Olukemi Lawani – PAWAS

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

Surgery offers an extraordinary healthcare intervention: delving into a patients’ vital organs with the knife, with benevolent intent. But the surgeon’s impact is holistic: our work goes beyond the operative and into a deeper understanding of principles of medicine to facilitate non- operative management of surgical disease.

The Caesarean section has revolutionized the broader process of child birth, aiding women who are unable to go through a spontaneous vaginal birth. It has safe-guarded millions of children from ischemic encephalopathy which was a common sequelae of obstructed prolonged labor.

Malignancies of the cervix and breast are the leading causes of cancer-related death in women in developing countries today, and surgery has continued to improve diagnosis and early identification. It plays a pivotal role in curative treatment of these diseases in their early stages and palliative care in the late stages. Surgeons are embracing the diversification of roles, with active collaboration in preventive measures, treatments and end-of-life care – far beyond merely cutting out the tumours, and handing over care of patients.

In Orthopedics, women are at more risk for rheumatologic disease. Treatment is a fascinating field with interwoven medical and surgical aspects which must be precisely advanced like the Knights on a chess- board in order to safe-guard painless function for the highest, meaningful quality of life. Likewise the surgeon’s emerging role in osteoporosis, as management of fracture shifts from repair and replacement to a more preventative approach.

The field of aesthetic surgery is pushing the boundaries further, giving more and more women the chance to navigate the peculiar link between aesthetics, appeal and esteem despite defects, disease or disability. Similar approaches are being used in other operations to reduce the visible impact of surgery without compromising tissue visualization.

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

The woman in Surgery must respond to training both by and to the standards of the traditional male surgeon – the natural yardstick by which generations of surgeons are measured. She must have a ‘heart like a lion, the eye of an eagle, and hand of a lady’. At least sixty percent of these requirements are gender-biased traits.

In such a male- dominated environment the female surgeon proves herself against dissenting voices: why does she want to do surgery anyway, does she think she can ‘cope’, how will she manage her personal and family life. She wants to show she can compete, that she doesn’t need time off (menstrual cramps every month, pregnancy or nursing children). And so we forge a dual creature with qualities that span traditionally ‘feminine’ and ‘masculine’ thought patterns – a unique and at times frightening thing.

Female residents still suffer some variously expressed exploitation (I am avoiding very deliberately the word ‘harassment’). After investing years in developing physical, mental and emotional strength it is easy to think that she’s accepted completely as ‘one of the boys’, but particularly when unmarried she sticks out like a sore thumb: estrogen in a minefield of testosterone where careless comments may be traded in ways that are impossible to ignore but nonetheless hurtful.

One important method of dealing with these problems is mentorship, particularly by other female surgeons. It is important that women, as they are empowered – in many instances by unique and visionary men – must empower other women. Fortunately surgical training refines the thinking to a point where logic becomes infinitely more valuable than sentiment.

PAWAS is working to bridge the gap through mentorship and collaboration, creating a platform for women in surgery across Africa to tackle some of the unique challenges we face – with the energy, discipline and passion the African woman can harness. At a time when gender parity is such a sensitive issue and purely gender-based roles are being reassessed, I’m excited about the future of such a dedicated group – especially as more women attain sufficient training and skill to shape surgical practice in Africa.

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

The woman seeking surgical care is faced with a peculiar set of problems:

1. Funds: the average woman is often not financially empowered enough to afford it.

2. Autonomy: a woman retains as much autonomy as society affords her. In many cases she may not undergo life-saving ablative surgery if her husband doesn’t permit it.

3. Awareness: appropriate dissemination of information is key, to ensure that seeds of knowledge are not irreparably damaged by superstition and cultural norms. Information distribution channels are also beset with the usual low-resource setting problems – power supply, infrastructure, and the ever-increasing gap between urban and rural communities.

4. Access: physical access to a qualified healthcare provider is sometimes literally across mountains and seas. This becomes even more critical in emergencies.

5. Communication: if the healthcare provider cannot communicate, the patient may opt out of vital surgical treatment because she lacks adequate information about the benefits and risks

6. Appropriate technology: dedicated institutions are often not available for women’s health issues, especially outside the requirements for reproductive health.

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

Medicine is a progressive organism, but change comes slowly. The key, I believe lies in empowerment, one woman at a time: we are as strong collectively as the sum of our parts. And the woman-surgeon is no ordinary woman is she? She is a uniquely trained creature who understands that power is a pawn to protect and achieve a pre- specified good, and not an end in itself.

It is important to continue to emphasize empathy as we train women, and not to squash the ability to empathize as weakness. Teams that include females surgeons and anaesthetists can be particularly helpful in rural areas – where in addition to raw skill, the ability to generate trust through empathy and to care may prove to be more important in getting people, especially women to seek and accept surgical treatments. I believe more collaborative efforts of women in surgery and anaesthesia should be encouraged.

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

Women in surgery are emerging from obscurity. We are being known increasingly for our determination and our attention to detail, and with the passage of time we’re taking up roles as senior trainers, teachers and administrators. Women are also bringing to bear their unique abilities in traditionally male-dominated surgical sub- specialities such as orthopaedics, urology and neurosurgery. It is an exciting thing. One important aspect is the increasing emphasis on intellect, and organization instead of brawn; method rather than madness in defining what Surgical training and practice requires.

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

Women are requesting to be respected as women, not as lesser men. Parity is not merely about equal enrolment, but equal opportunity for advancement – and it starts with changing thought behaviour on what women are capable of doing. It’s disparaging to welcome a woman to Surgery while simultaneously pointing out the ‘easy’ specialisations for her, regardless of preferences or abilities.

We are finding roads to space – can we not find methods for teaching Surgery to women, and ensuring that African women can be operated on by female African Surgeons in every sub- specialty if they so desire? The fight for gender- parity must be seen in proper light as a fight for the preservation of the autonomy of every individual. In our characteristic role as mothers, we women are really fighting to save not just ourselves but our men, our children and by extension our continent, and world. We invite you to join us as we work to build a better world!