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🌍 Global Perspectives on Digital Health
A podcast unpacking the stories, insights, and innovation shaping health systems and underserved communities.
🎧 Listen on Apple, Spotify. Watch on YouTube
Aral Surmeli (00:04)
it was 2021 when we applied to the USAID grant. It took one and a half years of back and forth before we were approved. And these are not short back and forths. Every time they send us questions, we respond, they respond. And honestly, like,
It was a long process.
And size of the grant is not amazingly huge, but we also know that having USAID name is the bigger thing, because they do do all kinds of due diligence. you being able to go through their due diligence means you have a high chance with other funders, because they're like, OK, they have
checked everything they can, so these guys are probably trustworthy.
Shubhanan Upadhyay (00:53)
We know that investors do that as well.
Aral Surmeli (00:55)
And I think January, we received a note of, know, stop work order.
which I was, you know, like I went onto LinkedIn and say, I'm not stopping. You can choose not to fund me, but I'm just not stopping, obviously. ⁓ But the biggest thing that people may sometimes forget is how much of work you did to get to that point, which is, a lost opportunity of, working with other, funders and everything.
Shubhanan Upadhyay (01:08)
Mm-hmm.
Aral Surmeli (01:24)
And one thing is when USAID
pulls out, a lot of other funders also pull out.
Shubhanan Upadhyay (01:34)
You're tuned in to the Global Perspectives on Digital Health podcast. We have a snazzy new website, which you can check out, gpodh.org.
This is the podcast, sharing the insights and stories.
of people implementing digital health solutions and AI with underserved communities around the world. The goal is really to foster learning between different contexts for people who care about ensuring we don't leave anyone behind.
With that in mind, we have a very, very relevant guest today. We have Aral Surmeli He is the founder of HERA Digital Health. creating digital tools and solutions for displaced people, for refugees. And we're going to be hearing about their journey, their challenges. I'm really excited about this one because I've talked to a few people, I've had a few meta conversations.
recently about things like regulation and evaluation and policy with Alain Labrique from the WHO. But ultimately all of that needs to kind of translate down to the actual building and the actual implementation and the actual impact for people and particularly vulnerable groups.
So let's get into this discussion,
Shubhanan Upadhyay (02:53)
Aral Surmeli, it's such a pleasure to have you on the Global Perspectives on Digital Health podcast. Thank you for taking the time to join us. I'm excited because you are doing, you're creating, you're building, and it's always good.
to talk to people who are in the weeds and building. So I'm really, really excited to get your insights. Welcome to the podcast.
Aral Surmeli (03:15)
Well, thank you so much for inviting me. I'm really happy to be here.
Shubhanan Upadhyay (03:18)
Yeah. Why don't we start with you telling us a little bit about yourself, your background
Aral Surmeli (03:24)
Yeah, so I am a physician from Turkey. I worked mostly in emergency rooms, ambulances, and humanitarian settings. The first nonprofit I founded back in 2013 was Medical Rescue Association. So we worked in disasters, worked with search and rescue teams to provide the medical side of response.
Then I moved to the US to do my master's in public health at Harvard and now I'm doing a PhD in public health at Johns Hopkins. But my kind of work started with the Syria crisis when refugee influx started to Turkey.
I was working in the border cities, Istanbul, where there's more than million refugees, and really seeing what they were experiencing. And the good thing in Turkey is that we have free healthcare for refugees, which is amazing. But we also know that that doesn't always mean that they have full access to healthcare.
And that's what I was seeing in the emergency room, in the ambulance, like children coming to my ER with vaccine preventable diseases that we know how to prevent, but they just didn't know where to get the vaccine or pregnant woman bleeding in my ambulance because she didn't know she could get pregnancy care. She didn't know where she can go, when she can go, which hospitals accept her and everything.
So that's how we kind of ended up working on HERA. We realized that this is a very tech savvy population. So we thought, you know what, we can use that digital health solutions to help them get connected with healthcare. And that's how kind of my work started. Yeah.
Shubhanan Upadhyay (05:20)
That's such a great origin story. So many stories start from you living and seeing people living in the problem. You saw it in the back of ambulances, you saw it in your ER. I wanted to pick up on something you mentioned. Can you elaborate? You mentioned that often these populations, although vulnerable, are tech savvy.
Aral Surmeli (05:43)
Yeah, that is a, I don't know if I should say counterintuitive for some people, but so mobile phones, especially smartphones are a lifeline for them because if you imagine like you left your home, all your family and friends are dispersed around the world. The only way to get connected is your phone. So we often find that mobile phones are a
not a luxury, but rather a lifeline for them and something that they really value. They may change phones, phone numbers, but especially in the case of Syrian refugees, that is their primary way of getting information. So that's how we kind of went this route, I would say.
Shubhanan Upadhyay (06:24)
So let's continue on this path then. So you had this insight that we've got a population that is suffering because they're not able to get the access and the information that they need to, although the healthcare is there, they're not kind of seeking it at the right time, Yet they are engaged with their mobile phones, their technology. How did you kind of put those?
