Visibility matters: She Cuts the Path

What do ‘I look Like, The Changing Tides, The all-male Panel, RCSI Women on the Wall and Greys Anatomy’ have in common…

A blog post by Dr. Fridah Bosire

August 2019, Tenwek Hospital Kenya. Dr. Fridah Bosire with her Attendings- Dr. Andrea parker and Dr. Angela Martin, performing a complex Trans-peritoneal repair of a ruptured infra-renal Mycotic Tubercular Aneurysm.

In August of 2015, thousands of female surgeons took over social media platforms with the catchphrase ‘#ILookLikeASurgeon’ to challenge gender stereotypes across a largely male dominated workforce. This was in response to the example set by Isis Anchalee, a female software engineer from San Francisco who created #ILookLikeAnEngineer. This trend gained global recognition, fueled by the fact that women are still under-represented in some professions worldwide.

Traditionally, the journeys of women towards leadership positions across various fields of work were stifled by systemic biases, created by institutional, societal, and cultural barriers. Leadership was generally perceived as a male perquisite, and women who dared to venture into leadership positions faced significant societal backlash, often labelled as neglectful of their ‘traditional roles’ and ‘overambitious’. Early women leaders had little to no support networks and role models, further making their leadership journeys immensely difficult. Women could barely access the fundamental prerequisites for decision making, such as voting rights, property rights, and access to education et cetera.  Furthermore, navigating societal expectations and traditional roles that de-prioritized career ambitions provided a challenge of balancing professional aspirations with personal responsibilities such as motherhood.

It is no doubt that women leaders are pivotal in driving social change through their unique strengths, values, perspectives and leadership styles that embody empathy and resilience. Despite significant progress in women's leadership, numerous challenges persist, one of which is visibility and representation. There is an obvious visibility gap for women in leadership positions. The impact of patriarchal socialization on how women show up in careers as well as leadership is quite present. Women have been known to sideline themselves in leadership roles, and hesitate to take up leadership positions, an effect of the deep moral injury caused by social conditioning. Internal barriers faced such as impostor syndrome, self-doubt, indecision, lack of confidence, second guessing et cetera dampen enhancing of female accomplishments, authority, and discourages autonomy in decision making.

Changing Tides…

With the changing times, there is an undeniable trend of emerging women powerhouses ascending into leadership echelons, women who are constantly breaking barriers and reshaping the future. I have had the immense privilege of sharing platforms with a few, and their inspiration has been more than profound.

The all-Male panel (‘Manel’) in Decision making Summits.

In 2023, Global chief executive officer of Amref Health Africa, Dr Githinji Gitahi, was applauded for abruptly walking out of the World Health Assembly stage due to absence of women representatives in the panel, where member states had gathered to discuss on Climate resilience, a topic that disproportionately harms women. He went on to advocate for women-led and women-responsive policies (https://mg.co.za/world/2024-05-31-i-walked-out-of-the-world-health-assembly-due-to-womens-absence-and-would-do-it-again/).

The all-male panel fails to platform women in pivotal decision making. In extreme situations, we have seen events with a ‘Manel’ discussing topics on issues directly and exclusively affecting females. The question to ask however, is that, is there a role that women play to perpetuate this lack of visibility, vis a vis, is society structured with deep rooted biases that prevent visibility by minimizing female accomplishments? The biases do exist. It is important to note here that according to the WHO, while women make up 70% of the global health workforce, they hold only 25% of senior jobs. In LMICs, that average falls to 5%. As Dr. Githinji Gitahi points out accurately, ‘panels seem to be curated to give a voice to the most senior person, and many of these are still male, which makes for all male panels. Getting a non-director female, who is just as informed, will bring insight from a woman’s lived experience’.

When you read Megan Dalla Caminas Amazon bestseller book ‘Women Rising: The Forces that hold us back, The tools to help us rise’, she introduces a fresh and interesting concept by stating that maybe we have been asking the wrong question. ‘It is not just about how workplaces change for women, it is about how women become so empowered , clear, and connected that workplaces have no choice but to rise to the new consciousness we create’.

