Dr Waheed Arian on escaping war, becoming a doctor and practising compassionate leadership

Key:

• R: Ruth Robertson

• W: Dr Waheed Arian

R: Hello and welcome to the King’s Fund podcast where we explore the big issues and ideas in health and care.  I’m your host Ruth Robertson and today I’m thrilled to be joined by Dr Waheed Arian.  Waheed’s journey is one filled with determination and hope.  From a childhood spent in war torn Afghanistan, to claiming asylum and studying medicine in the UK, most recently, in 2021, he was named one of the Times Newspaper’s People of the Year.  His legacy extends beyond his personal achievement through his two innovative organisations Arian Teleheal and Arian Wellbeing.  Both harness the power of digital technology to improve access to and the quality of healthcare across physical and cultural barriers. 

 Hundreds of lives have been saved through Arian Teleheal including in Afghanistan where Waheed’s journey began.  Waheed, we’re delighted to have you with us today, welcome to the podcast. 

W: Thank you so much to you Ruth, to the King’s Fund Team, and to your audiences for having me today.

R: Let’s get started.  I’ve just finished reading your autobiography ‘In the Wars’.  And I know you’ve quite consciously, and sometimes a bit reluctantly, put your personal story at the forefront of your work.  For listeners who aren’t familiar with it, could you say a bit about your story, and where things began?

W: So, my journey started in Afghanistan.  I was born in Kabul, Afghanistan, in 1983 during the Afghan/Soviet conflict.  The first five years I remember two happy memories which one was being taken to a local park by my mother to have an ice cream with my cousins.  And another one is when my father knelt down to give me a big kite, and then for him to suddenly disappear from our lives.  The rest of the memories consist of hearing bombs, soldiers and tanks on the street, hearing the sound of the jets in the sky.  And, a lot of the times, we were living in cellars to hide from it all.  And after about five years our family decided that we were not safe in Afghanistan and sadly we were not together, my father was in hiding from the Military Service.  So, we were raised by my mother. 

 And for us to be together, and to live peacefully, we had to migrate to Pakistan the neighbouring country of Afghanistan, like millions of other refugees.  And when that decision was taken it wasn’t a straightforward movement from Kabul to Peshawar City in Pakistan, because the normal borders were closed.  So, we had to take a very dangerous route through valleys, mountains, and rivers, that took us seven days and seven nights.  In Pakistan when we arrived, we were welcomed by the people, very hospital people.  But, sadly, like millions of other refugees, we started to live in inhumane conditions in refugee camps. 

 Our journey started in a tent which was later upgraded to a muddy room.  I was one of eight family members in that muddy room which had no clean water, a few pillows.  We only had one fan that was powered by the electricity that was given to us by one of our neighbours.  And the only food we received was the Russian from the UN Refugee Agency.  And the clean water was brought to us every two or three days. 

 As you can imagine, like for millions of other refugees, the conditions were ripe for various diseases.  And soon our family members, and I, suffered from malaria.  And it was within three months of living in those conditions that I started coughing.  I was coughing to the extent that I even brought up blood.  And I was walking like a skeleton, I had lost so much weight.  And that’s when my parents knew that there was something seriously wrong with me.  They took me to a local doctor and that local doctor then referred me to a specialist in Peshawar City.  The specialist, he examined me, he took a chest X-ray.  He broke the bad news to my father saying that I had advanced tuberculosis and I had more than 60, 70% chance of dying.

 And that’s when my father broke down and he told the doctor that he needed to know how to save me, and he would do anything.  And, after that, the doctor prescribed me antibiotics, but he also said that I had to be fed well with just normal food.  And my father took me back from his office, we got on this bus.  And, on the bus, I remember putting my head on my dad’s lap and I could see him crying and his tears were dropping down on me.  And I didn’t dare ask what was going on, I knew there was something seriously wrong with me.  And after one and a half years I got better.  On the other hand, I also saw that so many people lost their lives.  And that journey of recovery of illness, and seeing the traumas of other people, really shaped my thinking about life.  On the other hand, I also saw the power of healing that this doctor helped me survive.

