Nietzsche's critique of pity, what is the practical alternative, and does it collapse under structural suffering?

Nietzsche's critique of pity has always troubled me practically. He distinguishes between pity and what seems like respectful acknowledgment of suffering, the idea being that pity denies the sufferer their agency and treats their pain as simply unbearable rather than potentially meaningful. Fine as a philosophical position.

But what does that actually cash out to in practice? If I am not supposed to pity someone suffering, and also not ignore them, what is the appropriate response? "Respect" feels vague. And more pressingly, does this framework not completely collapse when applied to systemic or structural suffering? A child born into poverty or someone with a degenerative illness cannot exactly be told their suffering is a crucible for greatness. Is this a genuine limit of Nietzsche's ethics or am I misreading him?