The presence of an encouraging number of women in the medical field has resulted in a diverse surgical workforce. A career in surgery has significant lifestyle implications: the profession is associated with a high degree of patient acuity, significant on-call responsibility, and irregular work hours, all requiring a substantial commitment of personal time. How is it to take up something challenging and have work-life balance continuity? What keeps them motivated and become role models who motivate others? Here, we try to figure out the challenges women surgeons face during their journey, which consists of hard work, dedication, and capability to multiply strength and overcome shortcomings. We talked to well-established senior surgeons and surgeons who aspire to walk in that path.
Dr. Paleswan Joshi Lakhey, GI and HPB Surgeon, TUTH, HOD, Gastrointestinal and General Surgery
Dr. Paleswan Joshi Lakhey has been teaching and mentoring all levels of medical students, postgraduate surgical residents, and MCh residents at the Institute of Medicine. She has many publications in national and international peer-reviewed journals and made numerous presentations in national and international conferences as a faculty, representing Nepal as a gastrointestinal and hepatopancreatobiliary (HPB) surgeon. She married Dr. Sanjay Lakhey in 1998 before she did her General Surgery and has two daughters Prapti and Srishti. Prapti just joined medical college and Srishti is in high school. The unconditional support of her husband, who took a back seat so that she could excel in her specialty, has brought her to this height. She says that the life of a surgeon is very challenging and demanding, and that of a women surgeon is even more. Maintaining the intricate work-life balance has been a great challenge for her. In between her busy work schedule, she took out some time to answer our questions:
What are the challenges that a woman surgeon faces in terms of work-life balance, health and safety, job title, career factors, training, and pregnancy?
It is because of our patriarchal culture that women are supposed to take the major responsibility of the household and family, women in every walk of life tend to sacrifice their profession for the sake of their family. This affects their professional life by forgoing opportunities like trainings, fellowships, etc, I wasn’t any exception. Because of pregnancy and the responsibilities during childbirth, and due to other responsibilities at home as a wife and daughter-in-law, I had to compromise the opportunities for trainings, fellowships, and awards. I had to prioritize in favor of my family to maintain the work-life balance.
Is medical profession stereotyped?
Medical profession was very much stereotyped in the past because of various factors like our culture, mindset of people, and limited opportunities. But, in 2022, there is diversity and inclusion in the profession. Women have gone out of the way to break the barrier and the stereotype. In Nepal, women have not only taken general surgery, but also cardiac surgery, neurosurgery, gastrointestinal and hepatopancreatobiliary surgery, and transplant surgery.
Surgery is a challenging specialty that takes much of one’s family time and is dominated by males, the so-called “old boys club”. Therefore, one must take the challenge with grit and drive. You must believe in yourself, and at the same time know your limitations, as well as the strength. While you work on your strength, dissect limitations too. Then, embrace that in which you will excel in your surroundings. Make yourself strong in terms of knowledge and skill within your limitations. Develop a good support system at home as well as your workplace. Above all, learn to prioritize things.
Have you faced inter-professional workplace conflict? How to ensure equitable adjudication when conflict arise?
Everyone faces inter-professional workplace conflict. You must make yourself heard and express your view, and whatever you have to say to ensure equitable adjudication when conflicts arise. Sometimes, one must compromise for the benefit of the team. While working in a team, one must forget the personal benefit. The mantra is to create a “win-win situation”.
Does change in lifestyle help prevent certain diseases? What are the current prevalent gastro intestinal issues in Nepal?
According to the doctor, lifestyle plays a major role in the prevention of various diseases related to the digestive system, whether it is cancer or non-cancer. Smoking and alcohol are associated with various cancers of the digestive system like esophageal cancer, stomach cancer, pancreatic cancer, and liver cancer. Certain types of food are also related to digestive system cancer. Lifestyle also increases the risk of getting hepatitis B and C infection, which is responsible for development of liver cancer. Alcohol is responsible for development of cirrhosis of liver, chronic pancreatitis, and duodenal ulcers. Poor sanitation and low socioeconomic status lead to various diseases like H pylori infection, gastritis, gastric ulcer, and even stomach cancer. Stressful life also invites various digestive system diseases. My specialization is on stomach cancer, gall bladder cancer, pancreas and bile duct cancer, and pancreatitis.
