The doctor you couldn't find in three days

A father’s illness and three days without a doctor

The episode opens with Muzamil introducing Ehsan Imam and Asma Salman Omar — the CEO and COO of MARHAM — as two of the oldest players in Pakistan’s health-tech space, funded by Indus Valley Capital. The conversation begins with early life, but it is a medical emergency that explains everything that follows.

Ehsan grew up in Lahore, the son of a Pakistan Railways civil engineer who taught himself FoxPro and built the railway’s first booking software. That early exposure to computers — a 386 machine with a 20 MB hard drive and Prince of Persia — set Ehsan on a path to computer science at what was then Punjab Institute of Computer Science, graduating in 2006. He spent his early career moving between local software houses and remote work for a Canadian company, eventually landing at Confiz Solutions where he led delivery on a Microsoft-backed project with Target, the second-largest retail chain in the world.

It was during that project that his father fell seriously ill. “I was unable to find a doctor for my father for like three days,” Ehsan recalls. The condition was internal bleeding requiring a urologist. After a failed surgery and a last-minute intervention prompted by his doctor sister who happened to be visiting Pakistan, his father recovered. Ehsan went back to the office the next day. A colleague mentioned in passing that he had found a doctor for his own brother through a tip Ehsan had shared. That small moment crystallised something larger.

“If I can tell one person, why not tell the whole world about this experience? How many people can we save by sharing our experience?” The thought did not leave him.

From Sargodha to Confiz: Asma’s parallel path

Asma grew up in Sargodha, the daughter of a Pakistan Air Force officer. The air force environment — disciplined, organised, with F-16s overhead — shaped her early sense of what structured systems look like. She taught herself Photoshop, HTML, CSS, and Premiere from online resources by her first year of college, around 2008 and 2009, and was already earning from freelance work before she had a degree.

She entered computer science at the University of Sargodha through a narrow window — the one year the university accepted pre-medical students into the CS programme, a policy it reversed the following year. By the time she arrived, she was already ahead of her class. “I was like asking relevant questions in the class,” she says. She won first prize at a national-level competition at FAST and another at an EME Olympiad, representing a public university from a mid-sized city against students from Pakistan’s most elite institutions.

What she developed at university was not just programming skill but a sensitivity to user experience — the gap between code that works and software that people can actually use. That combination would later define her role at MARHAM.

She joined Confiz in Lahore after getting married and relocating. It was there, in a brief early interaction with Ehsan, that the conversation that changed her trajectory happened. “Nobody ever asked me ever in my life — what is your goal in life?” She had no answer. She turned the question back on him. Ehsan said he wanted to build a product and see its highs and lows. She did not fully understand what he meant, but the interaction stayed with her.

The 40-page document and the name

A few months later, Ehsan shared a document. Asma’s laptop had been stolen two days earlier. She went to a fee centre, bought a new one, and opened the file. It was forty pages long — a detailed articulation of the problem, the solution, the vision, and a one-year plan that would ultimately take four years to execute.

The document referred to the platform as GMP. Asma read it line by line. When she called Ehsan to ask about the name, he told her he had not spent time on it. She had already thought of one. “This is cure for the pain of people — the burden that patients and their families carry. What name does that suggest? Marhm.” She proposed it. He accepted it.

Her decision to join was not purely rational. She had grown up watching military healthcare — organised, structured, accessible — and had always wondered why civilian healthcare was so chaotic. “Why can’t the rest of the people have it? And when I had that discussion with Ehsan, the reason was because no one ever worked on it. No one took ownership of that problem.” She committed to it for life.

The Facebook community and nine minutes

Before building any product, Ehsan ran a validation experiment. He created a small Facebook community called MARHAM, seeded it with a few artificial questions to signal the topic, and added friends. Within weeks it had 5,000 members, then 10,000. People began asking real medical questions and sharing information.

Then came the moment Muzamil describes as the product-market fit signal. A cancer patient posted his story on the group. People suggested doctor A, then doctor B. A commenter said neither treated that condition. More people converged on doctor C. The assistant of doctor C then commented that even doctor C did not handle that specific case and directed the patient to the right specialist. The entire exchange — from problem to resolution — took nine minutes.

“If this community had not been there, everything in the medical field is very lethargic,” Ehsan says. “An appointment three weeks away, the doctor tells you this is irrelevant, come back in another three weeks.” Nine minutes to solve what the system would have taken months to address was the confirmation they needed.

What MARHAM is in 2022

Later in the discussion, Muzamil asks for a plain description of the product. Ehsan walks through it: a patient searches a symptom, receives a list of relevant doctors with clinic details, ratings, and availability, and can either book an in-person appointment or consult online. After a consultation, the platform can arrange home sample collection for diagnostics and, in select cities, medicine delivery. “MARHAM is currently an end-to-end experience — from finding a doctor to booking an appointment, to consulting online, to diagnostics from home, to medicine delivery.”

