Partnerships for Enhanced Engagement in Research Liberia (PEER/Liberia)

University of Liberia College of Health Sciences/A.M. Dogliotti Medical School

PI: Bernice Dahn
Project Duration: June 1, 2020 - October 31, 2023
Focus Areas: Clinical Resarch Training, Curriculum Development, Faculty Development Program, Infrastructure Improvements

Final Summary of Project Activities

The main focus of activities conducted by the University of Liberia College of Health Sciences was human capacity building. One major effort was the Teaching Apprentice Program, which was developed to identify and recruit future preclinical faculty for the ULCHS Medical School to replace foreign faculty. To achieve this, PEER funding supported 14 Liberian Teaching Apprentices (3 females and 11 males) to enroll in graduate degree programs in the biomedical sciences at the University of Ghana. Six members of the first cohort successfully completed their studies and returned home to join the ULCHS faculty, while the remaining eight will return home at the end of December 2023.

Meanwhile, 61 faculty members (21 females and 40 males) in three cohorts at the ULCHS and the main University of Liberia participated in the Faculty Development Training implemented in collaboration with the Vanderbilt University. The primary goals included promoting excellent classroom teaching and change management skills, encouraging research utilization, and advancing the capacity building of medical education through effective leadership in education, assessment, and evaluation. The ULCHS faculty involved in these trainings are all from preclinical and clinical disciplines with backgrounds in internal medicine, pediatric, surgery, psychiatry, and clinical pathology, and faculty from the departments of Chemistry, Physics, Biology from the main University of Liberia also took part. The program also included a mentorship component that trained two cohorts of faculty and medical resident as teachers and leaders through a blended program of web-based self-learning modules and interactive hands-on learning.

Another major outcome of the PEER Liberia program at ULCHS was a newly revised curriculum developed in cooperation with U.S. partners. The university’s infrastructure was also significantly enhanced with PEER support. PEER funded the purchase of two medium-sized buses to transport faculty and students between the JFK Hospital and the medical school campuses. The program also supported procurement of much-needed laboratory equipment and reagents for the ULCHS Medical School laboratories and refurbishment and purchase of equipment and reagents for laboratories of the departments of Physics, Chemistry, and Biological Science at the University of Liberia Science College.

Besides the academic and research capacity building aspects, this project also resulted in significant improvement in the university’s ability to manage external funding support, including the establishment of a ULCHS Grant Management Office. A financial assessment conducted in 2019 had identified major gaps that needed to be addressed in order to allow the university to receive a subaward directly from the National Academies of Sciences, Engineering, and Medicine. A third-party organization therefore managed the funds on behalf of ULCHS until the improvements were made in to accounting software, standard operating procedures, financial controls, audit protocols, and dedicated financial management staff. With these issues successfully addressed, the university was able to manage the funds on its own for the last year of the project. This represented an important step forward, putting the university in a position to gain the trust of other international donors and receive and independently manage funds to continue and expand the activities launched under PEER. By the time the project ended in October 2023, ULCHS reported receiving an additional $11.6 million in grants from 10 other U.S. and international donors to support ongoing work.

SIM, SIM/Liberia, ELWA Hospital (ELWA)

PI: Rick Sacra
Other team members: David Okiror
Project Duration: December 1, 2018 - August 31, 2023
Focus Areas: Family Medicine, Faculty Development Program

