February 22, 2018

Cracking the Glass Ceiling: Gulf Women in Health Care

Bahrain Medical Lab
A lab supervisor tests disease samples at the Bahrain Ministry of Health in Manama, Bahrain. (AP Photo/Hasan Jamali)

This post is part of a series examining women’s labor force participation in the Gulf Arab states, including areas of growth and challenges facing women in the Gulf.

For many conservative people in the Gulf Arab states, practicing medicine as a woman is still unacceptable. The nature of the job requires long absences from home and family responsibilities. It also requires interaction with men, which is against traditional cultural values. According to a public opinion survey, Saudi men are less likely to marry doctors and nurses because of their jobs. The hashtag #ترضى_تتزوج_طبيبة (#wouldyoumarryadoctor) has been trending on Twitter since 2012. The majority of men using the hashtag had negative responses such as: “I will never marry a doctor or a nurse,” “Stay away from doctors and nurses,” or “I will marry a doctor based on her specialization.” Such perceptions prevent some women from pursuing a degree or career in health care. According to a study, choice of specialty for Saudi female physicians is limited by the prospect of interaction with adult males and availability of training in fields considered suitable for women. As a result, many Saudi female physicians specialize in fields related to women and children or nonclinical work to minimize prospect of interaction with adult men. In addition, dentistry and pharmacology are popular choices for females in the Gulf Arab states, as they allow for a better work-life balance compared to other specializations. In spite of these challenges, many women from the Gulf states have worked hard to overcome social stigmas in their communities.

Yuthar Al Rawahy is a three-time cancer survivor and a cancer awareness advocate from Oman. In the late 1990s, Rawahy was a medical educator at the College of Medicine at Sultan Qaboos University, where she started talking about her personal experience with breast cancer to raise awareness of the importance of self-examination and early detection. Although breast cancer represents 32 percent of cancer cases in Oman and is the second leading cause of death, she faced difficulty convincing the public that talking about breast cancer as a disease is important because there is shame associated with  talking about an intimate part of the woman’s body. A few years later, she founded the National Association for Cancer Awareness, a nongovernmental, not-for-profit umbrella organization registered at the Ministry of Social Development of Oman. When she first started, Rawahy had difficulty raising funds and finding volunteers for the organization.

Twenty years later, outpatient breast cancer clinics have shown a decline in advanced stages of the disease, and an increase of 36 percent of patients in early stages. Over the years, cancer awareness and support have grown drastically in Oman; for example, while only 270 people attended the Pink Ribbon Awareness Campaign Walkathon in 2003, a record-breaking 7,800 attended the event in 2016. Women have been at the forefront of raising awareness of social issues in Oman. According to Rawahy, there are currently over 126 registered NGOs in Oman and women chair most of them. While the Ministry of Health is very supportive of health-related NGOs, Rawahy believes that Oman has a long way to go in accepting women as leaders in health care.

Talking about breast cancer in public is considered a culturally sensitive topic not only in Oman, but across all Gulf Cooperation Council countries. In Saudi Arabia, Samia Al Amoudi, an obstetrician, gynecologist, and two-time cancer survivor, founded Sheikh Mohammed Hussein Al Amoudi Center of Excellence in Breast Cancer at the King Abdulaziz University in Jeddah. In her book, “Breast Cancer, Break the Silence,” Amoudi notes the hesitance to talk about women’s issues in Saudi society – women with breast cancer have to deal with their disease in silence because women are not supposed to talk about their bodies in public. As a result, there is lack of awareness about breast cancer among women, including the importance of detecting breast cancer early with self-diagnosis. According to Amoudi, 73 percent of diagnosed women have advanced stage breast cancer, 30 percent of whom are below the age of 40 due to lack of breast cancer awareness.

Health Care Education and Reforms

Women in the Gulf states have come a long way when it comes to health care education and professions over the past 20 years. Such advancements have come amid GCC countries’ economic diversification initiatives and efforts to increase women’s labor force participation. GCC states have increased awareness about the importance of educating girls, opened local universities for females, sent female students on scholarships to study abroad, and pushed to empower women in various fields. As a result, Gulf women have risen to the forefront of health care both regionally and abroad. Bahrain and Qatar both have female ministers of health. Mariam al-Jalahma is the CEO of the National Health Regularity Authority in Bahrain. She was the assistant undersecretary for primary care and public health at the World Health Organization in Geneva. Jalahma has also served on the executive board of the Health Ministers’ Council for GCC States since 2007. Samira Islam, who heads the King Fahd Medical Research Center’s Drug Monitoring Unit, was the first Saudi woman to hold an official position at the WHO. Islam led efforts in introducing formal university education for girls in Saudi Arabia.