Women on the Wall, Royal College of Surgeons Ireland (RCSI)

In January of 2023, I had the privilege of being hosted by the RCSI College, in Dublin Ireland.  The head porter Mr Frank Donegan led me on an informative tour around the historic building at St Stephens Green. Not only did I get to see the RCSI Heritage collections of the founding fathers of surgery like William Dease and Abraham Colles, but I also had the immense pleasure of viewing the iconic Women on the Wall portraits. We ventured into this 19th century boardroom located at the first floor of RCSI original building. In 1885, a meeting took place at this same room, where under the second supplemental charter, it was agreed to open the medical school to women.

These portraits recognized the pioneering achievements of eight extraordinary women and enhanced their visibility as historic female leaders who forged careers in health care at a time when women were supposed to stay at home. Among a lot of things, I picked out a lot of interesting facts about these women. One common factor was that their histories were a tapestry woven with stories of resilience, perseverance, and academic achievements. For example, aside from being a health care worker, Dr. Mary Josephine Hanna (1859-1936) refused to pay taxes which applied to unmarried women but not unmarried men. Most of the women on the wall enjoyed and carried accolades for their distinguished academic performances.

Think ‘Greys Anatomy’ on Female empowerment and The Impact of improving visibility

Oh, the iconic female surgeons of Greys anatomy!

Any time I envision the enactment of powerful female surgeons and gender representation in surgery, I think of the women in the hit TV show Greys anatomy, a personal favorite.  I think of Dr. Miranda Bailey, Dr. Callie Torres, Dr. Christina Yang, Dr. Meredith Grey and all the iconic female characters who were represented as formidable, knowledgeable, excellent and accomplished go getters. Well, however fictional as it is, the producer Shonda Rhimes definitely did an amazing job at gender inclusion and empowerment, amplifying their accomplishments, accolades, research, and compelling the women of the show to be highly competitive and excellent in a male dominated workforce.  The female gender is given a bit more representation in Greys anatomy. The show, however hilarious, is quite inspiring.

In conclusion, we need to create spaces for women to thrive, elevate their voices, uplift them to be formidable leaders capable of equitable decision making, and promote accomplished women to visible leadership positions. Books to read:

Megan Dalla Caminas ‘Women Rising: The Forces That Hold Us Back. The Tools to Help Us Rise.

Reflecting on the GEIGS 2024 General Assembly: A Triumph of Advocacy and Community Power!

By Hannah Paraquett, GEIGS GA 2024 Social Media Correspondent

(Edited by Riya Sawhney, GEIGS 2024 Co-Chair )

As the dust settles on the greatness that was the GEIGS 2024 General Assembly, it's time to reflect on our remarkable journey and some key successes behind this event. This year, we not only surpassed expectations but also set new standards in organizing a global, virtual conference –  entirely unfunded and powered solely by the dedication and contributions of students and trainees passionate about global surgery.

Every event, no matter the size, has at least three parts: 1) preparation in the lead up to the event, 2) the event itself, and 3) the consequences or how we keep the momentum going. In this blog post I take you behind the scenes of a triumphant General Assembly. 

Preparations underway:

In the weeks prior to the Assembly, our team worked tirelessly to plan every aspect of our advocacy strategy. How could we reach the most people? How could we champion the strengths of our speakers? How could we make this a complete learning experience for those who attended? The answer: a bold social media strategy, creative tools to welcome the participants, a clear and cohesive visual identity throughout promotional material and conference media kits,and a wild twitter live session to enhance our conversations.

During planning, we knew that our speakers were the heart of the event, bringing a wealth of knowledge and experience to the table. To ensure they received the attention they deserved, we launched a series of posts, introducing each speaker and highlighting their impressive credentials. More than just sharing information, our publications were a strategy to connect with our audience showcasing the speakers' journeys and their passion for global surgery - we coupled some speaker introductions with our wider Global Surgery advocacy campaign. In this way, we educated our audience about key concepts, introduced them to leaders in the field, and drummed up excitement for the upcoming event.  Prospective attendees expressed  their excitement about the lineup: reposting,commenting and interacting with our posts. We got over 300 registrations, far exceeding our initial expectations. Considering we relied primarily on word-of-mouth marketing, the influence of our speakers, and the strategic use of social media, achieving (and surpassing) our goals demonstrates the power of our community!

