Invisible and Unrepresented

In between the celebrating and resting of a long holiday weekend, I have found myself doing research on the Canadian Medical Protective Association(CMPA). On Friday, I found this tweet of the candidates for a position on the CMPA Council and was incredulous at the fact that no women were running:

(CMPA Promoted tweet)

The Canadian Medical Protective Association is a “a not-for-profit, mutual defence association which is governed by a council of physicians representing members from across Canada”. Women members, however, might well take issue with the idea that this is a representative organization when the Council, the governing body of the CMPA is comprised of 29 Council members, only 7 of whom are women.

What are the implications for women physicians when their representation on the CMPA Council is so limited? Consider this in two broad areas.

The CMPA is in the business of risk. There are negative outcomes in healthcare and in some of those outcomes, physicians might have acted differently. While some will take issue with this view, often a negative outcome cannot be accurately predicted and this is where the risk comes in.

The CMPA, in its fee structure over a number of years has taken risk into consideration. For example, the risk that a surgeon will have a successful action taken against them is higher than the risk that a psychiatrist will be in this position. Hence, surgeons pay higher CMPA fees than psychiatrists. Also, the financial awards to successful claimants is higher in Ontario than in Quebec. Therefore, Ontario physicians have higher fees than Quebec physicians.

Consider then that there is evidence that women physicians have fewer complaints against them than male physicians. This being the case, why is this not taken into consideration into the fee structure? This seems like a clear case of gender bias.

My second concern is that women physicians do practice differently than their male colleagues and yet the CMPA does not seem to have done any research into the implications of this in terms of risk. The bias against women physicians by the public, other allied health care providers and even by the profession itself is well-established. New research continues to confirm this bias and yet there is no evidence on their website that this has even been considered by the CMPA.

An organization like the CMPA cannot completely be faulted when its elected Council does not have the number of women on it that might be optimal. However, one begins to be suspicious about gender bias when there has not ever been a woman President of the CMPA. If that is not enough to have members questioning whether women physicians have a strong enough voice in CMPA, a review of their committees will show that not many women are represented here either. Surely CMPA Council has some say over the number of women on committees?

When I raised similar questions about gender bias within the educational colleges last February, the Royal College did reach out to me, although unofficially, and not with any answer that I was given permission to publish.

I will be interested to see whether the Canadian Medical Protective Association has any response. My real goal in writing this, however, is to remind women everywhere that, in organizations, professional and otherwise, there is still a need for us to demand our due from our representatives. There is still a need for us to support the work of women colleagues whose presence will eventually change organizations. This is true in all areas of work – woman are still invisible, even in those professions where we are equal in numbers.

New York State of Mind

Once again this year I will represent Medical Women’s International Association at the United Nations Commission on the Status of Women, in New York City. I keep pondering the irony that the priority theme of this year’s Commission is Challenges and opportunities in achieving gender equality and the empowerment of rural women and girls and that we are focusing on this theme in such an urban setting as New York City.

It is only five years ago that the plight of rural women was considered at the Commission. This same theme is being considered once again because the meetings five years ago did not result in agreement being reached on how to meet the challenges facing rural women and girls. During the past five years, UN agencies and Civil Society have been working regularly to develop a proposed Outcome Document that stands a better chance of agreement. This document sets out the legal framework for gender equality that member states agree to support by the end of the Commission on the Status of Women.

What are the issues facing rural women and girls in their quest for equality? Think of the impact of climate change and unsustainable farming practices on rural life. Think of the barriers to women owning land in some parts of the world. Think of the financial barriers women face even in our own country. The issues of migrancy are particularly problematic for rural women. Rural women and girls do not have the access to adequate health and reproductive health support. They do not have access to legal support when required. For all these difficulties, there is overlap with the issues faced by women and girls in an urban setting, but the remedies are more difficult to establish and maintain for rural women.

One of the most amazing aspects of this meeting is that there are always women attending who have never been to New York City or the United Nations. It is always inspiring to speak with them about their experience of the city and the institution. Over the years I have attended this meeting, and in all the years I have come to New York, I find that my faith in the city grows, while my faith in the organization diminishes.

