In a groundbreaking effort to strengthen the anaesthesia care workforce in Sierra Leone, Mercy Ships has partnered with the Sierra Leone Ministry of Health and the University of Sierra Leone to establish the Nurse Anaesthesia Diploma Program. The initiative aims to enhance the surgical care capacity in the country by training specialised nurse anaesthetists, ensuring the sustainability of healthcare improvements, long after Mercy Ships leaves port in Freetown.

Suzanne Thomas, Director of Education, Training, and Advocacy (ETA) at Mercy Ships, highlighted the collaborative efforts that led to the program’s inception. “Our partnership with the Ministry of Health and the University of Sierra Leone is crucial for developing long-term solutions to the healthcare challenges here. The Nurse Anaesthesia Diploma Program was specifically requested by our partners at the Ministry of Health, recognising the urgent need for more trained anaesthesia providers in government hospitals.” Sierra Leone has approximately 0.1 anaesthesiologists per 100,000 population, or one anaesthesiologist per million people, which is drastically lower than the World Health Organisation (WHO) recommendation of 20 per million. Approximately 90% of surgical procedures in Sierra Leone are conducted without a trained anaesthesiologist, increasing the risk of complications among patients seeking critical surgical care. The perioperative mortality rate in Sierra Leone can be as high as 1 in 20 for major surgeries, significantly higher than in high-income countries.

These startling statistics underscore the challenges in many middle- and low-income countries, but in Sierra Leone particularly, where specialised anaesthesia training is cited as a major need throughout its healthcare sectors.

The program, which began in April 2024 with 20 students selected from across Sierra Leone, focuses on providing comprehensive training in anaesthesia. These students, already experienced nurses, demonstrated a strong commitment to specialising in anaesthesia care. The course’s curriculum includes theoretical knowledge and practical skills, with initial training conducted in the simulation centre on board the Global Mercy™.

Josefin Tapper, a volunteer Anaesthesia Team Leader on the ship, works closely with the healthcare professionals who come on board for training.

“It’s been really rewarding having them on board and sharing professional skills with each other. I think that’s the way to go to bridge the gap,” she said. “I think that’s the way to go if you want to make a lasting impact in the countries we serve in: to mentor, to educate, to advocate for our colleagues here so that they can have a better chance of doing their job to their best ability.”

One of the tutors helping facilitate the training, Hailemariam Kasim, is an assistant professor of Anaesthesiology at the University of Dilla, Ethiopia, and Anaesthetist Consultant with several years of academic and research experience.

“The nurse anesthesia diploma program in Sierra Leone is a beacon of hope, addressing the critical shortage of anaesthesia care providers and directly contributing to the reduction of the high burden of surgical disease in the country,” said Kasim. “This program is not just about training; it’s about empowering a new generation of healthcare professionals who will play a pivotal role in transforming the healthcare landscape of Sierra Leone, making safe surgical care accessible to all.”

Students are also excited to take this training, not only to further their own careers in healthcare, but to specialise in an area that will multiply capacity in Sierra Leone. The students surround a training mannequin laying face-up on a hospital bed and listen to Mr. Kasim explain various information about physiology, pathophysiology, anatomy, and regional anesthesia.

On Fridays, students attend lectures and discussions in a classroom setting held in the School of Nursing adjacent to Connaught Hospital, the principal adult referral hospital in Freetown. Held in a breezy, multi-story building overlooking Kroo Bay, the students sit attentively at desks and participate in group discussions.

“We are getting a very high-quality education from our trainers here,” said Mohammed Bangura, one of the students. “We know professional medical training can be challenging and anesthesia is no exception since it is a highly specialised field, requiring a deep understanding of complex medical concepts, technical skills, and critical thinking abilities that are crucial in ensuring positive patient outcomes.”

“This program will have a huge impact on my career because I will no longer be an ordinary medical practitioner at the end of this training, but someone with a specific specialty. This is going to have a huge impact on our country’s health sector,” Bangura said.

Once this course is completed, these students will augment the healthcare workforce throughout the country. Graduates will be able to bolster the number of anesthesia providers in the country, which will help increase Sierra Leone’s healthcare system’s capacity to perform necessary surgeries safely.

Education as Investment

Dr. Sandra Lako, Country Director for Mercy Ships in Sierra Leone, emphasised the program’s significance.

“Sierra Leone has a population of over 8 million but only about 50 nurse anaesthetists and two anaesthesiologists in government service. The estimated need is at least 200 anesthesia providers. By training an initial cohort of 20 nurses and planning for additional ones, we aim to make a substantial impact on the surgical workforce ,” Dr. Lako said.

Mercy Ships will support the program for three years, including providing two nurse anaesthesia tutors. These tutors will not only train the students but also help develop local faculty, creating a self-sustaining educational infrastructure that will continue to produce qualified anesthesia providers for years to come.

The Nurse Anaesthesia Diploma Program is part of a broader strategy by Mercy Ships to invest in the surgical systems of the countries it serves, supporting the growth of capacity within each nation long after its hospital ships leave.

Why Here, Why Now?

In Sierra Leone, several events in recent history have caused significant challenges to the healthcare system, such as a catastrophic civil war spanning from 1991-2002 that left hospitals, clinics, and medical facilities destroyed. This was followed by a serious Ebola outbreak that struck in 2014, further straining otherwise trajectorial medical and healthcare development in the country. While Sierra Leone has made strides to recover from these past challenges, the impacts on health outcomes and infrastructure still linger. Around 70% of hospitals in sub-Saharan Africa lack the essential infrastructure and supplies for safe anesthesia, including necessary medications and equipment.

The impact of the Nurse Anaesthesia Diploma Program extends beyond immediate training. The collaboration aims to ensure that trained nurse anaesthetists are deployed effectively across the country, especially in rural and underserved areas that lack anaesthesiologists, improving access to safe surgery for millions of Sierra Leoneans. The Ministry of Health has committed to employing these students, which is a critical step in addressing the workforce shortage and ensuring that trained professionals remain in the public health system where they are most needed.

Dr. Lako reflected on the broader implications of this initiative: “Our assessment in Sierra Leone highlighted the gaps in the surgical workforce. When we look at nurse anaesthesia in particular, the shortage is stark. By working with our partners to meet this need, we are not just training individuals but building a system that can sustain itself and continue to grow.”

Want to be part of this work, and together, make a tangible difference in partner nations across sub-Saharan Africa? Your skills, time, and support can make a life-changing impact. Here’s how to get involved.