A welcoming event:

Being a global organization, GEIGS prioritizes  trying to connect people from around the world. We attracted delegates from all corners of the globe, representing various disciplines and career grades within the field of global surgery. From newbies to well-rounded researchers: this diversity enriched the discussions and broadened the perspectives shared during the Assembly. Emphasizing the importance of a warm welcome and orienting our delegates, our team developed a comprehensive and thoughtfully curated “Welcome Pack” including essential information, resources, and some unique touches that reflected the spirit of our assembly. Additionally, we curated Zoom backgrounds special to our event for speakers to use, creating a cohesive visual identity. These small but carefully thought-out  details helped enhance the delegate experience. 

Tweeting up a storm for lasting impact: 

During the event, we kept the momentum going with a robust live-tweeting session

highlighting main messages from our keynote speakers and panelists  using brief tweets and thoughtful threads. Our social media team (honorable mention to their lightning fast fingertips), composed entirely of volunteers from Brazil, Argentina, Kenya, USA, and Ethiopia, ensured that every significant moment was captured and shared in real-time. This not only kept our online audience engaged but also helped to amplify the reach of our discussions across time-zones. Our efforts were supremely successful.We were “trending” on Twitter/X as the #2 conference that week. Our hashtag #GEIGSGA2024 became a hub for lively discussions, insights, and networking, further cementing GEIGS’ reputation as a leader in  global surgery advocacy.

Perhaps the most remarkable aspect of our 2024 ASSEMBLY is that all these achievements were accomplished by real people with full time commitments such as university or demanding clinical duties, without any financial backing. Every aspect of the event—from planning to execution—was carried out by a dedicated team who volunteered not just their time and skills, but also their deep passion for global surgery. This is a testament to what can be achieved when a group of like-minded individuals come together with a shared vision. It was more than just an event; it was a milestone in the movement for gender equity in global surgery.. We look back  with immense pride in what we have accomplished. We have set a new benchmark for what is possible when passion meets purpose, and we are excited to carry this momentum forward into our future endeavours.

Stay tuned to GEIGS’ upcoming work by following our social media @gendereqsurg on Instagram, Twitter, Facebook and LinkedIn 💜

How to be a “critical” male ally for gender equity in surgery

By GEIGS DEJ Lead- Rabbey Raza

(Edited by Riya Sawhney, GEIGS 2024 Co-Chair )

“Caution is a very powerful force”, and I say that coming from one of the regions of the world where gender-based oppression is currently the highest. As a medical student in Pakistan, I have seen some serious systemic oppressions firsthand: from everyday injustices against the (few) female clinicians in our workplace to poorer health outcomes for female patients, even sexual violence out in society at large.  It is these experiences that have prompted me to be an ally, and it’s only now, looking back, that I have realised why it was one of the most impactful things I could do. 

It is only natural for an individual to act cautiously when someone from a group with the reputation of systemic oppression tries to act in favour of them. It’s natural to suspect the worst when you’ve seen it. As a male medical student, how could my actions favouring gender equity be trusted?  This was a problem I saw many of my friends struggle with. Despite our genuine cause, our actions were still taken as performative, from the operating room with our colleagues all the way to the roads for campaigns and marches. How could we ensure that our actions were not perceived as superficial, but rooted rooted in genuine causes instead? Over the last year as the Diversity, Equity and Justice Lead for GEIGS, I have realised the importance of “critical” male allyship for gender equity, and in this blog post, I discuss some key learnings that have, helped me do that to a good extent.

Understanding privilege and allyship 

What exactly is privilege? To put it in simple words, it’s an unearned advantage individuals possess simply due to their identity or social group manifesting in various forms such as gender, race, socioeconomic status, and more. 

Recognizing your privilege is the first step to becoming an effective ally. This recognition involves understanding the current social biases and acknowledging how these privileges impact others.  

Once you have identified your privileges, you can move from passive support to active encouragement, such as actively seeking opportunities to highlight the achievements and insights of your female colleagues and ensuring that their contributions are recognized and valued. Active encouragement also means actively discouraging injustice. When witnessing discriminatory behaviour, as a male ally, you must be prepared to challenge them. This includes calling out derogatory remarks, microaggressions, bullying and biased practices commonly seen in surgical specialties, and openly supporting initiatives that promote gender equity.

