Nurse Anesthetists Leading Change in Liberia

Daisy WinnerBlog, Liberia, Nursing

Ravaged by civil war and the Ebola crisis, the Liberian health system has struggled to meet local health needs. Life expectancy is only 61 years. 67 of every 1,000 children do not survive till their fifth birthday. And the country’s high maternal mortality rate remains among the world’s worst.

But two men are fighting to change that. Dr. W. Fassah and Mr. Aaron Sonah, from Phebe School of Nursing, are two nurse anesthetists who are transforming care for patients by training the next generation of Liberian nurses.

The only training school for nursing anesthesia in Liberia, Phebe has trained the majority of Liberia’s nursing anesthetists since 1970. And this month, Dr. Fassah and Mr. Sonah have been visiting Boston for an intensive training program. In partnership with Northeastern University’s (NEU) School of Nursing, and Beth Israel Deaconess Medical Center (BIDMC), this unique training in nurse anesthesia education allows the two nurses to participate in both classroom and clinical training.

While they visited the Seed Global Health offices, we had a chance to speak to them about their time in Boston and what they hope to bring back to Phebe.

What do you see as the biggest challenges facing nurse anesthetists in Liberia?

 Mr. Aaron Sonah (AS): There are three main challenges. The first is education of staff. Nurse anesthetists aren’t being trained to pass on what they are learning. The second is difficulty within clinical sites. They clinical sites where students are being trained do not have adequate resources. They lack critical equipment and there are limited medications for patients. The third, resources and materials. We really struggle with the limited resources to teach our students. We lack the space to train the adequate number of students to improve anesthesia.

Dr. W. Fassah (WF): We also struggle with the large case load. We have to treat an extremely large number of cases, the majority of them obstetric. We also are responsible for a large number of emergency or trauma cases. Nurse anesthetists work all day long and never rest. You go to leave the hospital to go home, but there is always someone dying, who needs your help. So, you turn around.

There also is no career ladder for nurse anesthetists. There are few opportunities for growth and the pay is the same for nurses who have only their associates degree.

What is needed to promote and strengthen the specialty within the country?

 WF: We need to improve the opportunities for nurse anesthetists in Liberia. There is no way for them to grow. They receive a diploma after two years of study but it doesn’t take them anywhere. And we need to improve the settings for nurses. These nurses are often placed at hospitals far from their family, working around the clock, for little pay.

What has your experience at NEU and BIDMC been like so far?

 AS: We are being exposed to different techniques in teaching, different materials for students to use, and different ways for faculty to work together. Based on what we have learned, we are going to take it and try to modify it into our setting. This entire experience has been very rewarding.

WF: Being here is so inspiring. We are exposed to so much. We are learning how we can better plan and organize our teaching, and how to achieve more positive outcomes with our students.

The relationship between students and faculty members here in the United States is very different from back home. Here, students are involved in the learning process. We attended a faculty meeting here, and there were student representatives from each class. Together, they discussed challenges facing the school and its achievements. And everyone provided input. We are hoping to incorporate more of this into our own meetings and planning.

What has been the most significant part of your experience here in Boston?

 AS: We attended a Basic Life Support training in the simulation lab, and acted as the preceptors for students. And one of the new teaching methods we learned was to ask the students, “why?”. Rather than being there to give information, prompt the student to really think critically, ask them why they chose the treatment they did. I am really looking forward to integrating this into our teaching methodology back home.

WF: Everyone we have encountered is so friendly and wants to share their knowledge with us. What I have learned is the importance of patient pre-assessment. Here in the U.S., the pre-assessment is very thorough. In Liberia, the pre-assessment isn’t as thorough because we don’t have access to the equipment or tests that exists in the U.S. We sometimes assume that patients aren’t usually on other medicines because of the limited supply available, but it’s important to ask. It’s these types of things that I have learned that I am hoping to bring back to Liberia.