Sutures That Bind Us: The Experiences of Women Surgeons in the United States & Tanzania

Two women, working within two completely different economic, cultural and social contexts, thousands of miles apart, end up sharing very similar experiences, perspectives and advice as surgeons.

Over 50 million traumatic injuries occur around the world every year; 5 million of these injuries are fatal. This death toll exceeds that caused by HIV/AIDS, Malaria, and Tuberculosis, combined. Access to surgical care is one of the most neglected global health crises of our time. Mission: Restore addresses this problem by providing reconstructive surgical training to surgeons throughout East Africa.

As the Program & Operations Manager for Mission: Restore, I have the great privilege of working with our East African surgeon partners as well as a handful of advanced surgeons based in the United States who act as expert educators for our programs. Challenges that our East African surgeon partners face differ from our surgeons in the United States; East African surgeon partners often lack high-tech and cutting-edge equipment and materials, as well as common luxuries taken for granted in most developed countries, such as assured electrical power for operating rooms, consistent funding, and accessible surgical care for all patients. While surgeons from throughout East Africa face many unique challenges, one of which is having the highest patient to doctor ratios worldwide (with a doctor to patient ratio of 1:50,000 in some areas of Tanzania), one issue spans globally: the disparity in gender among surgeons.

Stone Town, Zanzibar: Mission: Restore local surgeons and surgeon trainers meet with a patient they operated on a year ago. The young girl suffered from third degree burns, needing surgery to regain functionality in her left hand and wrist.

We spoke with Dr. Olivia Kimario, a surgeon partner at Bugando Medical Centre in Mwanza, Tanzania as well as Dr. Joyce Aycock, a Mission: Restore surgeon educator based at the University of Colorado Denver, regarding their experiences as women in surgery. Despite being thousands of miles apart and facing separate surgical challenges, they share surprisingly relatable stories as females in the field.

Dr. Joyce has been working alongside Mission: Restore since 2014 as a surgeon educator, traveling to partner hospitals to facilitate hands-on training and lead education programs in reconstructive surgery for East African surgeons. She is an Associate Professor at University of Colorado Denver, specializing in reconstructive surgery. She attributes her focus on reconstructive surgery to hands-on practice. “I came across plastic surgery completely by coincidence when I did a rotation at a rural hospital in upstate New York. I loved that they did procedures all over the body on all types of patients young and old. I completely changed course and ended up becoming a plastic surgeon!” Dr. Joyce exclaimed.

Dr. Joyce and Dr. Olivia were both interested in pursuing medicine at an early age, but their focus and specializations in surgery took form a bit more by chance. Dr. Olivia, a Mission: Restore surgeon partner in Tanzania, acts as the only female Ear, Nose & Throat (ENT) Surgeon Specialist at Bugando Medical Centre (BMC) in Mwanza, Tanzania. BMC is the largest referral hospital in Mwanza, the second largest city in Tanzania. Like Dr. Joyce, Dr. Olivia developed a passion for performing cleft lip repair and other reconstructive procedures during a post-medical school internship period. She shared that she was inspired by a female reconstructive surgeon from Cornell Weill who specialized in ENT, and from that experience decided to pursue a career focused on ENT surgical care. “I don’t think this doctor knows the full impact she had on me, but I became interested in ENT and how it changes lives following that experience” Dr. Olivia reflected when thinking back to the influence her female colleague had on her years ago.

Sekou Toure Hospital: Surgeon trainer, Dr. Joyce (left) teaches and operates alongside local surgeon, Dr. Furaha during a Mission: Restore Surgical Training Trip in November 2015.

Dr. Olivia and Dr. Joyce shared feelings that being a female with a scalpel in hand comes with the same general challenges that women in any other competitive profession face as well. They both stressed that communication and time management are the keys to success. “I am a surgeon yes, but also a wife and a mother.” Dr. Olivia explained, “one needs to organize herself very well to do all these things. You can’t put one thing (job, children, marriage) in front of the other, you need to run them parallel to one another.” Both surgeons take on the roles of superwomen, juggling family and work, along with additional roles. Dr. Joyce also acts as Program Director to plastic surgery residents at University of Colorado Denver, while Dr. Olivia provides educational support to ENT registrars and works at her husband’s private clinic in addition to her surgical role at BMC hospital. Both women, who are married to men in the medical field, stressed the importance of acting as a fully engaged mother and role model to their children. Dr. Joyce emphasized the importance of making breakfast for her daughters and enjoying hikes and outdoor activities with them as much as possible. She adds, “Even though my daughters grumble about me working a lot, I feel like it is important to set a good example for them.” Dr. Olivia also agreed that her work as a mother and wife never stops.