I guess like you put those together, so how did you then approach doing something about that?
Aral Surmeli (06:53)
Yeah, so actually the interesting thing was, I think it was my last year of medical school and I had the opportunity to intern at Harvard's Global Health Delivery Center in Dubai, which was led by Salman Keshavjee know, head of Global Health and Social Medicine at Harvard, and Subash Chander, who was one of the leaders of the center there.
And then he was working on digital health, especially, know, vaccine reminders using, you know, short message services. And while I was interning, he was like, okay, you need to learn about this. So he made me read everything, digital health on PubMed. I mean, luckily there wasn't that many papers back then. It's not like now. But when I went back to Turkey, I'm like,
well, this could actually work here. And that's how I kind of made that connection. And then the first step, which is, think, very important whenever you're innovating or creating something new is to, even before that, just talking to the population. So we started doing formal and informal meetings with potential target groups. But one other thing that we did, which I think is extremely valuable, was working with the Syrian doctors who
They could be formally working in Turkish hospitals, informally working, but they knew the population very, very well. So going to them and like, hey, what do you think about this? But more than that, what would be the helpful, what would be the pain points that we can solve has been super helpful. So the first thing we did was really just doing a deep dive into the issues and how we can solve them.
Shubhanan Upadhyay (08:36)
So you sat down and listened to people who needed the care and the people who were like at the front line of delivering that right. And I think that's great that you engaged Syrian doctors who kind of really understood the nuances of the particular types of problems that the people that were looking after as well.
Aral Surmeli (08:42)
Yeah.
Yeah, and there's also the cultural difference, right? Like you need to kind of understand people's health seeking behaviors, when they want to seek help, when they have the opportunity to do that. Like as a mother, like they have like one or two children or more children, which means they can't really just, I feel bad, I should go to the hospital. So there are kind of like barriers to healthcare that's...
Shubhanan Upadhyay (08:57)
Yeah.
Aral Surmeli (09:21)
know, social, economic, know, cultural, and obviously being a refugee brings a whole lot of issues with it that you need to deal with where it may lead you to not prioritize your health. So yeah.
Shubhanan Upadhyay (09:36)
Yeah.
What happened next? How did you go to that from then, creating something that would solve the problems that they were facing.
Aral Surmeli (09:47)
Yeah, I'm not a technical person. and my co-founder wasn't, ⁓ which is a friend from medical school. So, we were two medical people who know nothing about coding and want to do this, which was not something I'd recommend, like have a technical co-founder for sure. So we had to learn it the hard way, but yeah, we started talking to,
companies and also like some friends that you know had technical background to understand how this would work, what we can do and everything and you know it was a long process long you know coming with an MVP trying different things. ⁓
Shubhanan Upadhyay (10:27)
And when was
this? When was this Aral?
Aral Surmeli (10:30)
2017, I think we started 2017, yeah. But the live product came out in, the first version came out in 2019, I think. But yeah, it was a long process of trying to decide on everything. Now that like, with AI obviously it made things much easier and at one point I was like,
Shubhanan Upadhyay (10:42)
Yeah, okay.
Aral Surmeli (10:57)
I'm just going to learn coding off YouTube for six months, which didn't work, but yeah.
Shubhanan Upadhyay (11:03)
I'm curious to know now if you were starting now, I mean, you know, with the proliferation of tools that help you, you know, where, you know, generative AI is helping you create code. Do you, I mean, people are, people are quite polarized about this often. Actually, people say it's just a faster way to get technical debt actually. What are your thoughts? you think, do you think that that having gone through and worked with technical founders and realized kind of like the
deep technical work that you needed to do? How much do you think if you were starting again you could try and spin up yourself?
Aral Surmeli (11:37)
Yeah, I I don't have the technical expertise to say what can replace what, but what I would say or I would do is like doing a quick and dirty pilot with an unfinished product using any kind of like AI tool I have in my hands.
I my understanding is that, again, the finished polished tool is not, I mean, at least most of it cannot be done with what we have right now. But I think it would be useful for piloting something, trying new things, new features. Yeah, yeah, yeah. That's kind of like how I would go. Because for us, it was a painful process. The bigger issue there, which we are kind of trying to kind
Shubhanan Upadhyay (12:13)
Prototyping etc. Yeah, yeah, yeah
Mm-hmm.
Aral Surmeli (12:24)
trying to solve now is you have this technical people who are highly experienced and experts in the technical stuff. So they know which language to code in, what to code, the UI and everything. And then you have this field people, which is us, know the context really well, but there's a miscommunication between the two. Because they're not used to people coming to them and saying, we want this to work in the worst form possible. They're more like,
Shubhanan Upadhyay (12:46)
Mm-hmm.
Yeah.
