Tallinn University of Technology

Iranian Fereshteh Shahrabi Farahani, or Feri, is a fresh MSc graduate from Health Technologies programme. In the interview, Feri tells how she found Estonia and chose TalTech after BA studies and internship in a hospital’s IT-department in Iran. By now she knows what it takes to win a e-health hackathon, get elected to Health Founders jumpstarter and become an entrepreneur.

Askur Alas | Photos: Karl-Kristjan Nigesen

Fereshteh Farahani

You have an interesting name – Fereshteh, and Feri on the website of your start-up. Does it have a meaning?

My name is Fereshteh and it means angel in Persian. Feri is my nickname.

You are from Iran, one of the cradles of civilization and nowadays the second largest country in the Middle East. Please tell us about your background.

I was born in Tehran, the capital of Iran. Tehran is the most populated city in Iran. It’s a live and active city with so many historical attractions, but at the time air pollution and heavy traffic are huge issues there. I grew up there, I went to school there. I remember that everything was super crowded. At the school, at the university it was always full of people. I studied mathematics in depth in high school. After finishing high school, those who prefer to continue their education and go to university, need to take a university entrance exam. I got accepted at one of the best governmental universities in Iran, Shahid Beheshti University in computer networks engineering. All the top students come there to study and to get a degree and skills. Many of them apply for universities in other countries and continue to study abroad.

It might be a cliché but many people might think that doors are kind of closed for women to obtain higher education in Iran, let alone become IT-specialist. Is it easy for a woman to study and become IT-specialist in Iran?

Unlike the belief of many people around the world women can freely choose their major and specialization in Iran. After graduation, they can also find a relevant job and be successful in their field. Everyone is encouraged to study in Iran, both women and men. Families are also supporting their children all the way and respect their choice. I think overall people in Iran are more encouraged to study engineering and technological subjects in comparison with other fields. What the media shows about living in Iran is a bit different than the real life there.

How is the situation with religion, does it hamper educational aspirations?

Similar to other Islamic countries, Islamic traditions need to be followed in the society. In Iran, people are required by law to obey Islamic rules in public places. For example, in universities women should dress according to Islamic rules. Religion is taught at schools and universities and taking some Islamic courses is mandatory for the completion of studies. Non-religious people don’t have to obey those rules in their homes but in the public, they have to obey. Otherwise, they wouldn’t get the same service as the other people, for example they don’t accept you to the university.

After getting your BSc degree in Iran, was it easy to find work?

After graduating, I started working as an IT helpdesk technician at a hospital. Since I had the IT knowledge and I had recently graduated from a high-ranking university, I was able to find an internship position and after getting the experience, I was offered to be employed in the same department. Working at the hospital and being in the IT department inspired me to combine my IT and healthcare knowledge. I want to use IT knowledge and skills to improve healthcare.

How did you find Estonia and TalTech?

I have a relative who studies computer science at the University of Tartu. I heard from him that Estonia is a digital country where everything is advanced in the field of IT. He recommended me to think of Estonia as an option. I searched for a relevant program and came across healthcare technology Master’s program offered at TalTech. I researched a lot before coming to Estonia, also about the ranking of the university, the atmosphere of the university and faculty and this is how decided that this suits me. I applied and I got accepted. I came to Estonia in August 2019. Without this relative I wouldn’t have found it, as I didn’t know there are opportunities for foreigners to study in Estonia.

When you moved from Iran to Estonia, how different was it? Was it a cultural shock?

Living here is not so shocking for me, but being away from family and friends, not being in touch with Iranians was difficult at first. I used to get homesick. In Iranian culture, people do their best to be polite and respectful to others. However, in Estonia people are direct and honest. They don’t waste time. Also, as Iranians are sociable and enjoy both small talks and long conversations a lot, I found Estonians seem to enjoy silence more. It is really different. Estonians seem to be very curious to know more about my country, history and culture of Iran. Most people try to be nice, even if there are language barriers. Although I don’t speak Estonian, still many people try to be helpful. So I have made many good friends, I have friends at the university, at work, my neighbors. I don’t feel isolated at all. But in the health care system most of the people don’t speak English. When I start speaking English with them, they are not that comfortable and therefore they might not be able to be friendly with me. So in seeking healthcare there are some problems for foreigners because of the language barrier.

What else surprised you in Estonia?

Definitely, the weather – I did not think it is so intense in the winter. But in the summer – everything is so bright and alive. I used to think that Estonia is covered with snow most of the year but actually the weather is rainy on many days as well. Of course, it’s much colder here than in Iran. In the beginning I wasn’t used to layering up clothes, but now I’ve found my way to protect myself from intense cold.

