Below is the article I wrote for the Yemen Times on women's health care in Yemen:
Women’s Health Care in Yemen: An Incomplete Prognosis
In the words of Dr. Fidaa Kayali, when it comes to improving women’s health care in Yemen, “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.” Of all the themes that could’ve been deduced from my interview with Dr. Fidaa Kayali concerning women’s health care, this statement sums up the situation most substantially.
Everything about Dr. Kayali was inviting, from her warm presence to the extreme display of Arab hospitality that greeted my presence, and my plate, for that matter. While I sensed her to be a warm and genuine individual, I was convinced when she received a phone call from a patient after the interview. The individual who called was being treated outside of the gynecological field and was seeking emotional support. When I inquired about the nature of the patient’s complaint she replied that she sometimes treats her patients in general medicine since they often feel uncomfortable seeking care elsewhere.
That same care and dedication appears to be an active part in all of Dr. Kayali undertakings, as she “tries hard to be a good wife, good mother and good doctor,” despite the strain it may put on her own health. She graduated as a General Practitioner at Aleppo University in Syria in 1987 and after specializing in gynecology, she began practicing in Yemen in 1995. Dr. Kayali has always enjoyed helping others, but with medicine she thought, “Maybe I can help people in a more complete sense.”
While the attitude and actions on the part of Dr. Kayali are inspiring, the statistics surrounding women’s health care in Yemen are frail in comparison. In the World Economic Forum’s Global Gender Gap report of 2008, which examined four major areas of inequality between men and women (health care being one of the four), Yemen received the lowest ranking out of the 130 countries examined. According to a young, educated Yemeni woman whom I will refer to as Aicha, “there is a lack of faith in the health care profession itself here in Yemen. Everyone has either had a bad experience personally or knows multiple people who have.” Several of her family members have had negative encounters with hospitals and health care professionals, finding them to be unprepared for the problems presented to them.
I addressed this issue with Dr. Kayali, explaining my impression that Yemenis don’t trust the health care system and claim mistakes are frequently made. “Is there any legitimacy to this statement?” I asked. “Well…yes,” she answered, quite matter of fact. “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 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’re supposed to.”
Greatly emphasized by Dr. Kayali was the need for simplification in women’s health care. “There are many centers, but they don’t speak or act in ways that are appropriate for all backgrounds.” According to Dr. Kayali, medical facilities in Yemen function in the same technical fashion which is not conducive to the lifestyle or level of understanding that most Yemenis posses. Also, she feels many Yemeni women don’t value themselves as highly as they should and because of this, they don’t consider entertaining basic things that would be beneficial, 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. In Dr. Kayali’s opinion, “this is very important and while things are better now than they used to be, people that work in the medical centers need to simplify their language and understand how to tell very simple women how to take care of themselves and how to love themselves.” She states that as a doctor, “it is my job is to deal with patients as they are, not only as I want them to be.”
As an example, Dr. Kayali referred to the use of brochures. “Brochures are given to direct patients on how to care for themselves, but they don’t always understand how or what the brochures are telling them. However, if I show a woman personally, at a level that she can relate to, how to conduct the given procedure, then she understands.”
Medical access or lack thereof, appears to be another major obstacle in women’s health care. Dr. Kayali stressed that a large portion of the population lives outside city limits and have minimal access to health care and hospitals. Often, the few hospitals that are within reasonable proximity from the villages have facilities that are severely lacking in resources including blood banks, machinery, and specialists. Additionally, women most frequently visit the doctor due to concerns surrounding pregnancy. While there are some midwives available in the villages for this purpose, these women usually do not have sufficient training in their field and fall short on the treatment they provide.
Yet another component to this struggling system is the nonexistence of preventative care. Aicha recognizes that, “people who live in Yemen are accustomed to treating whatever symptoms they have on their own, whether it’s a cold or something more serious. When Yemenis do visit the doctor, it is because they are already sick; there is no real preventative care. This is the mentality surrounding health care in Yemen.”
Dr. Kayali herself lists preventive health care as one of the more significant challenges in her field, citing pregnancy follow-up, especially for women in the third trimester, as a major issue. “Problems can develop quickly with pregnancy and if women aren’t getting regular check ups, they don’t catch problems that could be serious, such as hypertension and diabetes. There are also many issues that present themselves with home births.” In fact, the NWC report produced by the United Nations states that 40 out of 100 live births occur in health facilities in urban areas and the numbers drop to 17 out of 100 in rural areas. “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.” She also made mention of the importance of communicating any potential problems to the husband as it is not always the choice of the woman where and under what circumstances she will give birth.
