When Gradian began working in the Democratic Republic of the Congo in early 2016, we did so recognizing the various challenges this central African country would present. For instance, it’s the size of Western Europe, yet only has a few thousand kilometers of paved roads. While its national language is French, Congolese people speak dozens of other local languages. And, sadly, the country’s been mired in poverty and conflict for decades, with a per-capita GDP of barely a dollar a day and ongoing violence still occurring, particularly in the East. Needless to say, the DRC also has a dramatic shortage of anesthesia providers and equipment at the sparse health facilities dotting its countryside, making safe surgical care a rare option.

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We initiated our work in the DRC when we installed our first UAM at the Biamba Marie Mutombo Hospital in the capital of Kinshasa. Teaming up with the Dikembe Mutombo Foundation, we treated this first installation as an opportunity to build up a team of Congolese biomedical technicians and UAM users who could be our local support staff should we expand our work elsewhere in the country. Sure enough, within months, we began a large-scale partnership with a global health NGO that would require an all-hands-on-deck approach to installing the UAM and training hospitals to operate it.

The project consisted of 10 hospitals spread out across the North, East and South regions of the country. Since none of them had ever used inhaled anesthesia before (they had relied on injectable ketamine), it was imperative that we worked with our partners to not only install UAMs at each facility, but provide intensive on-site trainings for the anesthetists who would be responsible for using the equipment and the technicians charged with maintaining it. Tapping our seasoned anesthesiologists and biomedical engineers from Haiti, Benin, Uganda and Rwanda, we pursued a “train the trainer” model that allowed us to stagger the installations and trainings as we built up our in-country expertise and prepared the logistics of a national roll-out.

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First we set up training centers in Kinshasa and Mbararra, Uganda, near Goma, where existing UAM master clinical and technical trainers led didactic sessions and proctored cases for the new batch of Congolese trainers. Each trainee left these initial training centers with certification to lead trainings of their own.

Then we hosted centralized trainings in the North, East and South, where hospitals in each region could convene to learn to operate and service the equipment themselves. This was the first opportunity for the new set of trainers to orient others on the UAM, and — under the oversight of Gradian’s master trainers — each one managed to lead successful sessions.

Upon completion, 10 hospitals had both clinical and technical staff ready to deliver safe general anesthesia for the first time — a major step in the country’s ability to treat fractures from car accidents, childbirth complications, congenital defects and many other conditions.

 

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