Below is the interview I conducted with Dr. Kayali on women's health care in Yemen. As with before, it's minimally edited for clarification. I've also added an astrix followed by writing in parentheses to express any personal thoughts or clarifications. A good deal of this will be put into the article I'm writing for Yemen Today. Here it is:
Can you spell your name?
Fidaa Kayali
What is your title?
Doctor of Gynecology
Personal Questions:
Where did you receive your education?
"I Graduated as a General Practitioner (Doctor of Medicine) in Aleppo, Syria at Aleppo University in 1987."
"After becoming a doctor I worked as a General Practitioner in Yemen, then came back to Syria to specialize in gynecology and returned to Yemen in 1995 and have been practicing gynecology here ever since."
She says she enjoys having a stable practice and lifestyle here in Yemen.
What motivated you to choose this career path?
"I’ve liked helping people since I was a child. With medicine I thought “maybe I can help people in a more complete sense” *(meaning healing with the whole person in mind including the emotional, physical, and spiritual). I’m a good listener and people feel they can trust me. Without trust from the patient, the patient will not improve. For example, when I prescribe a medication, regardless of the patient’s level of education, I describe as accurately as I can for that individual how to take the given medication and why, as well as side effects or anything else they might experience so that they are educated enough to take the prescription correctly. By making sure they understand what I’m telling them and by being thorough in my details they trust that I’m giving them accurate information."
What do you like and dislike about your job?
"It’s sometimes difficult to have a balance between my work life and my family so while this isn’t something I dislike about my career, it also isn’t an easy challenge. I try hard to be a good wife, good mother and good doctor. While my family thinks I do a good job with this, it’s hard on me and sometimes on my own health because I’m trying my best with everything."
Health Related Questions:
1.) How do you feel about women’s health care in Yemen in general?
"Health care in Yemen needs to be more simplified for people. There are many centers, but they don’t give the good way and good language to help women from all backgrounds (highly educated to no education) so there should be the good language for every level." * (When Dr. Kayali says “the good way” or the “good language,” what she means is that every medical facility functions in the same technical way and it is not conducive to the lifestyle or level of understanding that most Yemenis possess).
"Also, many Yemeni women don’t value themselves in the way that they should and because of this, they don’t consider entertaining basic things that would benefit them, such as regular health care. They need someone else to confront them with the idea of their own self worth and what it means to preserve it. This is very, very important and while it’s better now than how it use to be, people that work in the medical centers should use more simplistic language and know how to tell very simple women how to take care of themselves and how to love themselves. Many ladies her do not feel that they are important so they do not take care of themselves. Many pregnant women deliver at home and many women do not go regularly to the doctor during pregnancy. I should tell them (as a doctor) when to come back and why it’s important…as a doctor, my job is to deal with patients as they are, not only as I want them to be because they are not educated, and this is not their fault. I want to help Yemen, many people here are uneducated therefore, while I should do something to benefit these people, it should be in my own way, through a great deal of simple advice and communication.”
"For example: Brochures are given to direct patients on how to care for themselves *(under various subjects, such as self breast exams for example), but they don’t always understand. However, if I show a woman personally, at a level that she can relate to, how to conduct one of the procedures given in the brochure, then they understand."
"In the Quran in Islam there are many places that talk about proper hygiene and health care. Essentially, it says you should take good care of yourself. Therefore, sometimes using this mentality helps get the point across. In Islam it is your duty to take care of yourself (health care, etc.) - even in health care, we use the expression “tewaqal,” which means “do all you can first, then ask for God’s help.” “I try to remind them (her patients) of this: when I ask God to help me, I should first do what God wants.”
2.) What do you feel the biggest challenges facing women’s health care are currently?
"We receive many cases of women facing problems during pregnancy and we are late in the diagnoses because they wait so long to be seen. If they think things aren’t urgent, women postpone seeing a doctor and the costs are greater."
"Another issue is that if a women’s husband travels, she will often wait for her husband to return home as she needs someone to take her to the hospital; another problem that postpones diagnosis."
Dr. Kayali sees this as a big problem. "Not everyone lives in the cities and those outside of city limits have minimal access to health care and hospitals. They have some midwifes in the villages for pregnancy cases, but these women usually do not have sufficient training in their field. Often, with hospitals near the villages, what facilities they do have are severely lacking in resources (blood banks, technology, specialists, etc). Not everything is the fault of education *(she uses the word “facilities” as oppose to “government”) and sometimes indirect messages are better."
