19 MINUTE READ

From Luke’s Journal March 2026  |  Vol. 31  No. 1  |  God at the Bedside

Finding my place

For the past three years, I have been volunteering as a nurse with Mercy Ships.  It is no exaggeration to say that this experience has changed my life.

Mercy Ships is an international Christian NGO that operates hospital ships in Africa, delivering free surgical care to people in low-income countries who would otherwise have no access to safe surgery. Beyond surgery, Mercy Ships is deeply committed to working alongside local professionals to strengthen healthcare systems so that transformation continues long after the ship leaves port.

When I first joined Mercy Ships, I thought I was signing up to volunteer my nursing skills. What I didn’t realise was that God was about to take me on a journey that would reshape my faith, my understanding of global health, and my sense of calling.

For most of my time with Mercy Ships, I served on board the ship, working in the hospital as a nurse. I truly loved it. There is something profoundly special about providing direct patient care, about walking with patients through fear, pain, hope, and healing. To witness lives transformed through surgery, sometimes after years of suffering, is humbling beyond words. Add to that the unique, faith-filled community onboard, and it becomes a place that gets under your skin and into your heart.

At the same time, God was doing something within me. Looking back, I can see that Mercy Ships wasn’t just a volunteer opportunity, it was part of how God has shaped my faith. Serving among suffering has a way of stripping away what is shallow and revealing what is real. It confronts you with questions you can’t tidy up with quick answers. It forces you to decide what you believe about God’s presence in pain, about justice, about human worth, about hope. For me, Mercy Ships became a place where faith moved from being something I thought about to something I had to live.

And yet, from the very first time I stepped on the ship back in April 2023, something else stirred within me. I remember hearing about our Education, Training, and Advocacy team (ETA) and feeling an immediate pull. Even before I fully understood what they did, I knew that was where my heart was being drawn. I have always been passionate about development work, about creating change that lasts long after we leave. The idea of equipping and empowering local healthcare professionals to lead in their own hospitals and communities resonated deeply with me.

Looking back now, I can see that this wasn’t just a professional interest or a personal preference. It was a calling. God was planting a seed long before I realised what He was preparing me for.

In January 2024, that seed became reality. I stepped into a new role with ETA, one that would take me off the ship and into the heart of Sierra Leone’s healthcare system, where I help run a Nurse Mentorship Program. I want to give you a glimpse into what it means to work alongside some of the most resourceful, resilient nurses I’ve ever met.

“I want to give you a glimpse into what it means to work alongside some of the most resourceful, resilient nurses I’ve ever met.”

You’ll hear about the realities of healthcare in Sierra Leone – not sugar-coated, but also not hopeless, because what I’ve seen here is not defined by limitations, but by possibility. I want to share the vision and structure of our Nurse Mentorship Program, the changes we’re seeing, and the stories of nurses whose confidence, leadership, and clinical skills are growing every day. I’ll also share my own journey – how this work has challenged me, changed me, and deepened my belief that when you invest in people, transformation follows. 

Context is everything

When I talk about nurse mentoring, I can’t simply dive straight into what I do. To understand this work, you first have to understand the place in which it happens, because context changes everything.

Sierra Leone is a country of approximately 8.4 million people, and its healthcare system is best described as a patchwork. There are government-run hospitals, private clinics, and facilities supported by NGOs or faith-based organisations. At the centre of this system sits Connaught Hospital, the country’s main teaching and referral hospital, located in the heart of Freetown. Connaught is where the most complex and urgent cases from across the country are sent. It is the place of last resort, the place where hope is often fragile but fiercely held.

The history of Sierra Leone has profoundly shaped its healthcare system. The civil war of the 1990s devastated infrastructure and displaced countless healthcare workers¹ for decades. Just as the country began to rebuild, the 2014-2016 Ebola outbreak struck, claiming thousands of lives and taking an enormous toll on the very people meant to protect public health – nurses, doctors, and community health workers¹. Even today, the system continues to feel the ripple effects of these crises: chronic shortages of trained staff, fragile supply chains, and limited access to essential medicines and equipment.

