A Beirut medical start-up has created augmented reality software that can ease a chronic global shortage of trained surgeons, save lives and transform the provision of medical care.

Proximie’s technology enables surgeons to remotely transport themselves via the Internet into any operating room to guide, teach, train and support other surgeons and medical staff.

Perhaps most importantly, it is hardware agnostic - it can function on a basic smartphone – as well as tablets and computers - is compatible with complex equipment such as robotic-assisted surgery devices and key-hole surgery machines, and can even be used over a 3G network.

“It's a simple, powerful technology we hope will change the world. We're starting to see glimpses of how this is going to have a global impact,” said Proximie co-founder Dr. Nadine Hachach-Haram, citing a report by Britain’s The Lancet estimating around 5 billion worldwide lack access to safe medical surgery. “Something has to be done differently.”

Dr. Hachach-Haram, 36, met fellow co-founder Talal Ali Ahmad about four years ago while the pair were volunteering at a surgical charity active in Beirut. Taking her expertise as a U.S.- and British-trained doctor and Ahmad’s background as a telecoms engineer and serial entrepreneur of 25 years standing, they tried using the then newly-launched Google Glass to stream operations to enable doctors to learn remotely.

“The concept of the glasses was amazing, but it was still immature and there were glitches. It required a lot of internet bandwidth and not all surgeons are happy wearing a camera on their head when they have other kit like surgical loupes and lights to wear,” said California-born Dr. Hachach-Haram, who is of Lebanese origin and returned home to graduate from Beirut high school. “I asked Talal, “can we make this device-agnostic so that any doctor anywhere with a mobile phone or a computer could use this”?”

The two co-founders set to work, designing and building a prototype which they then tested between California and Peru for a year. Those tests proved successful, with Dr. Raj Vyas, a surgeon at University of California Riverside, remotely training Peruvian doctors in surgical techniques. With those skills, the doctors were able to better serve their communities.

Then in 2016, a Palestinian teenager was seriously injured when an unexploded device leftover from Israel’s 2014 deadly assault on the Gaza Strip went off in his hand, prompting a Gaza surgeon to contact Dr. Hachach-Haram asking for help.

“We connected him with a UK-trained surgeon in Beirut, and suddenly through our simple technology, he was able to salvage a young boy's hand,” she said. “That reinforced our belief that we could have a significant impact, improving people's lives and helping local doctors up-skill so that local communities don’t have to rely on international missions. That this was a way of scaling exponentially the resources we have. There simply aren’t enough doctors worldwide to help everyone.”

PROTOTYPE

For the past 18 months, the company’s team has worked tirelessly to further develop the product as a universal healthcare solution – it’s an idea born out of crisis, and Proximie supplies its technology to non-governmental organisations such as Médecins Sans Frontières (MSF) International at cost price.

Yet the software could benefit all. It can help ease some of healthcare’s greatest challenges; maximizing doctor’s productivity without a loss of expertise, allowing patients to be ‘seen’ by experts at their local hospital, and ensuring high quality, consistent training of surgeons.

“We're working with hospitals, medical schools and medical device companies,” said Dr. Hachach-Haram. “It’s a very clinician-driven product - a lot of technology is engineer-driven, it's developed in the gaming industry and then adapted to healthcare. What we've done is clinician-born, frontline innovation. It's the brain child of a doctor working in conjunction with an engineer to deliver a product that can solve a real pain point.”

Proximie's platform provides real-time augmented reality collaboration and guidance tools, overlaid with curated content from renowned medical publishers. For instance, a surgeon can make annotations on the screen to show exactly where on a patient’s body an incision should be made. The crowdsourcing of information from live surgeries is also captured in its secure video library.

The technology has bandwidth adaptability and can work on low bandwidths, but it isn’t only useful in difficult environments with scarce resources – healthcare systems in wealthy countries also struggling with overstretched infrastructure and burgeoning costs.

“How are you going to deliver care when people aren’t able to travel long distances because of the centralization of services? It's about helping redistribute some of the resources virtually,” said Dr. Hachach-Haram.

BEIRUT BASE

With the help of the UK Lebanon Tech Hub (UKLTH), a joint initiative by Banque du Liban and the British Embassy in Beirut, Proximie has put down roots in Lebanon.

“Both being part of the Lebanese diaspora, we thought this was a great way to give back to our country,” said Dr. Hachach-Haram. “We set up an office in Beirut to help young Lebanese engineers grow a career. The Tech Hub then gave us some mentoring and advice on how to fundraise out of Beirut.  It connected us to the institutions that were funding such products. The Hub has always been like family, supporting us, championing what we're doing. We have a very strong relationship and hopefully we’ll do some more projects together.”

Proximie closed its seed funding round in late 2016, modifying the product to make it more commercially viable in March 2017 and launching full operations in the second quarter of last year.

The company employs 22 people worldwide – 10 of whom are in its Beirut office – and their expertise ranges from sales to engineering, business development and healthcare. “Everyone at Proximie feels like they're part of the family and they're all passionate about the impact our products can have,” said Dr. Haram. “They’re working with us because they love where this technology is going and how we can improve people's lives.”

With sales already completed to institutions in the United States and Britain, Proximie’s team are expanding its platform’s capabilities, while the company also expects to raise further funding to help meet demand for its services from the likes of Australia, China and South America.

“We're creating a portfolio of products – they’re all in line with what we're trying to do which is to create a virtual community of clinicians,” added Dr. Hachach-Haram.

“The idea is that through our platform no matter what device you're using, you could virtually transport yourself into any clinical setting to interact and work with other clinicians - to train them, to support them, to learn from them. It's about access and connection.”