3.) How do you think the challenges you mentioned can be addressed?
"We need to start to make a plan. We need to have medical centers readily available to all people in all areas then we should instill the idea of a proper health care mentality through education starting with youth. We must do it in this order because we can’t teach everyone about health care then not have the means to give it to them."
4.) Do you think that the lack of thorough health care can be, at least partially, blamed on regulations mandated by Islam; can Islam and quality health care for women co-exist?
"No, if regulations are placed on health care through Islam, it is because those enforcing the regulations are interpreting Islam incorrectly." According to Dr. Kayali Islam says:
A.) We are responsible for ourselves, our health, what we eat, and how we clean ourselves. Allah always says he loves every human being and has given us the ability to work with our minds. We should use this gift to our highest advantage.
B.) In the Quran, scientists are given the highest place in paradise because they make the best use of their mind, so why would God ask us to make sure we use of our minds to the highest ability and then punish us for it?
C.) Also, it is written that for every disease there is a medicine, as was said by the prophet Mohammad, therefore people must work to find the treatment for whatever disease exists.
5.) How do normal women feel about coming to the doctor, especially the gynecologist?
"Educated people come regularly, but uneducated women only come when they have a complaint so it is the duty of doctors to explain the importance of regular check ups. Poor people do not have the money to come regularly, though they are more likely to come during pregnancy, if they come at all."
"When it comes to their bodies, women can be very shy, especially for their first visit, but this is not a big reason for women not to come. This is not “haram” in Islam. *(In Islam, “haram” means not good or against religious beliefs) Some women do think that showing their whole body is not “allowed” in Islam, but when I am gentle and patient with them and when I explain to them that this isn’t the case, they have no problem continuing with the exam."
6.) What is something you would change about the health care system for women in Yemen if you could?
"We do not have enough to change, change implies that you have something complete and that is not the case. Here we need improvement and not just improvement, but a lot of hard work. Often, there are lots of plans made, but people don’t do what they should to achieve them; this very important to note."
"We should improve all emergency centers (for women, children, everyone and everything), this is very important. Anyone, you, me, and anyone reading this, if they have emergency and they’re in Yemen, they should go around and look at the actual facilities available. There are enough ERs, but not enough facilities in these ERs. There are many new hospitals, but ERs are still not working efficiently, sometimes they lack the appropriate number of beds, staff, facilities, etc. Emergency Centers are needed by everyone everywhere, so this is a very critical development that needs to occur."
"I also hope they start to enforce (in Yemen) one or two years of mandatory work in the villages (like a residency) as a doctor before they can work in the cities because all doctors want to work in the city. This is a requirement in Syria and it would be beneficial to have it applied here."
"Additionally, if we could successfully mix science and Islam we could do a lot of good for society because I believe when you want to communicate with people you communicate with someone in a way that’s suitable for them. When we have the correct Islamic mentality, there’s room for a lot of improvement. I believe that everything that comes from God is here to help us."
7.) What role do you think education plays in this struggle?
"Start education (regarding health care) simply. Start in schools and with women at home. Give education in the mosques. I don’t care where, I care that this information reaches the people (through television, radio, newspaper, etc., the best method depends on the area where the people you’re targeting live)."
8.) Do you think women are properly educated about health care, their bodies and the options available to them?
"No. Education should be started in schools in a way that’s suitable for the country (sex education in US for example could be used as a guideline, but it must be applied differently so that it's tailored for Yemen).
It’s important to mix Islam with science, because currently we only have Islam."
9.) Every year, more and more women are becoming doctors in Yemen, why do you think this is? What do you think this will mean for health care in Yemen?
"This will ultimately improve health care because these women understand both Yemen and health care and know how to communicate with the local population and the women here (their mothers, sisters, etc.)."
10.) Many Yemenis don’t trust the health care system and say many mistakes are frequently made. Is there legitimacy to this in your opinion?
"Well, yes. There are different components to a system that hold everything together and keep it in check. When you break certain laws there is a system that monitors and punishes when necessary. When you don’t have all the pieces to the puzzle, things don’t work the way they should and certain things are sacrificed. For example, when you teach a child to draw an apple, what do you do? You make points in the shape of an apple and you show the child how to trace a line from one point to another. If you forget to include one of the points, then the child ends up making a shape that isn’t an apple. It’s the same here. If you don’t have all the necessary pieces, things don’t come together the way they should."