To put staffing shortages into perspective, there are approximately 0.2 surgeons per 100,000 people in Sierra Leone¹. In contrast, Australia has around (estimated) 22 surgeons per 100,000 people, a ratio 110 times higher².  Numbers like these don’t just represent statistics; they represent delayed care, preventable deaths, and immense pressure placed on already-stretched healthcare workers.

The Nurses

But I want to talk about the nurses, because they are who I work alongside every single day. Nurses are the backbone of healthcare in Sierra Leone. They are the ones who keep the wards running day and night, often with little more than their own skill, creativity, and determination.

There are three main cadres of nurses in Sierra Leone.

• First are the State Enrolled Community Health Nurses (SECHNs). This was a certificate-level qualification and SECHNs make up the majority of the nursing workforce at Connaught Hospital. This course is no longer offered – part of a national move toward higher levels of nursing education and standardisation. Many SECHNs working today bring decades of experience, and it is encouraging to see many now returning to school to upgrade their qualifications.
• Then there are State Registered Nurses (SRNs), who complete approximately three years of training, similar to a diploma in many other countries.
• Finally, there are Nursing Officers (NOs), whose training is equivalent to a bachelor’s degree, although in Sierra Leone this takes five years. NOs often step into leadership or specialist roles.

Despite these differences in training, all cadres work side by side on the wards, often covering for one another in the same high-pressure environments. On most wards at Connaught, there are usually only one or two NOs, with the rest of the nursing staff made up of SRNs and SECHNs.

One reality that is difficult to grasp until you witness it firsthand is that not every nurse is actually being paid. Sierra Leone operates on what is known as a “pin code” system. To receive a government salary, a nurse must be formally registered and allocated a pin code. The process is slow, bureaucratic, and positions are limited. This means many nurses working full shifts in the hospital are technically volunteers.

They show up every day, care for patients, and receive no salary.

They do it because they feel a calling, because the need is overwhelming, and because, without working consistently, they may never be considered for a pin code at all. Some wait months. Others wait years. The uncertainty is immense, but still, they keep coming.

At Connaught, we are fortunate that most nurses do have pin codes. Even so, staffing remains stretched beyond belief. There are days and nights when one or two nurses are responsible for dozens of post-operative patients, each requiring careful monitoring. And even when nurses have the knowledge and the will, the tools they need are often missing.

Working without what you need

In Sierra Leone, patients are required to purchase almost everything needed for their care – medications, IV fluids, gloves, tubing, syringes, dressings. If a patient cannot afford these items, the nurse simply does not have the resources to provide safe or timely care.

I have witnessed countless emergencies where nurses have had to beg nearby patients’ families for permission to use their supplies for someone in crisis. Imagine pleading with one patient’s family to borrow IV tubing or gloves to stabilise the patient in the next bed. Imagine deciding who receives oxygen when there is not enough for everyone.

On many wards, there is only one set of vital signs equipment. Sometimes it is broken. Sometimes it is missing. Sometimes it has no batteries. When that happens, nurses are forced to delay or skip monitoring, relying solely on observation and instinct.

Oxygen supply is another constant challenge. Cylinders run out mid-shift. Concentrators break without warning.

I will never forget one shift when a patient deteriorated rapidly. We needed to ventilate them urgently, but the only ambu bag on the ward was broken, literally full of holes. We searched cupboards, trolleys, and other wards. Every bag we found was missing parts or unusable. To make matters worse, the oxygen tank had run out, and we had no adrenaline.

We did everything we could. But sometimes, despite knowing exactly what to do, patients die because the tools simply aren’t there.

In moments like that, faith becomes something you cling to. Not because it makes everything easier, but because it keeps you human. It reminds you that despair is not the only option.  It reminds you that God is close to the broken-hearted, even when you feel broken-hearted yourself.

I share this not for sympathy, but because this is the daily reality for nurses at Connaught. And yet, despite all of this, they keep going.

Jose’s story

One story that has stayed with me, and that reflects the compassion and dedication of the nurses I work alongside, is that of a young man named Jose. Jose had a chronic leg ulcer that required daily dressings and eventually complex plastic surgery. His family, unable to afford the cost of care, abandoned him at the hospital. With no financial support, Jose was discharged and left to fend for himself.

