“I have to get some stroke patients,” I told my cousin, who had lived in these parts his whole life. He quickly got to work, as anyone does in the light of perceived self-benefit from an easy-to-fool American transplant. The next night I found myself sitting in a local councilor’s office (his guest room), answering the questions he asked between puffs of his charas filled cigarette. He asked questions that I had learned to answer at this point, “why are you back to Pakistan, there’s no opportunity here,” “how do you know this is safe and effective?”

I was pitching this councilor, a dry cleaner in South Punjab, one of the poorest regions of the world, on the benefits of neurotechnology and constraint induced movement therapy in stroke rehabilitation. I basked in the secondhand smoke of Gold Leaf cigarettes, wanting to chuckle at the immensely low THC content they were smoking, wanting to tell them to take out the filter, desiring to make fun of them for smoking a quality worse than Reggie. I continued though, explaining that this was a technology used at one of the best hospitals in the world, Johns Hopkins, stating the name as if, by virtue of being American, I was connected to the institution. I stated that there were hundreds of scientific studies done on the safety and efficacy of this technology, of our therapy, as if I had personally designed the protocols and published the papers. I pitched this dry cleaning, Reggie-toking, Bahawalpur councilor like he was Peter Thiel. I was aware that if I made him comfortable, we would be the first to bring this amazingly innovative therapy to Pakistan.

It worked. He introduced me to a few stroke patients in the neighborhood. We decided to work with Fayyaz Ahmed. He was a man in his late 40s, always sporting a comfortable stubble, a driver for one of the higher-ups in the local police force. He told me he had to stop working because he could not drive with his affected hand, nor could he talk because of his severe aphasia. I told him to come see me at the clinic the next day.

He showed up at 9:15 AM, which was alright as I had told him 9, but in my heart, expecting 10. One of the village kids ran in and told me there was someone in front of the clinic. The clinic, which is still operating, is a makeshift shop where a trained practitioner sits in the evening. I was able to acquire it rent-free for the morning from the practitioner. Even in Pakistan, I was following the Lean Startup Model.

For context, the clinic is a few steps from where this picture was taken during local elections.

I opened the shutters, turned on the lights and played some jazz music on my laptop. I sat there for a bit, not paying attention to Fayyaz. I thought this would be a good way to build some credibility in a country where doctors purposefully ignore patients for self-importance. I was trying to act like them. I started him off with a few movement tests for upper and lower extremities, a test for aphasia and a test for cognitive issues.

The biggest problems for Fayyaz were his upper extremity control and severe aphasia. I explained to him our protocol and how we would be doing treatment. I asked him to commit to this for 15 days, 6 hours a day, and in that period, I promised him that he would be back to driving, walking and speaking close to normal.