negotiable and it has to work right for the partner we built it for. So, you know, optimizing on that, Y variable has been very important to us for the last two years, but now that we're in a place where we can actually start to talk about that Z about that end, you know, that scale, that's, we're really excited about that.
Hikma Health’s HER Has Been Released as Open Source Software
Senan Ebrahim: And at the end of the day, we're not alone in this. We have some amazing peers, really. They're not even competitors because in our space, you know, we we'd be very happy if, you know, Medic Mobile, for example, which, you know, we're, we're close with their founders as well. They built a SMS-based system a few years ago before we were even around, that was widely used largely in Sub-Saharan Africa. And whether, you know, we don't really think in terms of market share, right? Were we, and Medic Mobile are all on the same team and of the 70 million refugees. If we can serve 40 million and they can serve 40 million, we're all happy. That's. And that's why we released our technology free and open source. There are random groups in Uganda that are telling us, "Hey, we love what you're doing. We have our own engineers."
Sal Daher: This is cool.
Senan Ebrahim: Yeah.
Sal Daher: You released it open source.
Senan Ebrahim: Exactly.
Sal Daher: Very powerful.
Senan Ebrahim: The ripples of which will, you know, we won't even know right. That we told the Ugandan group, go do whatever you want with it. They're going to fork it.
Sal Daher: You never know what's going to go. What, what is it going back to the, uh, the Hobbit, uh, you know Tolkien, you know, you never know what's going to happen when you, when you walk out your door, you know what adventure is going to befall you.
Senan Ebrahim: Yeah, yeh.
Sal Daher: That's very promising. It's very promising. It gets me thinking that if there is sort of very rapid adoption of a very lightweight EHR, I just wonder if it wouldn't, uh, sort of like eventually kind of bounce back into developed markets and kind of be an alternative to the legacy-ware basically everybody has to contend with. My daughter's a physician, I'm an investor in a company that's in the medical records, you know, the EHR space, basically making information in EHRs available. I don't know if you've run across them, Healthjump.
Senan Ebrahim: I I've heard of them.
Speaker 1: Yeah. The founder is my brother-in-law Martin. He's the brother of my wife. I've interviewed on the podcast. He has, at the last count, something like 30 million patient records that are liquid. The patient can retrieve the records there anywhere they are. If they happen to be on this and anonymized versions of this can be made available for, you know, large-scale research, it was contributed into the, the COVID-19 Research Database. There's a lot of stuff that could happen and I can just, well, see your open source software being very valuable piece of the value chain in the future. So, Senan, at this point, what I'd like to do is talk a little bit about my investment syndicate. And then on the second half, let's get back a little bit more into your biography growing up in San Jose, California, you know, your parents, entrepreneurship and all that stuff.
Sal Daher: But first, you know, some listeners may not be aware, but if you are, what's called an accredited investor, you are able to invest in interesting companies that are private companies that could have a tremendous future. You need to really diversify and all of that. But this is what I do. I invest in these early stage companies and I love doing it. And I have what's called an investment syndicate for them, which is basically a list of names of people who are accredited investors that I can reach out to. In case I have an interesting company that I'm investing in and sometimes might get to participate directly. Sometimes they can participate via a special purpose vehicle that we form depending on how many people were interested. So it makes sense for you to sign up at angelinvestboston.com, go to the syndicate list and add your name, and it'll qualify you as an accredited investor, and then we'll be in touch. But anyway, so now let's get a little bit more fine-grain. So your father is from Pakistan and your mom is from Syria. Exactly what a extraction in Syria cause serious. There are many tribes in Syria.
Senan Ebrahim: Yeah. My mom is originally from Damascus for many generations, the Azem family there. And my grandfather was actually an engineer and he built the water system in Damascus, which is something that always stayed with me.
Sal Daher: Metropolitan city. I mean, Damascus had a flourishing literary scene before, you know, the Assad regime came in, you know, it was well like Cairo, Cairo also had a flourishing scene. It kind of, to some extent, you know, kind of survived in that way. And Damascus was really a happening place.
Senan Ebrahim: The exciting thing about technology is that that is all coming back even before a long time ago, like when Baghdad was one of the learning capitals of the world, right? It was all books. And, you know, whenever the Mongols sacked it and they say the Tigris ran blue with the ink.
Sal Daher: The Tigris ran blue with ink; the Euphrates ran red with blood.