Can you spell your name?
Fidaa Kayali
What is your title?
Doctor of Gynecology
Personal Questions:
Where did you receive your education?
"I Graduated as a General Practitioner (Doctor of Medicine) in Aleppo, Syria at Aleppo University in 1987."
"After becoming a doctor I worked as a General Practitioner in Yemen, then came back to Syria to specialize in gynecology and returned to Yemen in 1995 and have been practicing gynecology here ever since."
She says she enjoys having a stable practice and lifestyle here in Yemen.
What motivated you to choose this career path?
"I’ve liked helping people since I was a child. With medicine I thought “maybe I can help people in a more complete sense” *(meaning healing with the whole person in mind including the emotional, physical, and spiritual). I’m a good listener and people feel they can trust me. Without trust from the patient, the patient will not improve. For example, when I prescribe a medication, regardless of the patient’s level of education, I describe as accurately as I can for that individual how to take the given medication and why, as well as side effects or anything else they might experience so that they are educated enough to take the prescription correctly. By making sure they understand what I’m telling them and by being thorough in my details they trust that I’m giving them accurate information."
What do you like and dislike about your job?
"It’s sometimes difficult to have a balance between my work life and my family so while this isn’t something I dislike about my career, it also isn’t an easy challenge. I try hard to be a good wife, good mother and good doctor. While my family thinks I do a good job with this, it’s hard on me and sometimes on my own health because I’m trying my best with everything."
Health Related Questions:
1.) How do you feel about women’s health care in Yemen in general?
"Health care in Yemen needs to be more simplified for people. There are many centers, but they don’t give the good way and good language to help women from all backgrounds (highly educated to no education) so there should be the good language for every level." * (When Dr. Kayali says “the good way” or the “good language,” what she means is that every medical facility functions in the same technical way and it is not conducive to the lifestyle or level of understanding that most Yemenis possess).
"Also, many Yemeni women don’t value themselves in the way that they should and because of this, they don’t consider entertaining basic things that would benefit them, such as regular health care. They need someone else to confront them with the idea of their own self worth and what it means to preserve it. This is very, very important and while it’s better now than how it use to be, people that work in the medical centers should use more simplistic language and know how to tell very simple women how to take care of themselves and how to love themselves. Many ladies her do not feel that they are important so they do not take care of themselves. Many pregnant women deliver at home and many women do not go regularly to the doctor during pregnancy. I should tell them (as a doctor) when to come back and why it’s important…as a doctor, my job is to deal with patients as they are, not only as I want them to be because they are not educated, and this is not their fault. I want to help Yemen, many people here are uneducated therefore, while I should do something to benefit these people, it should be in my own way, through a great deal of simple advice and communication.”
"For example: Brochures are given to direct patients on how to care for themselves *(under various subjects, such as self breast exams for example), but they don’t always understand. However, if I show a woman personally, at a level that she can relate to, how to conduct one of the procedures given in the brochure, then they understand."
"In the Quran in Islam there are many places that talk about proper hygiene and health care. Essentially, it says you should take good care of yourself. Therefore, sometimes using this mentality helps get the point across. In Islam it is your duty to take care of yourself (health care, etc.) - even in health care, we use the expression “tewaqal,” which means “do all you can first, then ask for God’s help.” “I try to remind them (her patients) of this: when I ask God to help me, I should first do what God wants.”
2.) What do you feel the biggest challenges facing women’s health care are currently?
"We receive many cases of women facing problems during pregnancy and we are late in the diagnoses because they wait so long to be seen. If they think things aren’t urgent, women postpone seeing a doctor and the costs are greater."
"Another issue is that if a women’s husband travels, she will often wait for her husband to return home as she needs someone to take her to the hospital; another problem that postpones diagnosis."
Dr. Kayali sees this as a big problem. "Not everyone lives in the cities and those outside of city limits have minimal access to health care and hospitals. They have some midwifes in the villages for pregnancy cases, but these women usually do not have sufficient training in their field. Often, with hospitals near the villages, what facilities they do have are severely lacking in resources (blood banks, technology, specialists, etc). Not everything is the fault of education *(she uses the word “facilities” as oppose to “government”) and sometimes indirect messages are better."
