Late last year, Gradian embarked on our largest initiative to date: a national UAM installation and clinical training in Sierra Leone. After installing UAMs in every public hospital in the country, we sponsored Johns Hopkins University to administer a national training program for the country’s public-sector anesthesia providers, successfully training more than 50 nurse anesthetists on the crucial – and sometimes extremely challenging – skills needed to deliver inhaled anesthesia safely and effectively.

Three months later, Gradian accompanied the Hopkins team on a return trip to Sierra Leone for a refresher training. Our goal was to evaluate how well the newly-trained anesthetists retained their knowledge and skills, specifically around airway management, intubation and rapid sequence induction using the UAM.


Over the course of two weeks in February, we reassembled nearly all of the participants from the original training – half at Bo Government Hospital and half at Princess Christian Maternity Hospital in Freetown. Under the supervision of Sierra Leonean trainers and the Hopkins team, each participant ran through two simulations testing rapid sequence induction skills on the mannequins that were donated for the program. Knowing the drill inside and out, our new local trainers set up all of the stations, ran the drills and gave valuable feedback to all who attended.

The end result was a cadre of nurse anesthetists who demonstrated expertise in difficult skills related to inhaled general anesthesia. We were impressed with how comfortably the participants intubated patients and how familiar they were with the UAM – all signs that Sierra Leone’s capacity to deliver anesthesia for surgical care was greatly improved from this training.

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