Senan Ebrahim: There you go. And, you know, while some things never change. While man's inhumanity to man and the evil things, we see the tragedies, we witnessed those things. It's sad to see. It's heartbreaking when you talk to the refugees about those situations, but what gives us hope and what inspires us is when we meet a 17-year-old young man, Ahmed, who's learning to code. So you can provide for his family and he can be employed. He wants to work at Amazon one day, and now he's starting with a coding syndicate where he'll just basically get jobs farmed out to him. And that to me is the return of in the Middle East, as you probably know, from your friends and family, there's often the sense of bygone days like this was, you know, once Cairo and Damascus and Baghdad were the learning centers, et cetera, but with technology at the end of the day, it's all democratized, right? It doesn't matter which corner of the Middle East or which corner of the world you are. We have some of the best coders I've ever worked with or met are from Africa and Sub-Saharan Africa and India. And they are self they're totally autodidact. Some of them didn't even finish high school. So to me, you know, as someone who, I'm actually not a software engineer by profession, but in the medical world, it's just so striking to me
Sal Daher: For the other end of the pond. You're from the deep end of the pond to get to you, you cannot be an autodidact in medicine You can teach yourself, you know, heart surgery. No problem.
Senan Ebrahim: Well, depending on how many little brothers you have, I, uh,
Sal Daher: Experimenting on your little brothers. Yeah.
“Shout out to my little brother. My little brother Hassan Ebrahim was actually my co-founder at Hikma Health.”
Senan Ebrahim: Shout out to my little brother. My little brother Hassan Ebrahim was actually my co-founder at Hikma Health. You know, he and I actually to share a little vignette with you about, you talked about growing up. He and I, our first project together actually, or one of the first ones, we tried to dig a pool in our backyard. And that was that didn't end. Well, we didn't lay a foundation. We were not engineers. We were like probably seven and 10 years old. So the fence started falling in. And since then, 20 years later here we are. We learned from that experience, we iterated and here we are still working together today.
Sal Daher: I remember as a boy hearing my father talk about "estabilidade do talude" stability of the slope. Undergrad. I was a soils engineer. So soil is a very, very tricky, highly non-linear and a very tricky material to work with. So you guys were really in trouble.
Senan Ebrahim: Yeah. The boys could have used your advice back in 1998,
Sal Daher: Always built up because wood is very forgiving, but soil is terrible.
Senan Ebrahim: Exactly. Well live and learn. And here we are today, but we also feel like, because you know, for us, we were born and raised in San Jose, California.
Sal Daher: ...in a house with a big hole in the backyard!
Senan Ebrahim: Well our mom had us fill that one in pretty quick.
Sal Daher: I imagine with a Syrian mom, like people in America have to know that in the, in the Arab world, you don't get to talk back to your parents. Okay. You don't get to say no. It's like, your mom says, you're going to do this. You're going to do it.
Senan Ebrahim: That's right. It's not a, it's not a question.
Sal Daher: Here's a question for you. Like if you're a Lebanese boy growing up in Brazil and you're 16 and a half years old and you get your driver's license, who are you going to be driving around? You think you're going to be driving around, you know, girls? No, you're going to be driving around aunts. Lebanese aunts, in my experience, rarely drive. Maybe they drive, but they like their nephews to drive them around.
Senan Ebrahim: It's my, uh, so my aunt actually lives in Lebanon and she's been hugely helpful to us in a lot of ways.
Sal Daher: Don't tell me she's a race car driver!
Senan Ebrahim: She's actually a pilot. No, no, it's, it's actually interesting. So one, one interesting thing though, that we've, we've just realized through working a lot in the Middle East, and I'm sure there are parallels in Latin America as well. And actually from living for a year in Peru, there certainly are where, you know, the class structures are very different and if you're of a certain class, it's true, but man or woman, you know, you don't really drive yourself. You have often servants or at least like kitchen staff or, and, you know, we were, we were a middle-class family and still are. And we, uh, you know, we just cook all our own stuff and clean it and drive ourselves. And that's just, you know, it's part of the American way. Jeff Bezos still washes his own dishes, so I'm told.
Sal Daher: Class structures constrain, not just to people in the, in the bottom, but the people in the middle, the people in the top, you know, throughout it's rigid. And it kind of puts people into these rigid categories, which is costly in many ways.
Senan Ebrahim: Absolutely. And you know, so it's not to trivialize that like, you know, in the, especially in this country, you know, we see, and with the pandemic in particular, we see the significant effects really that are borne, the brunt of which are borne by the working classes. Um, so there are, there are certainly a lot of inequality in this country, but the ethos, right. And the economic opportunity at some level just never existed in a lot of these other countries, right? Like the, where there's a lot of this where like someone's driver will be like the son of whoever the driver was for the parents. And it's just, that's your station in life.