Médecins Du Monde maintains that Yemeni women have an average of 6.7 children and 360 women per 100,000 die each year due to complications with childbirth. Furthermore, 75 children per 10,000 die before they reach one year of age. In the poorest country in the Arabian Peninsula where 80% of the inhabitants reside in rural areas, poverty is a constant threat to the population. Regardless of legislation promising relief to the poor citizens of Yemen, patients are still held responsible for 75% of costs. As a result, medical attention is out of reach for the majority of the population. Both Aicha and Dr. Kayali introduced the population’s financial situation as a relevant barrier. Most people simply do not possess the monetary means to visit to the doctor on a regular basis.
Despite this, many that can afford to see the doctor have not been educated on the importance of doing so. Dr. Kayali mentioned that many educated women do come to the doctor on a regular basis, but uneducated women only come when they have a complaint. She feels it is the doctor’s duty to explain the importance of regular check ups on the rare occasion that this sector of the population does come to be seen. However, in an environment that does not encourage nor is conducive to women’s health care, one has to wonder how effective these efforts actually are.
Other factors limiting health care include ongoing problems concerning lack of electricity, a deficiency in clean water, proper sanitation and the limited amount of qualified specialists. These problems can at least partially be attributed to recent cuts in the budget for the Ministry of Health, decreasing from 5.1% in 1998 to 3.5% in 2002. During the interview, Aicha mentioned that “there are a lack of clean facilities at hospitals and clinics in Yemen.” She felt the issue to be of such significance, that when asked what she would change in regards to women’s health care, she suggested, “to create and maintain a system of health standards and regulations for all hospitals and medical facilities,” in order to ensure a clean medical environment and to guarantee that doctors follow accurate protocol for procedures.
When it comes to improving the current system, Dr. Kayali highlights the need to develop a solid 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. It is essential that this is done in this order because we can’t teach everyone about health care then not have the means to give it to them.”
In terms of health education, Dr. Kayali recommends that this be implemented simply, in a way that the Yemeni people can identify with. “We should start in schools and with women at home and provide education in the mosques. I don’t care where it’s done, I just care that this information reaches the people, be it through television, radio, newspaper or some other means.”
She also suggests that Yemen enforce one to two years of mandatory work in the villages which doctors would be required to fulfill during their residency period before being given permission to work in the cities. Since the majority of doctors prefer to work in the city, rural areas where there is a much higher demand for medical personnel, are neglected.
Women’s Health Care in Yemen: An Incomplete Prognosis
In the words of Dr. Fidaa Kayali, when it comes to improving women’s health care in Yemen, “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.” Of all the themes that could’ve been deduced from my interview with Dr. Fidaa Kayali concerning women’s health care, this statement sums up the situation most substantially.
Everything about Dr. Kayali was inviting, from her warm presence to the extreme display of Arab hospitality that greeted my presence, and my plate, for that matter. While I sensed her to be a warm and genuine individual, I was convinced when she received a phone call from a patient after the interview. The individual who called was being treated outside of the gynecological field and was seeking emotional support. When I inquired about the nature of the patient’s complaint she replied that she sometimes treats her patients in general medicine since they often feel uncomfortable seeking care elsewhere.
That same care and dedication appears to be an active part in all of Dr. Kayali undertakings, as she “tries hard to be a good wife, good mother and good doctor,” despite the strain it may put on her own health. She graduated as a General Practitioner at Aleppo University in Syria in 1987 and after specializing in gynecology, she began practicing in Yemen in 1995. Dr. Kayali has always enjoyed helping others, but with medicine she thought, “Maybe I can help people in a more complete sense.”
While the attitude and actions on the part of Dr. Kayali are inspiring, the statistics surrounding women’s health care in Yemen are frail in comparison. In the World Economic Forum’s Global Gender Gap report of 2008, which examined four major areas of inequality between men and women (health care being one of the four), Yemen received the lowest ranking out of the 130 countries examined. According to a young, educated Yemeni woman whom I will refer to as Aicha, “there is a lack of faith in the health care profession itself here in Yemen. Everyone has either had a bad experience personally or knows multiple people who have.” Several of her family members have had negative encounters with hospitals and health care professionals, finding them to be unprepared for the problems presented to them.
I addressed this issue with Dr. Kayali, explaining my impression that Yemenis don’t trust the health care system and claim mistakes are frequently made. “Is there any legitimacy to this statement?” I asked. “Well…yes,” she answered, quite matter of fact. “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 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’re supposed to.”
