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First Person

A Community of Women Separated by 6,000 Miles

Butts, Christine, MD

doi: 10.1097/01.EEM.0000547704.11356.dd
First Person

Dr. Butts is the director of the division of emergency ultrasound and a clinical assistant professor of emergency medicine at Louisiana State University at New Orleans. Follow her on Twitter @EMNSpeedofSound, and read her past columns at



Kurdistan, in northern Iraq, fits the image many have of the Middle East. Summer is brutally hot and dry, with average temperatures soaring over 100. Most people are Muslim, and the call to prayer can be heard ringing out multiple times per day.

But it is also a study in contradictions. Young women walk down the street in jeans and colorful blouses, their hair blowing in the wind. On warm evenings, the restaurants are packed with families eating together and children running and playing. Young people are on their phones, texting their friends and using Facebook.

I have been traveling to this region once a year for the past six years. I've learned a lot about the area and the culture. I've fallen in love with the spirit of the Kurdish people and worked alongside Kurdish physicians and nurses, with many of them becoming friends. I have been thinking over the past year more specifically about female physicians in Kurdistan and how their thoughts and views might compare with mine. I was fortunate enough to spend a morning with a group of such women and found that we share a great deal in common, more than I expected.

Many of us have perceptions about people from other cultures, and I confess that I did too. I knew that women make up a relatively small proportion of the medical community in Kurdistan. About a third of a typical medical school class is female. Most of those women will pursue training in one of a few areas, usually obstetrics. Kurdish society is changing, but it still considers it more appropriate for a woman to be intimately examined and cared for by another woman. Knowing that women are a smaller part of the medical community, I wondered if they faced more hardship and scrutiny in choosing to pursue medical training instead of a more traditional path. The women I spoke to dispelled this myth immediately. Their families were supportive of them and encouraged them to pursue medicine, many from an early age. Most of the women I spoke to had married while in medical school, and they said their husbands were supportive of their work, even with the knowledge that their work would pull them away from the home.



Women in the United States are constantly faced with choices when it comes to balancing career and family. We worry about how our absence from home is seen by our families when we are at work, and we worry about what we are missing at work when we are at home. It shouldn't come as much of a surprise that women in Kurdistan can relate to these feelings. When I began to describe this dilemma of trying to balance work and family, heads began to nod immediately. It was as if I were speaking to my female colleagues at home. “We balance,” they said, when asked how they managed these feelings, only to admit that they did not balance very well. Feeling guilty was a common emotion. Perhaps the idea of trying to have it all is not so unique to our culture.

I also wondered if these women had experienced anything similar to our #MeToo movement. This concept is universal among my female colleagues and friends at home, hence the hashtag. My initial perception of Kurdish society, seemingly a patriarchal society, was that this behavior would be rampant. I tentatively brought up the subject with the women, worried about offending someone. My tiptoeing around the issue was met with confused expressions, so I became more and more direct. Had they ever felt uncomfortable by the behavior of a male supervisor during their training? Had they felt talked down to or intimidated on rounds or in a meeting? Had they ever had to avoid a male colleague who wouldn't take no for an answer? To my surprise, the answer to every question was a resounding no. They felt respected and valued at work.

Perhaps the concept I found most striking was the culture of their work. As I mentioned, most female patients are cared for by women, and the maternity hospital is almost completely staffed by women, from managers to nurses. The women I spoke to talked about how much they enjoyed their work. They loved saving the lives of women and their children. They loved bringing joy to a family by helping add another child. They loved operating. They enjoyed working with a community of women, even if they didn't always agree with each other. Of course, they do not always love their jobs. They worry about bad outcomes and malpractice complaints just like we do. They also have the stresses of ISIS and a central Baghdad government that didn't pay physicians for more than six months.

As I watched them interact with each other, laughing and joking, I walked away heartened by this incredible group of women. I initially felt that I knew who they were and how they saw the world, but I was wrong in many ways. Their lives and work are so similar to mine, yet so different.

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