Final Summary of Project Activities

According to project PI Dr. Rick Sacra, the impact of this project has been nothing short of monumental. Family Medicine, a field that was virtually unknown in Liberia ten years ago, is now common knowledge at all levels of healthcare administration, including the Ministry of Health, the Liberia College of Physicians and Surgeons (LCPS), County Health Teams, and District Hospitals. Even though residency training only began in July 2017, by August 2023 there were 15 graduates from the membership program recognized by LCPS, serving as medical directors of hospitals and health centers, county health officers, and junior faculty within the Family Medicine Residency (FMR) Program. Furthermore, a new rotation in Family Medicine is slated to begin for final year medical students in 2024-2025 according to the revised A. M. Dogliotti (AMD) College of Medicine Curriculum. The USAID PEER/Liberia Partnership program can be especially proud that this funding catalyzed the development of a new primary care specialty in Liberia even during the COVID-19 pandemic, which could have easily derailed a project like this. Family Medicine will contribute to a shift toward more holistic and cost-effective care nationwide, in collaboration with all the other specialties that have faculties within LCPS. Following are summaries of the activities undertaken by the SIM/ELWA team under each of their three objectives, with explanations for those which proved impractical or were reworked during the course of the grant.

Objective 1: Strengthen medical training and build subspecialty medical capacity in Liberia through hospital-based residency training, medical student teaching, faculty development, subspecialty care training to family physician trainees, and behavioral health training

Under Objective 1, the first activity was to create a structured curriculum for FMR which aligns with the West African College of Physicians (WACP) curriculum. This has been accomplished as we follow the WACP, which itself has revised its curriculum several times. The ELWA Hospital Family Medicine Faculty received full five-year accreditation from WACP in 2020. A new 2023 WACP curriculum includes online core knowledge modules and is being implemented starting with the 2023 class of residents, with the residents being trained by fellows of the West African College and LCPS. Rotation plans have been developed and documented with the partnership of UMass FMR collaborators. Much needed updates to LCPS policies and procedures and their adoption for Family Medicine were accomplished through the intense involvement of Family Medicine faculty in rewriting the LCPS Residency Policies and Procedures document in 2019/2020 and orienting all residents to this document. Feedback about training, rotations, and faculty from both faculty and residents was been solicited through detailed questionnaires both periodically (in association with residency retreats held in 2019 and 2021) and after each rotation, with this feedback helping drive decisions about rotation content and faculty assignments. The recruitment of core Family Medicine faculty was a key goal under this objective. The program chair’s salary was initially funded by core USAID PEER funds, but those costs have now transitioned to partial funding by another long-term partner, African Mission Healthcare, for sustainability. Supplemental funds were used to bring in two additional core faculty, one of whom continues to develop the Part 2 Fellowship program/curriculum.

Under the project’s “Core Faculty” theme, SIM/ELWA deployed UMass Global Health Fellows to work in Liberia. The COVID pandemic interrupted this process, but even so, three UMass Global Health Fellows served 6-8 week stints in Liberia alongside UMass FM Residents (supported by UMass funds), who taught and coordinated Journal Clubs, clinical rounds, CPR training, and ALSO (Advanced Life Support in Obstetrics) training. The UMass team (Dr. Valdman and Maria Barluenga) was instrumental in assisting ELWA to organize schedules for clinical instruction, lectures, coordinating the mix of remote and in-person didactic sessions with the academic coordinator. The graduates who remained on as Junior Faculty, Dr. Igwilo and Dr. Korha, have been mentored and developed in their teaching and administrative skills.

The second theme under objective 1, which involved medical student teaching, was delayed by the constraints of working with the A.M. Dogliotti College of Medicine and their curriculum review system. However, SIM/ELWA joined in crafting the new curriculum, which is gradually being implemented. A complementary set of Family Medicine didactics and clinical teaching was put into the final year curriculum, to be implemented in 2024/25, with focus on gerontology, lifestyle medicine, travel medicine, and palliative care.

For the third theme, Faculty Development, the initial plan to use the “Training of Tomorrow” course was scrapped after in depth consultation with both UMass partners and Fellows within the WACP. It became clear that only WACP-approved training would be accepted in this context. After consultation with WACP fellows/faculties, Dr. Sacra and his team revised these plans and used the “Doctors As Educators” course, as well as sending their faculty and senior residents to the faculty development seminars provided by other USAID PEER partners in collaboration with LCPS.

