In far southeast Liberia on May 31, families packed into grand, high-ceilinged St. Theresa Cathedral. “No matter what comes my way, no matter how I cry,” a gospel choir led the crowd in singing, “one thing I know that is definitely in my heart, my tomorrow must be greater than today.” A speech from the dais echoed the themes of persistence and optimism, urging the guests of honor to continue to “go to bed smarter than you woke up.” Soon after, Tubman University, a Partners In Health-supported public university, graduated the first class in a groundbreaking nursing program.

When the 15 students enrolled two years earlier, they had already earned Associate Degrees in Nursing and passed the national board exams. Some had been caring for patients in hospitals, health centers, or clinics for a decade. With the launch of the Tubman University program, they had returned to learn even more skills, participating in the first RN-to-BSN program anywhere in the country outside of the capital Monrovia. They attended classes every weekday, studying subjects such as nursing theory, and conducted research on effective nurse-patient communication, for example. Now they’re ready to become nurse leaders, managers, and teachers, or pursue master’s degrees in rare-but-essential specialties like pediatrics.

Minnie Horace, a PIH nurse clinical lead and one of the program instructors, points to a tangible feeling of momentum. In 2015, PIH helped Tubman’s first class pass its RN exams. Since then, PIH has helped modernize nearby J.J. Dossen Hospital and expand Pleebo Health Center. The RN-to-BSN program is just the latest to stoke enthusiasm about the future of health care in Maryland County.

Of course even the graduates who have pledged to serve the county will be tempted to leave, travel 18 hours north, and find work in Monrovia, where pay can be better. Sixty percent of all trained health staff in Maryland County are paid by donor organizations or, astonishingly, volunteer in hopes of one day earning a salary. So the graduation is both cause for huge celebration, and a reminder that much work remains for any organization hoping to keep up with the dogged, unrelenting progress of local nurses and students.