The United Nations was built on lofty goals and tremendous idealism, but countries that deny women basic rights sit on the UN Human Rights Council. The treatment of the State of Israel by the United Nations has been worrisome at best. It is the Church Center for the United Nations that has most inspired me; its chaplains and its mission exemplify the spirit I wish I could find in all of the institutions of the UN.

The city, however, and the spirit of its people, have emerged stronger through the challenges they have faced. New York City lives and breathes and invigorates. I learn something every time I visit New York. I am like Tom Wolfe who said, “One belongs to New York instantly, one belongs to it as much in five minutes, as in five years.”

At the end of my time at the Commission on the Status of Women, I expect I will feel discouraged about my United Nations experience, but I will leave New York longing to hold on to a New York state of mind.

#MeToo

Over the past week, the systematic victimization of women in Hollywood by a serial sexual predator has caused many women to look at their own life experience and consider whether they have also been the victims of sexual harassment, or worse, in their workplace. Today I have been watching the intensity of the #MeToo campaign build and I have been thinking of the experience with sexual harassment of most women physicians and medical students, including myself.

The essence of the #MeToo campaign is that a woman who has been sexually harassed copies a prepared text onto their Facebook page, or Instagram, or Twitter with the hash tag #MeToo to indicate that she has also been a victim of sexual harassment. This is the screen shot from my Facebook page:

 

As a physician who trained in the 1970’s at McGill University in Quebec, I studied medicine in my late teens and early twenties. When I applied to medical school, I was asked by one interviewer, “Are you interested in getting married?” Having always been a little too smart-mouthed for my own good, I answered, “I’ve only just met you. Can I have some time to think about it?” But over the years of repeating that story, no one was ever surprised that someone (a man) asked me this question.

My women colleagues and I became used to professors and staff physicians and senior residents enquiring about our menstrual cycles, our marriage plans and commenting on our suitability for senior leadership roles. At the time, I suspect that most women medical trainees were like me. We took for granted that this treatment was typical in medicine. All trainees were subjected to humiliation, verbal abuse and a work load that was essentially equivalent to slavery. The sexual harassment that woman trainees experienced was influenced by a medical environment, but women were mistreated in all work environments. In fact, the term sexual harassment may have been coined at Cornell University in 1975, but that was not the literature medical professors considered valuable.

Over the past forty years, with both male and female colleagues, many of us are working to change this culture in medicine and we even have days when we believe we have been somewhat successful. We can say that there is now excellent evidence that respectful medical workplace behavior is still a problem and that every physician or medical student or resident should now be aware of the principles of medical professionalism and disruptive behavior. That’s it, however. That’s the extent of our progress: that we should know better. Medical students and residents continue to tell us that there is a problem and women doctors and medical students on Social Medial today are recording their #MeToo’s along with women in every other profession.
Many women in medicine will say that this misogynistic treatment occurred mainly when we were students and residents, but it is just not true. Women are still being passed over for academic promotion, hospital leadership roles, association leadership roles and even association awards. If you look through this list of winners of the Canadian Medical Association’s Frederic Newton Gisborne Starr Award, you will find the name of one woman. Even if you don’t count all the early years of the CMA when women couldn’t be doctors in Canada – not one of the best reasons for this low number of women award winners, mind you – it is still a sad statement about how women are regarded in the profession. Finally, and probably most telling, the specialties in medicine with the lowest fees are those dominated by women.

From the moment in an admission interview that I gave that sarcastic answer to an inappropriate question, I have been working for medicine to be a more positive profession for women. The number of women in medicine has grown, but we still work harder for recognition than our male colleagues. We still do not call out sexual harassment in medicine to the extent that we should. For all my women colleagues who think I am exaggerating, I suggest that you have a conversation with some work friends about your own experiences in Medicine.

This is what you’ll learn after thinking about most medical workplaces: #YouToo

 

Seria Una Cruz Verde?