Aral Surmeli (12:54)
Well, I can do this work in iPhone 15. I'm like, no, no, no, I want it to work. And so there is that, that yes, yeah, yeah. So that was the kind of the painful part, which I think we now having our own tech team has been, much better at it for ourselves. And we're, you know, helping other organizations build their tools as well. yeah.
Shubhanan Upadhyay (12:59)
I'm like literally a brick at Nokia.
I'm going to think just in general, in my experience, obviously working at Ada and bridging the technical and product and design with the clinical domain, you know, that job there really to help understand the context, where you need to go slow, where you can go fast, how to think about something so our technical colleagues can turn that into, okay, I understand now the constraints in which I need to work.
I understand the risks and understand we can work together on how to mitigate them. We understand now what the technical requirements are. We have therefore some clinical requirements or on the field requirements from you. That to me sounds like a similar journey that you've been on.
Aral Surmeli (14:01)
Yes,
definitely. then the context of refugees is much different than everything we have. And it's not a static condition, a static context. So you constantly have to adapt and change what you're doing. Like, for example, right now we are discussing whether we can kind of implement HERA inside Syria for the people who are going back.
Shubhanan Upadhyay (14:09)
Yeah.
Mm-hmm. Mm-hmm.
Wow, yeah.
Aral Surmeli (14:28)
And
we've been talking to teams and the people on ground, they're like, yeah, this would be super helpful. That's great. But also WhatsApp business doesn't work there yet. Facebook works, but Facebook ads don't work. App Store, if you're connecting through 4G, it works. But if you're on wireless, it doesn't work. there are things like that. If we design around those and if they don't work, then you know.
And it's not the same with Turkey. that dynamic and ever-changing context is really important to keep your eyes on.
Shubhanan Upadhyay (15:02)
That's a really good one, yeah, I like that. And just backtracking a little bit, can you just explain exactly what ⁓ Hera Digital, this app for women and children exactly does?
Aral Surmeli (15:16)
Yes, definitely. So right now, the main goal is to connect refugee populations with available healthcare services wherever they go. And we do this by an open source and free mobile app coupled with an AI powered chatbot, which is on WhatsApp. And what it can do is, well, first help them carry their health records. It's simply as, know, taking a photo of it and...
whether you lose your phone, your phone number, we still have access to those. Because as a doctor, when the people come to my hospital, I don't need the whole medical history. I just need to see if you have these vaccines and stuff. Another one is helping them find the nearest health center. Because if you imagine, even as a tourist, when you go somewhere, you don't know where the hospital is, ⁓ So imagine living in a new country with another language. Another one is calling 911 services.
Shubhanan Upadhyay (16:01)
Mm-hmm.
Aral Surmeli (16:07)
especially if you don't know there is like the, you know, the free ambulance service. And most importantly, and where we think is the biggest impact is helping them schedule out immunization appointments for their children or prenatal care checkup appointments for the pregnant woman. Because we know these are kind of the most, you know, cost-effective interventions they have in public health and they're often free. But
we need to help them prioritize, let them know when they can go, where they can go. This is essentially what we do. Over the last, this year, we have been focusing more on the AI-powered chatbot. The reason being you can actually do everything that an app can do over that WhatsApp bot. And if you adapt it culturally, make it context-aware, people actually prefer that.
which is interesting because we spend so much time on the UI of the app, but it turns out people just want to chat with a WhatsApp phone number. So those are kind of what we have right now. They're all open-sourced so others can take it, make it their own, and use it. We have no problem with that, which is actually something I wanted to ⁓ share maybe later in the episode about how to become sustainable and everything.
Shubhanan Upadhyay (17:28)
Super, yeah, no, let's definitely, we'll get into that. So I'm curious to know, so you've seen this problem, you've built something that kind of helps serve particularly mothers and their ability to look after their children or their unborn children so far, seek care when it's needed. And you mentioned, what are you observing as the most kind of common type of conversation on the WhatsApp tool? ⁓
What are they finding useful?
Aral Surmeli (17:54)
Yeah, so that's actually really interesting because we're always looking at the history of chat, what people are asking, what people want to know and everything. One thing that's been super helpful is the questions about sexual reproductive health, because these are culturally hard to discuss with another person, even if they're doctors or nurses.
So that's something that people ask a lot about, what they want to learn. Another side of it, when you say, AI Chatbot, everyone compares you to chat GPT. So we get questions like, should I invest in Bitcoin and stuff? We just say, hey, this is not what we do. But we do get those. But the most interesting part has been seeing the sexual and productive health and the questions they want to ask about,
Does this vaccine hurt my children? What are the risks and everything like that? So people not only use it as a tool, but also to commerce around health topics, which is what we kind of aimed for.
Shubhanan Upadhyay (19:00)
And is this an off the shelf solution that you've then fine tuned? Is it something you've developed yourself? What's the kind of solution that you're using that's kind of working in the back?