 On my last visit he gave me a stethoscope and a black, and white, textbook and he said, “Son, one day you will be a doctor.”  And that actually … now I reflect on that, and I always remember how I communicate with other people, how I interact with other people, that we’re always in a position to inspire.  We’re always in a position to help other people’s journeys.  After two and a half years in the refugee camp we moved back to Afghanistan, in 1991.  But, sadly, in 1992 the Civil War broke out.  It was a street by street bloody war because of which, again, we had to flee from one part of the city to another.  Again, most of the time, we were sheltering in cellars hiding from the daily rockets, the bombs.  And it was in those cellars where most of my self-education happened.  Having a lamp, and a desk, with some books that my father and I would buy from the streets of Kabul, one moment I would be reading, or trying to read, maths, or science, and the next moment we would be hugging each other in fear of being destroyed by the bombs that were raining on us.

 So, because of all these traumas, when I was aged 12, I started developing depressive symptoms.  I just could not make sense of the world.  On one hand I would see so many traumas, but, on the other hand, I had this dream that I wanted to do something with my life.  I wanted to become a healer, a doctor, just like the one who treated me.  But there was no education, there was no hope for me.  And for the first time in my life was that the resilience that was instilled in me by my parents that I was not working.  And that was one of the points in my life when I could not make sense of the world.  But the way I overcame it was still not giving up on hope and still thinking that one day I would be able to get an education.  One day I would be able to have friends, one day I would be able to have dinner around the table, and finally even giving me the courage to leave Afghanistan to move to the UK as a child refugee.

R: As you were talking, I was just thinking about the importance of belief and how people have, it sounds like, from a very young age, believed in you.  And your father believing that you’ll literally survive when the odds were really against you.  And a doctor believing and supporting you in thinking about becoming a doctor.  Could you say a bit about mentals and whether they’ve played an important role for you?

W: Mentals certainly have played a huge part in my life.  And I think that’s where they have shaped the hope for me to be able not to give up on living, in the first place, in the midst of war and disasters.  And secondly for me to have some sort of a dream to allow me to believe in myself that one day I will be able to realise that dream.  And I think it’s really difficult, when you are living in the middle of a conflict zone, when there is actually no hint of hope.  So, for them to believe in me, that allowed me to start believing in myself.  And for people who are going through so many traumas … and it’s an important point that the small words of encouragement, or any small acts of kindness, the way we interact with people, the manner we do it, all that makes a difference.

R: I wonder if that doctor knows what an impact he had on you with those words that day?

W: But, also, there are so many other people who impacted my life as soon as I arrived in the UK as a child refugee.  I came with $100 in my pocket, no family members with me, aged 15, and hardly any formal education.  But I did bring with me that huge determination that I would do something with my life.  And that led to this massive excitement for me that I forgot about that I didn’t have anybody with me to guide me, I would go about finding the way for myself.  I would find out from people on the streets, in the shops where I was working, or even from fellow refugees, how to pursue an education.  And I wasn’t put off, despite many people telling me that I should work in a chicken shop, or I should become a taxi driver.  Of course, these are very novel positions, jobs, important for the society.  But my dream was to become a doctor.  So, I continued working in three jobs which was sales, a kitchen porter, and cleaning, and at nighttime I continued studying.

 But here I was, I could actually now see opportunities in front of me.  So, all I had to do was to work extremely hard.  And that was one way for me to overcome, actually, the traumas that I was still in the background that I had experienced.  I still had signs and symptoms of PTSD.  For example, when I was walking in London streets the red buses would turn tanks and I had to shake my head to know that actually I was in London, I was safe.  A lot of the times I would have nightmares in the middle of the night.  The nightmares were that a sniper would be aiming at my head, trying to take my head off, and I would come and open the window to see that I was in London.  And that sadly went on throughout my journey studying medicine and, later on, to becoming a doctor until finally I opened up about my mental health after graduating from Cambridge University.

 And the tutor, he looked at me and he took me for a meal, and a drink, and he said that, “You really have to get some professional help.  He told me that he had not come across any other student having been through so much.  And I had bottled everything up but by then I’d run out of adrenaline that kept me going for such a long time. 

