Five Things I Learned After a Hospital Visit in Addis
A few weeks after moving to Addis, I had a terrifying health scare that was offset by my autoimmune condition (though I didn’t know the cause at the time). So, very hesitantly, I went to Kadisco Hospital in Addis Ababa to see a specialist. Put another way, this Americanah went to a hospital in a developing nation carrying lots of preconceived notions of what the experience would be like. But you know, I figured if Ariela from Princeton, NJ on 90-Day Fiancé can go to Kadisco Hospital and give birth to that acrobatic little cutie, I would be just fine.
And I walked out of Kadisco feeling like a moron because a lot of my preconceived notions were ignorant as hell. Why? Because I experienced a more compassionate and concerned standard of care here than I have with any gynecologist I’ve visited throughout my life in both New York & Washington, DC. Now, don’t get me wrong: this place was far from the prettiest or fanciest offices I’ve visited. The equipment and facilities were unimpressive, & the hallways reminded me of the public NYC middle school I attended. I don’t know who needs to call Sherwin Williams, but somebody please get my man on the line and convince him to ship more pleasant paint colors to Addis because this ain’t it.
Anyway, basic medical equipment & murky wall colors aside, this visit was eye-opening for me. On one hand, I walked out of Kadisco feeling seen, heard, validated, and adequately treated for a fairly complicated issue. On the other, I witnessed firsthand that resources are significantly lacking in Addis, and despite having some very skilled doctors, a lot of the challenges remain structural and thus, influenced by global inequities. Here are the few things I noticed during this journey:
All Black Everything: When I visit doctors or specialists in the States, I almost always immediately notice that I am the only —or one of very few— patients of color. Let me backtrack: as a person who compulsively google searches everything, whenever I feel a health ailment, one that WebMD always, always manages to convince me is terminal cancer, I next google search, “Best *insert speciality* doctor in the DC Area” and 90% of the time, that doctor is white. Throughout my life in the States, I had to actively hunt for Black doctors, often asking for referrals from friends or family. And don’t get me wrong: most of the time, those doctors were good and I received satisfactory care.
However, I’ve heard one too many stories from friends or relatives of color where they’ve been dismissed, disregarded, or carelessly treated by a doctor. (See here and here for studies on why Black patients benefit from seeing Black practitioners.) Counter that with my experience in Addis recently. I walked into Kadisco and everyone — I mean everyone from the guard standing at the hospital door, to the front desk staff, to the patients, to the nurses and doctors — everyone, was Black. What a novelty!
I had an early morning appointment, and arrived before the gyno did (see #1 here for how time is measured in Addis). When she finally did walk in, every staff member she walked past dropped what they were doing to greet her. “Good morning, Doctor!” each person said as she walked by. (Doctors, especially senior ones, are highly respected here.) She nodded and continued on with her swaggerific entrance. *insert heart-eyes emoji*
My Name was Pronounceable: When the front desk receptionist registering me asked, “what’s your last name?” I said “Tesfaye” and she immediately knew how to write it, and how to pronounce it. No spelling it out for her, no having to say, “Tesfaye, like wi-fi. T for Thomas, E for Edward, S for Sam….” The last name ‘Tesfaye’ is as common in Ethiopia as ‘Smith’ is in the US. When it was my turn and the nurse called me in for vitals, she pronounced my name like I was her second cousin. Who knew such a simple thing could feel so incredibly affirming? I felt like the hospital was built to treat me and those who have names like me. I didn’t feel like an inconvenience. I didn’t feel like an alien. It felt like I was home.
Treating the Issue, Not the Symptom: To date, my experience with health issues has been one where the doctor says, “that weird thing is happening? Ok, take this pill then. Voila! Problem solved.” But that pill inevitably leads to other, potentially more serious side effects. (Taking you on a tangent here, but have you ever seen those medicine commercials where they say the side effect of the medicine being advertised is death and/or the very condition it was meant to treat? Yeah…not okay.)
With the condition that caused me to visit Kadisco, I would have likely been given a prescription and that would have been it. Again, not the case here. What started as a gynecologic visit ended as an in-depth primary care consultation. Once my doctor discovered the underlying issue –my autoimmune disorder that was causing my body to go out of whack– she spent the next 25-minutes with me discussing ways we’d manage my condition. TWENTY-FIVE MINUTES with one patient. Again, time is relative!
No hidden bills: Some argue that one of the best things about hospitals in the United States is that you get the healthcare provided first, and then argue about bills later. Yes, that is true for the most part.
However, in recent years, I have felt a sense of impending doom as I wait for bills to hit my mailbox from the hospital. This was particularly true after childbirth. My bill after giving birth to one of my children was approximately $30,000. Granted, insurance took care of most of it, but I still had significant out-of-pocket costs. And those bills would just roll in. Just when you thought you finished paying, another bill would come. Anesthesia bill. Hospital room bill. Neonatologist bill. Bills that could vary wildly in costs for tests I didn’t even know were administered.Now, imagine a world in which someone tells you the cost for a doctor office visit up front: check-up, bloodwork, pap smear, & you go to the cashier to pay this cost up front *before* you enter the hospital room. No hidden costs, no hiding from the mailman as he comes with an envelope that has the Labcorp logo on it. Refreshing, right? That’s what happened here. I was told to pay 2,500 birr (rough equivalent of $55) at the cashiers office. They ran a full CBC panel for bloodwork, the doctor did a pap smear, I spoke to her, and I left with plans for a follow-up appointment, though the front desk receptionist refused to give me an appointment time and “told me to just come in on one of the days the doctor was in.” (Time is relative…again.)
Lack of Resources: In a follow up visit, the OBGYN wanted to perform a hysteroscopy (no, not hysterectomy, but a hysteroscopy –looking at my uterus through a microscope) to ensure that my issues were not related to anything more serious (read: cancer). However, she told me that there are no hysteroscopy cameras within the entire country of Ethiopia and said that I’d have to either go abroad to undergo this examination, or do it “the old-school way”: a biopsy. Since I didn’t have any plans to go abroad in the near future and couldn’t sit still wondering if I have terminal cancer, I opted for the biopsy. The biopsy came back negative thankfully, so I’ll be around to tell you all a few more stories.
This wasn’t the first time I was told that something very basic, something we wouldn’t even think twice about in developed nations, didn’t exist. I recently took my toddler to her pediatrician to get her standard booster shots, only to be told none of those boosters exist in Addis, and again, that I’d have to take her abroad or import the drugs in a freezer box. Not ideal.
On a more serious note, this situation wasn’t all jokes, roses, & ponies. It was scary. Really scary. The doctor I saw was very skilled and well-regarded in Addis, but the ratio of talented doctors to sick patients is dangerously low because some of Ethiopia’s best physicians are not at home. In addition, the doctor I saw wasn’t cheap, relatively speaking. I was lucky to have the resources to afford her visit, and follow-up care. Lastly, while a skilled doctor’s talent, focus, and dedication can solve most basic problems in Addis, they are hamstrung by larger, structural limitations when matters become more complex. Assuming that the biopsy did not come back favorably, things could have looked very different for me.
At the end of the day, my preconceived notion of doctors’ offices in Addis Ababa were largely misinformed. There are good doctors –really good ones– who can help you figure out most common health issues. However, there are resource limitations within the country –and the continent at large– which make going abroad to solve more complex issues a necessity, one that many locals cannot afford, and one that in an ideal world, would not be a reality.