Finally, as a male ally, you should use your influence, and privileges, to push for institutional changes that help foster a more inclusive environment. To give equal opportunities to everyone irrespective of gender or identity. And to ensure that the voices of the minority groups are heard and properly responded to with sustainable actions.

Think of it as a ‘coin’

Stephanie A. Nixon put forth a very simplistic model to address health inequities due to discriminatory policies, norms, and actions that she called the ‘coin model’. 

According to this model, an individual is represented as a coin. The top of the coin represents one’s unearned advantages, and the bottom is representative of one’s unearned oppressions. For example, I, as a male medical student in Pakistan, have both privileges (cis-gendered, male, educated) and oppressions (ethnicity, race, geographic location).

The coin itself represents the societal norms and structures that give advantages or disadvantages regardless of whether an individual is aware of it. The goal is to dismantle the structure (i.e., the coin) itself.

The question is, how can one dismantle a rigid structure like a coin (metaphorical pun intended)?

The answer is simple. It’s your mindset. 

You see, when you view problems as challenges faced by a certain group, the solutions will focus on alleviating those challenges. But when the parent tumour remains, metastasis is always inevitable. If the problem persists despite the challenges being solved, new challenges will emerge eventually. Focus on the problem instead. 

Look at the coin itself. For instance, solutions addressing disabled people tend to achieve the norm of able-bodied people, like medical care and rehabilitation. Conversely, if you view the problem as an unfair social structure, then the cause of disability shifts from being located in an individual's body to being understood as a result of social, attitudinal and political environments. 

Solutions should be focused on social change to achieve true equity. 

This is where you come in as a “critical” ally. Your job here is simple. Use your position of privilege to identify social norms that have become the root cause of inequity and injustice, and work towards mitigating those problems, instead of just focusing on the challenges that result from those problems. Speak up, advocate, and join hands with dedicated organizations and campaigns

The need to ‘Shut up and listen’

Dr. Simon Fleming, an orthopaedic surgeon by profession and culture change advocate, in his speech on ‘Empowering change through allyship’ during our 4th annual General Assembly this year, put forth an extremely simple principle for allyship that is likely going to resonate throughout the history of the gender equity movement. 

According to him, the first step of being an ally is to “shut up and listen”. It’s as simple as that. 

As people coming from a more privileged background, we have an innate, subconscious need to be listened to, because societal norms have programmed us that just because we come from privileged backgrounds, our opinions hold more weight and/or value. The privileged speak and the oppressed listen. 

This is where Dr. Fleming’s principle comes into action. If you are privileged, then stop speaking. Transfer your privileges to those who have not historically had them. Let them speak, let their voices be heard. Let their words echo through history because at the end of the day, it is their voices we are trying to amplify in the first place, and it’s their words that will echo in the pages of history. As a male ally for gender equity in surgery, this means: 

1. First and foremost, letting my female colleagues tell me what they need – I cannot assume! I need to be invited to be an ally.

2. Transferring my privilege when I receive it – if I have been invited to speak on gender equity, are there women on the panel? If I am co-authoring a paper on gender equity, are other women on the author list?

3. Listening to those in less-privileged positions around me 

4. Championing this cause in my everyday actions and standing up for injustices, whatever the cost

Only when the favoured start to favour the unfavoured will the change start to catalyse. Only when you’ve stopped speaking will the minorities be able to speak and let their words be heard by the world. 

Let this be your sign to join a movement, an organization, or an advocacy campaign. And if you take only one thing away from this, let it be your need to listen first, and transfer your privilege. That is the most basic principle and a renowned one for advancing allyship efforts for gender equity. The one that I have decided to truly stand by.

In Conclusion…

The path to effective male allyship in global health and surgery is both a personal journey and a societal commitment. It begins with a deep recognition of one’s privilege and an understanding of how systemic inequities shape the experiences of marginalized communities. In conclusion, the role of male allies in global health and surgery is crucial for advancing gender equity. It requires a commitment to humility, active engagement, and a focus on systemic change. By transferring their privileges, listening first, amplifying marginalized voices, and addressing the root causes of inequity, male allies can become catalysts for a more just and inclusive world.