R: It’s interesting how we’ve talked first about the external and the sort of mentals, the external influences that supported you on your journey.  And then, thinking about the internal, it feels like you really must have had to draw on that throughout those years when you first came to the UK and had to push yourself towards a dream that I think people told you was impossible.

W: It is indeed drawing in from the hope that I accumulated, during conflict, and then suddenly seeing all the opportunities in front of me that I never had.  And I didn’t want to waste a single one of these opportunities.  I remember going to King’s College in London, that was within the first year of my arrival in 1999, in the UK.  And I walked into the Admissions Office, and I said that, “How do I become a doctor?”  And I looked at the face of this Admissions Officer, she was absolutely puzzled.  And, so, she finally understood me, she was still very kind to me, she didn’t dismiss me.  And she gave me a prospectus which highlighted the requirement to become a doctor.  And I remember tearing that page, putting it in front of my desk, I blocked out all the noise and I continued pursuing the journey

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 Well, let’s move on to talk a little bit more about Arian Teleheal.  Because I’m fascinated to hear about the organisation.  Could you tell us a bit about the journey to setting that organisation up and how it works? 

W: So, after graduating as a doctor and besides helping in hospitals, in the UK, which give me so much joy, and have contributed to overcoming my own traumas, I then thought about helping people in Afghanistan, people just like myself who had suffered so many traumas.  And I kept going back and forth to see my family and, at the same time, I would go into the hospitals.  The first thing I did, over the next few years, was to really interact with the medical community there, to understand them, to build bridges, to build that rapport with them, and to become friends.  And that’s a very important aspect, that community engagement, that takes a very long time to build that trust.  And through that then I also identified the many problems they were suffering, the many problems that they were experiencing, such as lack of resources, the lack of technical expertise, the lack of medical expertise, the lack of medicine.

 And I also saw that my family were still suffering from all that.  My parents would go to Pakistan to be seen by a specialist, they would take some medicine and come back.  And that whole entire experience would last for a week or so, to come back.  We were in a privileged position to be able to afford, it at that time, but many people they couldn’t afford that.  So, that became an area which I focused on.  There were so many problems, but I had to isolate and work on one area that I could contribute towards.  And when I came across telemedicine, that was a lightbulb moment for me knowing that actually technology can contribute to solving this particular problem.  And that was the beginning of Arian Teleheal.  I founded the charity in 2015, it simply consisted of me connecting specialists from the NHS to medical colleagues in Afghanistan.  They would communicate on smartphones, they would discuss cases, our specialist colleagues would give a second opinion.  And that became the foundation of Arian Teleheal very simply.

 Later on, it became a lot more complex that we build a foundation around that, the governance around that, to make sure that there was clinical expertise was checked to make sure that data consent, all those governance issues were looked after.  But the core of it all was simply connecting medical colleagues from the NHS to medical colleagues in Afghanistan, to solve a problem to allow them to have a second opinion that otherwise they would not have, and for patients to survive as a result of that.  From Afghanistan then we scaled that up to Syria and to parts of Africa.  And now through the lessons that we’ve learnt, we advised international organisations such as World Health Organisation, the UN Refugee Agency, the Red Cross, and national organisations in the UK.

R: You’ve used technology to establish relationships between people who can help each other out, but you’ve done that across huge distances.  How did you get across some of those barriers, the language barriers, different cultures, completely different contexts in terms of the resources available, presumably in the NHS versus the doctors that they were talking to in Afghanistan or Syria.  How do you handle that, or support colleagues to be able to be effective across those divides?

W: I think that’s a very good point.  So, technology is actually not a problem solver.  And that’s one of the misconceptions nowadays with any technology that comes we think that’s going to solve a massive issue, healthcare issue, a massive social issue.  Technology will always remain as an aid to contributing to solving a problem.  But it comes down to always, in my view, between human and human interaction for us understanding a particular community, their problem, the culture, the background.  And that all starts from engaging with them in a way that we show compassion, in a way that we show genuine enthusiasm that we are passionate or at least curious in contributing to today, solving their problems or to helping them in some way. 

