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Editorial
Women are numerically dominant in virtually all health care disciplines except the medical profession. This anomaly is rooted in developments in Western medicine during the 16th and 17th centuries when knowledge of anatomy, physiology and the causes of diseases regained a scientific and theoretical base after the hiatus of the medieval period. Medical training was then established in the universities and the role of wise women and female healers was increasingly discredited and relegated to the treatment of women and those who could not afford the care of learned male physicians. The practice of medicine became an exclusively male domain throughout the Western world from the 16th until the middle of the 19th century. Women as nurses, midwives and other subordinate disciplines were accepted, however, as handmaidens who did not challenge male authority in the way in which women doctors did.
In contrast, in pre-medieval times, women were revered, in many cultures as doctors, natural healers, obstetricians, bonesetters, medicinal herb-gatherers and priestesses of the gods. In some countries, including South Africa, female traditional healers still enjoy this status despite the dominance of Western medicine. The traditional healers style of practice is indeed more woman friendly than that of scientific medicine which demands that women, (the majority of health care providers), should be available 24 hours a day, working night and week-end shifts, in situations where they are frequently at risk and subject to abuse. It is a remarkable feature of health care delivery in general, that many health care providers of both sexes are expected as a norm, to sacrifice their personal lives and those of their families in order to do their jobs. It is even more remarkable that so many do this willingly and almost without question. For women, who are usually also mainly responsible for home management and the care of children and dependent parents, this situation is exceptional.
It is not surprising, in these circumstances, that the incidence of high stress levels, burnout, depression and suicide is higher in women in the health disciplines than in the general population or in other professions. The reasons for the exploitation of women in health care specifically are not clearly apparent. They could be traced to the Hippocratic origins of modern medicine, which demanded dedication and commitment to the care of the sick and dying. Another important root of modem medicine is in religion and in the subjugation of self to higher ideals, as practised by religious orders. Army medicine also played a significant role, imparting an authoritarian and militaristic culture to the nursing profession in particular. Some of these historic precedents, determined by men, and subsequently imposed on all health disciplines are still prevailing values and are, in essence, necessary for the effective care of patients and for the survival of humanity. In this demanding era, however, stress must be minimized both during training and thereafter.
Working conditions must be improved to ensure a controllable lifestyle for the men and women who provide health services. A literature review conducted recently with the support of the Health Systems Trust, indicates that medical women (students and graduates) face particular difficulties. These were identified as:
- discriminatory practices, which limit advancement and lead to lower earnings
- the culture of some surgical disciplines which is inimical to women
- the expectation that doctors will work more than 70 hours per week and for 24 hours or longer without sleep
- lack of part-time training opportunities and rewarding jobs
- no provision for locums for pregnant doctors
- lack of mentoring and career guidance
- lack of childcare facilities at the workplace
- the predominance of men in positions of power in the medical political hierarchy and in academia.
The United Nations Organization, the World Health Organization and the Commonwealth, in various Declarations to which the South African Government is a signatory, have addressed these issues to some extent. There is a general acceptance of human rights and the need for gender equity as set out in the Declarations. In addition, the 1995 Commonwealth Plan of Action for Gender and Development emphasized that much greater attention should be paid to the needs of women as workers for health by:
- developing support systems
- implementing needs-based education
- establishing gender specific databases
- providing multidisciplinary training
- offering leadership training for women at all levels in the health services.
These are important objectives which, in conjunction with others identified previously, must be energetically pursued in the interests of women in health and of the communities they serve. If South Africa is to achieve the ideal of women for health and health for all, women who are now in leadership positions of power must accept responsibility for accelerating the process. |
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