The Gulf Co-Operation Council (GCC) represents a group of 6 countries [Kingdom of Saudi Arabia (KSA), Kuwait, Oman, United Arab Emirates (UAE), Qatar, and Bahrain] that are globally recognized as being both politically and economically important, due to their strategic location and oil wealth1. As a result, this region has recently had a heavy Western and international presence and influence. Despite this, little has been written about health care in those countries, resulting in many misconceptions existing about the region, particularly, regarding the status of women in the surgical profession. Some are led to believe that women in the Gulf region are repressed, second-class citizens that have little involvement in traditionally male-dominated fields, such as surgery, until today. The aim of this overview is to highlight the history of women in surgery in this region, to dispel some of these misconceptions, and to shed some light on recent developments that have resulted in significant changes in the stature of women in the surgical field.
Early history and the preoil era
Born in Medina, in Saudi Arabia, around 620 ad, Rufaida Al-Aslamia is recognized as the first woman to become a nurse and a surgeon in the Islamic world. Mentored by her physician father, she attained clinical skills that allowed her to become indispensable during battles. In fact, her skills were deemed so valuable that she was rewarded with the same bounty as soldiers who fought in battle. During those times, women were encouraged to take on the role of healers. As a result, she was able to train several prominent Muslim women, including 2 of Prophet Mohammad’s wives2.
After the decline of the Islamic Empire and until the late 1800s, little progress was made in the medical field, in the Gulf region. Before the discovery of oil and its associated wealth, the Gulf regions were made up of small settlements that did not have established universities or health care systems. Western missionaries were the first to provide health care services and establish hospitals in the region. During the late 1800s, the British consulate built the first hospital in the Gulf, in Muscat, Oman3. American missionaries further expanded health care services, by setting up larger hospitals, including the first American Mission Hospitals in Bahrain in 1903 and in Kuwait and Oman in 1911 and 1913, respectively. The first women to practice as physicians in the region at the time were Dr Marion Thomas and Dr Eleanor Calverley, from the United States4. In fact, Dr Eleanor Calverley, was a hugely influential figure in establishing Kuwait’s first Women’s Hospital. After completing her medical school at Women’s Medical College of Pennsylvania and her internship, she travelled with her husband to Bahrain and Kuwait on a medical mission. They spent close to 18 years there, and had 3 daughters, who grew up there until they were almost ready for college. As Kuwait’s first women doctor, Dr Calverley was tasked with treating Kuwaiti women with various ailments, including performing minor surgical treatments, such has umbilical hernia repairs, draining abscesses, and ophthalmic procedures, such as cataracts surgery (Fig. 1).
The discovery of oil and the emergence of the first women surgeons
It was not until after the Second World War, once the oil trade was firmly established in the Gulf countries, that training opportunities in modern medicine became available to local citizens. Initially, the only method available to obtain medical qualifications was to travel abroad to either neighboring Arab countries or to Western countries. In 1956, a Saudi Arabian became the first local citizen from the Gulf to qualify as a physician abroad and this ushered in a new era of modern medicine, where others in the Gulf followed in the same path. However, as training abroad was a cultural barrier for many women at the time, these physicians were predominantly men. When first medical schools were established in the region, women were able to formally enter the medical workforce. King Saud University, in KSA, was the first university in the Gulf to establish a medical school in 1969 and accepted its first class with women in 19755. While Kuwait University has welcomed women in its inaugural medical school class in 1973, making it the first in the region to do so. In the early to mid-1980s, Bahrain, Oman, and the UAE followed suit in establishing local medical schools. However, Qatar did not have a medical school until Weill-Cornell Medical College, opened a campus in Doha in 2001. Years later, the first public medical school opened in 20146.
During those early years, medical graduates seeking surgical training, had scarce postgraduate training opportunities. Newly qualified physicians could either travel abroad for their training, train locally under an apprenticeship-based model and then qualify to sit fellowship examinations in the United Kingdom or Ireland, or participate in the newly formed Arab Surgery Board, which was established in 1979. The first local surgical program to accept local trainees in the Gulf, was based at King Faisal University in KSA and took its first class in 1983. Kuwait established its own surgical local training program in 1984 and Oman followed in 1994. Bahrain, UAE, and Qatar are still dependent on the Arab Board or other international qualifications for their postgraduate training programs6.
The first local woman to enter the field of surgery in the Gulf was Dr Samira Arab from the KSA. She attended medical school in Pakistan and obtained a master’s in science degree in surgery from Bath University in the United Kingdom in 1985, before starting her practice. Shortly after, Dr Howaida Al-Qethamy (cardiothoracic surgery), Dr Asia Alrowaf (pediatric surgery), Dr Mervat Al-Saleh (general surgery) and Dr Randah Felmban (general surgery) became the first women to graduate from the newly established training program in KSA. In addition to their local training, these women obtained their certifications from the Royal College of Surgeon (England) and were the first women to qualify in their respective fields between 1987 and 1988. Most of them received further subspecialty training abroad. In Kuwait, Dr Masouma Habib, was Kuwait’s first ophthalmologist. After completing her medical studies in Cairo, Egypt, in 1979, she travelled to the United Kingdom to receive further training in ophthalmology and pediatric ophthalmology. Kuwait’s first woman pediatric general surgeon was Dr Saleemah Al-Ramadan, who was trained locally and obtained her Fellowship from the Royal College of Surgeons (FRCS) in 1988. She had valuable contributions to the pediatric and urology surgery department in Ibn Sina hospital and was the first women chairperson of that department between 1999 and 2006.
