Valerie Cai is a King’s College medical student. She is a co-founder of innovating catheter firm Nexacath, founder of PuffiN Mental Health and the current RCPsych PsychStar in perinatal mental health. She is also a former intern at Kanna Health, and former research assistant at Great Ormond Street Hospital. She discusses skill-building in the startup field, and shares her experience on balance, pushing boundaries and keeping on learning in challenging fields.
Y: Who are you and what do you do?
V: I’m a graduate medical student at King’s, currently in my fourth year. My main interests within medicine are psychiatry and women’s health, encompassing obs and gynae, fertility and menopause too.
Y: You’ve been quite involved with Nexacath – what has that involved?
V: Nexacath was the first startup that I co-founded, in my first year of medical school! I co-founded that startup with the CEO Reza Sarwary, who’s in my year, because I was interested in getting into entrepreneurship and med tech, but I really didn’t know much about it.
He came from a background where he had a bit of experience with med tech and we worked quite well together to grow that startup.
It’s a startup developing next generation catheters with an antibacterial lining. We grew it basically from the ground up.
We went through multiple rounds of pitching to different competitions. Then, we won a competition at Imperial, which gave us some money to do prototyping. Midway through prototyping, I left the company because I wanted to start my own company within the intersection of women’s health and mental health, which is what I’m doing now!
Y: What got you into Nexacath? Is med tech a direction you see yourself going into?
V: We started Nexacath when the pandemic hit, when I think people were often having identity crises about what they were going to do! Because obviously you had all this extra free time.
King’s has a really great entrepreneurship institute – they were offering money and mentoring for teams through this program called Kings 20. I didn’t have an idea at the time – I knew that I wanted to get into entrepreneurship but didn’t really know what direction to take it in.
I thought it would be really good for me to hop onto Reza’s team at the start. And it was the right decision! I would make that decision again because I think it was one where I was able to learn a lot, very quickly.
I had to be the driving force behind my own knowledge acquisition. Unlike medical school where everything’s quite spoon-fed and structured for you, this is one of the things where if you don’t go out and put yourself out there, you’re not going to progress as quickly.
Y: What additional skills were necessary for this role?
V: There’s a lot of skills! Obviously you have to be very self-sufficient, especially in the early days of startups. In med tech, you need a certain understanding of the technology and what it’s for. Essentially, we call this market analysis.
You have to understand what the problems are, that your customers are facing, but you also have to bridge into a lot of skills that weren’t natural for me.
That’s things like financial modeling and business development. Team management, fundraising too.
These are all very novel skills for most people that get into startups unless you’ve worked in a consulting firm before. And the only way for you to develop these skills is by going to lots of talks (of which a lot are free and available, especially for UK students). Also, by seeking out your own learning, through books and other resources too.
Y: Were there any difficult lessons learned during that period?
V: I think I didn’t understand really, as like a young person, how difficult it was to solve a problem! I think a lot of times, we see problems and we think, oh, the solution is very easy. You just have to do X, Y, Z and then we’ll solve it.
For example, one of the big problems we’ve ran into through Nexacath was not being able to find affordable private lab space, within commuting distance. That’s not really something you think about if you’re not in the space already.
Especially because in London, there are so many lab spaces around, that you question, how is it possible that we can’t find somewhere that’s affordable, even on a part-time basis?!
The reality is there is actually a huge crisis, in the lack of private affordable lab spaces. There are a lot of initiatives being set up to solve that problem. But that’s one of the things where you don’t know how difficult things are, until you’re at that point, and you don’t have a solution – you have to forge a path for yourself!
Y: You’ve done some internship with Kanna Health – what was that all about?
V: Kanna Health is a startup, but it’s a very different kind of startup.
The people that are running it left a very successful company called Compass. Compass Pathways are one of the first large companies that were looking into psychedelic use in psychiatry.
So, these people set up Kanna Health, which is a sub-company, within a larger company called Pangea Botanica, and they have a very different experience of startups.
They’ve come from backgrounds where they essentially built a very small company all the way to IPO (initial public offering). So, they have a lot more experience than we do!
They also, right off the bat, had a lot more funding than, of course, all of these students startups do. So the speed at which they’re able to innovate and do things is a lot faster.
It’s also a pharmaceutical company, so pharmaceutical companies have a very different trajectory than other med tech companies. You need a lot of money upfront to get you through each phase of development, especially because clinical trials, are extremely expensive and extremely lengthy. Unlike, for example, a technology company, which can probably go from conception to product in the space of a year or less, depending on who’s on your team.
It was a very different experience, but a really great one because it allowed me to see, how a fully-fledged, well-funded startup was run, as compared to a student-led startup.
Y: What was your day-to-day role over your internship?
