“How would you feel if your mother was treated that way?” Among all the reprimands from our attending senior gynecologist, this one echoes in my mind. She would invoke this powerful question whenever there’s an incident where we could’ve exercised more compassion. And she’s justified in doing so, because research shows that compassion has many roles, one of which is building trust. Perhaps this is one reason why there is a perceived mistrust of the health system among patients in Ethiopia. I recently experienced this system from a patients’ perspective while tending to close family members who had developed serious illnesses, and I found myself thinking about the shortcomings and potential improvements. During this difficult time, I felt worried just like anyone with a sick relative would probably feel. But my worry had a component of professional vigilance because, to a certain extent, I understand their illnesses, what should be done and what is actually being done. And while most of my reflections will be from the perspective of a professional, some are as a concerned family member.

The most important thing that stood out to me was how private hospitals operate like other private businesses in Ethiopia. Health economics teaches that the healthcare industry should be governed differently from other private ventures because the knowledge gap between provider and consumer is so large that it would be it easy to manipulate consumers. To this, I would add that the nature of medicine, as it deals with sick and vulnerable people, requires a unique sense of decorum and professionalism. But I had experienced incidents that were far from these moral standards. One clinic performed one of those generic “checkup blood work” that were available in house and assured a relative of mine that he has undergone a complete examination and that he was okay. If we had accepted their assessment and relied on the pain-relieving medications they prescribed, we would have missed the chance to detect a malignant tumor early. While misleading patients sounds shocking, examples of misleading customers outside of healthcare is much more normalized in Ethiopia. From being tricked into buying a fake gadget to adding improper additives to food, the examples are endless.

Then it’s worth questioning if what we’re seeing is an evidence of nonchalance and unprofessionalism seeping into healthcare. Starting from the unkind and dismissive guards at the door, to the grumpy nurses who ignore pain, all the way to the attending who orders unnecessary investigations, there is a palpable culture. This one time, a hospital simply decided to skip a dose of anti-microbial simply because they had run out of the medication. Had we not inquired whether all the prescribed medications were available, my cousin was going to miss an antimicrobial dose early in the treatment course of meningitis. And if our hospitals, which are supposed to be run by responsible healthcare professionals, are operating this way, how are other members of the healthcare industry expected to operate differently. Perhaps the concerning accusations that our medications, laboratory reagents, and medical equipment are below standard is true.

While accompanying two family members during their treatment at an advanced hospital abroad, I was inspired by the many ways we could improve our practices locally. The striking difference lies in our approach. While their private hospitals would also charge large sums of money, I felt that their service was delivered in a much more responsible and caring manner. And maybe that’s why their excellence isn’t only in the just large hospitals, impressive equipment or major procedures, but in the highest level concern given to the smallest and most routine activity like a blood draw. And just like their professionalism, their compassion is comforting. On one occasion, I had been barraging a surgeon with aimless questions, and after he answered all of them with patience, he humbly said, “I know you’re worried. I will do my best.” This may seem simple, but it made me feel seen and that was really important to me. The combination of these things made me feel like I could trust them and simply retort to being a concerned family member.

I am not writing this to advocate for going abroad, rather I am trying to reflect on our priorities. The claim that we need to build large hospitals to save on medical tourism spending presupposes that patients only go abroad for major illnesses. From my personal experience I have noticed that people with the means simply prefer to seek hospital care in other countries regardless of the severity of their illness because we don’t have enough trust. Rather than something that is demanded, trust is better conceptualized as an investment and I don’t believe we have enough of it in our patients. We’ve embarked on building massive, mostly diaspora led, medical facilities to curb spending on off-shore health services. And if our focus is solely on the infrastructures, we might be overlooking the important human element that will define quality care. These new facilities will be utilizing our own talent and the most sophisticated instruments are only as helpful as the staff operating during strained duty hours. Not only that, the prescribed drugs will be purchased in our own pharmacies with medicines produced or imported by our own pharmaceuticals. All this reliance on the local environment underscores the importance of cultivating a culture of compassion and professionalism in the healthcare industry. As a healthcare community, our priority to build these massive institutions needs to be coupled with efforts to improve our empathy and integrity. And to the argument that our healthcare professionals are serving a much larger populace with much smaller compensation, I would say, “Perhaps. But how would you feel if your mother was treated that way?”