In terms of overall challenges as a female surgeon, Dr. Joyce referenced gender pay gap, unconscious bias on the parts of colleagues, staff and patients, and work-life balance as some issues. Dr. Olivia felt that from her experience, the issues really rested in girls not feeling empowered or inspired to pursue the surgical field, having less to do with outright gender-bias but more so a subconscious way of thinking. Despite some shared challenges, both surgeons agree that there are many advantages to being females in the field of surgery, especially in terms of empathy and forming a strong relationship with patients. “I do think we (women) listen more and connect with the patients, so we get to experience that emotional reward” Dr. Joyce explained to me. Similarly, Dr. Olivia revealed that “some patients are very thankful, and happy for the connection that comes along (with a female surgeon).” She also surmised that “…being a female (in the medical industry) gives you unique perspective, more insight and makes you push harder as you are forced to question the system and your role within it.”

Dr. Olivia also shared that apart from empathy and a fresh perspective, women are by necessity good at balancing many tasks and being decisive — traits that are also essential to being a successful surgeon. “I do believe that women have something extra and offer a lot to the surgical field” Dr. Olivia explains. “Women are used to managing things, they are probably better at this than men. It’s just a matter of them deciding what they want to do with these skills — which really is anything — they just need to recognize this.” Organization is certainly a trait regularly executed by both Dr. Joyce and Dr. Olivia both in the operating room, and when tending to their families and extra-curricular pursuits.

Having dedication and passion for surgery and medical care is crucial to success, both surgeons agree. When giving girls a word of advice Dr. Olivia encourages them to change their perspective. “Do not feel discouraged by surgery. Women should not be scared to be surgeons, they just need to be dedicated to the job.” Dr. Joyce shared similar advice adding, “work hard and don’t let what other people think keep you from doing what you want to do.”

Bugando Medical Centre: Local surgeon, Dr. Olivia performs a cleft lip repair procedure during a Mission: Restore led Surgical Training Trip in March, 2017.

Two women, working within two completely different economic, cultural and social contexts, thousands of miles apart, end up sharing very similar experiences, perspectives and advice as surgeons. Recognizing that our global health and social problems are not so different after all, Mission: Restore calls upon women surgeons globally to work together and help build one another up, even across borders. Women are certainly advocating for equal recognition and pay in the United States, and likewise, Tanzania aims to empower girls early on. “I believe the Tanzanian government is trying to advocate for girls in STEM. I think that it is important for girls to be inspired and encouraged at an early age. I grew up knowing that you need to work hard to succeed, and was supported by my family, especially encouraged by my father. Others might not have the same perspective or confidence if they didn’t grow up with this encouragement to pursue education” Dr. Olivia explains.

Mission: Restore works with many female surgeons throughout the Sub-Saharan region, many of whom are leaders in their respective fields, taking on roles as mentors and teachers. Some of our female partners act as the first surgeon specialists of their kind within their hospitals, regions and in some cases, countries. Our East Africa Regional Training in Mombasa, Kenya hosted 60 surgeons, 20% of the attendees being women. Despite growing representation in our programs and the surgical field at large, both East Africa, and the United States have more work to do to support women as equals in the medical profession. For instance, according to the Current Statistics on Gender Equity, women constitute only 8% of Professors, 13% of Associate Professors and 26% of Assistant Professors of Surgery in the United States.

With our “Women in Surgery” crowdsourcing campaign we aim to recognize, empower, and validate women’s contribution to surgery. From the United States to East Africa, we look to not only celebrate current and future female surgeons, but to call upon them to step forward as necessary actors and leaders in filling the global surgical gap.