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Dr. Alaa Ahmad is a paediatric orthopaedic surgeon based in Palestine and the US, with a focus on paediatric spine surgery, and a special interest in disseminating knowledge about the management of spine surgery deformities among doctors in the global South. In February of this year, he flew to Nicaragua for the third time to carry out a week of paediatric scoliosis case ‘missions’ at Fernando Velez Paiz Hospital in Managua, and invited doctors from around the world to view the procedures via Proximie. One of these was Dr. Francois Waterkeyn — a neurosurgeon based in Tanzania.

The intention was not only to provide viewers the opportunity to learn by observing the scoliosis procedures, but also to demonstrate the potential impact of Proximie to create programs in other lower-middle-income countries (LMICs) that would allow for continuous training year-round, rather than the few times a year when skilled surgeons are able to make themselves available in person.

Typically, doctors in LMICs try to learn scoliosis surgery through collaboration with skilled surgeons making sporadic visits on missions. The results in building capacity under these conditions are limited, given that this is a complicated surgery in which the local surgeon needs continued support — something which is, at best, extremely difficult to provide between missions. Dr. Alaa Ahmad set out to prove that Proximie can make this continued support extremely easy, and have a huge impact on the accessibility of training under such circumstances.

“We are launching a program in Nicaragua in cooperation with the Ministry of Health and a medical school,” says Dr. Ahmad. “Within two years we aim to have a team of local surgeons who can comfortably perform the most common form of scoliosis surgery — Adolescent Idiopathic Scoliosis (AIS). Education is obviously a huge part of the program, so we were interested in using Proximie to deliver that — as well as to broadcast surgical demonstrations to programs in Salvador, Tanzania, Kenya and Pakistan.

“This is the first time we have used a platform like Proximie to fill in the gap between two missions. In the intervening period, we are now able to train surgeons and guide them through the program, and when we return for the next mission we are not starting from scratch — we are improving skills that have been developed during a continuous education programme. As a global surgeon, I know if a local surgeon is not convinced that they are continually involved, they become less enthusiastic about the program.”

Dr. Francois Waterkeyn is a Global Neurosurgery Fellow at the Weill Cornell Medicine Tanzanian Neurosurgery Program — a program started 14 years ago by Dr. Roger Härtl, Weill Cornell’s Director of Spinal Surgery, with the aim of providing expert training to local neurosurgeons in Tanzania, alongside the Scoliosis program that Dr. Alaa Ahmad has also been involved in over the last three years. Dr. Waterkeyn was asked by Dr. Ahmad to identify Tanzanian surgeons who would benefit from virtually attending the scoliosis course in Nicaragua via Proximie.

“I had three local neurosurgeons watching Dr. Ahmad’s surgery on the Proximie platform with me; one junior trainee, one junior consultant who had just finished training, one who is more advanced in their education,” says Dr. Waterkeyn. “All three were really impressed by the platform, and immediately very confident using it on my laptop. It took only a few minutes for them to get used to the annotation tools, zooming in on the images and speaking with Dr. Ahmad while he was doing the surgery.

“Their feedback was extremely positive, so I think it would be a good next step to implement Proximie in Tanzania as well.”

“For countries like Tanzania, education is sometimes difficult because of the lack of access to live assistance from people who have the requisite education, knowledge and experience with these kinds of surgeries. So the concept of Proximie is extremely useful — and those neurosurgeons who were watching with me could see that; they were very enthusiastic about the potential for Proximie to improve their education.”

Having been impressed by Proximie’s capabilities, Dr. Waterkeyn is also seeing how it might potentially benefit future events he is organizing.

“We will be organizing a course here in Tanzania dedicated to neurotrauma, consisting of lectures in the morning and live surgeries in the afternoon,” says Dr. Waterkeyn. “There will be 80 people attending from all over East Africa, but obviously it is impossible to get 80 people into the theatre to see the surgery. In the past we have found it very difficult to set up a remote screen with adequate picture quality, but having seen Proximie in action — how easy it is to set up, how effortlessly it can incorporate video streams from equipment like microscopes, and the extremely high image quality of the video feed — I think it would be an excellent way for course attendees to view the surgeries.”

With Dr. Waterkeyn coming to the end of his year-long fellowship, he will be looking into the possibility of installing Proximie at his hospital in Tanzania, hoping to leave behind a legacy of continual access to global medical expertise from all over the world.

“This is all part of the process of democratising medicine,” says Dr. Ahmad. “The core question in this process is always how to provide local surgeons in LMICs with the knowledge and skills they need to create widespread access to the best quality medical care.

“Proximie’s ability to relay remote surgical assistance and augmented simulation is a powerful tool in this process, facilitating continuous training and remote guidance in a way that builds surgeons’ confidence and allows expertise to be shared directly from the operating room.”