I am a pediatric critical care physician at Boston Children's Hospital launching the Boston Children's Global Health Program's new Global Critical Care Program. My main focus for the next year will be opening a pediatric ICU at JFK Medical Center in Monrovia, Liberia in partnership with local hospital leadership. This trip will serve as the foundational needs and readiness assessment prior to establishing the first pediatric intensive care unit (PICU) in Liberia.
During this visit, I will evaluate physical infrastructure (space, oxygen supply, power reliability, infection control), conduct a comprehensive equipment commissioning audit of recently received PICU equipment, assess baseline clinical competencies among nursing and physician staff, and engage key stakeholders including JFK leadership and the Liberia Ministry of Health.
Findings will directly inform the development of adapted clinical protocols, safety systems, and training curricula to be delivered in subsequent phases of the program.
This is not a short-term medical mission — it is the first step in a sustained, structured partnership aimed at building lasting pediatric critical care capacity in a country with no existing PICU.
This project serves critically ill children in Liberia, a country of approximately 5.4 million people with among the highest rates of child mortality in the world. Liberia's under-5 mortality rate is approximately 71 per 1,000 live births. The leading causes of child death include sepsis, severe malaria, pneumonia, meningitis, and complications of malnutrition — conditions that are treatable with appropriate critical care.
JFK Medical Center is Liberia's largest public referral hospital, serving patients from Monrovia and surrounding counties. Currently, no structured PICU exists in the country, meaning children with critical illness are managed on general wards without the monitoring, staffing ratios, or interventions needed to optimize survival. The populations most affected are those with the least access to alternatives: children from low-income families for whom medical evacuation is not an option.
This site visit will produce a comprehensive readiness assessment that serves as the evidence base for establishing Liberia's first PICU. Immediate outputs include an infrastructure and equipment commissioning report, a workforce competency baseline, and a stakeholder engagement framework to guide partnership with JFKMC and the Liberia Ministry of Health.
Longer-term, this trip initiates a 12-month implementation program that will result in an operational PICU staffed by locally trained nurses and physicians using context-adapted protocols and safety systems. A train-the-trainer model will ensure that clinical education capacity remains at JFK after each BCH visit, building sustainability beyond the grant period.
Learnings from this assessment will be disseminated through peer-reviewed publication — contributing to a sparse but growing literature on PICU development in sub-Saharan Africa — and shared with the broader BCH Global Health Program to inform future partnerships in similar settings.
Summary: JFK Medical Center (JFKMC) in Monrovia, Liberia is starting to implement ventilator use for critically ill children. In recent months the NICU has used a single ventilator for four infants with tetanus, and I was present for the third and fourth as part of a larger project to expand ventilator use and open a PICU in the next 1-2 years.
Through this travel grant, I visited JFKMC in Monrovia to assess readiness for its first PICU and to plan physician training.
Our goals are to:
• open a safe, sustainable PICU staffed by JFKMC faculty, with all residents rotating through;
• build local capacity in ventilation through training JFKMC can eventually lead;
• monitor outcomes
Trip activities:
• Clinical work: I oversaw ventilated infants in the NICU and covered the pediatric wards.
• Performed equipment inventory in the pediatric ED, NICU and wards.
• Conducted meetings with: pediatric faculty and residents, hospital leadership, adult ICU staff and anesthesia.
• Oxygen assessment: adapted the PATH oxygen assessment tool for JFKMC.
• Safety pilot: trialed a bedside ventilator safety checklist.
I am grateful for the support that made this trip possible.