Any dogmas that Estonians believe about Iran or Iranians you had to break?

I’ve met many people who think Iran is a very dry country and they didn’t know Iranians do winter sports. There are ski resorts in Iran and some people spend their weekends in cottages in the mountains and go skiing during winter.

What did you know about Estonia before you came here?

I had read articles about Estonia being a digital country and one of the leaders in technology, especially in e-governance, as well as about its clean and untouched nature. I had read somewhere that air quality in Estonia is among the best in the world.

Is the situation in healthcare and IT different in Estonia and Iran?

In Iran, the primary healthcare system doesn’t have family doctors, but there are private and governmental hospitals and clinics that people can turn to based on their needs. Also, so many medicines don’t need prescription in Iran while they can only be purchased with a prescription in Estonia. In terms of technology, internet speed is much faster in Estonia than in Iran. Most of the official processes are paperless here, but in Iran people need to go to different offices for most of their needs and official requests. One of the things I enjoy the most of Estonia’s technological advances is the ability to sign digitally and save plenty of paper by avoiding printing out unnecessarily. It’s also super convenient.

Is studying in Iran and in Estonia different?

Estonia provides excellent education in which unique programs that focus on high-tech education are offered. For example, healthcare technologies and e-governance are unique modern programs that are taught in TalTech. In addition, studying in Estonia is more comfortable as Estonia is a digitalized country. Modern methods are used. For example, during the pandemic, we had the opportunity to study online without any issues. The situation is different in Iran. Iran’s education system’s focus is mainly on engineering programs. These programs are very competitive and students study very hard to be able to get accepted into these programs at the university. One of the things that surprised me in TalTech is that they try to teach us more about how to be able to learn. In Iran lecturers go much deeper in details of something technical and students may actually forget how to actually use this knowledge. But when I came to Estonia, I felt that they let us free and we as students can be more independent and choose in which field we wish to grow and improve our knowledge and they just guide us and help us to achieve our goals.

What is your subject of research in TalTech Master’s program?

My Master’s thesis subject is the effect of socio-demographic factors on the utilization of radiation therapy in breast cancer patients in Estonia. We also wrote a scientific paper about this and submitted it to the International Journal for Equity in Health. It is currently under review and we are answering the review questions. This topic started when I had the course of epidemiology at the university and I met our lecturer, Dr Kaire Innos. She is the head of the Department of Epidemiology and Biostatistics at the National Institute for Health Development (Tervise Arengu Instituut). This topic is really interesting because it hasn’t been previously studied here and there is no record of association between the socio-demographic factors and the utilization of radiation therapy in Estonia. With this study, we combine the data from cancer registry database and other databases such as the Estonian Health Insurance Fund (Haigekassa) database and population registry. We studied the breast cancer treatment – radiation therapy – and Haigekassa data that had not been studied before in cancer treatment. This is particularly important as we showed that more than 30% of radiation therapy data was missing from the Estonian cancer registry.

What else has your study shown?

In this study, we showed the ability of using Haigekassa database to study breast cancer treatment and define variables of cancer treatment. Radiation therapy utilization has increased considerably over time, particularly for stage II and III patients. We found that there is inequality in the availability of radiation therapy in Estonia among different socio-demographic groups. For example, we found that single, widowed or divorced women are less likely to receive breast cancer radiation therapy in comparison to married women. There need to be some further studies about the exact mechanism of this.

We assumed that this could be because of the lack of social support and access to transportation, economical disadvantages etc. Studies have shown that these single women feel more concerned about this intense treatment and the care after the treatment because they don’t have enough social support or people to look after them after their treatment. It could be because they don’t have transportation or they don’t have someone to look after their child when they have to go for the treatment. So, they may refuse the treatment.

We also found that women with lower level of education are less likely to receive radiation therapy when they are diagnosed with breast cancer, so it has also shown that education has an influence on that. Women with lower levels of education may have a misperception about treatment benefits and have difficulties to overcome adverse effects of treatment. But we could not find any associations between the region of residence or nationality and the receipt of radiation therapy.

You are one of the co-founders of the start-up VocDec, which defines itself as „Improving the Autism Spectrum Disease diagnose pathway with a screening algorithm based on cry-signals in newborns“. How did you get the idea and how does this work?

In the first semester at the University, we had a lecture about the basics of e-health. In this lecture Peeter Ross, our lecturer, asked us to write an essay about an innovation in healthcare. When I was looking for ideas, I came across different articles where they found that the features of cry signals of newborns with autism are different from cry signals of normal and healthy infants. This gave me the idea that there could be some system or algorithm that could detect autism at a very early stage of life. Currently, autism is diagnosed between the age of 4 and 7 years, which is late, because early intervention with autistic children could help to improve the effectiveness of intervention.