Sal Daher: Most of the world is like that. Europe is also highly stratified. I remember spending some time on, I traveled to London quite a bit. Class in the UK is a lot more tangible than it is in America. And then there are countries that are sort of, you know, older cultures where class in a really very, very, uh, you know, people are highly stratified by class. And so America has sort of devolved into a class society used to be less of a class society 50 years ago. So there are not explicit barriers for people for moving, but they're implicit barriers. You say, Oh geez, all of the learning of humankind is available to you in the internet. You can read Aristotle for free. You can read anything. But the problem is that if you grow up in a household like yours, you know, or like I grew up in, you have a lot of social support, okay.
Sal Daher: I mean, your parents sitting you down and making a study meeting, you read your Aristotle or whatever classic you have to read. But the kids who are sort of stuck in difficult situations, don't have that. They'll not have that cultural capital to help them take advantage of the great, great benefits that exist in our world. And so, I think, you know, software, in some instances, some shape, like, you the EHR that you have points in that direction. I've seen platforms to help kids learn to kind of basically get them on task and so forth. So, I think that there's, there's a lot of promising stuff that I think in five to 10 years we're going to be seeing just a lot more breaking down of barriers of class barriers and so forth and allowing human flourishing to reach through all these barriers that exist. Very hopeful,
“…Dr. Feras and he's a personal hero of mine. He works with Endless Medical Advantage [medical care in the Beqaa Valley in Lebanon].”
Senan Ebrahim: Same. And I think, you know, with Hikma Health, we’re we do wrestle with this a lot because we are trying to just really focus on what we do, which is the health component. And we know that health is a cornerstone for any kind of economic advancement, but we hear this time and time again from the refugees we serve, from the doctors who themselves are working in these communities. So literally like Dr. Feras and he's a personal hero of mine. He works with Endless Medical Advantage. Literally himself used to drive a mobile van around the, he just started walking and then, you know, then he got some support and now he has a van. And now he has an assistant who drives a van, but literally he operates in these clinics in the mountains of, you know, the Beqaa Region. It's actually the Beqaa Valley, but it's a very mountainous area on the Lebanese-Syrian border.
Senan Ebrahim: And he just drives around in his van, taking care of these people, doing whatever they need. And he is a medically licensed trained physician. He's not a specialist, he's a, he's a GP, right. He's a generalist. And during the war, when he was in Syria, he to do surgery by watching YouTube videos, right. Because there was nobody else to do it. So he's an amazing human being. And at the end of the day, right, we want to support him. And what he tells us is, Hey, you know, I'm not just a doctor. I'm also, you know, whenever when the people need cooking oil or heating oil, because they're going through a freezing winter and they can't, I'm in my truck delivering the oil. So Endless Medical Advantage and Doctor Feras, who's their medical director. They have really tapped into this, that like, to really take care of people's health. There are these co-dependencies with their economic security, economic needs, their safety needs, their educational needs. All of these things are interconnected. And in the next stage of growth for Hikma Health, as we even try to scale our impact positively to more people, we also want to start thinking about, okay, how can we support some of these additional needs through our technology?
Sal Daher: Very, very promising. So Senan tell me again. So your parents both came to the US they're entrepreneurs or they're working in technology...
Senan Ebrahim: ...software engineers...
Sal Daher: ...software engineers. Okay.
Senan Ebrahim: They met at MIT actually.
Sal Daher: They met at MIT?
Senan Ebrahim: So full circle, full circle for me. Yeah. So I took a, I took two classes at MIT in college. Um, and my mom, you know, my mom actually insisted that I get the Harvard class ring, but as you probably know, the Brass Rat is, is something different, something special.
Sal Daher: My mother was the same, but I didn't get into Harvard. I got into MIT. I didn't get into Harvard. So tell... your mom is going to be so happy to hear this.
“Taking two classes at MIT does not qualify for a Brass Rat. So now that I did HST, maybe I'll have to seek my mom's blessing to see if, uh, if I qualify for a Brass Rat…”
Senan Ebrahim: Well, my mom, my mom has been incredibly supportive. I still remember she was teaching us when we were like five, six years old with the baking soda, vinegar volcano. And she's an amazing engineer and scientist herself. So very much my inspiration for going into this space at all. But at, you know, at the end of the day, when she, when she came to visit, she was like, Nope. Taking two classes at MIT does not qualify for a Brass Rat. So now that I did HST, maybe I'll have to seek my mom's blessing to see if, uh, if I qualify for a Brass Rat, but, uh, the ever elusive Brass Rat for me.