3.) How do you think the challenges you mentioned can be addressed?
"We need to start to make a plan. We need to have medical centers readily available to all people in all areas then we should instill the idea of a proper health care mentality through education starting with youth. We must do it in this order because we can’t teach everyone about health care then not have the means to give it to them."
4.) Do you think that the lack of thorough health care can be, at least partially, blamed on regulations mandated by Islam; can Islam and quality health care for women co-exist?
"No, if regulations are placed on health care through Islam, it is because those enforcing the regulations are interpreting Islam incorrectly." According to Dr. Kayali Islam says:
A.) We are responsible for ourselves, our health, what we eat, and how we clean ourselves. Allah always says he loves every human being and has given us the ability to work with our minds. We should use this gift to our highest advantage.
B.) In the Quran, scientists are given the highest place in paradise because they make the best use of their mind, so why would God ask us to make sure we use of our minds to the highest ability and then punish us for it?
C.) Also, it is written that for every disease there is a medicine, as was said by the prophet Mohammad, therefore people must work to find the treatment for whatever disease exists.
5.) How do normal women feel about coming to the doctor, especially the gynecologist?
"Educated people come regularly, but uneducated women only come when they have a complaint so it is the duty of doctors to explain the importance of regular check ups. Poor people do not have the money to come regularly, though they are more likely to come during pregnancy, if they come at all."
"When it comes to their bodies, women can be very shy, especially for their first visit, but this is not a big reason for women not to come. This is not “haram” in Islam. *(In Islam, “haram” means not good or against religious beliefs) Some women do think that showing their whole body is not “allowed” in Islam, but when I am gentle and patient with them and when I explain to them that this isn’t the case, they have no problem continuing with the exam."
6.) What is something you would change about the health care system for women in Yemen if you could?
"We do not have enough to change, change implies that you have something complete and that is not the case. Here we need improvement and not just improvement, but a lot of hard work. Often, there are lots of plans made, but people don’t do what they should to achieve them; this very important to note."
"We should improve all emergency centers (for women, children, everyone and everything), this is very important. Anyone, you, me, and anyone reading this, if they have emergency and they’re in Yemen, they should go around and look at the actual facilities available. There are enough ERs, but not enough facilities in these ERs. There are many new hospitals, but ERs are still not working efficiently, sometimes they lack the appropriate number of beds, staff, facilities, etc. Emergency Centers are needed by everyone everywhere, so this is a very critical development that needs to occur."
"I also hope they start to enforce (in Yemen) one or two years of mandatory work in the villages (like a residency) as a doctor before they can work in the cities because all doctors want to work in the city. This is a requirement in Syria and it would be beneficial to have it applied here."
"Additionally, if we could successfully mix science and Islam we could do a lot of good for society because I believe when you want to communicate with people you communicate with someone in a way that’s suitable for them. When we have the correct Islamic mentality, there’s room for a lot of improvement. I believe that everything that comes from God is here to help us."
7.) What role do you think education plays in this struggle?
"Start education (regarding health care) simply. Start in schools and with women at home. Give education in the mosques. I don’t care where, I care that this information reaches the people (through television, radio, newspaper, etc., the best method depends on the area where the people you’re targeting live)."
8.) Do you think women are properly educated about health care, their bodies and the options available to them?
"No. Education should be started in schools in a way that’s suitable for the country (sex education in US for example could be used as a guideline, but it must be applied differently so that it's tailored for Yemen).
It’s important to mix Islam with science, because currently we only have Islam."
9.) Every year, more and more women are becoming doctors in Yemen, why do you think this is? What do you think this will mean for health care in Yemen?
"This will ultimately improve health care because these women understand both Yemen and health care and know how to communicate with the local population and the women here (their mothers, sisters, etc.)."
10.) Many Yemenis don’t trust the health care system and say many mistakes are frequently made. Is there legitimacy to this in your opinion?
"Well, yes. There are different components to a system that hold everything together and keep it in check. When you break certain laws there is a system that monitors and punishes when necessary. When you don’t have all the pieces to the puzzle, things don’t work the way they should and certain things are sacrificed. For example, when you teach a child to draw an apple, what do you do? You make points in the shape of an apple and you show the child how to trace a line from one point to another. If you forget to include one of the points, then the child ends up making a shape that isn’t an apple. It’s the same here. If you don’t have all the necessary pieces, things don’t come together the way they should."
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