There is a need to detect and start treatment of autistic children as early as possible. So, I wrote about the algorithm that could detect autism by analyzing the recording of the cry of an infant.

It didn’t end there, did it? What happened next?

After that we had a hackathon at TalTech. I walked on the stage and told the audience about the idea I had. Some of my classmates who are now my colleges were also interested in the idea and we started working together. We won the hackathon and decided to keep working on it. The reason for motivation – not to leave the project – was that Priit Kruus, our program manager, asked all the students to keep working on their ideas as a semester project. And we got three credit points for that. That was really good motivation for us, and we are all thankful for this as we kept trying and working and researching. During the semester we had different check points and we had to report to Priit and other members of the program about our development and achievements.

After finishing the semester project, we applied to EIT Health Jumpstarter which is a European jumpstarter for innovation and ideas in healthcare. We were chosen to participate in their seminars and workshops. After lots of coaching and workshops we had a competition where we had to pitch our start-

up to the audience. We won the prize for innovation with the greatest impact. We also won money. VocDec was also elected to Health Founders jumpstarter.

In EIT they motivated us to register a company and start working as a start-up. So, we did and kept working on our ideas. We didn’t have a working algorithm yet because we needed data for this. Currently we have the data and we are in the process of developing the algorithm.

Are you sure you can make this algorithm work?

Yes, we are sure. But what is important is how accurate it is. It needs to have at least 95% precision to be registered as a medical device. We are aiming for high accuracy and we hope to be able to get this by getting healthy and high-quality data.

We are sure that the cry patterns of autistic newborns are different. Several articles have shown it

Fereshteh Farahani

What are the trends in health technology that you find especially interesting or inspiring?

During the pandemic, we all felt the need for digitalization of healthcare and here in Estonia, thanks to the patient portal, it is much easier to improve the system. For example, these days (end of May) everyone can get vaccinated in Estonia. There is a problem of vaccine passports or certificates in other countries, but I have read in the news that Estonia is one of the leaders in this field. They can also develop and integrate it in the patient portal. It does not need to be a paper-based passport, it is already registered in the patient portal and it facilitates everything: travelling and opening up borders after the pandemic. This also demonstrates the importance of cross-border data sharing.

I think this is a field to improve in other countries. For example, I know that in Iran they are right now vaccinating elderly and people in the risk groups, but the certificate that they give to people is only paper-based, which I think might be problematic if these people want to use their vaccination certificate to cross borders. It might not be valid in other countries.

What new possibilities did the pandemic open in healthcare?

It definitely was a motivation for health care providers to offer more digital services for their patients, like telemonitoring or teleconsultation. For example, if a patient needs to consult with a doctor, he doesn’t need to go to the doctor’s office any more. Health care providers have started to develop systems needed for patients to have a video call with their doctor. I think that in every field of healthcare, providers feel the need to digitalize everything. Another example: due to lockdowns and forced isolation, people reported more depressions and mental issues and this has opened up a path in digital mental health solutions.

Is entrepreneurship one of your characteristic traits?

It’s my first experience to be an entrepreneur. I am really grateful for all that led me here, from the beginning when I applied to TalTech till now. I have got all the necessary support from people around me. Although this wasn’t something I was expecting to be when I graduate, this is actually the best thing that could happen – to be an entrepreneur.

Estonia is the best place to have a start-up because everything is digitalized and even if I want to move to another country, I am not afraid to lose my business because I can have e-residency and keep on running the company from abroad.

What are your future plans with your education? Do you see your future in connection with TalTech? Or is Estonia too small?

I want to continue my education in the PhD. I am very interested in epidemiology and public health and I will apply for a public health PhD position, but I am not so sure if I will do it in Estonia or if I want to discover some other countries. I have not decided yet.

But for the time being I will probably stay in Estonia because I want to do more research and write more scientific papers. I’m also working on my start-up and I need to be in touch with other co-founders. I will definitely need to search for opportunities to study PhD here in Estonia as well.

Could you give any advice to foreign students who are thinking about coming to study in TalTech?

Estonia is a beautiful and friendly country and welcomes international students. I would recommend to come and explore the opportunities here, especially for people with a background in IT and those who are interested in multidisciplinary programs, there are great possibilities to study and also to find a relevant work after graduation.

From my experience, students will get the necessary support and guidance from the faculty and lecturers at the university. And if they reach out to the lecturers – they are always welcoming. You will get everything you need for your growth and to improve your skills and knowledge.

Fereshteh Farahani Akadeemikute alleel