Dr Nadine Hachach-Haram is a visionary plastic surgeon, lecturer and tech innovator. She created the digital platform Proximie, which enables surgeons around the world to collaborate live by connecting remotely to the operating theatre. Proximie has completed over 6000 assisted procedures and was used in 20% of all NHS hospitals during the COVID-19 pandemic. She tells Melanie Sykes about her life-changing work.

Nadine, you are London-based now but you grew up in post-war Lebanon. How did this shape your desire to become a surgeon?

Nadine Hachach-Haram: Seeing the human impact conflict exacted on my homeland had a profound influence. You would see a lot of deformities, people with arms and legs injured and missing, things that you shouldn’t see as a teenager.

I look back at devastating events such as the Qana Massacre in 1996 as a pivotal moment. My Mum’s family is from Qana and we used to spend our weekends and summers there. At that point, I started to get interested in helping patients and looking for opportunities. When I was 14, a family friend who was a plastic surgeon was going down to Sidon to do some reconstruction for some young trauma patients who had deformities in their legs from burns, contractures and blast injuries. He was probably a bit surprised I wanted to go with him! But he was willing to take me, which was great. I owe him everything for that.

I still remember the day. He picked me up at 6 am in his jeep, and we drove down to the south, and I saw him operating on these children. At that point, I just knew that this was what I wanted to do. I was mesmerised. After that, any time I could get into an operating room, I wanted to see what was going on. Even now, I still love it.

What inspired you to create Proximie?

Nadine Hachach-Haram: Proximie was built to allow experts to virtually scrub in to operating rooms and cath labs around the world, to support, coach and mentor each other, and to look at the continuum of expertise throughout a surgeon’s career.

I was exposed to early-stage telecommunications platforms, but all of them are anchored to one moment in time. One meeting, one call, one conference, but then it’s gone.

What we wanted to do with Proximie was to create a multi-sensory experience that was a catalyst for collaboration and could digitise a surgeon’s footprint. I wanted to extend a surgeon’s geographical reach and create the effect of a borderless operating room that could empower physicians to remotely share knowledge that could ultimately reduce variation in care and help save lives.

Proximie was born out of a need. My ambition as a surgeon was to find a solution and scale it using technology. Having that mission front and centre of everything we do has enabled us to be purposeful and, really importantly, evidence-based. If we’re not enabling physicians to collaborate and help save lives, we’re not doing our jobs.

Can you tell us how the platform works?

Nadine Hachach-Haram: Using augmented reality, healthcare practitioners can remotely interact in a procedure or assessment from start to finish and mentor a local clinician through a live operation in a visually and intuitive way. An internet-connected device allows them to view a live camera feed of the assessment or operation. It can provide verbal instructions, draw or overlay important patient scans or X-rays, and virtually reach the clinical field to provide precise guidance.

It has now been used in every surgical speciality and can extend across the whole surgical industry or ecosystem within a hospital, at a time when people have desperately needed to work efficiently, remotely.

We’re truly building something here.

What is your long-term vision for Proximie?

Nadine Hachach-Haram: We know inequities in healthcare exist all over the world. Today people die unnecessarily without access to simple surgery in both the Global North and the Global South. By solving the issues that can compromise a surgery in any area of the world, such as not being able to access the right clinical skills or the right equipment, we can help to ensure that the 300 million-plus surgeries that happen each year can be delivered in a consistent way, and in a way that helps to save lives.

We need to increase our capacity to deliver better care quicker and further than ever before. It’s incumbent on us to continue to push the boundaries of what is possible in an operating room, to empower physicians with real-time insights and data and enable them to create better patient experiences.

We have created a borderless operating room, where every operation in every hospital can be recorded, analysed, and predicted for future use. It’s incredibly exciting to think of the future global network of operating rooms interconnected by the world’s best clinicians. By digitising surgery, we can help accelerate the adoption of best practices, democratise access to the best surgical expertise for training and help to create better patient outcomes.

How has the Covid19 pandemic impacted you?

Nadine Hachach-Haram: Necessity is the mother of invention, and we have seen how COVID-19 has forced innovation at a previously unthinkable pace. The urgency needed to try and combat COVID-19 has been a catalyst for incredible collaboration. We have been deployed across a host of NHS sites in the UK to remotely support surgeons and healthcare workers in the battle against COVID-19. As a frontline NHS surgeon myself, I’m immensely proud that we have been able to help in the acute phase of the pandemic.

What’s exciting is that Proximie’s use is being hardwired into clinical pathways worldwide, which is only going to benefit the patient. It’s certainly not going to dissipate once the world has successfully battled COVID. If anything, their use will become more habitual.

In addition to working with the NHS in the UK, Proximie recently teamed up with Jhpiego, a Johns Hopkins University affiliate, on a safe surgery project in Kenya. Our platform is being used to improve obstetric surgical care for women in five hospitals in Makueni County.

I saw your TED talk. How was that experience for you?

Nadine Hachach-Haram: Nerve-wracking! I’ve probably never been that nervous before, to be honest, but it was incredibly exhilarating and what a fantastic opportunity. I feel in very esteemed company and grateful that I could talk about a subject that I believe in on such an amazing platform. I have never watched the talk. I hate seeing myself on film, so it’s not something I have ever revisited, but it’s one off the bucket list!

How do you keep yourself healthy, mentally and physically? What do you do in your downtime?

Nadine Hachach-Haram: I know it’s very cliched, but I would say my family is fundamental to my happiness and my health. I have three children and my husband, who are a constant source of inspiration and happiness. They keep me grounded and we have a large extended family too. Having that network in place is critical for me. It takes a lot of emotional and physical energy to drive and grow a disruptive business; there are many highs and many lows. My family lives and breathes my journey as much as I do, and I couldn’t do this without them.

I’m a big Arsenal fan in terms of my downtime, so checking in on the Gunners is always high on my list. Even that can be a little stressful at times, though!


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