Special Publication of the Brazilian Society of Neurosurgery - SBN

Edição 01 • Setembro de 2018

AROUND THE WORLD /////////////////////////////////////////////////////

The challenges of female neurosurgeons in four continents

Love is really an universal feeling. The passion for brain complexity and its specificities is the common point among the world’s female neurosurgeons who have chosen to overcome all the obstacles that reality imposed to help people through medicine.

If in Brazil, women who choose neurosurgery as a profession face discredit in some situations, in several countries around the world they undergo similar or even worse circumstances. In common, all female neurosurgeons show that it is possible to overcome social conventions and thus write their own stories. Meet the reality of neurosurgery in some countries: Pakistan and Saudi Arabia. Located in Asia and with a little more than 190 million inhabitants, Pakistan became an independent country in 1947 only when it was no longer a British colony. The country is not considered a peaceful place because, in addition to internal conflicts, it carried out historical wars with great powers of the world economy and was highly militarized and carrying nuclear weapons. In the same continent, is Saudi Arabia with about 32 million inhabitants. The country is one of the largest oil producers in the world and was formed in 1932, after the unification of some territories.

Thanks to oil, the country has established a friendly relationship with the major international powers. In both countries, most of the population is Muslim, but Shiite and Sunni division among them is a cause of religious conflicts. The policy in the two countries is very rigid for women who, in general, do not have the same rights as men. And the practice of medicine, both in Pakistan and in Saudi Arabia, is not a science that is above faith. Religion is the strongest of beliefs. In the history of struggle and achievements of the two countries, there are two women – Aneela Darbar, M.D. (Pakistan) and Aisha Alhajjaj, M.D. (Saudi Arabia) who decided to challenge reality and overcome the obstacles of social and governmental laws for a dream – to become neurosurgeons. The journey to pursuit their dreams and gaining both personal and professional satisfaction was not easy for any of these women, but they recall their stories with much enthusiasm. Dr. Aisha, for example, was the first female neurosurgeon in Saudi Arabia and said she already chose to become a physician at the age of 3, the passion for specialization arose from the first contact with the discipline. “The first difficulty I faced was that neurosurgery alone is a challenging field. Then, the burden in my shoulders from the responsibility to prove that women can do this specialty”, she recalls. Dr. Aneela, who has become one of ten neurosurgeons in Pakistan – there are 150 male specialists in neurosurgery – also points out that the profession choice arose in childhood. “When my grandmother suffered a stroke, I felt that I should become a neurosurgeon. Since the episode, I was attracted to the complexities of the mind and brain and have always wanted to learn and explore the anatomy and different functions of this system”, she said. For the physician, following the dream was not an easy task, since the profession alone has a very thin borderline between people’s admiration or rejection. “Neurosurgery is by far one of the most emotionally and physically demanding occupations. The pendulum swings to us daily, we range from gods to nothing in a matter of minutes. We do not have room for mistakes”, she says. Choosing medicine, however, a career in which mistakes are little accepted, was not the greatest obstacle to the doctors, being a woman, yes. “In a patriarchal society like Pakistan, women are often treated as second-class citizens. Therefore, accept a woman to operate in the most valuable possession of your body, i.e. the brain, is not easy. Patients are always looking for an older, more experienced man to be their neurosurgeon”, says Dr. Aneela. Dr. Aisha also felt the same difficulty. “During my career, the biggest difficulty I faced was undoubtedly my space in a very masculine and competitive environment. Understand the policy and survive”, she recalls. The confidence in the work of the specialists was conquered little by little, with the indication of one to others that were attended by the female doctors. Today, female neurosurgeons have a thorough routine and carry the responsibility of motivating and supporting all female medical students who want to follow neurosurgery as a career option. Algeria, United States and France: The proportional difference between men and women neurosurgeons in Algeria, the United States and France is lower than in Asian countries. Women who opt for the specialty face some discrediting by certain people, but nothing compared to the challenges of Islamic countries. In Algeria, for example, there are 340 certified neurosurgeons, 85 (25%) of them women, the largest percentage in the world.  Bakhti Souad, M.D. is a member of the Algerian Society of Neurosurgery and chair of the Women’s Committee of the WFNS – World Federation of Neurosurgical Societies and says that in her country, the difficulties of women who choose the specialty are the same as those of men. “The main disadvantage for Algerian neurosurgeons in my country is that some of them do not trust themselves and in the traditions”, she says. The Frenchwoman Ana Paula Narata, M.D. also shares the same opinion of Dr. Bakhti. “It’s a very masculine specialty in any country, but not reserved to men. We can have our space and show our value”, she points out. For the American physician Kathryn Ko, however, the difference in the number of women and men in the specialty was a challenge in her career. “My residency training in neurosurgery was very challenging. There were few women, so it was quite lonely. But I was willing to go through the difficulties because of my passion for neurosurgery”, she recalls. In the United States, the struggle for women’s equality in the field began in 1990 with the creation of Women in Neurosurgery –WINS, a group whose goal is to promote a cooperative and supportive environment among women who practice neurosurgery, including those in training to become neurosurgeons. As the group grew, it became an international organization with members in Asia, Europe and Africa. In 2010, upon completing 20 years of existence, some members of the WINS Commission wrote articles and essays on their experiences in neurosurgery. The texts compose the book Heart of a Lion, hands of a woman, which showed the strength of the Commission and all female neurosurgeons around the world. Despite the different places of work, the three female neurosurgeons believe that the great challenge of the profession is to manage the time between professional and personal life. “Our routine is the same for all women who embrace a career. But if we have passion in our work, anything is possible”, concludes Dr. Bakhti

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