Dr. Moazam gives the State of the Art Lecture, “Evening the Odds for Female Surgeons: Hunooz Dilli Dur Ast,” at the annual meeting of PAUS 2023, Karachi.
Women Surgeons: Hunooz Dilli Dur Ast
Farhat Moazam*
In October 2023, the Pakistan Association of Urological Surgeons (PAUS) invited me to give a State of the Art Lecture in their international conference held in Karachi. As a female surgeon, I chose to speak about the continuing challenges for women wishing to train in and practice surgery subtitling my talk Hunooz Dilli Dur Ast (Delhi is still far away). This famous phrase, traced to 14th century Sufi Nizamuddin Auliya remains, I believe, an apt metaphor for women wishing to pursue surgical careers.
During the 1970s and 1980s while training in general and pediatric surgery in the USA, I was the sole female trainee in surgical programs, and subsequently the only female surgeon for a decade I spent as faculty in an American university. I was constantly reminded how tough it was to become a surgeon, that “even men do not make it through training,” that surgery “requires a man’s temperament, women are too soft, emotional,” and given backhanded compliments that I “worked like a man.”
One could argue that matters have changed since then for women wishing to become surgeons. However, studies published within the last five years indicate that for many women Dilli dur ast remains the reality. The global increase in females graduating from medical colleges over the last three decades (now 50% to 65% of graduating classes) does not reflect a proportionate increase in women trainees/consultants in surgical specialties (excluding gynecology).
Due to lack of indigenous research, this information is unavailable from Pakistan but I suspect the numbers may not be too dissimilar. I conducted an informal, pre-talk survey of the three top healthcare institutions, all with sought after surgical training programs, that had organized the PAUS conference. Between them, they had well over 200 surgeons on staff of which roughly, 20 were women. Majority of female surgeons held junior positions and merely two women had made it to full professor.
A comprehensive scoping review about the experiences of female surgeons from 26 countries (Human Resources for Health, 2020) reveals several factors that continue to serve as hurdles for women. Among the most pernicious is the persistence of stereotypical gender roles, the old canard that “biology is destiny.” Notions that women are less courageous than men, emotional, less rational, are voiced as jokes and jibes directed against female trainees and surgeons. Such perceptions often translate into gender based discrimination against women in surgery with less opportunities in the Operating Room (OR), and emotional and physical harassment by male surgeons.
The scoping study specifically identifies lack of mentorship as an important global impediment reported by women trainees and younger surgeons. Sociological studies indicate that having female surgeons on the faculty can encourage young women to consider surgical careers. This pattern of a dearth of mentorship for women trainees, also surfaces during my conversations with younger female surgeons in Pakistan. Curiously, I also hear from some criticism of women who do “make it in surgery” yet remain unsympathetic to experiences of younger colleagues.
As a woman mentored by male surgeons, I believe it is important that we work towards not perceiving surgery as a war between the sexes. Experienced surgeons, female and male alike, can be effective mentors, tough but fair irrespective of the sex of trainees and younger colleagues.
The Spanish poet Antonio Machado writes, “Traveler, there is no path; the path is made by walking.” Female and male surgeons in Pakistan, and globally, have to walk together to make this path.