Sal Daher: Maybe you could get a brass rat. One of the brass rats that my daughter made during IAP. IAP is the independent activity period in January. They don't have a January term. So you get to do crazy things. So she took a course in doing metal castings. And so she did metal castings of Brass Rats. She has like an aluminum Brass Rat that's look, it looks really grotty. Maybe he can wear one of those [wink, wink].
Senan Ebrahim: Yeah. That'll, that'll actually, I'll, I'll take it, I'll take it,
Sal Daher: But that's tremendous, really a wonderful story. Uh, so Senan take a moment and think if there's anything that you want to address to our audience of founders, of angel investors and of people who are just interested in early stage companies that you think would be helpful or inspiring to them, take your time.
Senan Ebrahim: I think there's three key things I'd love to touch. So one is that no one can do anything alone, and this is probably obvious to a lot of you. But when I first started Hikma Health, I literally started it with me, Android Studio, trying to figure out how, and I'm not a software engineer. So huge amount of credit also to, uh, one of my early co-founders Eric Gruder, who was a software engineer at Amazon and Jobcase, and worked at a whole bunch of tech companies and was like, yeah, this isn't, this isn't an EHR. Like, let let's, let's talk about application layers and data layers, you know, drawn out the whole architecture. So I learned so much from my teammates at Hikma Health throughout this process and looking to the future and everything I do it's about the team.
“Senan, I don't want to put words in your mouth, but would you agree with the statement: “Get a co-founder?””
Sal Daher: Senan, I don't want to put words in your mouth, but would you agree with the statement: “Get a co-founder?”
Senan Ebrahim: Amen. Amen. I don't, I don't even understand how, like, you know, a lot of the mythology in Silicon Valley emerged around these solo founders, Steve Jobs, Zuck, whatever, but at the end of the day, no one, including those luminaries or innovators, none of them accomplished anything alone. And for me, it's actually, it just makes the journey [funner]. So why wouldn't you, especially, you know, we're fortunate, you know, MIT, Harvard, wherever, wherever you are, right. There are talented folks around you that can certainly contribute to whatever it is that you're trying to do. And I've seen the power of teamwork at every level from folks organizing in a village in Peru to a refugee camp, to a nonprofit clinic here in the United States, a van clinic, trying to serve homeless people, to tech companies, to tech nonprofits, anywhere you are, whatever it is you're doing folks around you with complementary perspectives, often challenging perspectives.
Senan Ebrahim: Me and my CTO are often, you know, coming from diametrically opposing standpoints, but the synthesis from the thesis and antithesis ends up being just a perfect strategy. So I've really found in particular, if you're not a technical person, you know, find the technical person that, you know, maybe it's very challenging and can be difficult to work with at some level, or like they really don't agree with you on anything. And they're constantly like, ah, that doesn't work. You can't do that. Right. But at the end of the day, you will arrive at a really beautiful place, both in terms of the product and your ability to serve the folks you're looking to sell.
Sal Daher: Well, I can, I can reassure you Senan, as an MD candidate from Harvard Medical School, you always like to be able to cite the science. I can tell you that what you're saying is the most robustly supported result from the study of entrepreneurship. And I have heard that from Ed Roberts and MIT and his doctoral student, uh, Chuck Eesley at Stanford, what you're talking about, complementarity of skills, shared values, complementarity of skills get a co-founder and get co-founder. So please continue.
Senan Ebrahim: Absolutely. And just last note on that, I have to also share when I was, uh, when I was in college, actually I was the student body resident and my vice president, Bonnie Cao was.. Transformed the, I think about a lot of things, gender in particular because I, as a guy with two brothers, right? I don't, my mom was never a complainer. Right. You know, she was always pedal to the metal excelling despite the discrimination on gender and other axes that she encountered in Silicon Valley in the eighties and nineties, but at the end of the day, right, she was someone who just hunkered down and got it done. So when I was in college on like when I came to college, I was relatively insulated from the challenges that women face every single day when they come to, into any room and then watching how, when I delivered whatever our stump speech line was about, we're gonna build this new software platform or this new governance structure for Harvard.
Senan Ebrahim: I deliver it and people will be like, Oh, okay, great. And then when she would say the exact same words, the exact same sequence, the response was just diametrically opposite, whether from other students or, you know, the 60 year old Dean of Harvard sitting across from us. So it was just, it really changed the way I think about gender on my own team, as well as for the people that we're serving. So when we're in, you know, whether it's in the Middle East or Latin America and whatever, the cultural context who are the people we're trying to help, what are their health needs? And I think that, uh, so a lot of credit to Bonnie and to the women in my life that have really helped me think critically about that entire axis that I was just personally never had my eyes opened to.
