Nadine Hachach-Haram is a practising surgeon and co-founder of healthtech company Proximie. Having qualified as a surgeon, Nadine saw an opportunity to use emerging technologies to improve access to healthcare by using everyday devices like laptops and smartphones, combined with cutting edge Augmented Reality (AR) software.
With a group of like-minded colleagues, Nadine developed Proximie, AR solutions that allow specialist surgeons to share their expertise from afar, guiding and instructing complex surgical procedures where they are needed through the medium of an internet connection and a screen.
This is Nadine’s story.
“I was born in San Diego, California, to Lebanese parents and spent my early childhood there with my three sisters, one of them my twin. My parents had left Lebanon in the 70s at a time of civil war, but we returned to Beirut in my teens, and it is here that I decided I wanted to become a surgeon.
I knew by the age of 14 that I wanted to be a surgeon. Like lots of young people, I was convinced I could change the world for the better. I wanted to be able to help the people I saw who carried the scars of war. When I learnt what plastic surgery was, that was it. I didn’t need to be taught how powerful reconstructive surgery could be, I saw it with my own eyes. I set my heart on making sure surgical care was available where it was needed most.
There was also one other big influence who shaped my outlook and the path I took. My grandmother committed her life to charitable work, she was tireless in her dedication to helping others. She instilled that drive in me, and taught me that no matter what the obstacles are, you must always give your all for what you believe in.
I took a pretty standard route into medicine and surgery. I was living back in California at the time so I followed the US route of taking a premedical degree. Then I moved to London and ended up graduating with a BSc in Biochemistry and Molecular Biology from University College London.
After that, I went to Barts and The London School of Medicine and Dentistry on an accelerated graduate entry programme to do my medical training and subsequently joined the London training programme. So at that point, I was very much following the path I’d had in mind since I was 14.
However, at the back of my mind, I felt I could do more. Don’t get me wrong, I love my work, I love being an NHS surgeon and take great pride in what I am able to do to help my patients. I still do. But that desire to make a difference, to make surgery more accessible to everyone who needs it, no matter where they are, would not go away.
I ended up getting involved with organisations like Facing the World, Global Smile Foundation MENA, BFIRST, and BAPRAS Innovation group. Working with them really helped to focus my passion for bringing surgical expertise to the places where it is needed most.
And then I became interested in technology. I heard about new concepts like remote surgery and telemedicine, and they fascinated me. What really grabbed my attention was the idea that, using the internet and digital communication devices, doctors and medical practitioners could carry out examinations or consultations from afar. More than that, particularly through the example of robotics, there were concrete examples of surgical procedures being carried out under the guidance of a consultant who was in another city or even another country.
This really fired my imagination because, when you look at the underlying reasons why there is not good access to surgery all across the world, you realise that the main issue is a shortage of expertise. There just aren’t enough surgeons to go around. Even in places like Europe, the UK, the US, surgery has always depended on having a qualified surgeon in the theatre to carry out a procedure. That means travelling to where a surgeon with the required skills and expertise is based, which is what causes waiting lists, spiralling costs and, ultimately, people missing out.
I started to see a solution. What if, as with remote robotic surgery, you could have a consultant or specialist overseeing a procedure from afar – but instead of operating through an expensive robot, they were guiding and collaborating with a surgical colleague? This was happening in telemedicine – two doctors using a live video link via an iPad to collaborate on a patient consultation, to get an expert opinion in real time and speed up the care process. I believed the same could be done with surgery.
The breakthrough came when I met Talal Ali Ahmad, a hugely experienced telco engineer based in Boston, Massachussetts. It was Talal who was able to add the magical ingredient to my germ of an idea – Augmented Reality, or AR. With AR, it is not simply a case of two surgeons communicating via video link, and one telling the other what to do.
AR creates a rich collaborative experience, the ability to overlay digital content onto a live video feed so you can demonstrate, guide, query and instruct in much greater depth. From digitally marking up where an incision should be made, to transporting yourself into the image your colleague sees via your camera to demonstrate a technique, AR replicates the experience of having a senior colleague in theatre offering expert guidance and opinion – not just voice, but visual demonstration.
Together, Talal and I ran with the idea and founded Proximie and in 2015, the first procedure was carried out – reconstructive surgery carried out on the hand of a young man in Gaza who had been injured in a bomb blast, under the guidance of a consultant in Beirut.
The switch from surgeon to technology entrepreneur has been a steep learning curve. But it has also been the realisation of what I set out to do in the first place, all those years ago. I have seen Proximie used to make surgery more readily available in places where there is a chronic shortage of resources, for example to support cleft lip corrective surgery for children in Peru and Vietnam.
But the truth is that Proximie has grown beyond my original vision. The technology we are using has applications right across healthcare, from training the next generation of surgeons to making it easier for medical device companies to bring their own solutions to market, demonstrate what they can do, and offer training and support.
I am still driven by the same desire to democratise access to surgery that I set out with all those years ago. And while I am very proud of what I have achieved so far, the true scale of the challenge is enormous. A major report by The Lancet Commission estimated that two thirds of the world’s population did not have access to safe surgery, and we would need 1.27 million additional surgeons to change that. So you could say there is still a long way to go!
So my ambition is to see Proximie become a real transformational tool in the way surgery is conducted across the globe, because it would improve access and experiential training, enhance skill transfer, crowdsource global knowledge, lower costs, and lead to better outcomes for patients.”