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My Proximie

After 13 years working in conflict management in the Middle East, Shannon Shibata-Germanos switched career paths to pursue a career in scientific research, studying for a masters and doctorate in Neuroscience at UCL. Now, she is a startup investor, advisor and consultant, with a focus on medtech, healthtech and biotech. What follows is an interview that has been edited for length and clarity.

I was exposed to some amazing technologies while working in the Middle East. The Weizmann Institute of Science in Israel leads globally in medical and scientific innovation for example, and at that point in history, there was a huge growth in biotech, healthtech and medtech. I saw that the startup scene in these verticals were becoming quite robust, and thought “Wow, this is definitely the future.” From mind-blowing advances in genetics to digital health, the way we are able to harness biology and technology for the sustained well-being of human kind is remarkable.

Watching this evolution of health innovation from the outside, made me want to dig in, having always found science and medical technology incredibly interesting. This is where I made a leap that most people thought I was crazy to pursue as I had not previously had any scientific training. Despite this, I changed career tracks quite dramatically and went back to university to study neuroscience, in order to learn the discipline and rigour of scientific research from the inside. I wanted to know what’s possible and what’s not for myself, to learn how to ascertain who’s telling the truth — because there’s a lot of hype in the startup world and the barrier to entry in these sectors is quite high. The plan wasn’t to become a career academic in the long-term; it was to gain the tools necessary to be able to intentionally invest in startups, specifically defensive verticals like medtech, healthtech and biotech — because I feel these areas are going to have a major impact on the world as the cycle of discovery is accelerating.

There is huge potential for medical technologies to redress global healthcare inequality, and the products/tools that attract me as an investor are those that are able to function in a wide variety of geographical areas, social contexts and environments — not products designed solely for use in the global North, or financially wealthy societies.

The key is accessibility; some startups seem to think they can’t do impact-based work until they have strong revenue or an IPO, so they can re-invest some of that money in a CSR-type strategy — but again, that means making the best new commercially built technologies available only to certain sectors of the population globally, contributing to the inequality gap.

Recently, I’m seeing more products like the remote surgery platform Proximie — in which I’m an investor — that are made widely accessible from the outset. In Proximie’s case, this is because it has been designed by a surgeon, for surgeons, to make surgical expertise available anywhere in the world via a simple internet connection. The founder has a huge heart to serve, and fundamentally understands the pain points of that sector, and has built her platform to be light, easily deployed on low bandwidth, and therefore as usable in austere environments as it is in a high-end hospital. To me, that is extraordinary. Products should, in my experience, be built from their outset with the most agile and intuitive design possible, thinking of a global footprint, not just focusing on one market such as Europe or the US as the “end-all”. That lacks imagination. There is a big difference between stacking your product roll-out in a stepwise and thoughtful manner, versus only designing your product with a limited customer base in mind, ignoring the rest of the world.

Other companies are starting to scale down the physical size of various diagnostic tools — I’ve recently invested in Ilara Health, which is bringing handheld ultrasound devices like Butterfly iQ and other key diagnostic tests to rural clinics throughout Africa, for example. Traditionally, these are large machines that are very expensive to purchase, or tests requiring complex labs, meaning that in certain places, people would have to travel to city centres to get tested in cost prohibitive settings. Now, everything’s being reduced in size — and what was once happening to mobile phones is now happening to health tech as well.

Medical devices are being shrunk into the palms of our hands, so that people in rural areas can get a sonogram for example, with incredible ease.

This also allows for creative financing models to be reimagined for access to such diagnostics. That’s one way we can address global healthcare inequality; by becoming intentional in our innovations, making them portable and bundling such interventions throughout the continuum of care.

Companies have habitually made a weird distinction between impact investment and commercial investment, but where my husband and I have found our sweet spot as investors is in asking why can’t a company be built commercially — with the aim of making money — but with a product that is fantastic and can be accessed from anywhere in the world? Why does it have to be one or the other? There are ways to build companies like this from an early stage, when they’re prototyping and scaling, and there are interesting means of creating these partnerships and ecosystems where they can be tested and deployed in other areas of the world — so everyone can access the innovation from the outset, without it being a drag on the commercial vision and aims. Innovation is not just about the product itself. It is also the way of thinking around the greater strategy for growth, and how the value of the company is positively impacted by becoming a part of the global healthcare policy landscape. If you influence policy through your product becoming an effective implementation tool for better care, you become a global FACT as a company, while instituting quantifiable change.

For example, we were talking about running a prototype project and deploying Proximie in rural Kenya. The biggest need to address there (from speaking with our partners) was maternal surgical care, because there are over 8,000 deaths associated with childbirth in Kenya every year, and they have the seventh highest Maternal Mortality Rate in the world. There is a significant variation in the quality of care between regions, hospitals and clinics, while the roads in rural areas are often long and difficult to traverse — meaning that it can be perilously hard for patients to get to the best possible place for treatment in the nearest city or town. This is where Proximie’s remote surgical guidance comes in.

One challenge in deploying the product was that more than half of rural Africa still lacks telecom infrastructure, and some of these places have very low bandwidth — yet the remote surgery platform was still able to run, so having that level of accessibility was fantastic. While more access to infrastructure is becoming available every year, global health innovation goes hand in hand with the need for increased renewable energy and telecom infrastructure to create a “digital health backbone” as recently outlined by UNAIDS Health Innovation Exchange. Another question was, who should be dialling in to provide remote surgical assistance — international doctors or local doctors? You might assume you want the best surgeon from Harvard on the line, but that’s not necessarily the case; we also need world-class surgeons from centres like Nairobi or nearby regional hospitals, because they will have a greater contextual relevance and familiarity with the types of cases that are prevalent locally — for example, the fact that uterine fibroids present very differently in women in Kenya than they do in the global North.

Co-creation and listening to end users of your product are foundational exercises for success. You may have the best idea in the world in your mind’s-eye, but if that does not align with what people are ultimately asking for, there will be a fundamental disconnect with your user base. It is not enough to be an innovator. It is also critical to be observant listeners, curious about other’s needs, respectful of their context and culture.

As an investor, what ultimately drives me is human empathy. It doesn’t make sense to me that people have to live without proper care in this day and age. I’m interested in anything that’s going to make this world more efficient, more empathetic, more balanced and more intelligent — ultimately, with less pain.

What is our legacy going to be? For me, access to quality healthcare is a basic human right, alongside access to food and shelter. We select our investments based on extraordinary founders and their ability to create companies with the potential to scale exponentially, yet have clear impact capacity in respect to basic human needs and rights. I recognise that where one is born, or raised should not dictate what one has access to. We live in a time where commercial success can absolutely go hand-in-hand with creating life-changing value. I certainly know that I want to contribute to such a shift in mentality through the investments, founders and projects that I champion.