Dr. Joshi was born as a first child to late Mr. Bharat Raj Joshi and Dr. Bimala Joshi. From early childhood, hard work and perseverance was instilled in her by her parents. She did her schooling from St Mary’s High School, Jawalakhel, and was second among girls in the School Leaving Certificate (SLC) exam and was awarded Ratna Bidya Padak in 1986. She completed her Intermediate in Science from Amrit Science Campus, was first among girls and was awarded Aishwarya Bidya Padak in 1988.Then she went to Fatima Jinnah Medical College, Lahore, Pakistan, to do her MBBS. She developed much interest in surgery during her internship in Pakistan and joined Institute of Medicine for Masters in General Surgery in 1998. She became a general surgeon in 2001 and a gold medalist.
Then, she joined Institute of Medicine as a faculty in Surgery. In 2011, she did her post masters degree in Surgical Gastroenterology (MCh) from Institute of Medicine. She received intensive short-term training in gastrointestinal and pancreatobiliary oncosurgery from Seoul National University Hospital, Seoul, South Korea, in 2009. In 2018, she had an opportunity to do a four-week observership in HPB surgery at Memorial Sloan Kettering Cancer Centre at New York as the travelling fellow of Society of Surgery for Alimentary tract (SSAT) from developing nation. She was promoted to Professor in 2015 and was appointed as the first female Head of Department of Gastrointestinal and General Surgery in 2019 at Maharajgunj Medical Campus, Institute of Medicine. In 2021, Department of Surgical Gastroenterology was established to specifically treat and teach gastrointestinal and hepatopancreatobiliary diseases and surgery at Institute of Medicine and she was appointed as the first Head of Department. Her work includes treating patients with disease related to digestive system, doing all complex GI and HPB surgeries, and therapeutic ERCP. She has been treating patients with cancer of stomach, gallbladder, bile duct, liver, pancreas, small intestine, and large intestine by performing surgery. She believes in the fact that surgery is one of the prognostic factors in cancer treatment. Quality of surgery is an important benchmark in cancer surgery. Not only the long-term outcome in terms of survival, but perioperative outcomes, margin negative resection, and adequate lymphadenectomy are the surrogate markers of quality in cancer surgery.
Dr. Namrata Khadka, M.Ch. Resident, Neurosurgery
Dr. Namrata Khadka is a M.Ch. Resident at Neurosurgery Department, Bir Hospital. From childhood, she liked taking up challenges. If not a neuro surgeon, she would probably have joined the army or become an air force pilot. Being a scholar student throughout her life gave her the confidence to pursue medicine, and after finishing her MBBS, she decided that she wanted to become a surgeon. She chose neuro surgery, as she found it challenging and fulfilling at the same time.
Challenges that woman faces to become a surgeon
Women are very special and gifted for multitasking, and it’s an added advantage to be able to carry a baby in the womb and give birth. There might be an appropriate age for everything, whereas male counterparts seem to have advantage over us in this aspect. We have natural inconvenience during our menstrual cycle, both physically and mentally, but we have been standing out and working equally like our male colleagues. Finally, women are obliged to think of their safety while at work, but things have changed and will change. In all the professions, there is difficulty in convincing and gaining confidence over both males and females with Y factor influences. Society is yet to realize there are female doctors, accepting females as surgeons will take time.
Is medical profession stereotyped?
