Ann Hagensen, RN: Improving Medical Education in Central Africa

Landing in a small plane on a grass-covered runway in the middle of a jungle is the quiet part of Ann Hagensen’s journey to Africa. Because once the doors open, she and the traveling medical team are welcomed by throngs of locals from Karawa, a remote city in the Democratic Republic of the Congo.

First year nursing students in Karawa, Democratic Republic of the Congo

First year nursing students in Karawa, Democratic Republic of the Congo

Last February Ann, a registered nurse and Virginia Mason Patient Relations project manager, made her second journey to Karawa accompanied by five volunteer physicians. The group represented the Medical Ambassador program of the Paul Carlson Partnership, an organization dedicated to medical and economic development in the Congo. The group’s mission was to train local nurses and doctors in methods of trauma care.

Systems of care that are routine for medical teams in developed countries like the U.S. – such as standards of triage for multiple trauma cases – don’t exist in central African hospitals, where simply maintaining basic supplies is a daily challenge. Ann and the team worked from manuals provided by the World Health Organization, specially created for these hospitals and their limited resources.

“They have farming accidents, falls from trees and the possibility of an epidemic, such as Ebola, with potentially many patients to triage,” says Ann. “We taught basic trauma care for serious injuries and illness, but also a systematic way of thinking about triage and treatment.”

The Congolese professionals who receive training return to their clinics and hospitals, where they will train dozens more medical staff, equipped with the manuals and needed supplies. This “train the trainer” model means one medical ambassador can eventually train about 100 people across multiple facilities.

Ann scheduled her first trip to Karawa in 2012, after hearing about the work of the Paul Carlson Partnership at her church. Ann did rounds with a physician’s assistant, a resident missionary who was starting a nutrition program. To get growth data after adding moringa (a protein-rich plant) to children’s diets, Ann helped teach nurses how to obtain an accurate body weight and measure the circumference of the young patients’ arms and legs, explaining the importance of tracking results as the moringa increased their muscle mass.

Ann was struck by an observation on that trip: the region’s medical system was run by nurses. Twelve doctors cover five hospitals and 104 clinics, with most clinics staffed by only one nurse. By necessity, many nurses learn to perform surgical procedures, like C-sections and appendectomies. Ann decided nursing education must be the focus of her ongoing partnership work.

“On my first trip to Congo in 2012 there was only one level of nursing school, providing something like our associate of arts degree in nursing, if they could afford to stay in the program,” says Ann. “Then they must pass a state exam, another barrier, since it costs money and the test may be in another town, an eight-hour walk away.”

Ann spends time with the local children.

Ann spends time with the local children.

Today Ann leads the Nursing Focus Group, comprised of 16 nurses across the U.S. who meet online once a month. The nurses divide their efforts between curriculum support, fundraising and obtaining supplies for the nursing schools. There are two schools now: a university level program for nurses was added in 2013. A recent supply shipment to Karawa contained stethoscopes and blood pressure cuffs, to help stock the nursing students’ new “learning lab,” a dedicated teaching room Ann helped provide to increase student resources on her last visit.

When Ann arrived in Karawa for her second trip, over and over people would touch her and say, “Thank you for not forgetting us.” Ann marveled at their immense gratitude in the face of unrelenting need.

“To us, they have nothing, and yet they are grateful and experience joy in many ways,” says Ann, who is budgeting for future medical ambassador trips. “They want you to meet their children, they are so proud of them. They want their children to go to school and be healthy, just like we do. I have grown in my gratitude and love for the Congolese people and look forward to our journey with them as we strengthen their nursing practices together.”

A version of this article was originally published on Virginia Mason’s internal news site.


  1. Theresa says:

    Truly amazing selfless, productive work.

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