Aral Surmeli (19:09)
Yeah, I mean, my CTO would be better at answering that, but my understanding is that We do use couple off the shelf solutions, put them together and then fine tune them and make them more context specific. Because none of the LLMs are trained with refugee data, let alone Arabic. Yeah, so you need to really kind of train it, give one shots or off shots.
Shubhanan Upadhyay (19:27)
100 % yeah yeah yeah yeah
Aral Surmeli (19:35)
for it to understand the population and everything. But yeah, that's the thing to do because I mean, LLMs are pretty good right now. You don't need to develop yours, but making it work for your population, which is not represented by the training data that these models are trained on is the important part.
Shubhanan Upadhyay (19:48)
your context, yeah.
100%. Yeah.
And I'm curious as well, because the cultural nuances,
what's the type of work that you do to make sure that that's relevant, right? Because obviously you're Turkish and speak Turkish. So how are you involving the Syrian doctors in the fine tuning as well in terms of the Arabic, making sure that health information is relevant, not just like broadly in the whole Arabic speaking world, but actually for like what's pertinent or what's relevant within this population.
Aral Surmeli (20:23)
I mean, on top of working with field organizations and the, like grassroots organizations and the Syrian healthcare workforce, one thing that I think has been very important and valuable for us, which I would recommend for anyone in this sector is we hire refugees. Our senior developer is a refugee himself.
before him, we also had a refugee. Our field team is mostly refugees or disaster affected people. That's kind of how to make sure that you have representation. And one thing that with our senior developer, what I love is he has two kids, a wife. So anytime we talk about features, he's like, hmm, let me go and ask my wife because she is from the target population. So, you know.
That's been, yes, yes, exactly, exactly. So that's how you make sure there's representation and what you build is, he was recently in Syria to go and look if he can kind of work with populations there, talk to people and everything. So that's how we kind of make sure what we do makes sense to the population that uses it.
Shubhanan Upadhyay (21:12)
You've got a fast feedback group. You've got a fast feedback loop right there. Perfect. Perfect.
Super, that sounds awesome. Have you got any data of the impact you've had that you can share with us? Any individual stories of people's or lives that you've affected? I think that'd be really helpful for people to understand the type of impact you've had.
Aral Surmeli (21:54)
Yeah, definitely. So I think the most striking numbers are, I think we have more than 40,000 people using our technologies, WhatsApp chatbot, the app, other kind of technologies that we've created. On top of that, with the trainings and the field work, our work has impacted
310,000 people, if I remember correctly, both with the refugee population and in the earthquake zone in Turkey, Syria, which I'm really happy about because, I mean, considering the funding we had until now, it's been highly cost effective. Story wise, one kind of story that I like
is one of the Syrian doctors that we work with, a pediatrician who's like an amazing pediatrician who's been, you know, helping us build this from the beginning. One day he texted me and he works as a pediatrician with children, right? He vaccinates them and everything. One day he texted me, hey,
I totally forgot about my child's own vaccines and I received a reminder from the app and that's how I remembered I need to, you yes, yes. And it's someone who routinely vaccines kids. it's funny, but also it shows the life as a refugee that you have so many things to do, you know, get education for your child, know, learn your rights and everything. And health loses its priority, but we know that
Shubhanan Upadhyay (23:03)
His own child. ⁓
Aral Surmeli (23:22)
vaccines are super helpful. So I think I like that story a lot. And also it's someone I know closely and comfortable sharing. But yeah, that was kind of like one of the stories that we always find super interesting.
Shubhanan Upadhyay (23:34)
Yeah.
And that takeaway that you have of if you really want to understand that context, it's easy for us to kind of sit here and do our desk research and understand, and get a very superficial understanding of what life is actually like. But I think that's a really great story of like, there are so many difficulties to juggle if you've been displaced. And even if you're a doctor.
who understands this, that falls off your priority list because there's just so many important things going on that you have to manage. And yeah, I think that's a great reminder that if we really want to impact people in ⁓ the right way, we really have to understand what they're going through. So that's a really, really good one. Any stats in terms of, or data in terms of...
Aral Surmeli (24:05)
Yeah.
Shubhanan Upadhyay (24:27)
health outcomes or lives impacted or preventative successes that you've had.
Aral Surmeli (24:33)
Yeah, so we actually are just finishing up a study that we did with the Ministry of Health and I think the biggest highlight which will be published soon, hopefully I need to get on it, is the increase of uptake in pregnancy care appointments by 20 to 25 percent, which is huge because that would mean like one extra
pregnancy prenatal checkups, which the baseline being zero to one out of, know, Turkey still uses four, WHO uses eight appointments during the pregnancy. So that scaled up would be a, you know, huge ⁓ impact. I think that's the most striking one that we have like some evidence for. But other than that,
Shubhanan Upadhyay (25:21)
Mm-hmm.