V: I was a business operations intern, working with the business development team, to implement different tasks. One of the tasks I did was looking at different pharmaceutical companies and what areas of pharmaceutical innovation they were covering, to see whether any of those companies would be potential partners, down the line, for any of the companies within Pangea Botanica.
Y: how did you get into that role? How did you find them?
V: I just looked around! There’s two different ways you can go about it. One is Google, LinkedIn or Indeed, and you just look. Another one is through your university’s careers portal – Kanna Health was one of the ones on my careers portals.
But to be honest, in that application round, I applied to over 30 companies, and I had two interviews. So, the success rate is actually extremely low!
But I always told myself, through that process, that you need one internship, because you can only do one internship at a time! Just keep applying until somebody asks to interview you and then offers you a job.
Y: How long did this go on for?
V: Just over the summer. I didn’t want to interrupt my medical studies, and I couldn’t interrupt my medical studies because I’m an international student.
Y: In terms of the future, what’s your plan? What doors are open right now?
V: It’s hard to say, because obviously the NHS is in a bit of a pickle at the minute with its funding, and we see lots of things around how junior doctors are treated in the workplace.
It’s my first aim to get through F1 and F2. That’s definitely something I want to do. I do really want to be a psychiatrist. I think I would really regret it if I didn’t; I think my mindset at the minute is that I’ll do psychiatry training part-time or at some capacity that’s less than a hundred percent. That’s so I can continue some of these projects on the side.
I’m not a big fan of over-planning my future. I think a lot of times, situations control you, rather than you controlling the situation. You have to be open to take opportunities, at whatever point in your life that you think is correct and be flexible with that.
I think it will probably either be psychiatry, med tech or consulting and I haven’t really chosen between the three!
Y: You’ve started your own company too. What’s that about?
V: So one of the areas that I’ve been looking into a lot, and I suppose you could say that I’m falling in love, with the subspecialty perinatal mental health. This looks at the mental health of parents, from conception to officially two years postpartum.
Because of the biological, social, and environmental changes that happen in this period, there is an increased susceptibility for mental health conditions.
Compared to other subspecialties, there’s not much entrepreneurship around this area. Personally, I think it is because it’s traditionally been a very female heavy space and unfortunately, as we know, female-focused technology and other areas get less funding in in general.
We wanted to start a company around providing low intensity perinatal mental health care for all parents, that’s evidence based. We aim to provide low-cost mental health services, especially through the lens of health tracking.
Digital health tracking and peer support are some of the areas that we think can be really scaled up. So that’s a really great thing. But the problem is that there are still really long waiting lists, and because this period is so critical to the development of the child, as well as the wellbeing of the parent, having a delayed service access of just 10 months or so has a huge impact on the child.
We know that this can increase susceptibility for neurodevelopmental disorders for example. So really looking at implementing mental health support early, and consistently, for this population is what I would like to do with this new startup, PuffiN Mental Health. It’s going to be a digital platform.
Y: How tricky has it been getting that off the ground?
V: It’s hard, I won’t lie. This company is extremely young. I think we’ve had a team for around four months, so you’re really catching us at the outset. What I really do love about it is that this is my passion.
So it feels very different from my first startup in that, all the work, regardless of if it’s going smoothly or not smoothly, is on a topic that I feel very passionately about. So that’s great.
The difficulty is that, when you’re so young, people don’t really want to give you the time of day because you don’t have huge, demonstrated evidence of traction, because you’re just trying to get everything off the ground at once.
But I’m really enjoying it. I think it’ll go really well. We’re really trying to get our TikTok and Instagram off the ground right now – you can find us at @PuffinMentalHealth, and we talk about perinatal mental health issues there.
Y: How do you balance your interest in psychiatry alongside your interest in tech?
V: That’s a good question. I think it’s a question that probably everyone with multiple interests asks themselves daily. I think balance is a personal thing.
I think when your life is swaying too far in one direction, it’s up to you to take control and bring it back, in the way that you want. It’s not going to look the same week to week. So what looks balanced to me this week is not going to look balanced to me next week.
One of the really great things about these projects being flexible, and the way they are, is that I have the freedom to control. For example, if it’s exam season, I am going to put my startup slightly on pause. But if it’s core fundraising season or fundraising deadline season rather, I’m going to be working more on my startup. That’s how balance looks for me as a whole.
Y: In terms of role models, could you pinpoint anyone that gave guidance, mentored or supported you?
V: In perinatal mental health, my main mentor is a perinatal psychiatrist called Dr. Claire Wilson. She’s really, really great. She does so much for the perinatal mental health space. She was the whole reason I was able to shadow and learn more about perinatal mental health. I think without her I would probably would not be engaged in this subspecialty.
The Royal College of Psychiatry are also great. I feel very supported by them. They always make time for me, when I have a specific thing that I want to mention.
