Aschkan Abdul-Malek had come to Afghanistan to solve problems. He was working for a consulting firm, and in 2013 was helping the World Bank study healthcare constraints in developing countries. One day, as he was home talking to his cook, he learned how personally devastating the healthcare problem could be: The cook was spending six times his annual income to fly his wife to India for medical care, because she couldn’t find the doctor she needed at home. Many Afghans were in similar positions: Despite an average annual income of about $680, locals spend nearly $300 million a year on what’s called medical tourism.
Abdul-Malek wondered if he could fix this.
Entrepreneurship was new for Abdul-Malek, 34, a son of Iraqi and Iranian parents, who was raised in the U.S. He holds a law degree and an MBA from Vanderbilt University, worked in investment banking and strategic consulting and spent time with an NGO in Northern Iraq. But corporate life never suited him, he says: “At no stage was I ever that guy that would just get lost in a crowd.” He races cars at 160 mph for fun. When a bomb goes off near the office, he checks that everything’s OK and gets back to work. He performs well under pressure. A Kabul startup was his kind of challenge.
In 2014, he launched AlemHealth. If understaffed Afghan hospitals had a reliable way to connect with foreign specialists, he reasoned, patients could be spared the expensive travel. And if it worked in Kabul, it could scale to other developing countries. He hired an office manager and brought in a UAE-based cofounder with telemedicine experience along with his experienced team of Bangladeshi software developers.
Kabul may be one of the world’s most unstable cities, but with the local population looking for ways to create jobs, and foreign aid agencies keen to promote entrepreneurship as a road to economic growth, a startup community is sprouting. The past few years have seen the city’s first tech accelerator, Startup Weekend and coworking space. “It definitely can be challenging,” says Roia Shefayee, a director of the local accelerator Founder Institute, Kabul Chapter. Startups need to deal with security issues, government corruption, unreliable electricity and shaky infrastructure. But, she says, “there are challenges in any country you go to.”
As Abdul-Malek built AlemHealth, he discovered that Kabul’s challenges came with benefits. “It’s like trying to do things in space,” he says. “It will test your redundancies in ways that you never planned for, and it allows you to build something that’s so robust and flexible that you can take it anywhere.” For example, many hospitals weren’t set up for telemedicine, so he had messengers shuttle X-rays and MRIs across town to his office, where they were digitized and transmitted to specialists in the U.S. and India. Once the company proved there was demand, it developed affordable hardware; Afghan doctors could then send the images from the hospitals, and pay only when they used it.
He also learned the local quirks — like documenting everything to avoid any mistakes or disputes. He’d heard a rumor of someone in the medical community clashing with a client and then disappearing soon after. One client accused AlemHealth of breaking a machine and took the dispute to a jirga, or traditional council, which brokered a $2,000 payment to the client. “You’re sitting in someone’s living room with a bunch of old guys with beards, trying to explain to them the nuances of a CT machine,” says Abdul-Malek. “It’s kind of hilarious.”
After processing hundreds of patient records and signing up a handful of hospitals in Kabul, AlemHealth scored a $151,000 angel investment. In early 2016, it expanded to Lagos, Nigeria. Now Abdul-Malek is working with 15 facilities across the two countries and plans to be in Iraq and Sudan by the end of the year. Like Kabul, these new locations, he expects, will challenge him — and make him better.
“You’re constantly reacting and learning very quickly, and these are skills that every startup founder needs,” he says. “If it starts to feel comfortable, you’re probably not pushing the boundaries enough.”