Aral Surmeli (25:26)
you know, we had, you know, 20,000, you appointments, pregnancy or immunization appointments that we help get connected between the people and the healthcare, local health services. You know, a lot of things that people don't really realize is the translation, like talking with your doctor, which has been
used a lot. We thought of it as a fringe feature. Hey, we should have that. But it turns out it's like, on average, we have at least 500 to 600 conversations every month. People talking to our AI translation tool, it talks back in Turkish. That helps them connect with the or communicate with their doctors and everything. But yeah, so those are kind of like
what we've been seeing impact in.
Shubhanan Upadhyay (26:18)
Yeah, and you were just recently at the AI for Good Summit in Geneva, which we're recording this in July. So a couple of weeks ago you were there and you reached the final of one of the the competitions in terms of social impact. Can you tell us a little bit about that?
Aral Surmeli (26:33)
Yeah, HERA was a finalist in AI for Impact Awards. And there are so many amazing organizations. First of all, the summit was great in the sense of, you know, we often talk about the risks and threats of AI and being together with organizations that are obsessed with using it for good.
was amazing, being in their presence. And the competition was between the organizations that are using it to help the vulnerable populations access services, maybe healthcare, education, and everything. So I got to meet with amazing organizations, some using...
a fetal movement to predict if there's going to be a risk to the child. know, humanitarian open street maps. They're an amazing organization that we work with a lot for, you know, mapping services and such. But yeah, it was super interesting. Yeah.
Shubhanan Upadhyay (27:30)
Awesome. And before we move on to the next section, you've been doing this since 2017, you said. It's now 2025. There must have been some big challenges, things that went wrong, things that you've really learnt from. Do you want to share anything that you felt was like a big thing that you got wrong or that you had to kind of change or change course with or learn the hard way?
Aral Surmeli (27:58)
I mean a lot, how much time do you have? But it's, one thing is I did it part-time most of the time because I was also practicing. If I'm not practicing, was studying for my master's and PhD. that was kind of like the biggest difficulty I had. Another one, as I said before, not having a technical founder.
Shubhanan Upadhyay (28:11)
Yeah.
Aral Surmeli (28:27)
technical co-founder. So if you're a person or a health person, first find yourself a technical co-founder because you need that. That was the biggest issue we had. And I'm glad to say that it taught us a lot. Like right now, it's much easier for us to build tools on the ground because we understand the context really well.
Shubhanan Upadhyay (28:41)
Mm-hmm.
Aral Surmeli (28:53)
Another one was obviously funding. That's always an issue. Innovation in high-income settings is something that's easy to fund because it promises a good profit or valuation. But innovating for humanitarian context is
is different because not only it won't bring profit, but also it could fail because it's an innovation. So people are more risk averse. But yeah, those are, I would say, the biggest ones.
Shubhanan Upadhyay (29:22)
Yeah.
And I guess you're a bit... These settings as well, you mentioned at beginning, the context is always changing. And it could change in such a catastrophic way that you've got no ability to go forward, I suppose, as well. So that's always a risk as well.
Aral Surmeli (29:44)
Yeah,
mean, the traditional way of applying to grants for writing a project that's five years long, if I can predict what's going to happen in five years, it wouldn't be where I'm working. And I can't tell you what's going to happen in five years. I shouldn't be able to tell you, or you shouldn't believe me when I said, OK, in five years, I'm going to be doing this. That's not how, not only the context changes, but also, as we know now,
Shubhanan Upadhyay (29:57)
Mmm.
Aral Surmeli (30:11)
technology changes a lot. I shouldn't tell you like five years I'll be using, you know, llama this. We don't know what's going to happen. So that's the kind of like the difference and changes.
Shubhanan Upadhyay (30:12)
Mm-hmm.
Yeah.
Let's carry on this thread because it kind of you what you've just talked about kind of especially in terms of challenges, you kind of left us a little a little good segue into kind of the next ⁓ topic, which was really around funding and the challenges of that and being becoming sustainable. This is a context and setting refugee health humanitarian settings that don't lend themselves well to
Definitely investor funding, even donor funding can be hard. You, I know as well, one of the ways we connected as well was, you know, post USAID funding and you've had the rug pulled from under you. So I want to use your experience to, guess, like then go into the meta concept that you've alluded to of like how, what needs to change in terms of donor funding, financing, humanitarian causes.
How do we think about it? But maybe let's start with your experience of having your funding cut and stopped.
Aral Surmeli (31:22)
Yeah, well, so.
I think it was 2021 when we applied to the USAID grant. It took one and a half years of back and forth before we were approved. And these are not short back and forths. Every time they send us questions, we respond, they respond. And honestly, like,
It was a long process. Not only that, we were the first ones to be accepted from Turkey, like for a USAID grant. So much so they said, like, hey, so we don't know how to give you money in Turkey. Can we give it in the US? And you guys deal with that. I mean, as long as you give the money, I don't mind. Yes, yes. So the team is in Turkey. So we have the nonprofit in Turkey, nonprofit in the US.