Subspecialty Care Training was the focus of the fourth theme, and the team recruited faculty and provided subspecialty-based training in HIV/viral hepatitis care (by UMass fellows), Obstetrics (by an OB/GYN specialist funded by USAID), ENT (by a specialist from Ghana who made six one-month visits to teach intensive rotations to two residents at a time), Ophthalmology, Mental Health, Microbiology, and Pathology. Pediatrics was provided by another resource. This allowed the SIM/ELWA team to provide the full range of subspecialty training required by the WACP Family Medicine curriculum. Many of these didactic sessions are now in UMass Family Medicine databank.

For the fifth theme, Behavioral Health (BH) Training, Dr. Liz Dykhouse from UMass provided interactive remote didactic sessions to residents, providing a full range of BH resources, including the trainees’ self-assessments of their own reactions to patients and to the traumas and stresses of physician practice, as well as a full range of BH tools for patients with a wide range of mental health issues.

Objective 2: Improve the ability of Liberia to conduct clinical research

An initial set of four research trainings was conducted in 2019, funded by PEER (carried out by UMass in collaboration with other partners and JFK departments), each running four half-days. A second set of trainings was carried out in 2020, in online/zoom format due to COVID-19. This led to a set of eight pilot projects being approved, including one led by a family physician resident. These research projects continue in various states of completion as of August 2023. Thanks to supplemental funds provided by PEER/Liberia, the team organized a research training in December 2022, based at ELWA Hospital and conducted by Dr. Trish McQuilkin (UMass Pediatrics) in collaboration with three local faculty from the Liberia College of Health Sciences (LCHS). Participants included one part-2 senior resident, four FMR graduates, and five Family Medicine faculty members. A follow-on mentoring scheme was put in place to allow ongoing pursuit of research opportunities through an agreement with one of the local Liberian faculty through the fall of 2024. Research outputs include presentations at various Scientific Sessions by Family Physicians, including “ELWA Hospital Primary Care Intervention to Manage COVID-19 during the First Peak of the Epidemic from April 2020 to August 2020 in Monrovia, Liberia. Outcomes and Lessons Learned” by Dr. David Okiror and 14 others, presented at the recent LCPS Annual General and Scientific Meeting. Research is probably the area where Liberia has the largest gaps and needs before developing state-of-the-art outputs, but this grant has done a lot to introduce trainees to research fundamentals.

Objective 3: Increase access to specialty care for Ebola survivors and the broader population

By the time funding was received in December 2018, the Ebola epidemic had faded to the back of peoples’ minds. There were still a few Ebola survivors attending the ELWA Hospital Continuity Clinic at the beginning of the project, and they were folded into the ongoing efforts to improve access to high-quality Family Medicine care at ELWA. Family Medicine’s emphasis on developing curriculum, a quality improvement mindset, and training time in the outpatient setting should go a long way toward improving preventive and chronic disease care in Liberia in the long run.

Yale School of Medicine (Yale)

PI: Onyema Ogbuagu
Other team members: Lydia Aoun-Barakat, Laura Crawford, Sheela Shenoi
Project Duration: July 15, 2018 - August 31, 2021
Focus Areas: Clinical Research Training, Infectious Diseases

Final Summary of Project Activities

The original goal of the PEER award to Yale was to establish an infectious disease (ID) fellowship program at the John F. Kennedy Medical Center. This was then modified to coordinate West African College of Physicians (WACP)-recognized ID fellowship training at an institution in West Africa for two eligible Liberian physicians. Only one eligible candidate was identified, and at the time of the final report in November 2021, Joyce Bartekwa was completing the training she began in 2019 at Jos University Teaching Hospital in Nigeria and was board eligible (scheduled to sit for her fellowship exam in April 2022). The Yale team offered mentoring and one-on-one ID support Residents and junior faculty to nurture interest in ID-related research issues. This has included preceptorships in inpatient and outpatient settings (the infectious diseases and HIV clinics) as well as creation of a repository of ID lectures and other resources for the entire Medicine department.