Medical field is changing very fast with AI and robot-assisted surgery, and stereotype will be a myth soon. A girl should have strong determination and courage to face the challenges. The surgical field is physically challenging, as well, but with adequate family support, a girl can be a surgeon in any specialty. When one works in an environment where your male counterparts are very supportive, it’s bliss; everyone should listen to each other and respect everyone’s opinion, ideally there shouldn’t be conflict. Having said that, I feel proud that women surgeons are working equally hard like our male colleagues, so there is no point being judgmental as a surgeon who is female. Finally, I would like add that Professor Paleswan Joshi Lakhey, who is our mentor and mentor to so many aspiring males and female surgeons, has stood out in the crowd of surgeons in Nepal to be one of the best surgeons in the country. We should remove the tag of calling us female surgeons. We are SURGEONS!
Current prevalent diseases
Currently, stroke in young adults is increasing, it might be due to a sedentary, gadget-assisted lifestyle, and junk food; staying physically active is necessary to stay healthy.
Dr. Aakriti Sharma, MBBS, MS, MCh (CTVS), Asst Prof at Thoracic Unit of Cardio Thoracic Vascular Department, Manmohan Cardio Thoracic Vascular And Transplant Center, Maharajgunj
Dr. Aakriti Sharma is a cardiothoracic and vascular surgeon. Currently, she practices thoracic surgery, which deals with lung, esophagus, and every in-mediastinum cavity, apart from the heart. She joined CTVS because she thought it was the most challenging surgery she can ever get and the system she would master and learn throughout her lifetime. After schooling in India, she returned to Nepal in 2005 and started her MBBS journey at Nepal Medical College, where she became fascinated with surgery and dreamt of being a CTVS surgeon, and she could pursue the same as she cleared her entrance for masters. After this, she joined the most dedicated surgery team at Kathmandu Medical College. After finishing her MS, she approached the team at Manmohan in Maharajgunj and did MCh in CTVS. She was fascinated with cardiac surgery, but after she finished her MCh, she joined thoracic surgery. She is content that there’s no looking back and every day is a learning.
Challenges that a woman faces to become a surgeon
We need to work honestly, and surely those who think otherwise will respect and trust you. I feel, be it any profession, if you work hard to aspire to become someone you can overcome any challenges in life.
Is medical profession stereotyped?
I am very passionate about my profession and for me it hardly feels like a work day in that way, it’s pretty balanced. To be a success in any field, one needs a support system, and I am lucky to have that. It’s the age of breaking the glass ceiling, so nothing can or should be stereotyped.
Lifestyle and diseases
We need to stop idolizing hustle culture; healthy eating; intermittent fasting; exercise; and avoiding smoking would prevent lots of disease we have right now due to urbanization.
Dr. Udita Mishra, Department of Urology, NAMS, Bir Hospital
Dr. Udita Mishra belongs to a small village of Mahottari, Pigauna VDC, and was brought up in Janakpur. She always wanted to be a surgeon. She did her MBBS from Kathmandu Medical College and MS (General Surgery) from NAMS, Bir Hospital. She joined government health services a decade back, and right now she is pursuing MCh Urology in NAMS, and is a mother of an energetic, unstoppable three-year-old toddler. She joined Urology, as besides it being a subject of interest to her, she also noticed that there were lots of female patients with urology related issues, and there was hesitancy in women going to an urologist, as it is a male-dominated domain, so if there are female urologists, it would be convenient for them.
Challenges that woman faces to become a surgeon
Our society is male-dominated, and surgery moreover, is heavily male-dominated; people show doubt when you say you want to be a surgeon. I clearly remember when I was in medical school and shared my choice of pursuing surgery as a specialty, my male colleagues would make fun of me. Back then, only a few female surgeons were there in Nepal, even my family was like, it’s such a demanding field in terms of physical work and duty hours, how will you handle that? When you are unmarried, these challenges are not evident, but once you get married, become pregnant, have kids, the real task begins. In our society, work, home conflict makes you guilt-laden at either place. We start doubting whether we are doing justice to either. We are brought up in a way that, despite being equally educated and equally capable, home making and child rearing becomes our sole responsibility.