Shubhanan Upadhyay (32:03)
And you were in the US at the time, right? yeah, yeah,
Aral Surmeli (32:12)
So it's not a huge problem for us. And size of the grant is not amazingly huge, but we also know that having USAID name is the bigger thing, because they do do all kinds of due diligence. you being able to go through their due diligence means you have a high chance with other funders, because they're like, OK, they have
checked everything they can, so these guys are probably trustworthy. ⁓ Yes. Yeah. Yeah.
Shubhanan Upadhyay (32:40)
We know that investors do that as well. So it's interesting to see that happens in the donor
circles as well.
Aral Surmeli (32:46)
Yeah, so towards the end of last year, we got the news that, you know, things are not going to come out and you're like, so we weren't sure back then what was going to go down, like all of it taken out or just like pieces of it, or are we going to go under more scrutiny and everything? And I think January, we received a note of, know, stop work order.
which I was, you know, like I went onto LinkedIn and say, I'm not stopping. You can choose not to fund me, but I'm just not stopping, obviously. ⁓ But the biggest thing that people may sometimes forget is how much of work you did to get to that point, which is, you know, a lost opportunity of, you know, working with other, you know, funders and everything.
Shubhanan Upadhyay (33:20)
Mm-hmm.
Aral Surmeli (33:37)
we were pretty sure we were going to get the money. So we're like, okay, let's focus on this rather than going after different funders because this is going to bring a lot of impact with the money we are getting. We had randomized control trial. We got the ethical approval for and everything. So it was a difficult process. And one thing is when USAID
pulls out, a lot of other funders also pull out. Because not from us, but we were lucky that our funders were supportive of what we were doing and really tried to help us. But in many settings, that means that the money is, not only money from USAID is gone, but also other things as well.
Shubhanan Upadhyay (34:17)
⁓ that must have been hard. How did you...
What did you do next?
Aral Surmeli (34:24)
I mean, yeah, was hard. It still was hard. We barely were able to fill that gap, which meant that we had to go into survival mode rather than expansion. I mean, we had to let go of some of our people, majority of our field team. yeah, and with the recent changes, the...
the administration, other funders were also kind of scared on supporting the work that USAID is doing.
Shubhanan Upadhyay (34:55)
And was that development funding
or was that philanthropic funding? Or like what type of funders were the ones who were feeling anxious? Nah. Yeah.
Aral Surmeli (35:03)
I think all. I don't
have a specific example, but we can see the funding pulling out of global health and a lot of work. Because everyone was unsure what to support or what to do.
Shubhanan Upadhyay (35:12)
Hmm.
Okay, so you, it kind of also, you observed it was having a ripple effect. on your ability to carry on, have the impact that you were having. You had to scale down, scale back your work. How did you approach thinking about what you needed to do? How did you prioritize? Okay, well, this is how we need to adapt.
How did you think about how to deal with like A, so you kind of were in survival mode and then you needed to be like, well, we need to move from survival mode to like, how do I sustain here? How did you think about that?
Aral Surmeli (35:58)
So yeah, one kind of silver lining out of all of this was really focusing on the digital side of things of community engagement and making more people aware of our tools, using social media, the social networks and everything. So that's been kind of what we've been focusing on. And another thing now that we're...
mostly down with our field work was just diving into the statistics and the data that we're collecting on health impact, the outreach and everything. So we spent a couple of months with the team, brainstorming, looking at the data and what we are doing and everything. And it did help us a lot in understanding the impacts of...
doing this virtually or digitally, which I wouldn't say is the way that you purely should be. You always have to be on the ground with the population and everything. But there's a lot of things that can be done digitally, which was the of like the silver lining. Yeah. Yeah. So we saw that like now that we had the time and energy.
Shubhanan Upadhyay (37:03)
Do you have any examples so people could picture it?
Aral Surmeli (37:11)
We tried different Facebook ads on what resonates with people and different wordings and everything. we saw that pregnancy related ads or showing the features of our tools on pregnancy were more effective than the immunizations.
One thing we also saw was while we were working on the ground, majority of the people who we were doing workshops with were women with children rather than pregnant women. And the reason is pregnant women usually stay at home instead of coming out. So we realized that an online way of reaching pregnant women was more effective while women with children of vaccine age, it was easier to
reach them on the field. So was kind of like an interesting learning for us to work on.
Shubhanan Upadhyay (38:00)
Interesting. So you look back at your
data and you're like, what can we learn from this to, guess, like refine to see where we need to change tack strategy, where do we prioritize and hone down on is what I'm hearing.
Aral Surmeli (38:16)
Exactly,
exactly. Yeah, yeah, exactly.
Shubhanan Upadhyay (38:19)
Very good, I think that's a really good lesson that, you know, sometimes we're trying to look externally, oh my God, what do we need to do? And actually sometimes it can be good to be like, okay, well, let's, have we really looked at what's, like, let's do a, I guess like an audit or like, let's really look at what's happening on the ground right now. So yeah, it was great that you did that. So you then...