The online consultation flow runs through MARHAM’s own app. Doctors use a parallel app called MARHAM Connect. Patients select a time slot, pay the fee, and enter a waiting area. The doctor appears, calls the patient through the app — similar to a WhatsApp call but with the ability to share reports and camera views — and simultaneously fills in an electronic medical record covering diagnosis, prescriptions, test recommendations, follow-up timing, and referrals. When the consultation ends, the doctor sends the prescription digitally to the patient. The prescription carries the doctor’s credentials and can be shown on a phone or printed for a pharmacy.

By the time of recording, 30 million people have used the platform. Between 1.5 and 2 million patients have been actively served. 26,000 doctors from 121 cities and towns are registered across 130 medical specialties. Online consultations account for 30% of all bookings, with the remainder being in-person appointments.

Bootstrapping to profitability, then raising from Indus Valley

Muzamil asks about the investment story. Ehsan is direct: “We are one of the startups that have achieved profitability. We are self-sustainable.” From 2016 to 2018 the team bootstrapped. By 2018 they were cash-flow positive. They ran the company on their own money until 2021 — five years — before approaching investors.

The decision to raise was not driven by desperation. It was driven by the recognition that proof of concept had been established and the next phase required capital for growth. Ehsan had an early conversation with Atif Mian — who had worked on LinkedIn’s growth — through office hours, which shaped his thinking about what scaling actually requires. MARHAM pitched to several local VCs. Most made offers. They chose Indus Valley Capital for shared values and relevant expertise. The round was $1 million.

“We don’t require a lot of cash,” Ehsan explains. “We don’t need to purchase stock or inventory. All of the money goes into the team and growth.” The investment produced 400% growth.

The business model for doctors is modular and flexible. Basic registration is always free — a deliberate choice to maximise accessibility, the platform’s founding objective. Appointment management, EMR, and enhanced profile features are paid add-ons. Doctors can pay a fixed monthly fee or a usage-based fee. Patients pay only the doctor’s consultation fee, nothing more.

The broken demand-supply problem and what Muzamil sees in the product

By the end of the conversation, Muzamil pushes into territory that is part product critique, part brainstorm. He notes that Pakistan simultaneously has 50% of young doctors unemployed and patients waiting weeks for appointments. “It blows my mind how that’s possible. It just seems like there is a broken system where there’s a lot of power consolidation within certain hospitals.”

He also observes that the current app is designed for a mature digital user — someone who knows what a gastroenterologist is, who can navigate a list of 140 specialties. The mass-market user, the post-2013 smartphone user from a smaller city, needs something different. “For me it’s really just about how you begin to play with data to identify what this person needs.”

He proposes a thought experiment: a stripped-down app — he calls it MARHAM Plus — with a single feature. A user opens it, taps call a doctor, and a verified but newly graduated doctor appears immediately, free of charge. The doctor guides the patient, refers them upward if needed, and builds a review profile through real interactions. As the doctor’s credit score rises, they move into paid tiers. “You distribute all of those patients into all of these available doctors, and suddenly demand and supply evens out. A lot of female doctors sitting at home suddenly hop on to the system. The price point drops to 100, 200 rupees. A doctor working five hours a day earns 150,000 rupees a month. For a young doctor, that’s pretty good money.”

Asma acknowledges the team tried a free doctor feature early on and had to pull it back because of abuse — people calling at midnight for non-medical reasons. The feature exists in the system but is switched off while they work on a fix. She confirms that product-led growth — using data and experimentation to progressively open the product to wider audiences — is the explicit framework for the next phase. “We know that the child in Layyah who has studied up to fifth grade should also be able to use this easily and access healthcare for their family.”

Whether that means evolving the existing app or building a separate product, Asma says, will be determined by data and user behaviour. “Data will guide us on how this will happen. But it will happen, inshallah.”

Pakistan in 28 years: values, culture, and a difficult question

Muzamil closes with a question he asks all his guests: how do you see Pakistan in 28 years? Ehsan’s answer is rooted in culture and values. He argues that no country grows beyond its people, and no people grow beyond their values. “The biggest treasure we have — the secret — was already given to us by the Prophet, peace be upon him. The question is what are we doing today that they were doing then, and we are not.”

Muzamil pushes back, not on the premise but on the mechanism. He points to Egypt, Indonesia, Malaysia, and Saudi Arabia as places where Islamic scholarship is being conducted at an institutional, academic level — not through chains of religious patronage but through libraries, comparative study, and structured discourse. In Pakistan, he argues, that institutional layer is absent or broken, partly as a legacy of colonial disruption and partly because of how religious thought was weaponised in the 1980s and 1990s. “When were our educated Muslim class going to take a leadership role in something that is super important to them and not let it be run by people who have no business running it?”

The conversation does not resolve. It ends with a shared point: the solution is not secularism as a label, nor is it religion as a brand. It is reformation in how religion is understood and applied. “Making it a secular country is not going to solve it. Reformation in your understanding of religion is going to solve it.” Ehsan adds that Islam, properly implemented, is a framework — a balanced way of life — and that Pakistan’s challenge is not the framework but the failure to operationalise it through culture. The audience is left with an open problem statement and an invitation to propose solutions.