Health care reforms are a crucial part of regional governments’ agendas, as the demand for health care services in GCC countries is growing along with their populations. Changes in the demographic, social, and economic make-up of the region make health care a more pressing issue than ever before. However, government health expenditure as a percentage of gross domestic product in GCC countries remains low compared to other high income developed countries: OECD members 12.3 percent, Bahrain 5.0 percent, Kuwait 3.0 percent, Oman 3.6 percent, Qatar 2.2 percent, Saudi Arabia 4.7 percent, and the United Arab Emirates 3.6 percent. Although health care is free for all citizens in GCC countries, many people travel abroad for medical advice or treatment, at the government’s expense, due to the health system’s inability to address complicated medical needs. Total GCC health care spending is expected to hit $69 billion by 2020 and the GCC states will need major reforms in order to face all the challenges ahead: improving health care services; providing opportunities for citizens to pursue degrees and careers that will shape the future of health care; and ensuring a competitive local environment to avoid brain drain, particularly with regard to women who have remained abroad to work in the health care field.

Based on the latest health care reforms, the main trends across GCC countries are research and development, information technology, and artificial intelligence. The UAE and Saudi Arabia are leading the Gulf states when it comes to research and development expenditure as a percentage of GDP at 0.87 percent and 0.82 percent respectively, though they are still behind compared to OECD members’ spending at 2.55 percent. (Bahrain 0.10 percent, Kuwait 0.30 percent, Oman 0.25 percent, Qatar 0.48 percent). There are number of Gulf initiatives in the health care field to support governments’ visions to shift from an oil-based to a knowledge-based economy. Saudi Arabia launched The National Science, Technology and Innovation Plan, which provides support and funding for scientific research and development in the kingdom. The top funded projects are in the fields of biotechnology and medicine and health.

Funded Projects

Gulf governments have provided many women who have become innovators in the biotechnology field with scholarships to study abroad. Hawaa Al Mansouri, the deputy medical director at the Imperial College London Diabetes Centre in Abu Dhabi, is the co-founder of SonoStik, an ultrasound-compatible catheter. She plans to launch SonoStik in the UAE and across the GCC states after obtaining the necessary accreditations. Adah Almutairi, a Saudi woman, studied chemistry in the United States and is currently the director of excellence in nanomedicine at the University of California, San Diego. She holds more than 10 patents for her inventions in the pharmaceutical and biology fields. She created polymers that become nanoparticles, which can deliver drugs or imaging agents to molecules in the body.

Additionally, GCC governments have focused on information technology and artificial intelligence in health care. Bahrain’s Ministry of Health has launched I-Seha services as part of the National Health Informatics System. Initially, the program will offer an online appointment booking system applicable to all Ministry of Health institutions in the country. In Saudi Arabia, an e-Health initiative goal is to improve efficiency by using electronic health records, which will help doctors to access patients’ data from any hospital across the country. In the UAE, the Dubai Health Authority has announced the use of artificial intelligence and robotics in hospitals, which will cut down time spent on routine procedures such as x-rays and physical checkups as well as provide support to surgeons in the operating rooms. The shift toward a more digitized health care approach will reduce interaction between patients and their doctors in the future. This could help address some of the cultural issues of women interacting with men in the field.

Women have made considerable advances in the health care field in recent decades. This has come in part due to economic and social reforms, as well as from investments in education, science, and technology. However, there should be a social component to reforms to address the issues women still face in a number of Gulf communities that limit their ambitions and participation in the economy. One initiative to address these social issues includes the Fatima College of Health Sciences awareness sessions for female students and their families to talk about the challenges they face as women in health care and to encourage their families to support them. Additionally, the Rahma initiative, launched by the Ministry of Health in the UAE, is aimed at Emirati families to highlight the role of nurses and enhance the attractiveness of the nursing profession among Emirati women.

Thuraiya Alhashmi is a visiting fellow at the Arab Gulf States Institute in Washington.