Aral Surmeli (38:39)
Yeah.
Shubhanan Upadhyay (38:44)
you use this to kind of see where you needed to prioritize. What happened then? How are you thinking, like what's happened between then and now and how are you navigating, I guess like turning HERA into something sustainable in this backdrop of, reduced development funding, donor funding also potentially drying up or being earmarked and being hard to predict where the next vertical priority is gonna be.
How do you think about that? How are you trying to navigate this as a founder, as an organization?
Aral Surmeli (39:17)
Yeah, mean, a lot of conversations with funders and other organizations is about sustainability. How can we be for impact but sustain with some sort of business model and everything, which is great. But also there are risks associated with that. Because for me, especially in humanitarian aid, since...
we're never gonna be asking refugees to pay for it. Then we are gonna ask the ministries of health or UN organizations to pay for it, which is good, but those money also come from funders. So either funders are giving me money to do that or giving the service provider to buy services from me. So I have some reservations about...
that being sustainable or how that changes the mathematics of it. But we do have those conversations. One thing that I think is going to be super important is being open sourced because, I mean, again, my impact needs to be sustainable, not me. If my work is being done, I mean, or someone else is doing it, someone else is doing it better than I do.
Shubhanan Upadhyay (40:06)
Mm-hmm.
Aral Surmeli (40:30)
I don't need to be sustainable. can cease to exist. That's fine. That's I think the difference that people often forget. It's not Hera that needs to be sustainable. It's my work that needs to be sustainable. And I don't mind it being used by someone else, someone changing the name. Honestly, I don't. I can go back to being a doctor. My mom still is like, hey, when are you going to make money? As a doctor, I thought we were going to be rich.
Shubhanan Upadhyay (40:55)
Thank
Aral Surmeli (40:57)
That is kind of like a thing that we need to discuss, but I don't have a clear answer honestly on where things are gonna go from here. I know that the refugee crisis is not gonna end with the climate crisis. More people are gonna be displaced and our health systems are not designed for them. They're designed for people who are born and die in the same place. So we need to kind of change the way we think about refugee healthcare. And I think
Shubhanan Upadhyay (41:03)
Yeah.
Aral Surmeli (41:25)
What we're trying to do, something that moves with them rather than stays in one location is our first take on how we can provide care for refugees with HERA and open source tools.
Shubhanan Upadhyay (41:39)
Absolutely, oh man, some really, really interesting perspectives there on, I really like what you said around, hey, it doesn't have to be me or this organization that needs to survive, it needs to be the impact for people, right? Which is a really interesting take and the route to then make this open source, I can see how that fits with that thinking.
And also kind of what you said around, know, there will always be, with the way the world is going, unfortunately, there will be consistently displaced people, whether it's due to war and conflict or due to climate change. And one, how do we make sure health systems are designed better for that?
but also the digital infrastructure. And I was at a conference called HLTH where there was a panel about refugee health. And one of the panelists talked about the fact that it's really, really key. We talk about access and the way the health system should be able to serve them. But in this world right now, having a digital identity is like such an important enabler. And Alain Labrique
from the WHO had said this as well. It's like one of our big failings right now that people who are vulnerable do not often have a digital identity. And to me, kind of, you're in public health. We talk about the inverse care law, right? Those who need medical care the most are usually the ones who don't get that and no better example there than vulnerable populations and displaced people, right? And as we're building AI into everything, as we're transforming digital health,
you this is a form of health data poverty that exacerbates the inverse care law, right? And so I wanted to get your thoughts on this and how it's such a foundational thing that they talked about, well, you don't always need to think about getting an ROI from this, right? You just think about it as an investment of being able to give people high quality care. And yes, there may be things down the line. You've
worked with refugees in the company on the field, right? These are very resilient people who can contribute to society if they have a good start. And so that was one of the things that they discussed. What are your feelings around this? Do you have any thoughts around kind of the sorts of things that have been mentioned there?
Aral Surmeli (44:00)
Yeah, well, first, let me say that, you know, Alain is a hero of mine and he used to be my PhD advisor before he left us and yes, yes, was. Then he went to WHO. And this is right. This is like the, I mean,
Shubhanan Upadhyay (44:09)
You were at Johns Hopkins, he was there, right? Absolutely, yeah, yeah, yeah.
Aral Surmeli (44:19)
Similar to healthcare, identity is also designed for people who are born and die in the same place. And if that reality is changing, then we need to think about it as well. And ROI-wise, I mean...
ROI is a tool to compare the different interventions for the same outcome and see what is cheaper in the same outcome or what costs the same but has a better impact. It's not an absolute like a thing to do look at absolute in absolute numbers. That's I think something we for yes. Yeah. Yeah. Yeah. Yeah. Yeah.
Shubhanan Upadhyay (44:56)
like should you go or no go or continue funding based on the ROI number?