Not long after, one of the nurses found him outside the hospital, his wound badly infected. The nurses refused to turn their backs on him. They brought Jose back to the ward. They pooled their own money to buy his food, cover dressing costs, and advocate tirelessly for his surgery. Eventually, Jose underwent an amputation, a decision that, while not the original plan, ultimately saved his life.

Jose stayed on the ward for around four months. During that time, he became part of the ward family. Each day, he sat outside reading his Bible, greeting me with the brightest smile. His faith and resilience marked me deeply, but even more so, the nurses’ selflessness spoke volumes about the heart of nursing here. They showed me what faith in action can look like, God at the Bedside.

Resourcefulness and resilience

There is extraordinary strength in the nurses here. They are resourceful in ways that constantly amaze me. I have seen cervical spine collars made from cardboard; water-seal chest drains fashioned by hand; tourniquets made from old IV tubing; and homemade traction devices constructed from whatever materials were available.

One day, during a critical moment, an oxygen tank malfunctioned. In most hospitals back home, you would simply switch to another tank or rely on piped oxygen from the wall. At Connaught, most wards have only two tanks, and they are often empty. That day, without hesitation, the nurses assessed the problem and improvised a solution using tape, tubing, and sheer determination. And it worked.

I remember standing there afterwards, overwhelmed, not by the fix itself, but by the spirit behind it. When the tools fail, the people don’t. It reminded me of how God often works, through ordinary people doing extraordinary things, not because they have everything they need, but because they refuse to give up.

What is it we actually do?

So, you’re probably wondering what exactly I do at Connaught Hospital?

I help lead our Nurse Mentorship Program, part of Mercy Ships’ Safer Surgery Program. Our focus is on five surgical wards, two male, two female, and one paediatric. The heart of the program is simple: every surgical patient deserves safe, high-quality care, not just in theatre, but before and after surgery as well.

Mentorship here is about walking alongside nurses, not standing above them.

A key part of this program is the way we show up. We do not come in as outsiders to “tell nurses what to do.” We come as colleagues, mentors, and partners, working shoulder to shoulder. This matters because mentorship is relational. Skill development is relational. Confidence grows inside relationship. And in this environment, where nurses are often under-supported, under-resourced, and sometimes overlooked, relationship isn’t a ‘nice extra’. It’s the foundation.

In many ways, this reflects in faith, too. Jesus didn’t lead by distance. He led through presence. He walked with people. He ate with them. He noticed them. He restored dignity. Mentorship, at its best, is a form of presence. It’s saying: I see you. I’m with you. Let’s grow together.

Year One of the program focused on trust. Before the program even formally began, we spent months building relationships, listening, learning, and showing up consistently. Trust grew slowly, but once it did, mentorship flourished. Over that first year, we trained 45 nurses, developed eight clinical modules, and delivered mentorship through classroom teaching, simulation, bedside mentoring, and structured assessments.

Simulation became a favourite. Nurses practiced critical skills in a safe environment, laughed through mistakes, and learned together. Confidence grew visibly. Some days, formal teaching wasn’t possible. On those days, we worked as nurses. True mentorship happens in the middle of chaos.

Time to pause…

After one full year of mentoring on the wards, we intentionally chose to pause. This was not a pause because the work was finished, but because reflection is essential if growth is to be meaningful and sustainable. We needed to step back, look honestly at what had worked, what hadn’t, and what the nurses themselves were experiencing through the program.

The challenges of that first year were very real. We were working with nurses who had vastly different levels of training and experience, some with strong clinical foundations, others still developing basic surgical nursing skills. Staffing shortages meant nurses were frequently pulled away from mentoring sessions to respond to urgent patient needs. Attendance was sometimes inconsistent, not due to lack of interest, but because nurses were juggling overwhelming workloads, unpaid shifts, and in many cases, ongoing university studies.

“We were creating something new while actively living inside the pressures of the system.”