Numerous challenges were encountered in the course of implementation of this project. Dr. Ogbuago reports that he and his colleagues pulled back for a wider view of the medical education pipeline, and these modified expectations revealed the ill-prepared status of the Residents in JFK's Department of Medicine Residency Program with regard to passing the WACP Membership exams at the end of residency, which would then allow further regionally recognized specialty training. Support was provided to Residents for the virtual (and mandatory) workshops prior to the twice-a-year WACP membership examinations. The most impact was from the hiring of four senior faculty MD specialists (in Gastroenterology, Cardiology, Pathology, and Nephrology) to each spend 12 weeks at JFKMC providing didactic and hands-on training, as well as specialized attention to the skills and responses sought by WACP examiners. This positioned a class of six residents to be eligible for and hopefully perform well in the forthcoming WACP membership exams in April 2022.

Part of the difficulties encountered on the project may have been due to the high standard set by the Yale team for the residency program and the physicians it produces. WACP is the recognized bar that has been set for JFKMC's Department of Medicine residents. The Department's training program has been accredited by WACP to provide post-graduate training, and most of the physicians recruited from the sub-region to teach are WACP Fellows. Despite the challenges, of the 22 trainees with the Yale team worked, 20 had passed their WACP primary exam by the end of the project, five had obtained WACP membership, which signals the completion of residency, and two have further achieved WACP Fellowship status in General Internal Medicine. The local Liberia College of Physicians and Surgeons (LCPS) offers a less rigorous examination that does not carry much weight outside of Liberia; all 22 have their LCPS primary certification, and 19 have their LCPS membership certification.

Yale joins several other PEER/Liberia partners in collaborating on the USAID program Bringing Research to Impact for Development, Global Engagement, and Utilization (BRIDGE-U): Liberia, which runs from 2021 through 2026.

Vanderbilt University Medical Center (VUMC)

PI: Troy Moon
Other team members: Marie Martin, Bonnie Miller, Amy Chomsky, Sapna Gangaputra, Jessica Howard
Project Duration: June 1, 2018 - June 30, 2022
Focus Areas: Clinical Research Training, Curriculum Development, Faculty Development Program, Ophthalmology

Final Summary of Project Activities

The Vanderbilt University Medical Center (VUMC)-led component of PEER/Liberia aimed to promote institutional and administrative capacity building to strengthen the A.M. Dogliotti School of Medicine (AMD) and Liberian College of Physicians and Surgeons (LCPS) to become accredited, sustainable, and robust local institutions. Following are the key results and impacts achieved on main objectives of the project:

Objective 1: Strengthen Medical Training and Build Subspecialty Medical Capacity in Liberia

49 faculty members and teaching apprentices participated in the Faculty Development Program, enhancing teaching skills.
AMD's medical school curriculum was reformed, resulting in a new seven-year, integrated, and competency-based curriculum launched in 2021.
The Faculty Mentorship Training Program was implemented to strengthen faculty mentorship in Liberia.
The Residents as Teachers and Leaders (RATL™) Program was introduced to improve clinical teaching skills.
Camp xSEL, a science camp for high school students, was launched to support the science education pipeline in Liberia.
Ophthalmology subspecialty development in Liberia was supported, with training, remote mentorship, and access to online resources.

Objective 2: Improve Ability of Liberia to Conduct Research

A four-part research capacity building workshop series was held for clinical residents, faculty, and medical students, covering research methodologies and ethics.
Research projects on various health topics were developed, including pediatric influenza and RSV surveillance, cryptococcal meningitis, and family planning in Liberia.
A COVID Webinar was conducted for clinical faculty, residents, and medical students to address research during the pandemic.
A needs assessment of IRB functioning was conducted, and educational workshops on research ethics were organized for different IRBs in Monrovia.
Collaboration with USAID's BRIDGE-U funding mechanism resulted in projects building on expertise and collaborations fostered through PEER Liberia.

