PROXIMIE: A REAL SOLUTION TO A REAL PROBLEM

“This is clinical grade medical technology. Privacy and patient safety are key to us”, said Shannon. I held my cheek, tilting my head in the direction of the Permanent Secretary (PS), hoisted on a swivel chair at the end of a rotund conference table. His red tie and the seat position announced the epicentre of authority in the boardroom. To his right was another gentleman donning a red tie. He also carried his authority- the head of the delegation, The President of the Surgical Society of Kenya (SSK), the only professor (yet) in the boardroom. 

Shannon continued her brief, speaking about the cutting edge power of technology that Proximie, the company she works for, brings to Kenya and Africa. The company has already conducted proof of concept work in Makueni county, installing cameras in operating rooms and remotely beaming live obstetric surgeries from remote corners of the lower eastern Kenyan County to specialist obstetricians. The specialists are able to follow through and guide their juniors in delicate operations, obviating the need to cross hills and valleys where last mile tarmac is yet to reach, often in the dead of the night. (Why do most babies opt to arrive at the wee hours of the morning, by the way? )

I have heard the story of proxime and Makueni County before. It was presented in one of the scientific conferences of SSK long before I became chair of the scientific committee. I must have been in another plenary room but I recall the abstract title. 

But now here we are. This time, leveraging on the success of the obstetric intervention to answer two questions:

Can this technology be extended to all fields of surgery? 

Can this technology be used for remote teaching and tele mentoring? 

The answer to both has been a resounding yes. From both SSK and Proximie, and extending to more partners. That is why SSK signed the MoU with Proximie long before the rejected Finance Bill 2024 was even conceived. And after the Gen Z protests had subsided, Shannon had flown in to tie the final loose ends and put faces to names. 

Shannon radiates energy in any room she enters. You will not believe her when she confeses to being an introvert in private. But I can belief her because I think I live the same description. She worked for years as a political conflict mediator mostly in the middle east. After her own Damascus moment, she divorced the arts and got betrothed to science, making the ‘crazy decision’ to pursue a PhD in Neuroscience at 34! She is no longer crazy. She imagines a future where the top transplant hospital in the Global North partners with an ill-resourced regional hospital in the Global South for mutual learning and capacity development via her company platform. By the look of recent events, that future is already here, as a certain university slogan goes. Shannon Shibata-Germanos,PhD is her full name. She gave a TED talk some years back. She has pleaded with me not to watch it, arguing that she did not give her best. I haven’t watched it (yet). I encouraged her as we do in Toastmasters, “your worst speech is better than the best speech you never gave.”

Anyway, back to Shannon flying in to tie the loose ends. The SSK had requested for a courtesy visit to the PS Medical Services, Mr Harry Kimtai for a briefing on this. The leadership of SSK was there, as was that of Makueni County Health docket. The PS had walked into the 6th floor boardroom with two technocrats well versed on the matter at hand. After introductions and a brief by Prof Odula about SSK, Shannon took over for her brief, speaking about the cutting edge power of technology that Proximie-the company for which she leads Global Health, brings to Kenya and Africa. She did it well, sharing the Makueni County experience with the digital platform and how the county has spread this technology in 7 operating rooms across Makueni. “Kenya can set the pace for Africa. You have done it with MPESA. You can do it with Proximie”, she concluded. The PS was impressed, asking all present to give a round of applause for Shannon. 

When he reacted, Mr Kimtai reiterated the importance of digital transformation in the healthcare delivery in Kenya. This is in line with the government’s agenda on UHC and digital economy. The ministry is ready and willing to support all counties to replicate the success witnessed in Makueni, the PS reaffirmed. 

This innovation comes at a time when the Country has set in place the Digital Health Act, a few years after the data protection act. It is the opportune time to get the conversation going, assessing the innovation available and the regulation enacted. The MoH visit was followed by a three day training of few experts in Minimal Access Surgery who would become the local trainers of the Kenyan surgeons on the use of the platform. The training involved experts from UK, India and Uganda. The trained local experts will be based in 6 facilities Kenya- Makueni CH, Muranga CH, Nakuru CH, Tenwek , PCEA Kikuyu, The Karen and Avenue Hospitals. The Proximie platform will enable these trainers to broadcast porcedures live to select members of their teams who can observe and follow the procedure remotely on a secure website or application or within the theatre through additional screens outside the main operating room. 

Eight years ago, a similar model was pitched at a different platform. It had a similar value proposition but the surgeon needed to wear goggles which could then transmit the procedure realtime. Several things differ. The goggles were heavy on a surgeon’s head. They meant constantly looking into the wound- this is not always necessary. Sometimes the hands do the looking for the surgeon, carrying out blunt dissection, assessing tissue planes or even throwing down hand tied slip knots into deep cavities. For such, one needs a static camera focused on the field, not the dynamic one that moves with the surgeon’s head turning. Equally, 4G and 5G technology was not common place. Today we boast of better internet speeds compared to 8 years ago. I can continue to float hypotheses but the true answers lie with the founders of that company. 

Those of us in global surgery have often observed a critical failure of global  north innovations being deployed to the global south: they come as solutions looking for problems to solve. The danger with this is the proverbial man holding a hammer, to whom everything looks like a nail head. 

Proximie comes at a time when we know that it works.  The Makueni case speaks for itself. The need has been curated to focus on vital components: training, mentoring, patient safety. The enabling factors include internet connectivity, political climate among others. They are the factors we must watchout for, going forward. 

It is now time to hit the surgical ground running and deploy this technology and reap all the benefits it will bring with it, both intended and contingent.