As we entered year two of the pandemic, the weight of prolonged uncertainty was palpable. Though a shared experience, the impact that COVID-19 had was not the same for us all. Each country, community, and individual had a unique experience during the pandemic, meaning a one-size-fits-all approach was not an option. It was a year of customizing, iterating, and persevering. We saw this firsthand among our local partners, impassioned advocates and, most importantly, dedicated front-line providers.

This past year gave us an opportunity to think strategically about how we ensure the sustainability of the investments made in response to COVID-19. Put simply, how could rapid response efforts accelerate health systems strengthening? For Gradian, this meant investing in localized training infrastructure and growing our operations team in East Africa. We also undertook our biggest product development effort, which we’re excited to share with you later this year. But most importantly, we listened. We listened to our customers’ successes and listened even closer to their challenges and needs. It guided our work last year and set the stage for the year to come.

Though we have heard from many of you throughout 2021, we know that there is still so much more that we can do and learn. We invite you to send your feedback and ideas about our products and services to us directly at customers@gradianhealth.org, so we can continue these important conversations.

As we move forward, we want to also share some of the major highlights of 2021 – a year where we centered our work around our customers and built partnerships to address their needs.

Supporting COVID-19 Response in Nepal
Gradian, in partnership with the Nick Simons Foundation, the National Innovation Center Nepal (NIC), and the America Nepal Medical Foundation (ANMF), launched a partnership to strengthen critical care services at nine hospitals across Nepal. Over 50 Comprehensive Care Ventilators (CCVs) and 100 oxygen concentrators were distributed to zonal, regional, and teaching hospitals in remote regions throughout Nepal, as well as three central hospitals in Kathmandu including Bir Hospital and Civil Hospital. NIC engineers and technicians then installed the CCVs, led biomedical training for hospital technicians, and provided support, with the coordination of Gradian’s clinical training, for providers at the hospitals. Under the leadership of Gradian’s lead clinical trainer in Nepal, DrPusparaj Poudel, over 150 clinical providers were trained across the nine hospitals using Gradian’s mobile simulation training kits and CCV training curriculum. Of note, Gradian and its partners mobilized this effort within a matter of days thanks to the technical expertise of all three partners in medical technology, clinical practice, and biomedical engineering.

Gradian Champions
Clinical training during a pandemic did not come without its challenges. The impacts of COVID-19 and the inability to gather in-person propelled us to develop innovative training modules that kept people safe while also ensuring that Gradian’s users were confident in their ability to operate our products. We created open lines of communication with our users through various remote platforms, allowing us to change and adapt our training protocols quickly. During the height of the COVID-19 pandemic, Gradian champions Dr. Ndaba and Dr. Sweetbert led a cohort of trainers in Tanzania. Between June 2021 and November 2021, the team conducted 24 CCV training sessions and 54 Universal Anesthesia Machine (UAM) training sessions in Tanzania.

New Markets and New Opportunities
Last year brought opportunities to expand to new markets, most notably in Niger. With the assistance of our dedicated network of existing clinical trainers, like Dr. Papytcho, we welcomed and trained new French-speaking doctors. This effort wouldn’t have been possible without Gradian’s newest French-speaking clinical trainer, Dr. Bandiare, who delivered Gradian’s first clinical training in Niger, representing a further expansion into Francophone markets. Despite COVID-19 challenges, an initial lack of French-speaking trainers, and the need to create French training materials, Gradian, with the support of our partners, was able to provide the same level of high-quality training and support to hospitals in Niger and other Francophone countries.

Innovative Clinical Training Models
Through remote, hybrid, and in-person training modules, Gradian trained over 1,900 individuals across 12 countries on the use of our products.

Growing Our Partnership with KMTC
In July 2021, Kenya’s Ministry of Health, Kenya Medical Training College (KMTC), and Gradian, partnered to launch a high-fidelity simulation laboratory focused on strengthening anesthesia and critical care in the region. The simulation lab, located at KMTC’s main campus in Nairobi, provides clinicians an opportunity to train in real-world environments. Following the launch of the lab, Gradian partnered with Dr. Wagaki Gicheru, KMTC’s Coordinator of E-Learning Services, to develop a critical care curriculum based on feedback received from Gradian’s customers. To deploy this curriculum, we worked in partnership with the Kenya Society of Anesthesiologists (KSA) to identify training champions that would act as mentors to hospitals. As a result, between March 2021 and December 2021, KSA trainers trained clinicians in 24 hospitals in the region.

Maintaining and Servicing Our Products in the Face of a Pandemic 
The second half of 2021 was a busy year for our technical services team as they adopted protective measures to safely visit Gradian customers in-person. The team, led by Derick Kamina, Gradian’s Technical Services Manager, and supported by Praygod Lyimo, Gradian’s Senior Biomedical Engineer, impressively pushed through the challenges of the pandemic to ensure product installation and maintenance moved forward. In 2021, the team conducted 231 installations and 704 preventative maintenance visits across 18 different countries.

Partnering with the ELMA Relief Foundation 
Our partnership with the ELMA Relief Foundation, whose grant helped Gradian increase critical care capacity in Uganda, led to remarkable progress. By February 2021, ELMA’s support contributed to the training of over 480 clinical providers, through both virtual and on-site capacity building, and led in partnership with the Association of Anesthesiologists of Uganda (AAU). This training effort enabled meaningful uptake and use of the 109 CCVs installed across 17 hospitals during the pandemic.

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