In summary, the overall project expanded medical training capacity in Liberia through curriculum reforms, faculty development, and mentorship programs. Research capacity in Liberia was strengthened, with increased knowledge and skills in research methodologies and ethics. Collaborations and networks among Liberian institutions and U.S. academic partners were fostered, enhancing coordination and knowledge sharing, and sustainable developments were achieved in medical training and research institutions in Liberia, setting the foundation for continued growth and progress. Vanderbilt University and its partners actively contributed to the growth of medical education and research in Liberia, with a focus on building local capacity and fostering collaborations that will continue to benefit the country's healthcare and research landscape in the future, and the Vanderbilt team continues as an active partner in USAID's BRIDGE-U program.

University of Massachusetts Medical School (UMass)

PI: Olga Valdman (original PI: Patricia McQuilkin)
Other team members: Steven Hatch, Stuart Levitz, Ann Moormann, Sanjay Ram, Olga Valdman
Project Duration: June 1, 2018 - August 15, 2023
Focus Areas: Clinical Research Training, Family Medicine, Infectious Diseases

Final Summary of Project Activities

Since 2018, the collaboration between multiple partners from the U.S. and Liberian sides on the PEER/Liberia grant has accomplished most of the goals set from the beginning, at times even going above and beyond. The involvement of the University of Massachusetts (UMass) team focused predominantly on Family Medicine and the collaboration with ELWA hospital in Liberia. Additionally, together with their Liberian colleagues they developed a robust research training course, supported pilot research projects, and developed and implemented an infectious disease teaching curriculum. Specifically, the following accomplishments should be noted relative to the three objectives in the work plan:

Objective 1: Strengthening medical training and building specialty and subspecialty medical capacity in Liberia

During the five years of the project, UMass helped ELWA and the Liberian College of Physicians and Surgeons (LCPS) to develop a robust Family Medicine training program. Here are some activities undertaken:

Developed a three-year curriculum in line with West African College of Physicians (WACP) standards.
Created policy and procedures for residency administration, including a three-year template for rotation schedules, recruitment, admission process, orientation, disciplinary actions, promotion, and approaches to working with challenging learners.
Supported preparation of residents for WACP exams, of whom 23 sat for the WACP primary exams and 20 passed those exams during the course of the grant. Additionally, one Family Medicine (FM) graduate passed the WACP membership exam. Locally, in training and graduation exams were developed utilizing both the WACP format, Liberian priorities, and Objective Structured Clinical Examination (OSCE) testing.
Conducted extensive work on the evaluation front, including development of rotation evaluations, faculty and resident feedback forms, on-the-fly professionalism evaluations, and semi-annual evaluations providing residents with comprehensive formative and summative feedback and support for improvement. E-formats of these evaluations were also developed to facilitate efficiency, completion, and data tracking.
Developed specialty rotations with curriculum and structure for Otorhinolaryngology (ENT), Ophthalmology, Family Medicine, Community Medicine, and Radiology. At the time of initiation of this work, there were no ophthalmology or ENT faculty in Liberia. Therefore, such faculty were recruited from the Ghana College of Physicians and sponsored to come and train FM residents twice a year while also developing local capacity for these specialties; now the rotation can be run in-country, no longer requiring overseas faculty travel.
Created other specialty training as per work plan, including HIV medicine through UMass HIV fellows developing and delivering an HIV management curriculum, as well as a longitudinal Behavioral Health curriculum developed and delivered by the director of behavioral health education at UMass Chan Medical School, Dr. Liz Dykhouse.
Placed three UMass Global Health fellows in Liberia for a combined total of seven months providing bed-side teaching, aiding curricular development, introducing teaching modalities, and delivering lectures.
Organized several faculty retreats bringing faculty from J.J. Dossen and ELWA hospital together with residents to collaborate, reflect, and plan for upcoming years.
Delivered more than 200 hours of didactic lectures remotely and posted the recorded videos with open access to build sustainable education material access.
Although the team was unable to develop a focused family medicine rotation for the medical students due to the timing of the A.M. Dogliotti School of Medicine (AMD) curriculum reform and new curriculum roll-out, they were able to send residents and fellows to physician-as-teacher trainings and develop a team structure where students and especially interns in the ELWA and J.J. Dossen hospitals work closely with FM residents and fellows who provide clinical and evidence-based teaching.