Greatly emphasized by Dr. Kayali was the need for simplification in women’s health care. “There are many centers, but they don’t speak or act in ways that are appropriate for all backgrounds.” According to Dr. Kayali, medical facilities in Yemen function in the same technical fashion which is not conducive to the lifestyle or level of understanding that most Yemenis posses. Also, she feels many Yemeni women don’t value themselves as highly as they should and because of this, they don’t consider entertaining basic things that would be beneficial, 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. In Dr. Kayali’s opinion, “this is very important and while things are better now than they used to be, people that work in the medical centers need to simplify their language and understand how to tell very simple women how to take care of themselves and how to love themselves.” She states that as a doctor, “it is my job is to deal with patients as they are, not only as I want them to be.” As an example, Dr. Kayali referred to the use of brochures. “Brochures are given to direct patients on how to care for themselves, but they don’t always understand how or what the brochures are telling them. However, if I show a woman personally, at a level that she can relate to, how to conduct the given procedure, then she understands.”
Medical access or lack thereof, appears to be another major obstacle in women’s health care. Dr. Kayali stressed that a large portion of the population lives outside city limits and have minimal access to health care and hospitals. Often, the few hospitals that are within reasonable proximity from the villages have facilities that are severely lacking in resources including blood banks, machinery, and specialists. Additionally, women most frequently visit the doctor due to concerns surrounding pregnancy. While there are some midwives available in the villages for this purpose, these women usually do not have sufficient training in their field and fall short on the treatment they provide.
Yet another component to this struggling system is the nonexistence of preventative care. Aicha recognizes that, “people who live in Yemen are accustomed to treating whatever symptoms they have on their own, whether it’s a cold or something more serious. When Yemenis do visit the doctor, it is because they are already sick; there is no real preventative care. This is the mentality surrounding health care in Yemen.”
Dr. Kayali herself lists preventive health care as one of the more significant challenges in her field, citing pregnancy follow-up, especially for women in the third trimester, as a major issue. “Problems can develop quickly with pregnancy and if women aren’t getting regular check ups, they don’t catch problems that could be serious, such as hypertension and diabetes. There are also many issues that present themselves with home births.” In fact, the NWC report produced by the United Nations states that 40 out of 100 live births occur in health facilities in urban areas and the numbers drop to 17 out of 100 in rural areas. “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.” She also made mention of the importance of communicating any potential problems to the husband as it is not always the choice of the woman where and under what circumstances she will give birth.
Médecins Du Monde maintains that Yemeni women have an average of 6.7 children and 360 women per 100,000 die each year due to complications with childbirth. Furthermore, 75 children per 10,000 die before they reach one year of age. In the poorest country in the Arabian Peninsula where 80% of the inhabitants reside in rural areas, poverty is a constant threat to the population. Regardless of legislation promising relief to the poor citizens of Yemen, patients are still held responsible for 75% of costs. As a result, medical attention is out of reach for the majority of the population. Both Aicha and Dr. Kayali introduced the population’s financial situation as a relevant barrier. Most people simply do not possess the monetary means to visit to the doctor on a regular basis.
Despite this, many that can afford to see the doctor have not been educated on the importance of doing so. Dr. Kayali mentioned that many educated women do come to the doctor on a regular basis, but uneducated women only come when they have a complaint. She feels it is the doctor’s duty to explain the importance of regular check ups on the rare occasion that this sector of the population does come to be seen. However, in an environment that does not encourage nor is conducive to women’s health care, one has to wonder how effective these efforts actually are.
Other factors limiting health care include ongoing problems concerning lack of electricity, a deficiency in clean water, proper sanitation and the limited amount of qualified specialists. These problems can at least partially be attributed to recent cuts in the budget for the Ministry of Health, decreasing from 5.1% in 1998 to 3.5% in 2002. During the interview, Aicha mentioned that “there are a lack of clean facilities at hospitals and clinics in Yemen.” She felt the issue to be of such significance, that when asked what she would change in regards to women’s health care, she suggested, “to create and maintain a system of health standards and regulations for all hospitals and medical facilities,” in order to ensure a clean medical environment and to guarantee that doctors follow accurate protocol for procedures.
When it comes to improving the current system, Dr. Kayali highlights the need to develop a solid 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. It is essential that this is done in this order because we can’t teach everyone about health care then not have the means to give it to them.”
In terms of health education, Dr. Kayali recommends that this be implemented simply, in a way that the Yemeni people can identify with. “We should start in schools and with women at home and provide education in the mosques. I don’t care where it’s done, I just care that this information reaches the people, be it through television, radio, newspaper or some other means.”
She also suggests that Yemen enforce one to two years of mandatory work in the villages which doctors would be required to fulfill during their residency period before being given permission to work in the cities. Since the majority of doctors prefer to work in the city, rural areas where there is a much higher demand for medical personnel, are neglected.
No comments:
Post a Comment