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I graduated from medical school in Addis Ababa in 2024 into an emergency medicine system that barely existed a decade ago. Working in Ethiopia’s emergency departments has underscored that building emergency care infrastructure in a resource-limited country requires creativity, governmental commitment and acceptance that progress will be uneven and incomplete for years. One illustration of this reality occurred during periods when commercial inhaler spacers were unavailable, when clinicians locally fabricated simple spacer devices using clean plastic bottles to facilitate bronchodilator administration for patients in acute respiratory distress. Used as a temporary mitigation rather than a substitute for standard equipment, this approach illustrates how frontline teams adapt care processes when essential resources are lacking.