Other than that, within the startup space, obviously I have to thank Reza, who is my first co-founder! I think without him I probably would’ve never made it into the space at all.
These people, those two, have been particularly impactful in my life.
Y: What do you think are the biggest challenges moving forward?
V: Balance, as you said! So, balance is a weekly struggle. Often, especially as we get more and more tasks as you grow a startup, you always compound them with tasks that you have week to week. So balance can be very tricky.
And also clearing space for me to prioritize myself. Prioritizing not just my company and my work, but also my personal mental health and physical health is tricky as well.
Y: You’ve been involved with the Royal College of Psychiatry as their PsychStar – what is that about?
V: PsychStar is their early medical student mentoring scheme. It’s really great. They have, I believe, around twenty to thirty PsychStar slots each year.
They provide you with an amount of funding, to go to conferences and other activities.
There are general PsychStars, but there are also faculty-specific PsychStars. This year I’m the perinatal faculty PsychStar and I can choose to do things around that.
You get to access lots of CPD courses and recordings that they have online. I get sent the British Journal of Psychiatry every single month for free. Also, I get my own mentor within the college who’s been really great and really interesting to speak to.
I really encourage people to do that. It obviously looks good, as you’ve engaged with the specialty that you’re interested in and it allows you to get more involved in the things that the college are doing.
Y: what are your goals for the future?
V: My main goal is to grow my startup, but I am somebody who likes to continuously push my learning, outside my comfort zone.
If I know something makes me very uncomfortable, I try and challenge myself and make sure I’m constantly going to talks on that topic, so that things that start off very uncomfortable for me to think about gradually become more comfortable!
One of the things that makes me very uncomfortable right now is legal, the whole legal system around startups, and IP, that all makes me extremely uncomfortable because I haven’t been exposed to very much of it!
Y: For students reading this who think, I want to be in her shoes, how can they get there? What kind of resources can they use to develop the skills?
V: It’s very hard for me to think about somebody wanting to be in my shoes obviously, because usually I’m on the flip side of things!
I would say the best way to get started is to see if your university has an entrepreneurship or business institute and engage with societies at your university related to entrepreneurship, med tech, etc.
That’s often the best way to start putting yourself into the circles, where everyone has those similar goals. And oftentimes you’ll find that students who are going to these events also want to start their own company or they’re interested in finding others who want to start a company.
That can be a really great way to get the connections that you need, to start building the skills that you need to do this.
And then another thing about startups is that people always seem to think that it’s very difficult to start a startup. The first thing you want to do if you’re thinking of building a startup, is to make sure that the problem you’re trying to solve is actually a problem. And that’s not a hard thing to do at all.
If you’ve ever done a quality improvement project, it’s very similar to that. You want to establish that there’s a problem and the way you do that is by going out and speaking to people in a structured way.
Either do like a survey or you do like a structured interview. Once you get something like 50 to 100 responses, then you’ve identified that the problem, that you think exists, is actually a problem that exists, then you can start to look at solutions. That’s not anything that requires large amounts of funding or large amounts of knowledge. But that’s a really great way to get into the space.
Y: You also worked at Great Ormond Street Hospital (GOSH) as a research assistant. What did that involve?
V: I worked as a research assistant for the Great Ormond Street Psychological Medicine department. They were running a study, looking at the health economics of running a low intensity mental health intervention, for patients who are at the hospital for other physical health needs.
It was looking to find out how beneficial is it to allow them to have a drop in service to access psychology. It was part of my mentor/PhD supervisor’s PhD project. So I worked with them for a year. I did things like research recruitment.
I got to sit into clinics and that’s actually the experience that convinced me to study medicine, because prior to that I always thought that medicine was something that was really not suitable for myself. I think this is partially because I grew up in China and the medical system looks very different there.
So, I never really saw myself as a doctor, but once I got into that project, it convinced me!
That’s what cemented my early interest in psychiatry. The way that I got that research internship was literally by emailing.
I literally just Googled, found a bunch of emails, sent everyone emails, and then one of the projects didn’t work out but they referred me onto this project and they ended up taking me for a summer, which ended up becoming a year because I loved the project so much!
Y: Any parting words of advice before we wrap up the interview?
V: I think if you are interested in things outside of medicine, I would 100% continue those interests.
I think a lot of times, especially because medicine is so demanding, once people get into it, they sort of abandon all their other interests. But I would really encourage you to maintain a sense of interest in other things outside of medicine, because oftentimes that’s what distinguishes you from everyone else.
And oftentimes like this one, it can turn into a potential career path somewhere down the line. But even if it’s just a hobby, that has no economic benefit to you, I would encourage people to keep pursuing that.
MedicDiaries: Melissa Torkizadeh, Consulting Intern/> 
Wow!