Miriam Mutebi – PAWAS

Miriam Mutebi2 Name: Miriam Mutebi

Role: Breast Surgeon – oncology

Location: West Africa

Organisation: Pan-African Women’s Association of Surgeons

Hashtag: #IWDSurgery

Why is surgery such an important aspect of women’s health? 

Some of the top causes of premature death of women in Africa are maternal deaths and cancer related deaths largely from breast and cervical cancers. Many of these causes are amenable to surgical intervention and treatment if detected early.

Though surgery is an essential part of primary health care, 9 out of 10 people in sub-Saharan Africa have no access to safe surgery. There is an increasing burden of surgical disease in Africa with a deficit of about 143 million surgeries required  in developing countries to prevent disability and death.

Premature deaths of women are associated with dire downstream effects such as decreased childhood survival – and in Africa particularly, a loss of critical contributors to the economic development of nations, where women are responsible for 70% of labour in the  agricultural sectors and up to 90%  of food production on the continent.

What are some of the challenges facing women working in surgery, and how is your organisation working to address these?

There are still very low enrolment rates and high attrition rates of women looking to engage in surgical specialities in Africa. Part of these challenges are due to a lack of support and mentorship. We started PAWAS to provide a vibrant and collaborative community of practice where women can get support at each stage of their surgical journey.

In many countries the place of women in surgery is still evolving, and comfort and support from colleagues and senior role models aims to inspire medical students and trainees to choose a career in surgery, and to retain women in the speciality through work life integration.

Driving change requires passion, enthusiasm and resilience, which can be harnessed through networking and support of like-minded women surgeons. PAWAS spearheads the importance of mentorship and networking within the surgical community of the African continent and from countries abroad.

What are some of the challenges facing women trying to access safe surgery?  

There is a complex interplay of factors contributing to poor access to safe surgery for women in Africa. Poverty and poor available resources are compounded by a lack of empowerment and equity. In many environments, women are frequently not the primary determinants or decision makers behind their own health seeking behaviour.

Whilst female surgeons serve all members of the community, their position and understanding of women’s perspective of disease may make them uniquely placed to advocate and provide a platform to improve women’s health on the continent.

How can female doctors and patients work together to ensure access to safe and essential health care services including surgery and anaesthesia?

Access to safe surgery is a multi-layered concern which needs to address issues of health awareness, education, early detection and treatment of disease – while at the same time considering equity and empowerment of women to determine what the diverse barriers within our populations really are.

Currently about a 1/5th of  43 countries surveyed in sub-Saharan Africa do not mention surgery as part of their national health strategic plan, with only minimal mentions in over half the countries surveyed. As surgeons we need to get this dialogue started. There is a clear need for surgical advocacy both at a community and health policy level!

Women in surgery recognize that they have great value to their healthcare system and to their community – and by collaborating as an association, we aim to ensure this effect is exponential. The directive for PAWAS members is to be catalysts for change in their immediate environment, using the group and its resources to educate, advocate and empower our women and the greater population.

We’ll also use this forum to mentor, network, support each other and to support existing collaborative initiatives aimed at improving surgical care. An equally critical task is to develop and foster collaborative research aimed at surgical pathology and women’s health.

How have women’s roles in surgery changed over the years?

In most medical schools, women comprise at least 50% or more of enrolled students – it’s clear that women’s roles are continuing to expand and broaden with more women taking on more responsibilities and leadership roles.

But this has not always translated into subsequent training in certain specialties like Surgery, that have been traditionally gender specific. Though still slow, we are beginning to see a steady increase in the number of women enrolling in surgical specialties.

This year’s theme for IWD is ‘pledge for parity.’ What does this mean for professional women in African healthcare? 

We believe in an Africa where women play an increasing role in improving surgical healthcare. The economic benefits towards developing a gender-balanced team for any sector have already been demonstrated.

This means embracing the sustainable development goals and ensuring women’s ‘full and effective participation and equal opportunities for leadership at all levels of decision-making in political, economic, and public life’ – of which the health sector remains a key component.

It demands that we initiate and maintain the dialogue that openly addresses concerns about remuneration, job satisfaction and equity and that foster a work place that caters to, celebrates and supports different strengths and skills of all individuals.

Ultimately as clinicians, our intrinsic objective is to ensure that we deliver effective, timely and safe health care to all. Our continent has been crying out for too long!

At PAWAS we envisage an Africa where as both male and female clinicians, we flip the script and take ownership of our continental health challenges and use our collective collaborations and resources, to develop innovative ways to address the deficits in the delivery of surgical and other health care services, to our populations.