 Then the second layer from that community engagement and having that good rapport and a good relationship on top of that is a good foundation of governance in how to make sure that we do this in the safest possibly way.  But even prior to that it’s identifying a particular problem that that community is experiencing.  There are so many problems that we can focus on, or one can focus on, there are many problems that one can focus on.  But it’s also identifying the strengths of an organisation, identifying the strengths of a particular group of people, and seeing how those strengths can contribute to a particular set of problems, and I think that’s a really difficult one. 

 In Afghanistan, for example, there were so many problems that I could not contribute towards.  So, I had to really work and think hard to understand one problem very, very well and then contribute to that.  So, the technology really comes at much later stages, innovation technology, again, two different sets of solutions.  Innovation is doing things that may not have been done before and you’re looking for the most efficient way to solve a problem, at the end of the day, and then you can use, or may not use technology.  But the approach to have to build the technology, to build an innovation, and look for a problem, is where a lot of the companies, a lot of the big organisations, go wrong when they keep building all these complex solutions in the background and then hope that those solutions would go on and solve problems in the community. 

 It’s actually the other way around.  That if we go engage with a community, understand their problems, understand their culture, understand the language, and then arrange the problems, arrange the expertise around that … arrange and then arrange innovations, and arrange expertise around that, the problem not only becomes solvable in the immediate term, but it also becomes sustainable and a long term solution.

R: It feels so relevant to the challenges that the NHS is having implementing various different digital innovations.  Your points about the importance of community engagement, understanding and developing relationships, defining the problem, taking an assets based approach and building on strengths.  I mean, I know you were doing this in a completely different context but to me, at least, it feels like some of those lessons are very useful for people working in the English health service.

W: It is indeed.  I’m very passionate about the NHS UK.  And the NHS are the foundation that has allowed me to realise my dream, it’s my home.  And I’m so privileged to still be working in the Accident & Emergency Department on the frontline.  Over the weekend, and weekdays, I work in other organisations.  And I could never for a moment imagine giving up on my job.  But, on the other hand, I also realise that actually there are a lot of ways we can improve our healthcare or health and social care.  Of course, technology innovation is not the only answer, we need more resources.  We need more staffing and, actually, that’s at the core of it.  And we need more hospitals, more social community, more community services available.  But, also, we need more innovation, we also need more efficiency.   So, in particular, when we talk about innovation, absolutely, there are pockets of innovation that are happening in the NHS very well.  But also, I see firsthand that a lot more could be done.

R: And perhaps this is a moment to ask you a bit more about your second organisation Arian Wellbeing which I think I’m right in saying you founded last year.  Can you explain to our listeners what that is, and your focus with that organisation?

W: So, Arian Wellbeing is a social impact initiative.  We are an innovative digital health organisation that connects psychological therapies with exercise to provide high quality mental health services to everyone including to hard to reach populations.  We are trauma informed and we are culturally sensitive.  We started working with the Cheshire West & Chester Council last year and we’ve built our proof of concept from that by supporting the staff of Cheshire West & Chester Council who are exposed to a lot of trauma.  And we also supported the clients they were looking after, including the refugees from Afghanistan who are highly traumatised sadly and they were coming from a culturally different background. 

 And that’s where we’ve been focusing really on building our services to make sure they are as efficient as possible using technology but, at the same time, they’re culturally sensitive and they are trauma informed, and they’re expert led.  I have personal experience from PTSD so it’s a problem that’s very close to my heart.  I’ve seen so many people suffer from it, back in low resourced countries such as Afghanistan but also in the NHS.  And it really breaks my heart to see people keep going in and out of the NHS services including GPs and A&E.  So, beside the human suffering there’s a lot of cost implications.  So, we aim to complement the existing amazing services that the NHS has such as talking therapies, but the waiting list is huge.  And there are many people who may not qualify for these mental health services, simply because they’re too complex but they’re not severe enough to go to the hospital, but they’re not simple enough … or, in other words, they wouldn’t fit the criteria of talking therapies.

