Proximie builds stronger surgical workforce to expand quality care on AWS

More than 5 billion people globally lack access to safe, affordable surgery, contributing to 18.6 million preventable deaths each year (more than HIV, tuberculosis, and malaria combined), according to a study published in The Lancet. As a practicing surgeon, Proximie founder, Dr. Nadine Hachach-Haram, experienced firsthand how surgical workforce shortages and geography perpetuate inequity in care. Believing that technology was vital to solving this inequity, Hachach-Haram created Proximie in 2016 to bridge this gap.

“As people live longer, they have more complex ailments, and many lack access to specialist care,” says Dr. Shannon Shibata-Germanos, head of global health at Proximie. “Anywhere from 30–50 percent of the population across sub-Saharan Africa lives more than 2 hours from surgical care access. We need to use technology to scale experts to remove geographic boundaries, saving time while helping us to train exponentially more surgeons.”

As a commercial company, Proximie embedded the concept of “global health” into its ethos from the start, making sure that vulnerable populations could also gain access to its technology while the technology scaled and expanded commercially across the United States, Europe, and Asia. Through its Global Health Initiative, Proximie worked alongside the AWS Social Responsibility and Impact (SRI) team to establish digital communities of practice in East Africa, starting with Kenya. Each community is powered by an AWS-based digital hub, which helps surgeons across continents collaborate on complex cases, connects surgical teams for knowledge sharing, and directly improves patient care through access to upskilled specialists and experts, regardless of their location. Proximie codesigned the digital communities of practice with local surgeons and surgical associations to support surgeons across East Africa, providing sustainability and relevance in low-resource environments. “We make it possible for local surgical teams to run this solution,” says Shibata-Germanos. “We’re training the clinical innovators of the future.”

Proximie’s platform streams high-resolution surgical procedures in near real time, with a delay of less than 250 ms, and provides on-demand access to a digital library of over 80,000 videos. Proximie stores over 100 TB of data using Amazon Simple Storage Service (Amazon S3) Glacier storage classes for long-term, secure, durable data archiving at low cost and millisecond access. This helps surgeons retrieve case libraries for quality improvement analysis without undermining performance or compliance, even in rural hospitals.

Proximie’s Intelligence Suite uses computer vision to capture OR data and analyze OR workflows. This way, surgical teams can better identify patterns that can improve efficiency and patient safety through root cause analysis, helping prevent OR delays and adverse events. The suite uses Amazon Kinesis Video Streams to capture, process, and store media streams for playback, analytics, and machine learning and employs Amazon SageMaker AI to build, train, and deploy machine learning models.

“We tune our machine learning models to the specific environment that they work in, so it may be that the model that runs in one OR is different from that in another OR,” says Richard Carter, chief technology officer at Proximie. “Amazon SageMaker AI is critical to managing this specificity at scale, to orchestrate our deployments so that we can provide quality across the entire estate. Reproducing what Amazon SageMaker AI does for us would take years and cost hundreds of thousands of dollars, if it could be done at all.”

Through initial funding from the AWS SRI, Proximie partnered with the government of Makueni County to advance the Obstetric Safe Surgery Mentorship and Training Program. Through digital training offered on Proximie’s platform, early indicators demonstrated that mentorship efficiency improved by 820 percent, increasing capacity from 1 session per month to 12. “Taking the main obstetrician out of the facility for a full day of training has a huge impact on care delivery and cost,” says Shibata-Germanos. “With digital training and asynchronous access to the cloud-based library, people have consistency of training and rich quality improvement opportunities without traveling out of their facility.” These early successes helped Proximie receive subsequent AWS SRI awards to expand and scale across seven East African countries across surgical disciplines.

Across sub-Saharan Africa, Proximie has now deployed 32 AWS-powered digital hubs in seven countries. Through these access points, Proximie’s platform has supported the training of over 500 surgeons in obstetrics, oncology, neurosurgery, orthopedics, laparoscopy, and endoscopy. Proximie’s goal is to deploy 50 digital innovation hubs by the end of 2026. This expansion aims to upskill 30,000 surgeons across the region, bringing safer, high-quality surgical access to an estimated 1.3 million patients.

“We’ve built an incredible, adaptable, agile technology that can run anywhere in the world. It can face low-bandwidth settings and austere environments,” says Bryn Davies, global health and growth adviser at Proximie. “Technology has to be designed from the outset to be accessible to everyone, not just high-income environments.”

“Working alongside AWS, we’ve stretched our imagination in terms of training,” says Dr. Michael Mwachiro, general surgeon, endoscopy expert, and president of the Surgical Society of Kenya. “Proximie has transformed the mentorship and proctorship experience entirely. Now, I can watch and guide a procedure in rural Kenya—like in Makueni County—in the morning and teach a case transmitted to rural Uganda in the afternoon, all while I’m based in my hospital in Nairobi. We’re bringing surgical connectivity into isolation.” In a qualitative study conducted by Proximie, Jhpiego, and the government of Makueni County, 92 percent of healthcare providers reported that using Proximie for professional development and growth increased their self-confidence in the OR, and 100 percent of participants said that Proximie improved their performance in Obstetric Safe Surgery best practices.

“What we’re doing today would have been impossible even 15 years ago,” says Carter. “Using AWS cloud and AI technology is key to delivering our solution into low-resource environments at scale with high reliability and in compliance with data safety and local regulatory requirements.”

Proximie also plans to expand its solution into new regions, including rural areas in Wales and the United States. Many think of health inequity as a problem that exists only in distant countries, yet the Proximie team knows that this impacts patients globally and is a “problem everywhere, not just somewhere.” As the company’s platform is deployed in more communities, Proximie continues to break down barriers to equitable surgical care, strengthening local healthcare systems and empowering surgeons to bring the best care possible to their patients. “We have so much excitement from our surgeons. They’ve embraced this new method of teaching and mentoring,” says Shibata-Germanos. “It’s really beautiful to see.”