People at work expect us to do equal physical work, and that is not unfair to a certain extent, but what I feel unfair is, that they won’t trust you in terms of responsibilities and opportunities. Here I must say that I am lucky enough at both the places, as my workplace is very understanding, supportive, and encouraging, and so are my parents, husband, and in-laws, and it’s because of them I was able to dream and become what I dreamed of. But, the medical profession as such is not too stereotyped, and in terms of male predominance, if it is, it certainly is changing.
Knowing what you want to do and perseverance is the key.
Prevalent urological diseases
Urological-related diseases prevalent in Nepal are urinary tract infections, urolithiasis, BEP, urinary incontinence, carcinoma of urinary bladder, and other urogenital malignancies.
Dr. Rojina Shilpakar Swar, Plastic and Reconstructive Surgery Department, Sushma Koirala Memorial Hospital (SKMH)
Dr. Rojina Shilpakar Swar has been working at Sushma Koirala Memorial Hospital for the last 11 years. When she started as a medical officer at SKMH, she learned about burn injuries in Nepal and became very passionate about burn prevention and treatment. She considers her hospital a second home. She has a beautiful family, with very inspirational in-laws and husband, who is very understanding, and a daughter, who supports her continuously. Her parents, siblings, family, and friends are food for her soul who helped her to become what she is today.
What are the challenges a woman surgeon faces in terms of work-life balance?
In almost all societies across the world, and especially in Southeast Asia, women, even those who are working, are expected to ‘take care of the house’. This mentality, unfortunately, still persists. There have been significant changes, however, I still feel we have a long way to go towards changing this mindset. This attitude also extends to patients, who sometimes show hesitation when approaching female surgeons. This, too, will be overcome when there are more of us doing quality work. Hopefully, the gender of a person in any STEM field will not matter at all in the future generations.Having said that, we must acknowledge that there will be some aspects where significant biological differences will result in women facing difficult choices. This is especially relevant in marriage and pregnancy, due to social pressures and biological constraints.
Is medical profession stereotyped?
Stereotypes are present for a reason.They are the most replicable studies in the field of psychology. But, in today’s world, I’m sure one can find all kinds of people in all fields of academia. I feel this is because the world is much more interconnected, and people are exposed to many different ideas and points of view. So, gone are the days when the most studious in the class would be doctors and engineers, and you could guess a person’s occupation by looking at their high school yearbook.
Have you faced any inter-professional workplace conflict? How to ensure equitable adjudication when conflict arises?
Workplace conflict is something that arises wherever one may work. This necessarily doesn’t mean that such conflicts are always bad. Any difference of ideas or opinions may arise when you have a vibrant working environment. It is how we tackle these issues that determine our work environment, whether it’s challenging or simply toxic. As for resolving conflict, I always believe in giving my colleagues the benefit of doubt. This simply means that I assume that they are coming from a place of goodwill in their arguments.
Does change in lifestyle help prevent certain diseases? What are the current prevalent plastic surgeries in Nepal?
Lifestyle is extremely important in determining the quality of life. An active daily routine with proper nutrition definitely sets one up for a long and healthy life. A majority plant-based diet, as well as being physically active, is paramount in preventing a whole range of non-communicable diseases like hypertension and diabetes. It’s sad how plastic surgery is misunderstood even today. Even in the educated circle, people assume plastic surgery is cosmetic surgery. Well, the most prevalent plastic surgery has to be burn surgeries in Nepal. Cosmetic surgery is just a little drop of water in the sea that is plastic surgery. Plasticos actually means molding in Greek. From it comes plastic surgery, which is largely reconstructive surgery. Every year, in Nepal, more than 55,000 people from different parts of Nepal get burn injuries with flame, chemicals, and electrical shock. Around 2500 people die without access to treatment, and those who survive invariably get some kind of deformities over their limbs and face, depending on the areas of burn. And, these are the patients who have to undergo the knife multiple times so we can get their body parts to be functional, so they can go back to community and work and have normal life. And, that my friend, is real plastic surgery.