This article is part of an ongoing series that highlights the successes and challenges faced by advanced medically trained clinicians (AMTCs) in developing countries.
Physician assistants (PAs) have been a presence in Liberia since 1965. The PA program was developed in the 1960s with external support from nongovernment organizations and was to be absorbed by the Liberian government. It has not exactly been an easy transition, but it can be said beyond a shadow of a doubt that the Liberian PA program has made huge contributions to the health of the Liberian people. In fact, during the civil war there, PAs were some of the only healthcare providers working in Liberia. The impact of these PAs on the population’s health during this time did not go unnoticed by the public, and subsequently the profession became extremely attractive and applications for programs increased.
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Doctors and nurses have universal titles and can easily leave their country of origin to work in other countries, but PAs do not have the same opportunity to leave and so many stayed and worked during this horrible time in Liberian history. One of the global issues for PAs is the continuing lack of awareness of the impact on a population’s health that PAs and their equivalents (clinical officers in western and eastern Africa, clinical associates in South Africa, and health medical officers in Ethiopia) can have.
The term accelerated medically trained clinician (AMTC) is now being proposed to the World Health Organization and other major organizations as a general term to encompass the various titles our profession shares. Although AMTCs have many different titles, we have similar roles in the healthcare system. An article in this Global Health Rounds 1 year ago reported on Liberian PAs.1 The current article discusses an American PA who, through his work with American Baptist organizations, has set up a PA school in Liberia.
In 2014, I had the honor of interviewing Steve Trexler, an American PA with 30-plus years of experience. He is also a practicing Baptist. Mr. Trexler has been instrumental in developing a private Baptist PA program in Liberia to help address the healthcare provider shortage there. There are public PA schools in Liberia, but only a few, and thus there is a need for private PA institutions. Mr. Trexler helped found the Baptist College of Physician Assistants. The college serves a major need in Liberia, making it possible to educate more PAs. Although the Baptist College of Physician Assistants is rooted in the Baptist faith, Mr. Trexler said that they do not restrict people of other denominations, although they do seek faith-based students.
This interview is from 2014, and thus the current situation has most likely changed; however, the work Mr. Trexler has done and his mission remain an amazing example of development work in Liberia. Below is a transcript of our interview.
In fall 2014, I interviewed Steve Trexler, an American physician assistant (PA) who works in Liberia. Mr. Trexler has been a PA since 1977, and he first went to Liberia in 2002. He worked at a Liberian hospital and, following that experience, started a PA program. In 2014 he graduated the first class of 20 students and a second group of students started classes in 2014, but the program was postponed because of the Ebola outbreak.
I asked Mr. Trexler about the stability of the PA profession in Liberia, to which he replied that the PA profession is very stable in Liberia. PAs are some of the only healthcare providers working in Liberia in addition to nurses and some physicians, and their contribution is very important.
I asked Mr. Trexler what types of conditions Liberian PAs see. Some of the common conditions, he said, are malaria, typhoid, dysentery, amoeba infections, and other infectious diseases. He told me that PAs encounter many people with pneumonia, muscular skeletal problems, and hypertension. Chronic diseases such as diabetes and hypertension are also an issue. Mr. Trexler said that Liberians have poor access to diabetic supplies and cannot afford glucometer strips and other devices that help in the management of chronic diseases. He stated that hemorrhagic stroke rates are high because of the high incidence of untreated hypertension. There is much need for health care in Liberia, he said, and PAs are just scratching the surface with regard to the needs of the people.