By the early 1990s the rest of the Gulf countries had caught up. Oman’s first practicing woman surgeon was Dr Halima Al-Maskani, who joined Khoula hospital in 1992, after obtaining her medical training in China, Tanzania, and Germany. In Qatar, Dr Bahia Al-Baker and Dr Bibi Taleb were the first women surgeons. They both attended medical school in Egypt, receiving their diplomas in 1982. Following that, they completed their surgical postgraduate training in Germany in 1992. In Bahrain, the first woman ophthalmologist, Dr Ebtisam Al-Alawi and the first general surgeon, Dr Suhair Al-Saad, qualified in 1992 and 1993, respectively. This was also around the same time that the UAE gained its first woman surgeon, Dr Houria Kazim, who trained in Ireland and the United Kingdom and received her FRCS in 1993. She was inspired by the numerous cases of advanced breast cancer that she saw to pursue a career in surgical oncology and breast surgery. At the time, many women allowed their disease to dangerously progress as they were too embarrassed to be examined by men physicians.
Until recently, most of these women continued to practice in silos or as a minority in the surgical workforce for many years, as surgery was still not seen as a viable career option for most women.
Growth and the current status of female surgeons in the Gulf
The new millennium heralded a new era for women in surgery in the Gulf, where there was an exponential increase in the numbers of surgical trainees and graduates. This growth was multifactorial and could be attributed to a large expansion in the size of local programs, an increase in the number of women role-models, a greater number of training opportunities abroad for women, a significant increase in the number of female medical students, where they currently represent more than half of the medical graduates in most of the Gulf countries and a greater cultural acceptance of women in surgery.
The increase in the numbers of women medical graduates has also been mirrored by an increase in the number of women surgical trainees in the Gulf. Currently, the proportion of women surgical trainees is estimated to be around, 22% in Kuwait, 27% in KSA, 39% in Bahrain and 63% in Oman. In fact, 70%, of the accepted candidates for entry into Oman’s local training surgical program this year (2019–2020) are women, an unprecedented proportion. In addition, currently, there is women representation in every single surgical specialty and subspecialty in the Gulf countries6.
Over the past few years, there has also been a concomitant rise in the number of women occupying leadership positions, including Chairs of Department, training program directors, administrative positions locally and globally, societal leadership and faculty positions at the university7.
The future: unique challenges and opportunities
Although large strides have been made in achieving a gender-balance in the surgical workforce in the Gulf, a bottleneck still exists due to several barriers, such as a disproportionately lower number of women surgeons occupying leadership positions compared with those in surgical training and practice, a perceived inability to achieve an optimal work-life balance, a lack of mentors and mentorship programs for women in surgery and overcoming implicit gender biases. In addition, unique to the Gulf, are cultural barriers, which may limit some women from traveling abroad for training or entering a male-dominated work force6,7.
Recently, the first women’s surgical group in the Gulf was created, the “Women Surgeons of Kuwait” (WSK) in 2018, which is now officially a committee in the Kuwait Association of Surgeons (KAS). Despite being in its infancy, the WSC has already been successful in recruiting a large member base, establishing a mentorship and networking program, spearheading regional efforts to create guidelines during the COVID-19 pandemic crisis and engaging the public through public events and social media. In addition, the WSC has been instrumental in organizing the first, “Women Surgeons of the Gulf” meeting in Kuwait in 2019. The meeting provided a hub for women surgeons to network and to address challenges that face women surgeons in the region. It was concluded with the release of consensus statements, aimed to advocate for women surgeons in the Gulf. Plans are already in place to hold the next meeting in KSA, in 2020 and to create similar groups in the Gulf countries. In addition, the WSC has attained global support from several international surgical societies, including, the Association of Women Surgeon, the American College of Surgeons and others, which has accelerated the growth of the society in the region and has highlighted the importance of international collaborative efforts.
It is imperative to note that legislative changes in the past decade have expedited the recruitment of women in the surgical field. In Kuwait, for example, a law was abolished in 2011 that limited the proportion of women medical school entrants to no more than 50%, as it was deemed unconstitutional7. In KSA, laws have been passed that have substantially relaxed guardianship/travelling restriction and driving for women recently8.
In addition to these grassroots and legislative efforts, highlighting women’s’ contributions in surgery, implementing changes at the institutional levels and encouraging social responsibilities to be shared more equally, are some of the steps required to further seal the gender gap in leadership positions in surgery. History and current trends appear to indicate this goal is achievable soon, as the region is witnessing an era of transformation, with most of the Gulf countries pledging to comply with the implementation of the United Nations sustainable goals, including “Goal Five” (Gender Equality)6.
Not indicated for this review.
Sources of funding
No funding was received for this work.
All authors have contributed significantly to the work produced in this review.
Conflict of interest disclosures
The authors declare that they have no financial conflict of interest with regard to the content of this report.
Research registration unique identifying number (UIN)
Dr Asmaa Al-Rashed.
The authors thank Dr Fayza Haidar (Kingdom of Bahrain), Professor Abdulaziz Al-Saif (Kingdom of Saudi Arabia), Dr Zainab Al-Balushi (Oman), and the Saudi Council for Health Specialties (SCFHS), the Kuwait Institution for Medical Specialization (KIMS), and the Ministry of Health (MOH) of Kuwait for their support.
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