I am watching the news from the Venezuelan election and wondering what I would do if I were a doctor in Venezuela today. The election is the most recent assault on the people of Venezuela by their President, Nicolas Maduro. By the end of the day, or within a few more days, he will become the dictator of Venezuela. The making of a dictator is the undoing of security in a country and many young Venezuelans have seen their country go from being the richest country in South America in the 1980’s to having an 86% poverty rate in 2017.
Since April, over 100 young people have died in protests in Venezuela. That total increased by 19 this weekend as protests over the election intensified. Venezuela’s neighbours, Brazil and Colombia are bracing for a refugee crisis. The country is experiencing a food security crisis and medicines are not at all available.
The scale of the humanitarian crisis was confirmed by Dr. Douglas Leon Natera, President of the Medical Federation of Venezuela. Natera is reaching out to colleagues in the region. This is a communication to Dr. Maite Sevillano, Vice President of the South American Region of Medical Women’s International Association:
“To the friends: The health sector being headed by the doctors is only attending emergencies, trying to continue to give priority to children, pregnant women and the elderly. These resolutions are being followed by 96% of doctors in public services and 85% in private.” (Personal Communication to dra Sevillano)
Venezuelan physicians are especially concerned about the impact on children, who have been most affected by the food insecurity. Also, youth have been the majority killed in protests against the Maduro regime, according to Dr. Natera.
In Venezuela, however, some of the heroes are also young. Medical students and recent graduates of the Central University of Venezuela have banded together as volunteers to provide first aid and whatever care they can to those injured in protests, on both sides. However, despite the group’s impartiality, government forces usually see them as part of the protest. As they help, some have been injured and one of the volunteers was killed. To identify themselves, the volunteers wear white helmets with a green medical cross and carry white flags bearing the same green cross. Cruz Verde (Green Cross) is what they are called and those injured in protests call out for them, and pray for them.
As most of the volunteers are in their twenties, they were born when their country was still wealthy. They have witnessed its disintegration. They are studying – and learning – the basics of public health, emergency medicine and the impact on health of a humanitarian crisis in the most unfortunate way. Their older colleagues, led by Dr. Natera, are also working to provide basic medical care to starving and desperate Venezuelans. When I read about their work and watch youtube videos of their working conditions, my own first world medical concerns dissolve into this philosophical question:
“Seria una Cruz Verde?”

(Photo credit: Christian Science Monitor)

One Hundred Years of Women Doctors

Over the next ten years, various women’s medical organizations from around the world will be celebrating their centenaries. I was contemplating this while attending the Centenary of Britain’s Medical Women’s Federation last week. The American Medical Women’s Association celebrated its Centennial in 2015. The Federation of Medical Women of Canada was founded in 1924 and the Australian Medical Women’s Federation formed in 1927 even though Australia’s first medical women’s society was founded in 1896. In 2019, the international body to which all these associations belong, Medical Women’s International Association, will celebrate 100 years of operation, the oldest international medical association. Many of these organizations took as their inspiration the women’s suffrage movement – the theme colours of Britain’s Medical Women’s Federation are exactly those of Britain’s suffragette movement.

This means that there have been one hundred years of women physicians’ influence on medicine and health care. What has this meant for health and for the status of women physicians?

From the beginning of medical women’s organizing activity, women doctors have concerned themselves with the health of women and children and with advocating for opportunities for women doctors. All told, most of these women doctors’ organizations would likely believe that they have been more successful on behalf of their patients than on their own behalf.

Despite growing numbers of women in medicine, women continue to be underrepresented in the highest paid specialties, in university professorships, in clinical leadership positions and in most other medical leadership roles. This is true even in those countries in which women have formed the majority of the medical workforce for many years, such as China and Russia. The underrepresentation of women in powerful medical roles is of such concern in most first world medical women’s organizations that advancing the position of women doctors has become a primary concern for most of these organizations. “Equal pay for work of equal value” has its own meaning for women doctors!

