This article is part of an ongoing series that highlights the successes and challenges faced by advanced medically trained clinicians (AMTCs) in developing countries.

This story focuses on Calvin Momolu, a physician assistant from Liberia. When I spoke with him in July 2014, it was the height of the Ebola crisis – more than 10,000 persons in Liberia contracted the disease, and over 4,800 people have died from it.  According to WHO, an unprecedented number of medical staff were infected with Ebola during the outbreak, which highlighted the shortage of proper medical equipment, as well as a shortage of medical staff, who worked well beyond the number of hours recommended as safe.

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While Ebola was obviously a top concern, Mr Momolu spoke to me about the history and current situation for physician assistants in his country. The physician assistant was one of the few healthcare professionals that remained in Liberia during the civil war, which led to an increase in the profession’s popularity. Liberian physician assistants have had a major impact on the health of Liberians and serve in the most remote areas of their country. However, they have not, as a whole, benefitted from their success. Liberian physician assistants have low pay and a lack of professional development, which have led to a loss of these professionals to other occupations. Learning about the Liberian physician assistant made me realize how valuable non-doctor, mid-level healthcare providers are.

The Liberian physician assistant

Physician assistants have long been established in Liberia, with the first training school opening in 1965. The physician assistant program is 3 years long, and similar to many of its African counterparts, this program starts after high school. The program awards students with a diploma degree, which, according to Mr Momolu, makes it difficult for physician assistants to progress professionally without a bachelor’s degree. The education of the physician assistant is a combination of theoretical classroom work and clinical work. The 1st year is spent mostly in the classroom where students study the basic sciences.  The 2nd year is spent doing clinical observations, and then in the 3rd year, they do more practical, hands-on work.

According to Mr Momolu, the majority of physician assistants work in rural, underserved areas throughout the country. They are a very important part of the healthcare system, and they provide the majority of healthcare services in Liberia. Prior to the civil war, physician assistants enjoyed support from many NGOs, which entitled them to housing, transport, and a decent salary.