Anesthesia care provision remains slender and deficient in most low-income and lower middle-income countries despite the efforts of the World Federation of Societies of Anesthesiologists (WFSA) and the World Health Organization (WHO) and their member states to make safe emergency and essential anesthesia and surgical care a priority and an integral component of Universal Health Coverage and Health Care Systems strengthening. These challenges are extremely demanding in sub-Saharan Africa. Here, the situation is very poor because the growing population and their need for surgery and anesthesia outweighs the insufficient number of anesthesia providers, poor surgical theater infrastructure, and limitations in anesthesia equipment, materials, life-saving drugs, anesthetic agents, and healthcare resources by far. To somehow cope with conditions and external circumstances, anesthesia providers have adapted their practice to the environmental challenges by using ketamine to provide safe anesthesia, pain, and critical care. Although healthcare materials, equipment, manpower, and educational resources are very limited, this has revolutionized the use of ketamine in such regions, harnessing its clinical effects with the goal of improving patients’ outcomes, experiences, and healthcare systems effectiveness.