Through these activities, the team achieved their stated project objectives. Family Medicine has become one of the most sought-after specialties, attracting the highest number of medical students applying each year. Thanks to PEER support, the UMass researchers have recruited and supported four Family Medicine faculty as well as Ob/Gyn faculty; additionally, several graduates of training activities under the project are serving in junior faculty/mentorship roles at ELWA and other hospitals across the country. The number of Liberian physicians trained in family medicine increased from 7 to 22, with 13 more candidates in the training process as of the fall of 2023. ELWA received a five-year accreditation from WACP in 2020 and LCPS in 2022 for both residency and fellowship training (the first fellowship in Liberia to be accredited by LCPS). The first LCPS fellow in Family Medicine is slated to graduate in 2024 and will become a faculty member, while others will be starting their fellowship in the next year. Through the participation of the UMass team in the AMD curriculum reform, they were able to ensure that family medicine is formally incorporated as a stand-alone rotation in the medical school curriculum for the first time in history of medical training in Liberia; the rotation is set to begin in the 2024-2025 academic year.

Postgraduate medical education in Family Medicine in Liberia has improved dramatically; the chair of LCPS named Family Medicine as the strongest residency in Liberia. Family Medicine is now contributing to the pool of Liberian specialists, with four graduates per year. Although there are no exact data on improved patient outcomes in terms of reduced morbidity and mortality in Liberia, observations of the situation indicate that the physician staffing levels at the ELWA, J.J. Dossen, and several other hospitals where FM graduates have been placed have improved dramatically. It can be reasonably expected that the presence of highly trained medical doctors, especially in rural areas where commonly there might only be nurses and para-professionals available, is expected to translate to improved morbidity and mortality.

Objective 2: Improve the ability of Liberia to conduct clinical research

In this objective UMass took leadership not only through Family Medicine but across PEER/Liberia initiatives. The original PI for the UMass team, Dr. Patricia McQuilkin, led the development of PEER/Liberia research training. She developed several iterations of research training courses with lectures given by Liberian and U.S. faculty across more than five institutions. In years 1 and 2, several in-person research workshops were held with close to 100 participants joining at least some lectures and 23 completing the full training series. As COVID broke out in 2020, the training was adapted to a virtual platform and became a longitudinal series of 13 two-hour sessions delivered online and recorded. A total of 60 trainees took part in the online training and 72 more listened to the recordings later on. In year 3, the training was pivoted to a train-the-trainer model focusing on training 15 teaching apprentices (TAs) and supporting local faculty in taking over the course, which has now (as of 2023) been integrated into the new Master of Public Health program and the University of Liberia training curriculum. The TAs trained were engaged in the latest supplemental funding year (2022-2023) by Family Medicine to assist with the research training course that took place in December 2022 for FM fellows and faculty, as well as supporting ongoing research development. Family Medicine developed monthly journal clubs for residents, as well as research-in-progress meetings for faculty and senior residents supported by Liberian research experts. By the end of the grant in the fall of 2023, the previously trained TAs had become the key faculty in Family Medicine research training, as well as other courses provided by the University of Liberia.

In addition to developing a comprehensive curriculum, building the workforce, and transferring ownership of the training to local partners, the UMass PEER team launched a pilot project grants program that funded eight research projects supported and mentored by the PEER research team. Dr. Andrews has completed and published her project. Drs. Ireland, Ekyinabah, and Oguni have completed their projects and have used the results to pursue fellowship status in the West African College of Physicians. Drs. Gorpudolo, Gbalon, and Sanoe have completed data collection and were working on data analysis. Dr. Barclay completed collecting data and was working on analysis.