On top of all of this, there was no pre-existing mentorship framework to build from. We were creating something new while actively living inside the pressures of the system. And yet, despite these challenges, the outcomes were remarkable. When we assessed nurses’ skills at the beginning of the program using an A–E assessment OSCE, only 16% were able to pass at baseline. By the end of the year, after consistent bedside mentoring, simulation, and skills practice, that number had risen to 76%. This wasn’t just an improvement in technical skill; it reflected growth in clinical reasoning, confidence, and the ability to recognise and respond to patient deterioration.

We saw a similarly significant change in post-operative vital signs monitoring. At baseline, 0% of patients were receiving post-operative vital signs at the recommended intervals. By the end of the year, 26% of patients were receiving full, correct post-operative monitoring. In a resource-constrained setting, that figure represents far more than a statistic. It means deterioration was being identified earlier. It means nurses had the information they needed to escalate concerns. And ultimately, it means lives were being protected, and in some cases, saved. These improvements affirmed something we had believed from the beginning: when nurses are supported, mentored, and equipped, they rise to the challenge.

So, what’s next?

Year Two of the Nurse Mentorship Program is about sustainability. While external mentors like me continue to play an important support role, we learned that long-term impact depends on mentorship being driven from within the hospital itself. This year, we transitioned to a ward-based mentorship model focused on developing local nurse mentors.

We are now training 20 State Registered Nurses (SRNs) and Nursing Officers (NOs) from the surgical wards to become clinical mentors. Using a “mentoring the mentors” approach, these nurses are being equipped not only with advanced clinical knowledge but also with skills in adult learning, bedside teaching, coaching, and giving constructive feedback. The goal is not simply to increase knowledge, but to develop nurses who can confidently guide, support, and inspire their colleagues in day-to-day practice.

Each month, a new clinical topic is introduced, topics that were identified and selected by Connaught nurses themselves, ensuring relevance and ownership. Learning happens where care happens; at the bedside, during real patient interactions, embedded into the rhythm of daily ward life rather than separated from it.

One nurse said to me, “I want to be the nurse who teaches the next nurses.”

That statement captures the heart of what we are working toward. This is the ripple effect, mentorship multiplying beyond us, knowledge being passed from nurse to nurse, and a culture of learning and leadership beginning to take root.

What a journey

This work has taken me on an emotional journey I didn’t expect.

There have been moments of deep frustration, standing at a bedside knowing exactly what to do but not having the tools. Moments of tears, carrying the weight of patients lost, not because people didn’t care, but because oxygen ran out or equipment failed.

Those moments have tested my faith. They have forced me to sit with God, not in neat answers but in lament. And I’ve learned that lament is not a lack of faith. It is faith that refuses to disconnect from pain. It is prayer with tears.

“And I’ve learned that lament is not a lack of faith. It is faith that refuses to disconnect from pain. It is prayer with tears.”

And yet, woven into that frustration has been joy. Joy in watching a nurse who once doubted herself teach her colleagues with confidence. Joy in seeing patient smiles after suffering. Joy in laughter on a chaotic ward when something finally clicks.

This journey has changed me. I came thinking I would teach, but I have learned just as much from the nurses I walk alongside. They have taught me resilience, faith that holds steady when resources run dry, and servant leadership that is about presence, sacrifice, and community.

They’ve also reshaped the way I view nursing itself. Back home, nursing often looks like skill wrapped in professionalism. Here, nursing is courage: showing up without pay, improvising without tools, fighting for patients who have no one else.

There are still days when doubt creeps in. But then I remember the faces, nurses stepping up as mentors, patients whose stories remind me why we do this, and I find hope again.

Final thoughts

If you take nothing else away, let it be this: investing in people changes everything.

Buildings, equipment, ships, these matter. But when you equip a person with knowledge, confidence, and vision, the impact ripples outward for patients, families, communities, and entire systems.

Jesus said in John 15:16, “You did not choose me, but I chose you and appointed you so that you might go and bear fruit, fruit that will last.”

That’s what this work is about: fruit that lasts. Seeds planted in nurses who will teach other nurses. Confidence growing into leadership. Care becoming safer. Hope becoming more real.

And in the middle of all of it, I am reminded again and again: God is not only working through grand outcomes. He is working through ordinary faithfulness, through nurses who keep showing up, and through the quiet, stubborn decision to hope.

---