Learning to Go Pole Pole in Tanzania

Reflections on Healthcare/ AI Startups While Avoiding Altitude Sickness

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Last week, I had a hard time breathing. This wasn’t due to my regular startup day at Zebra Medical Vision, but rather a (naive?) part of summiting Mount Kilimanjaro for my 40th birthday, also known as the rooftop of Africa.

We did end up making it to the top and back in one piece (visual proofs below!) and yes(!) watching the sunrise come up through the clouds are beneath your feet is a unique experience. But this was not the main takeaway I wanted to share with you. What really resonated during the trip is the notion of “ Pole Pole”.

Pole Pole in Swahili translates to: slowly, gently, softly, quietly, to slow down.

We kept hearing these words from our local guide every 10 minutes during our climb to the summit. They were very strict in making sure we are walking at the right slow pace. Why?

Because around 50,000 people attempt to climb Kilimanjaro every year. The chances of reaching the summit of Kilimanjaro is highly dependent on the number of days taken to trek the mountain.The more days, the higher the probability of success as your body has more time to adapt and acclimatize. The last reported numbers by the national park office show a 45% chance of summiting across all climbers. This number made us feel very special and heroic. However, when you zoom into those numbers, you see climbers who ascended to longer 8 day routes had around a 3x increase in likelihood of summiting over climbers who tried to summit in 5 days.

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So, Startups and Altitude Sickness?

While every industry is evolving according to a different pace, the most common notion with startups (supported by their dear funders, investors and VCs) is to grow fast or go away! Scale! Expand quickly! Open new territories! Announce more news! This is who we are and this is how our brains get conditioned as entrepreneurs and VCs.  

Back in Tanzania, I was trying to catch my breath on the way to the top (of an actual mountain), and realizing there is not much oxygen when you are at 5,900 meters. I kept hearing “Pole Pole” and thinking about what are the “peak summiting”  statistics of startups (less than 10%) and  how counterintuitive it seems for us as entrepreneurs to actually slow down in order to maximize our chances of summiting. Is this one of the reasons why so many startups fail so fast and don’t reach the summit? Is it all a matter of altitude sickness?

The symptoms and side effects of “startup altitude sickness” seem to include: irrational PR and funding in years 1-2 , jumping into working with co-founders you don’t know just because of their AI-Google-Facebook-Stanford-fill-in-the-blank pedigree filled resume, too many vice presidents in the company in years 2-3, unexplainable valuations ( hint : adding the term AI is not an explanation) in the first rounds and a lot of VC praise while gaining zero good references from real customers. Founders are on stages and attending events (and at Burning Man) more than they are with their teams and customers. I’m sure we all have a few startups in mind while I rattle off these examples. Unfortunately, in the healthcare field these accumulate and distance the clinical community from trying out new innovations.

After reflecting on thousands of years of African wisdom and applying it to my world in working at and amongst healthcare startups, I’d make the following suggestions:

  • Build the right team that can go the distance and don’t jump into believing you have the right team until you saw them working together.
  • Focus on meaningful and paced work (and relationships) with customers and prospects. Listen to their needs and slowly try to make their dreams come true.
  • Constantly develop your data. Clean it, get more of it than you ever think you’ll need, and really challenge it. AI output is only as good as its input data.
  • Pick the right investors to walk with and guide you on the way to the summit. These are not necessarily the ones that will give you the highest valuation, throw the coolest parties or post all over Twitter regularly.
  • Be patient with regulatory affairs. Working through rules and regulations takes time and cost money – BUT keep in mind that regulators are professionals experts that are genuinely interested in keeping patients safe (and less interested in the buzz around AI if it cannot produce actionable items for them). You wouldn’t want your loved one to be treated by an untested cool new medical device, right?
  • Validate your innovation patiently and publish research. This takes time, digging deep, and a very long breath but is necessary. You need to gradually establish your reputation in the busy and conservative clinical community who have seen too many startups with altitude sickness.

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Zebra is not my first (or second or third, for that matter) startup but it is the first healthcare one. In the first few years, I was still trying to forcefully resist the pace of regulatory affairs, the field, and clinical decision-making processes at hospitals. I could not understand why everything takes 5x more time than in other industries while patients lives can be improved through needed innovation. People kept telling us we were moving too fast, creating too many algorithms at once without knowing enough about the clinical use or regulatory pathway – and dealing with too much data all at once. They were right and it did take a few years to start realizing the right pace to climb our way to the summit. We are still far from being there but I am very proud of what the team as learned in the last 4 years. We’ve moved forward – developing our foundation and watching our steps – with scientific projects and developing a platform of real and validated products doctors will actually be able to use.

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I am still reflecting on this Kilimanjaro experience and how each startup needs to find the right pace and pathway to fit its industry. I’d like to hear your thoughts about this and hear your learnings as startup founders and team members.  In the meantime at Zebra, we’ve managed to honor and also speed things up just a bit industry-wise. We’re now preparing something we’re very proud of for health providers and patients globally. Yes , even in Africa!

Stay tuned.

*All photo credits go to the one and only, Tuval Berler

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