10.27.2015 – I had dinner with Dr. Alemayehu at Rodeo, a cowboy-themed open-air restaurant in Bole, Addis Ababa. It was lovely; wood fires burned ambitiously in large pits about the patio. I had steak and beer; Alemayehu, chicken and rice and mineral water. We coursed over many topics, from the deeply personal to operational matters for our charitable healthcare program, EHN. We spoke of the larger framework of governmental health programs, charity and NGO management, including work by the Gates Foundation. I said I understood that the government’s model is to provide a healthcare worker (a nurse) or two for every 100 households, and one clinic for every 1,000. I thought this was good, and hoped that it would put my small non-profit out of business.
Alemayehu lamented the quality of care at the large health centers, and said there are still large gaps that EHN and NGOs fill. In fact, today, he said, he saw a man  who had terrible stomach pain. He had been to multiple doctors and health centers. He paid 1,700 ET Birr (about $90 USD) for an invasive endoscopy. They had given him medicines and many tests. Nothing improved. Alemayehu touched the man, palpated his abdomen. He felt a mass on his liver. He conducted ultrasound. There was a large mass, a tumor. LeAlem’s lab analyzed the patient’s liver enzymes and function. The numbers were very high. The man had liver cancer, and was going to die. Alemayehu respectfully and kindly gave the accurate diagnosis and prognosis. The man was comforted, thankful, after months of stress and wrong diagnosis and treatment.
We discussed the patterns where the large health centers perform the function, but do not treat the patient, and as a result they miss things. I’ve seen this in the United States, for example, where my father was on needless chemotherapy (Neupogen) for months, and my mother’s amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease) went undiagnosed by esteemed practitioners. (Even the suggestion of ALS, by my father, was laughed at by our family physician, my wife’s doctor.) So nothing is perfect. But my base sense is the medical care provided by a patient-focused doctor, who seeks to understand the full context, is better. More, I think a community-based physician in a developing country like Ethiopia may be more skilled because he or she has to cope with a broader array of affliction, with less technical intervention and support. In the main, a third-world community doctor, like Alemayehu, is very closely connected to those he treats.
 The subject is a private patient, not an EHN beneficiary.