As for health and healthcare, medical women and medical women’s organizations have championed women’s and children’s health, and especially women’s reproductive health. A look at the websites of any of the national organizations listed above will demonstrate this important work. The work of the members of Medical Women’s International Association (MWIA) has been so noteworthy that its projects have ensured that it has official working relations with the World Health Organization (W.H.O.).  MWIA also maintains Category II Status with the Economic and Social Council (ECOSOC) and is involved in the Immunization Programmes of the United Nations Children’s Fund (UNICEF). MWIA is represented in all three of the United Nation Centers, New York and Geneva by Permanent Representatives. MWIA is a Founding Member of the Council for International Organizations of Medical Sciences (CIOMS) and continues to be actively involved in that organization. MWIA also sends representatives to the European Women’s Lobby.

The projects of the various national organizations and of MWIA itself are as varied as its members. In recent years, MWIA has worked with ZONTA to distribute birthing kits to those women in poor countries who have their babies at home, often without any birth attendant – not even a neighbour. As well, one Past President, Dr. Gabrielle Caspar of Australia has collected ultrasound machines in that country to deliver to African countries. MWIA members from around the world are compiling a series of typical cases of intimate partner violence into a training manual for use around the world. The cases will cover an unprecedented example of cultural and social impact on intimate partner violence.

One hundred years ago, at the time that women around the world began to insist on a role in government by means of the vote, women doctors began to insist on a role in medicine that would allow them to have the impact on health, and especially women’s and children’s health, that was needed to improve health standards in general. These pioneering women physicians realized that healthcare must be equal for all. They fought for it then and continue to champion the same goals today.

(Note: The above photo is of the original members of MWIA in Geneva, Switzerland at the time of their founding meeting.)

Women’s Rights and Medical Women

Most of us know that the world’s leaders met this past weekend at the United Nations to discuss and commit to sustainable development goals. They formally agreed to a set of goals that they hope to bring to completion by 2030: http://www.un.org/apps/news/story.asp?NewsID=51968#.VgkpN3ldGUk

This was the second agreement of its kind, the first agreement, the United Nations’ Millenium Development Project, was launched in 2000 and, since that time, women’s groups have been measuring the extent to which these lofty goals have been addressed. These goals are outlined here and even a brief review will show that many are related to women’s empowerment and women’s health. The changes with this first set of goal have been so slow that one might wonder whether just building another set of goals will truly help. http://www.un.org/millenniumgoals/2015_MDG_Report/pdf/MDG%202015%20Summary%20web_english.pdf

When one considers the Sustainable Development Goals developed for 2030, wondering if they can possibly be achieved, it is worth looking through the photographs on the link. Once you have, you will realize that most of the leaders discussing these are men. There are a few notable women, like Angela Merkel, but mostly men. Truthfully, on the ground, most of those actually working on the goals, getting their hands dirty and their egos bruised, are women and I want to be sure that their voices were heard and their suggestions included.

Each year at the United Nations Commission on the Status of Women, we gather into our groups and negotiate to improve and strengthen the statement and listen to talks about interventions that are succeeding in one goal. We cobble together an acceptable document only to have some state that does not value women remove certain key proposals or statements. Which states will hold women back? These include some of the Middle Eastern States and, of course, the Holy See.

Both sets of sustainable development goals are embraced by women’s groups for they represented the kind of world we wanted to leave for our children and grandchildren. Whatever the politics, it seemed as if women were more likely to get past it and get on with the work.

Women physicians, through Medical Women’s International Association, have always been involved in the consideration and development of the sustainable development goals. Each year a delegation attends the Commission on the Status of Women and lobbies for the inclusion of the most effective measures. While the progress is slow year to year, it is building. It is building to a point in the same way that women’s suffrage did. While medical women from every corner of the globe come together to provide evidence based care so that more girls and women are able to lead healthy, happy lives in careers of their choice, the world will be a better place.

This past weekend, the Federation of Medical Women of Canada met in Toronto. Like all women physicians groups, they are working toward those goals, focused on those very real Canadian concerns: poverty, domestic violence and, now, the arrival of Syrian refugees. Their numbers wax and wane as women do not always see the value of defending women’s rights until something happens to them personally to remind them that there are still barriers to woman’s advancement and equality.