Objective 3: Develop an outpatient residency continuity clinic to care for Ebola survivors and the broader population

Through the PEER grant initiatives, Family Medicine established a continuity clinic at ELWA Hospital for the first time in the country. Family Medicine residents were assigned patients to follow on an inpatient and outpatient basis, including Ebola survivors. A staff member dedicated to scheduling and coordinating appointments was hired and given a phone that patients were able to call to set up appointments. Unfortunately, during Covid this effort was significantly disrupted and has taken time to rebuild. However, the residents who were involved in the pilot have seen the value and impact of continuity and are eager to pursue it in other settings in which they are working and leading now. Additionally, ELWA had a cohort of Ebola survivors who were monitored and connected to specialty care, including ophthalmology at the L.V. Prasad Eye Institute.

In addition, Advanced Life Support Obstetrics (ALSO) training, which was initially started in April 2022 and continued in June 2023, has been a tremendous success. In April 2022, Dr. Olga Valdman and senior UMass FM resident Dr. Rebecca Gwaltney organized three distinct courses on ALSO in accordance with American Academy of Family Physicians standards and protocols. A total of 17 people were trained as providers and 9 as faculty, and 5 others audited the course. All participants reflected on the rigor and impact the training had on their skills to provide safe maternity care. Mannequins and equipment were donated to ELWA to continue performing such trainings all year round. In 2023, the UMass team engaged the local faculty on the ground, especially Dr. Susan Kimono, director of the Ob/Gyn department at ELWA, as well as faculty responsible for obstetrics training of FM residents, in preparing for the course, updating course materials, and delivering the bulk of the content with UMass support. Two more instructors were trained in 2023 as well. For the three-day provider course this year, 13 Family Medicine residents, one general practitioner, and 5 midwives participated. Although 3 individuals had to re-take the final exam, they were able to do it successfully on their second attempt, joining the other 16 who passed the course initially. Because the course had been offered the previous year, it was decided that residents who had taken it previously would have to take it again. All 7 of them unanimously agreed that taking it for the second time fully solidified their skills and improved their comfort level in managing obstetrical emergencies. They were even able to apply skills to several cases that presented on the ward, and several reported doing vacuum-assisted deliveries successfully for patients who previously would have been taken for cesarean sections.

During the course of the entire PEER grant, in addition to trainings mentioned above the UMass team also implemented Basic Life Support (BLS) training with the help of UMass/ Family Health Center of Worcester Global Health fellow Dr. Duy Nguyen, who traveled to ELWA in 2021 to conduct BLS training and provide mannequins and materials for ongoing learning.

Another capacity building highlight of the project was the visit of key Liberian partner Dr. David Okiror to the United States in the spring of 2023 to present at the Society of Teachers of Family Medicine annual conference with Dr. Rick Sacra of SIM/ELWA and Dr. Olga Valdman of UMass, after which he spent one week visiting the UMass Family Medicine Department. The bilateral exchange of ideas and practices and the collaboration that has developed between two sister Family Medicine training programs have been powerful and will continue to bear fruit for the trainees for both programs.

In summing up the impacts of this five-year effort, PI Dr. Olga Valdman notes that despite any challenges and ups and downs, this investment has been transformational to the health system and to specialty training in Liberia: “Although we know that this grant was an anomaly for PEER, which traditionally funds and supports research initiatives, we want to applaud USAID for investing in medical education at the specialty level. Family Physicians trained through this grant both as clinicians and researchers will now be leaders across the country leading primary care teams and setting up standards and processes, and the impact of this investment will have many ripple effects to come.”

Resources

Didactic Lectures Recipient Resource

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Partnerships for Enhanced Engagement in Research Liberia (PEER/Liberia)

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Partnerships for Enhanced Engagement in Research Liberia (PEER/Liberia)

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