Sal Daher: And that score. I was a little bit ahead of you Senan. I have a sister, very outspoken sister. So it wasn't just my mother, you know, mothers can be very indulgent. Sisters that never indulgentof their brothers.
Senan Ebrahim: They call you out?
Sal Daher: Sisters are never indulgent, only sisters, even less. You know, one sister, three brothers, uh, that's quite, she had everybody jumping through hoops. But she's a wonderful person. The dynamic of growing up, we were four growing up and I tell you, it was a wonderful life. Both my parents, their family life growing up was not a happy one, can very difficult circumstances and so forth. And they were like incredibly dedicated to making our childhood a great one. You know, I'm very grateful for that. So Senan, if there's anything else you want to touch on?
Senan Ebrahim: I just wanted to end with a call to action for all the entrepreneurs out there, all the investors, all the folks who are in this space, listening to this kind of a podcast, you are all extremely talented people who are either launching really exciting things or supporting really exciting things. I just want to say, think about how you can apply those approaches to the folks that might really need your help the most. And it may or may not be through a non-profit vehicle, but at the end of the day, right, it adds a lot of value to not just your company immediately, but thinking 10, 20, 30 years down the road for yourself as an investor or as an entrepreneur, to the way you approach problems. Because if I had not started Hikma Health, I would not have even a 10th of the ability to approach a problem critically with an idea of what a market needs a real need is what my resources and what the product vision looks like. So I would say, you know, for anyone out there just think very critically about how you can help anyone out there in our own country, in your own neighborhood and your own community, or anywhere around the world.
Sal Daher: Start something, start something, you know, another very interesting result from the study of entrepreneurship is, uh, I think Professor Nordhaus at Princeton. He is a Nobel Prize in another area, but he did work on, you know, how much of the value of a new enterprise, a new technology enterprise can the investors and the founders capture. And he did this study over many years. Listeners to the podcast approach, familiar with this, I think over like a decade and a half, uh, he came up to conclusion. They basically capture 5% of all of the value that's created by the enterprise. The other 95% are captured by employees, by customers and so forth. So starting something new, even if it very small scale throws off huge, it sort of throws off these huge it's a diseconomy. I mean, it's, it's stuff that's not accounted for in what we see normally, but it's a positive diseconomy throws off these tremendous rewards to a lot of people around you. And, uh, and so this is the same, uh, I mean, even though this is a non-profit, uh, you know, venture, even a for-profit venture has a lot of nonprofit aspects for profit ventures, technology ventures of basically 95% nonprofit,
Senan Ebrahim: Right? Because they're not capturing that profit exact, and that value
Sal Daher: Capture that. I mean, actually I was having a conversation with Joe Caruso. Who's a, an angel investor who you should meet at some point, they were really great guy. And I was talking to about this with Joe and Joe says, well, of course not, how are you going to get customers if they don't get any value? I said, well, Joe, but it could be that the founders capture 50% of the value and the customers capture 50%. The customer is still be very glad because it's value they wouldn't have gotten otherwise. Right. But the point is that it's not 50%, you know, some people say, you know, they can only capture 20%, but it's still the overwhelming majority is captured by other people. And of course it doesn't count all the losses that come along. So yes, go out, start something, especially if you're somebody who's young, who's just starting their career.
“...most likely it [you venture] will be a face plant, but believe me, you will learn from it. And maybe it won't be, maybe it'll be a success.”
Sal Daher: Go out, you can do a face plant. That's fine. Uh, you know, when you're, you know, 45 years old with a mortgage and three kids and, you know, with braces and all that, it's much harder doing face plants. So, try your face plant when you're still in your twenties. And, most likely it will be a face plant, but believe me, you will learn from it. And maybe it won't be, maybe it'll be a success.
Senan Ebrahim: Amen, amen.
Sal Daher: All right, well, so Senan, let's take this as part one, and I can promise you in my audience that, that there will be a part, two of the Senan Ebrahim story, which will be very interesting. And it's an interesting direction, which we, you know, we can't really discuss at the moment, stay tuned. And, uh, I'm very grateful to you for the time to be on.
Speaker 2: Thank you so much for having me Sal. It was really a pleasure to share the Hikma Health story with you and, uh, really look forward to continuing the conversation.
Sal Daher: Congratulations. This is a really very impressive thing that you've done that you and your team, and I hope it continues to prosper and grow.
Senan Ebrahim: Thank you, Sal. Thanks a lot.
Sal Daher: This is Angel Invest Boston. I'm Sal Daher.
Sal Daher: I'm glad you were able to join us. Our engineer is Raul Rosa. Our theme was composed by John McKusick. Our graphic design is by Katharine Woodman-Maynard. Our host is coached by Grace Daher.