At this Federation meeting, Canada’s women doctors were joined by doctors from around the world, the Executive Committee of Medical Women’s International Association. This group includes not only North American women but also women from Europe, Asia, Africa and South America. This group knows the hardship women face in getter better healthcare for themselves and their families on a daily basis and they work to improve health conditions for all.

These women are today’s suffragettes, although they are fighting for women’s status not just votes. They are also no longer going on hunger strikes. Rather, they are travelling to the United Nations and the World Health Organization and to the corners of the globe to ensure that there is a strong healthcare cornerstone in the building of women’s empowerment. Take a look at their website www.mwia.net Be inspired!

United Nations Commission on the Status of Women, Session 59

Each year hundreds of women from around the world attend the UN Commission on the Status of Women. I attended for my sixth year and found the program to be as exciting as ever, making me wish I had more than the two days I was able to participate.

As a delegate for a Non-Governmental Organization, specifically Medical Women’s International Association, the main task is to find out what the United Nations, individual member nations and other NGO’s have been doing during the previous year. In addition to this review, this year’s meeting was a time to reflect on the progress that has been made in the world since the Fourth World Conference on Women, held in 1995 in Beijing: http://www.un.org/womenwatch/daw/beijing/platform/  What was important about the Beijing Conference, as compared with the previous three, was the development by delegates of a Platform for Action, with goals of achieving greater equality and opportunity for women. This is a link to the Platform for Action: http://www.un.org/womenwatch/daw/beijing/pdf/BDPfA%20E.pdf

This year’s Commission was meant to consider the progress that has been made toward these goals and Medical Women’s International Association(MWIA) held a Parallel Event entitled The Role of MWIA in Promoting Health and Reproductive Rights since Beijing and Beyond. Other than MWIA presenters, we were fortunate to be able to hear about the work of H.E. Professor Malgorzata Fuszara, the Polish Government Plenipotentiary for Equal Treatment and of Ruchira Gupta, Apne Aap Founder and Woman of Distinction Awardee NGOCSWNY 2015. Here are links to a two-part series to Professor Gupta’s work from PBS Newshour: http://www.pbs.org/newshour/bb/police-inaction-human-trafficking-india/ and http://www.pbs.org/newshour/bb/rescue-girls-sex-trafficking-indian-activists-confront-tradition-family-ties/

For my contribution to the MWIA Parallel event, I reflected on incidents at university campuses in both Canada and the United States in which young women have been aggressively sexually harassed or assaulted and the culture of Guyland that is failing to prevent these actions. I believe that it is important for us to reflect on these incidents which are occurring among the most wealthy and privileged young people and ask ourselves why we have not been successful in making universities a safe place for young women. In examining these incidents, researchers have been able to develop some possible areas of study to eliminate these threats. Also, I wanted to focus on what women’s organizations in particular can do to improve safety on campus.

In order to understand why this issue concerns me, studies indicate that 25% of young women are victims of sexual aggression in North American Universities and 33% experience “stressful sexual harassment”. This is in the context of underreporting, which we know is standard for both sexual assault and sexual harassment. Naturally,recommendations include seeking better data in further studies, but they also include education with respect to what constitutes sexual assault and sexual harassment, which is concerning given the level of education, knowledge and sophistication of the young men and women at universities. This recommendation, which is consistent in all of the centres, truly suggests that neither young men nor young women understand what constitutes sexual assault and sexual harassment. Fundamentally, what does our culture promote as normal sexual relations since sexual assault and sexual harassment are not clearly understood. This vignette, reported by Newsner, does indicate the level of ignorance I wanted those attending the parallel event to consider: http://www.newsner.com/en/2015/03/a-boy-sexually-assaulted-her-daughter-in-school-her-reaction-omg-she-is-amazing/

It was gratifying that medical and graduate students attending the event approached me afterword with their own stories of exactly the kind of harassment we were discussing. A number said that they were unaware of how their own institutions actually support young men and women facing sexual exploitation, and that they were going to find out. For me, that’s a good enough outcome for this year’s Commission on the Status of Women. When you look at the progress in women’s rights in the past twenty years, it’s best not to set the bar too high.