Dare to Act.

The world has a thousand ways to drain our courage. We’re told who we’re supposed to be from an early age. Too often we grow into what others think we should become rather than who we most yearn to be. Those brave individuals who dare to act based on that yearning often do so in response to dark times, difficult times. They find their confidence based on serving others, not simply focusing on self. And sometimes, they accomplish amazing feats.??

The Pakistani doctor-cum-social entrepreneur Sara Saeed Khurram is a role model for moral courage–for taking risks again and again in service of others. Through failures and successes, she has remained focused on a singular north star: reimagining health care for low-income women. But responding to the difficulty with creativity and resolve is what sets Sara, and her team at Sehat Kahani, apart.

Born into a middle class family, Sara grew up internalizing expectations that she would pursue an advanced degree, marry, and have children. She chose the path of medicine and married at age 24; but unlike many peers, continued her clinical work after marriage. According to Sara, more than 70% of medical students are female, but only 23% practice after graduation; and even less practice after childbirth. Sara hoped to continue working as a mother, but the pressures to stay home were enormous.

Some things we can’t predict. Sara adored her infant. But she was unprepared for the postpartum depression that descended upon her after childbirth. For four months, she suffered mightily. If being a mother was part of her new identity, so still was her work as a doctor, and her sense of service to others. She had no clear plan of what to do. So she started where she could.

Sara Saeed Khurram helping her children study at home (Photo: Nida Mehboob)

Sara called the nurse at the clinic where she had worked and asked her to be in touch in case any of the incoming patients required a doctor’s consultation. The arrangement worked well, so why not try to meet them face to face, Sara asked herself. In 2014 she asked the nurse to affix an outdated webcam to an old computer – and both nurse and doctor immediately saw the benefits to patients of bringing Sara “into the room.” As for Sara, the few hours she spent speaking to patients via a webcam “was just my way of getting into the world again. I really saw that this was helping patients. And it was helping me. I was feeling better.”

Indeed, she loved this new way of working so much that along with two partners, she began to dream of building a business based on the idea of employing married women doctors to “see” patients via telemedicine. Of course, everyone thought the idea was crazy. “I used to talk to people about this and they would say what is this?” Sara shared. “ A female doctor sitting at home providing consultations to a far off community? through a telemedicine platform?? No one believed in it, no one was interested in working with me. Even my friends and my own family would say it wouldn’t work, but somehow I thought it would.”

Dr. Tooba Afzal giving a consultation from her home (Photo: Nida Mehboob)

A deep sense of purpose nurtures courage. Sara applied and was accepted to pitch her business idea at a start-up competition in a foreign country. The real work, however, was in mustering the bravery to learn to build a business plan, gaining the competency to build excel spreadsheets and digging deep to make an elevator pitch on a stage in front of multiple venture capitalists.? “I was very nervous because these were things I’d never done. Trying all these new things in those three days took a lot of internal courage. At this time I’m also thinking maybe I’m not a good mother, maybe I’m not a good wife.” But just as she felt stress, so did she experience joy in putting her dream into the world.

And then, she won first place in the business plan competition: a prize of $25,000.? The money allowed her to start, despite the naysayers. It covered several early mistakes (after a very successful first clinic, the second one failed). And it enabled Sara and her co-founder to learn from mistakes and try again.

But business rarely grows in a straight line. Within a few years, it was clear the original co-founders had divergent visions for what the company could be. Courage enabled a decision for the founders to part ways in a manner that enabled Sara to start again, this time with more experience, more knowledge, different kinds of failure under her belt, and an even deeper conviction that there was a better way to deliver healthcare to women who were overlooked and underserved by the existing system.

Sara partnered with a new co-founder, Dr. Iffat Zafar, also a married female doctor with a young child and the urge to upend the traditional system for health and for doctors (both women now have two children). The co-founders immediately chose an Urdu name for the company (her original company had an English name), Sehat Kahani, which means the story of health. Many felt that using a local name would reduce the company’s appeal to highly trained doctors. But the majority of the company’s customers didn’t speak English and this company would signal early its grounding in moral imagination.? “I wanted [the company] to have a local name,” she said, “Because I thought people in Pakistan would relate to it more.”?

Sehat Kahani e-clinic in Model Colony, Karachi (Photo: Nida Mehboob)

Out of failure, success. The company grew to 26 clinics across Pakistan.? But it had neither broken even nor scaled. “I see what it does to a patient that comes to a clinic,” said Sara. “I see babies getting born, I see cancer being recognized, I see a child getting support for polio, so many things I would see and think, why can’t we enable this for all patients?” Courage to renew: Sara decided to build an app to reach beyond the physical footprint of the clinics – though very few women used the app because it was so new and demanded real behavioral change from women who expected to see someone in person if they were making a payment.

Patients in a Sehat Kahani e-clinic in Karachi (Photo: Nida Mehboob)

And then the pandemic changed everything. The government mandated all private rural clinics to close. A day later, the government issued a request for proposals to offer telemedicine to patients across the nation. Government lacked the funding to back this – and it required services to be offered for free – not an easy feat for a start-up healthcare company with limited experience in technology and a small customer base.

But crisis begets opportunity. And it was the right thing to do. Sara and Iffat, unsure of where they would find the funding and the doctors, said yes.??

Yes is a powerful word. We so often think about the cost of daring, but what of the cost of not daring?

First step: Sara made a call for doctors. Within days, forty were on the app. Acumen made a $50,000 emergency grant to the company – enough to provide stipends to doctors and keep the company going. Today, almost 400 doctors, 20% of whom are outside Pakistan, are available for consultations and Sehat Kahani operates 38 clinics.? Sara and Iffat are the first women in Pakistan’s history to raise a million dollars in a series A. And the company advised and contributed to Pakistan’s national digital healthcare policy.

All of this was made possible because Sara dared to listen to her deepest yearning and defy traditional expectations of what women were capable of doing. And because both she and Iffat continued to dare, at times turning existential challenges into transformational opportunities.? Building a new economy that puts our humanity and the earth at the center of our systems will take new kinds of moral courage.? Just remember to practice courage in small ways, for each tiny victory will lead to greater confidence. Courage builds courage – and if ever there were a call for courageous moral leaders, it is now.

Sara Saeed Kurram, Co-founder of Sehat Kahani (Photo: Nida Mehboob)

The work of leaders like Dr. Sara Saeed Khurram is supported by the generosity of people like you. Donate to Acumen today to support a new generation of leaders for a new economy.

This is part ten in Jacqueline Novogratz's monthly series on Moral Leadership, featuring a new generation of leaders for a new economy. The photos in this piece were created by Nida Mehboob, a grantee of the Magnum Foundation, as part of a partnership to invite readers into the stories that are shaping our shared future.

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About Magnum Foundation

The?Magnum Foundation?is a nonprofit organization that expands creativity and diversity in documentary photography, activating new ideas through the innovative use of images. Through grant making and fellowships, the Magnum Foundation supports a global network of social justice and human rights-focused photographers, and experiments with new models for storytelling.