 So, there’s a huge population that can fall through the cracks and we aim to really provide this mental health support to these patients who have complex mental health issues and also contribute to a reduction of the waiting list of the talking therapies.

R: Such a theme in our conversation today about, kind of, listening, understanding, and then building up from there.  And kind of having it … that ‘Let’s do it’ attitude that must have driven you through some really difficult times.  It sounds like you must be extremely busy with those two organisations and also your practice in A&E at the weekends.  But is there anything else in the pipeline?  What’s next for you?

W: So, for me, the big vision now is that how can we make high quality mental health services available on everyone’s Smartphones, at a click button they can get connected with a psychologist, or therapist, who can speak the language, who can provide them culturally sensitive services, on demand, not only in the UK but globally in the next five years, five to ten years?  And that requires a lot of work.  And I’m very fortunate to have many experts around that vision, I keep inspiring them, they’re working hand in hand with me.  But then I also work with partners such as local councils and I’m very enthusiastic to partner with the NHS Trusts, and organisations, very soon.  Because we are here to contribute to solving a national and international crisis which is mental health.

 But that can’t be done just by ourselves, partnership is really key to all that.  And, for me, keep inspiring other people is very important but also looking after my own wellbeing.  And that’s something that I keep learning.  For me I’m very privileged to have a loving family.  I keep exercising, I keep using psychological therapies, for myself, and I know when to take a break.  From time to time, I do struggle with the balance to be really honest about it, but I’m more aware now to make sure that, on one hand, I give to the society, but I can also enjoy that journey.  It’s not just about the destination, it’s about enjoying that journey.

R: And does that focus on self-compassion affect the way you lead?

W: My leadership, actually, you can summarise it really through self-compassion and through compassion to my colleagues.  But, also, I know that through doing that work it makes me feel better as well.  I know that may sound a little bit selfish, but we have to bring it to the fore that the work that we do can, somehow, we make it meaningful.  Of course, the hours can be tiring but, mentally, it can be extremely energising.

R: That can be a therapy in itself helping others.  That’s such a positive message.

W: It is, indeed, it’s a therapy in itself.  But I think on our own we can’t do it, then it’s about bringing other people who are likeminded, have a similar vision, to motivate them, inspire them, and it’s about the collective compassion of other people, or group of people, who can give to the community, but we can also look after each other.  And I see that in the NHS that so many colleagues they work, in solo.  But I think we could do a lot more with that compassion towards each other, we could do it also with that collective compassion, from top to bottom, where the leadership is connected to the people who are serving on the frontline.  And I think there is still work to be done in that area.

R: And, you know, finally, your story is one that’s filled with so many challenges, but you persevered.  What advice would you give to listeners who might see themselves reflected in parts of your story?

W: For me it’s always about finding hope in the midst of adversities.  It’s about shaping our life in such a way that there is purpose to it, for those people who have their dreams, not to give up on their dreams.  But, also, knowing that in order to achieve our own dreams we need to have a compassionate foundation around us to be able to exert that compassion in the community, but also have that compassion for ourselves.

R: Thank you so much.  I’m left thinking about the fact that the NHS is quite a challenging place to work at the moment.  And I think your story and the points you’ve made about hope, self-compassion, inspiration, the importance of, kind of, innovative thinking within all of that and leadership that, kind of, focuses on positive change and supporting people to come together to make a difference is, I think, going to be a really inspiring one for our listeners.  So, thank you so much.  I think that’s all we’ve got time for today.  I could have spoken to you for a lot longer, but thank you so much for joining me, Waheed, it has been a great conversation.

W: Well, thank you so much Ruth, thank you very much for listening to me.

R: The show notes for this episode, and all our previous episodes, can be found at www.kingsfund.org.uk/kfpodcast.  And you can get in touch with us via X, formerly Twitter, our account is @TheKingsFund.  The producer for this episode was Natalie Cleverley and it has been edited by Bespoken Media.  Don’t forget to subscribe, share, rate, and review, this episode, wherever you get your podcasts.  And, of course, thank you for listening.  We hope you can join us next time.