Building Anesthesia Capacity and Knowledge in Acute Care

By: Vipul Shah, MD

I am a critical care physician and anesthesiologist who recently had the opportunity to travel to Liberia with the support of IMR. I had met IMR’s Dr. Sleemi during a prior trip when we overlapped during our time at Phebe Hospital in Bong County. Since that time, I have been involved in helping to develop the nurse anesthetist program at Phebe, as well as creating an acute care curriculum in collaboration with IMR's Dr. Josh Schiller. The purpose of my most recent trip was to scout auxiliary sites where the nurse anesthetists could attain a wider breadth of clinical experience, as well as find interested Liberian partners for the acute care curriculum.

Travelling to Liberia during the rainy season was a much different experience than what I had previously experienced. The rain comes down in sheets, not at all like the constant mist of my current hometown of Seattle. Much of the country is inaccessible during this time given the condition of the roads, which made my goal of seeing multiple clinical sites, some of which were far off the main road, unrealistic. Instead I focused on the hospitals near Phebe along the main highway, CB Dunbar and Ganta. CB Dunbar is a Ministry of Health hospital run by Dr. Obed Dolo; the facility specializes in obstetrics and women’s health. Dr. Dolo was very receptive to our ideas and it seems as though the nurse anesthetists will be able to rotate through CB Dunbar soon. This will allow them more exposure to OB anesthesia, a specialty that is sorely lacking in Liberia, as well as give them more gynecologic cases to add to their overall case mix. I also was able to visit Ganta Hospital, which is located near the Guinea border. There I had a very productive meeting with the director of the hospital and made plans to work on the collaboration, the biggest logistical hurdle being housing.

Through out this time, I continued to work with the nurse anesthetist students as a clinical mentor. The nurse anesthetist program is based in Phebe, and they have struggled with inconsistent NGO support and a lack of resources. Mr. Wilmot Fassah, an amazing gentleman who has basically kept the anesthetist program afloat during the difficult periods of the civil war and Ebola, is my primary contact there. He has been working diligently with Mary O’Sullivan, a nurse anesthetist stationed at Phebe, through a program with the Peace Corps designed to adapting the curriculum to fit the needs of the Liberian students and population. It was amazing to work with such dedicated people, and the students are the reason I stay so involved as they have sacrificed a great deal to continue their training in spite of a lack of recognition by the Ministry of Health as nurse anesthetists. . Progress is slow but steady; I am hopeful that in time there will be a robust anesthesia program that can safely serve the people of Liberia.

Overall, I had an excellent trip and look forward to returning to Liberia in continuing this work. I really appreciate the support of IMR and hope that we can continue this fruitful collaboration.