Between duty and distress: a phenomenological study of moral dilemmas and emotional labor among Chinese medical aid workers in Botswana

Chinese medical aid teams play a crucial role in providing healthcare services in Botswana. However, healthcare professionals in these teams often face complex clinical environments and resource constraints that differ significantly from their home context. Despite their critical contributions, the lived experiences of these workers regarding moral dilemmas and emotional labor remain underexplored. This study aimed to explore the essence of moral dilemmas and emotional labor experienced by Chinese medical aid workers in Botswana. A qualitative descriptive phenomenological research design was employed to explore the lived experiences of healthcare professionals. Utilizing purposive and maximum variation sampling, 21 participants comprising physicians and nurses from various specialties who had served in Botswana were recruited. Data were collected between March and May 2026 through semi-structured, in-depth interviews. The resulting transcripts were analyzed using Colaizzi’s seven-step method. The analysis highlighted the essential structure of the participants’ experiences, defined by the struggle between their professional obligations and emotional distress. Four key themes emerged: (1) The Landscape of Scarcity and Cultural Dislocation; (2) The Anatomy of Moral Dilemmas; (3) The Price of Professionalism: Emotional Labor; and (4) The Transformative Arc: Identity Reconstruction. These experiences precipitated a paradigmatic shift in professional identity, characterized by a move away from the curative model towards a relational role of companionship and witnessing. The findings illuminate the substantial emotional and moral challenges faced by Chinese medical aid workers in Botswana. These experiences demonstrate the importance of improving pre-departure psychological training and establishing comprehensive institutional support systems during service. The transformative identity reconstruction observed suggests that moral distress, while burdensome, can catalyze professional growth when adequately supported. Future research should target longitudinal measures to mitigate emotional labor and promote the sustained well-being of international medical aid personnel. Not applicable.