Silence of the caregivers Taboos sexual health virtual torture ob-gyn ward
Taboos surrounding sexual health mean many women are reluctant to ask for the information and medical care they need. But equally complicit are doctors who do nothing to reduce the virtual torture of ob-gyn ward visits
By Shanel Khaliq and Rabia Bugti
Ay la Aziz, 21, contracted chlamydia from her husband of 11 months; her marriage was a tale of torture and abuse, with the husband maintaining multiple partners at a time. When Ayla returned to her parents’ house in Lahore, she bore a bruised eye from the physical abuse and was experiencing abnormal pain when urinating.
Accompanied by the mother, Ayla went to a gynaecologist in one of Lahore’s largest government hospitals. Although the doctor remained mum at first, nurses began asking her uncomfortable, invasive questions.
“One quipped, ‘Is the black eye because of the infection or is the infection because of the black eye?'” narrates Ayla. “Another said young girls like you should enjoy sex, did you not like it? I ignored them at first because the nurses had started off with cursing my ex-husband. But then the gynaecologist herself spoke up and said I probably have had multiple partners by now and so it was understandable that I had an STD.”
Ayla has not been to an OB-GYN ward ever since.
HOUSE OF HORRORS
The obstetrics and gynaecology (OB-GYN) wxird is no sanctuary. And no other moment captures this more when a woman is admitted for childbirth. In those moments, it is a play of power — by hospitals eager to admit patients by citing urgency, by doctors’ preference for caesarean births, and by attendants exerting their decisions over medical advice.
Her reliance on others increases manifold; the others seem to assume that a woman loses her sense of rational thought inside the OB-GYN ward. There is an erasure of age and of experience; she is now a child who shall be directed into giving birth. She is expected to hand over her good sense to others, including novice doctors, nurses and even distant family, when the only two people to decide her fate ought to be she and her doctor. A common thread linking the performance of these various levels of power is how a woman’s agency and voice vanish into thin air.
“My doctor had barred a particular injection because it was causing an adverse reaction to something,” says Lahore-based Rehana of the day of her delivery. “She went away for a while and, in the meantime, I stalled struggling with immense pain. The nurse picked up the same medicine to inject and, when I protested and said the doctors had disallowed it. she simply ignored me and went ahead anyway. Thankfully the doctor arrived just in time.”
Another woman from Peshawar, Zehra, now in her 40s, recalls her horrific experience at one of Peshawar’s renowned hospitals: “The nurses’ attitude was rather haughty. Their behaviour was very harsh and there was lots of loose talk. Whenever a woman
Most doctors want to get done in a 30-minute-long operation. This is a matter of money: doctors can only deliver five or six babies in a day through vaginal deliveries but when it comes to C-sections, they can deliver between 15 and 20. C-sections save time and bring in more money they earn far more money than they would for regular deliveries.
Dr Uzma Shah | Hyderabad
writhing in pain called for attention, they’d snidely remark, ‘You all love having intercourse but when it’s time to have babies, you feel so much pain.”‘ These jibes were the extent of the medical help provided.
A huge part of the why the OB-GYN ward is a house of horrors [see stories on Page 2] is about how information about a woman’s body and well-being becomes privileged information — to the extent of the woman herself being deprived of that information.
Access to healthcare is yet not a reality for everyone and, even for those who can afford private healthcare, gendered norms often force women into a lack of awareness, guilt, moral judgments and character assassination. This is especially true for young women who decide to approach healthcare professionals on their own — not just for pregnancy-related affairs but also about personal sexual health.
Aasia Ali, a 28-year-old development sector professional, went to a gynaecologist with inflammation in her urinary tract. She initially contacted her friend who had graduated from medical school; the friend advised her to apply an ointment first. When that didn’t work, she recommended a tube, which had to be inserted inside her for the medicated liquid to be released. When that didn’t work either, she went to a gynaecologist at a private hospital. It tui ned out to be a yeast infection.
“1 kept asking her how was it caused but she did not give me a convincing answer” narrates Aasia. “She simply looked at me
judgmentally and I kept musing out loud about whether it was because 1 did not change my pad on time or whether I used a dirty washroom. But she barely looked up at me and made no effort to explain anything.”
Aasia then went on to tell her that although she was a virgin, she and her fiance had tried to fool around a little. She also told the gynaecologist that she had used a certain kind of tube that her friend had suggested.
“Upon hearing this she snapped and said. ‘What? We don’t recommend that to unmarried girls’ and continued to make me feel uncomfortable after she realised 1 was unmarried and trying to experiment with my fiance’.”
DEMONISING SEXUAL WELLBEING
Where knowledge ought to enlighten and broaden perspectives, it seems medical education in Pakistan is still confined by the mores of virtue and shame. The attitude in a large part of the medical community is extremely conservative — moral values and ethics taught in colleges often get repeated in practice across hospitals in Pakistan.
The provision of sexual education in the country seems to be an unfulfilled dream in the foreseeable future, as most people perceive sexual education to be an encouragement for young people to become sexually active. Unfortunately, as a result of this, sexual health suffers, particularly among women who have lesser access to healthcare and low levels of mobility. In addition to this, a woman who questions anything about her sexuality is considered to be bypassing the prescribed boundaries of honour and “haya’ [shame] that are considered a requirement for her to command basic respect.
Young medical graduates’ medical advice is often tied up with notions of shame — often to the detriment of the patient. Information isn’t passed on and critical knowledge is often compressed into two or three words. Many doctors today are simply not equipped to talk to their patients to explain what is going on and to answer any queries.
Dr Shazia Sharaf, a practicing gynaecologist in Islamabad, agrees with the notion that it is the doctor’s responsibility as a person in a privileged position, to help people understand what they are going through.
“A lot of times they are not able to find the right words when explaining their problem.” says Dr Shazia. “For instance, if I can guess that my patient is sexually active or might have had multiple sexual partners, it is my job to ask them and ensure they are using protection etc, all the while making sure that they are feeling safe. I ask them in a way that they don’t feel judged or scared. The responsibility falls on the doctor to make that call, how to ask and what words to choose.”
Even in situations where the doctor ought to have known belter, the case is often complicated by the doctor simply not
communicating with the patient. Most women interviewed for this story related that they have had to ask for specific details about their case rather than doctors explaining progress on the case as routine practice. The most common doctors’ response is a word or two — “normal” — before moving on.
Many also assume that a patient’s history is the same as routine. Very few seem to look into other ailments that could inform treatment. Even fewer take the woman’s consent as a necessity.
Shazia Zubair is mother to three. Like most paients, she is exhausted by the end of the day. Unlike most parents, however, it isn’t the parenting that drains her but excruciating pain in her joints. “1 was 19 when I conceived my first baby,” she narrates. “But I also had a history of arthritis. The doctor simply did not educate me about the kinds of side-effects an epidural could have. Now, after three children, doctors tell me that this excruciating pain in my joints is because of the epidurals administered to me.”
The downright abuse meted out in many OB-GYN wards simply reinforces the fear that women have of discovering their bodies and about their sexual wellbeing. Many women shy away because the pressure of being judged and made to feel guilty about maintaining their sexual wellbeing is too much. Dr Shazia is also cognizant that it takes a lot of guts in the first place to actually come up to the doctor with a problem. There are thousands who
SILENCE, PAGE 2
The doctor left post-operation procedures to junior staff. Fifteen days later, returned to the hospital because bleeding hadn’t stopped, was sent home without any explanation from the doctors. Another 15 days passed and I felt the same painful bleeding. My sister rushed me to another facility where doctors explained to us that my uterus had gotten severely infected. 99