Aral Surmeli (45:02)
In my case, it could be like, hey, sending reminders two weeks before the appointment or one day before the appointment is more effective and costs the same. That would be like an ROI, where I would use ROI. It's not like, should you do it or not? That's, think, important. And also we have enough evidence from all around the world that not just immigration, but refugees
having refugees in long term has huge economic, you know, outcomes, positive outcomes in that locality. We know this for sure. So, mean, ROI wise, it's always, you know, taking care of people, not just equitable and it's a human right, let's, know, those are not even up for discussion, but it's always a net positive, that's for sure. So yeah.
Shubhanan Upadhyay (45:55)
It's interesting because most of most political commentary in particularly in Europe and the US does not talk about that actually. It's often framed as a big strain on resources and society. And so, you know, it's well documented what you've said, but that just doesn't
filter down to, I guess, like journalism and political rhetoric. So that's really, really poignant, I think. I wanted to talk about as well, what's giving you hope in going forward, because, you know, things you've kind of pointed out that things are pretty tough right now. You, you're still trying to navigate through this. You've talked about
you know, going down the open source route, what's giving you energy and motivation and hope to carry on forward.
Aral Surmeli (46:48)
Yeah, I often think about that myself as well, but I think...
Well, first of all, events like the AI for Good Summit, where I get to meet with people who are going through similar things, had their funding pulled but they show up every day is what gives me hope. I am part of this group of fast forward, and they're an alumni of their program, and I get to meet with the teams.
quite regularly and seeing them going through similar things. these are amazing people who have PhDs, computer scientists who could have been making a lot of money and have a much easier life instead of focusing on impact. Choosing this is what gives me hope. And also the
Obviously the communities that we work with, they don't get to give up. So I don't see that as something that we can just stop doing. those are kind of the things that give me hope, honestly.
Shubhanan Upadhyay (48:00)
That's a really, really good message. if you are, I mean, you haven't asked me to say this ⁓ and this is just coming from me, but if you are an organization that cares about this, then give Aral a shout, honestly. If you are funding this or you think this is important and aligns with your investment thesis or some priorities that you have, then hit up Aral. They could do with some help navigating this.
Aral Surmeli (48:14)
Yeah, definitely.
You
Shubhanan Upadhyay (48:29)
Let's wrap up here. Maybe we could end with what is, you know, there's a lot of people who are maybe building in the space trying to do something similar or adjacent to what you're doing and are starting out in their journey. You mentioned one thing, which was find a technical founder, but maybe a technical founder. Maybe this is a technical founder who's listening to this. like, well, I'm already technical. know, someone's... Find a domain expert. Yeah.
Aral Surmeli (48:47)
Yeah.
then find a domain expert. If you're doing healthcare,
work with healthcare people.
Shubhanan Upadhyay (48:59)
Yeah, yeah, very good. ⁓ Any other kind of big takeaways or things that you want to share for people who are kind of building or implementing in underserved communities around the world.
Aral Surmeli (49:11)
Yeah, I I would say if you're listening to this podcast, like this episode, and you're in a low point of, you you whether maybe did not receive the funding you needed, you know, you had a bad review from an advisor or, you know, someone said, you know, this doesn't work and everything. Just keep showing up is what I would say. It's not a direct, path.
And I'm not saying this as someone who succeeded or done. We're all in the process of it. I just have been through enough lows to know that you go high after a low. Yeah. So that's what I would say. Cause it can be a really, you know, lonely journey. Even if you're with a co-founder like, or have a couple of co-founders, it's really hard to, you know, share this or have people kind of understand what you're doing, you know, empathize with your work. So.
Shubhanan Upadhyay (49:46)
You gotta keep going. Yeah.
Aral Surmeli (50:06)
just keep showing up. And that's been the most important feedback I can give.
Shubhanan Upadhyay (50:17)
keep showing up, I'm definitely going to be taking that away. It definitely resonates with some of the things that I've been wrestling with lately as well. So that's a really, good takeaway. Where can people get in touch with you and find out more about your work?
Aral Surmeli (50:24)
Hehehehe
Yeah, mean, first of all, check our website, heradigitalhealth.org. With a quick Google search, you can also see some of our presentations and our work featured in different places. But yeah, get in touch with me. I'm happy to share my email and I'm always happy to talk, brainstorm about other tools.
Because this is a small group. need to know each other and need to support each other. Yeah.
Shubhanan Upadhyay (51:01)
Yeah, 100%. ⁓ That's a great offer. So if you're starting out in your journey, yeah, that sounds like a good, good offer to take up for sure. Aral, it's been so insightful to talk to you. Thank you for sharing your challenges, your journey, the things that you're trying to navigate, telling us this like honest, authentic account of what you're going through and showing up for people who are...
displaced people who are refugees, listening to them, building and trying to improve their lives. It's a great inspiration. Thank you.
Aral Surmeli (51:36)
Yeah, thank you for having me and thank you for the insightful questions that are often about like people don't think about.