WOW | Coffee Break

the power of female surgeons & the challenges of having it all

Surgery is predominantly considered a male career choice. However this trend, as with every other field, is changing gradually. In this edition of coffee break, we bring you four women surgeons who not only are breaking career barriers but are also accomplishing great heights of success in both professional and personal life with sheer hard work and determination. They are smart, efficient, accomplished, enjoy life to the fullest and are great role models as parents, doctors, and women of substance.

Dr. Jyoti Rayamajhi Rana
42, Libra, Married with one child
Education/ Area of specialisation: MBBS, MS General Surgery, Fellowship in Cosmetic and Reconstructive surgery from Medanta, India, Training in Breast Surgery, Singapore
Husband: Orthopaedic Surgeon

Dr. Jyoti Rayamajhi Rana is currently Assistant Professor of Surgery at Nepal Army Institute of Health Services. She received her undergraduate degree from Baldwin Girls High School, Bangalore and her medical degree from Manipal College of Medical Sciences. After serving in the Nepal Army she completed her general surgical residency at National Academy of Medical Sciences. Thereafter she started working as a Consultant Surgeon at the Norvic International Hospital apart from full time service at the Army Hospital. Dr. Jyoti then went to Medanta, India to do fellowship in Plastic, Cosmetic and Reconstructive Surgery. She also completed Surgical Oncology training in breast surgery at Singapore General Hospital.

What inspired you to become a doctor and choose your area of specialisation?

The medical profession is the only profession that involves improving someone’s quality of life or saving a life which in my opinion is intrinsically emotionally rewarding. There is something magical about being able to see the problem, fix it immediately, and move on to the next problem. It is like social work- you are able to do something meaningful and help people while you are doing a job. At the same time you get huge satisfaction as well as earn respect from people in return. It was my interaction with one of the female surgeons early on in medical school that cemented my passion for the field.

The surgical field is very challenging and can require doctors to stand on their feet for as long as 24 hours at a time. Surgery training itself is physically rigorous. The demands and stakes are daunting. Lives are literally on the line. As a result, female doctors traditionally have stayed away from surgery. Therefore, an overwhelming majority of surgeons are men. But then, surgery offers many paths and you need to decide what your priorities are, you also need to realise that you cannot do everything and that every decision comes with a tradeoff.

I just didn’t want to acquire a degree but wanted to make a mark in others lives.

During the course of my practice in general surgery, I found that for all the other problems except female related ones people preferred a male surgeon. However, the female populations irrespective of their age, both in rural and urban areas, were still hesitant to go to male doctors with breast related disease due to various social and cultural reasons despite the fact that breast cancer is the second most common cause of cancer deaths in Nepal. As a result, they were presented to the hospital in an advanced stage, and many just lost their lives and money. Therefore, I decided to focus on women’s health and issues such as breast onco and onco-plastic surgeries, cosmetic and reconstructive surgeries to be able to bring a significant impact in the lives of women of my country as well as the health sector in Nepal. I went to various places for training in breast and cosmetic surgery. Now I am doing Breast Onco-Plastic surgeries along with the general laparoscopic, reconstructive, cosmetic surgeries and GI surgeries.

I have been going to various rural and urban areas to raise awareness on breast cancer and give free consultation and treatment where possible.

Do you feel women doctors have to work extra hard to establish their credibility?

The real answer to the question is more complex than the typical girl versus boy conflict. Biases are more subtle, may be often not intentional, and take on different characteristics at different stages in a woman only to emphasise the man’s world in which all of us have entered, the conscious and unconscious prejudices we have all experienced along the way.

In a man’s world, as both a surgeon and an army officer, I have had some extraordinary experiences. Women in our profession rarely get recognised as a doctor, and almost never as a surgeon. I am most often confused for a nurse by the patients in the outpatient departments, and as a gynecologist amongst other professions in the hospital here and abroad.

In my earlier days, when I introduced myself as the consultant surgeon, patients often asked me when they were going to meet the operating doctor. I have watched patients ignore everything I say and continue to look to the xyz male trainee/ junior doctor or assistant for his opinion.

Being strong is one of the most important qualities for a career in surgery. Specially for us, we need to be physically strong and have a strong ego and strong work ethics just to keep going and show up every day without fail… even if the patient is not doing well, even if you don’t feel well, even if you made a mistake, even if you don’t get the promotion you want and even if your kids are sick at home. No matter what happens, being a surgeon is a responsibility that is with you 24 hours a day, 7 days a week.

Most times, I found myself having to work harder, having to justify my decisions and thoughts, and prove that I am worthy of being here. While I always expected to face these demands in my career, my male colleagues almost invariably never faced the same demands

How is it like working in Nepal?

Now, after many years in this field in Nepal, I also realised that for a woman surgeon no matter how good you are, it’s very difficult to stake a balance between personal and professional life. It is possible to be a great mom and a great surgeon, a great wife and a great teacher. But balance is difficult to maintain. One day the scale will be tipped more on one side; the next day it will tip the other way. So you can end up feeling off balance and torn despite all your hard work. For those who don’t have kids, having kids may mean less time dedicated to research and clinical care. Academic promotion may be slower. Conversely, not having kids may allow you to advance faster, but then you miss out on all the special things that come with having children. You may become full professor quickly or successful surgeon /leader.

Therefore women have to put an extra effort to balance their professional and personal lives but then, this is considered a sign of weakness in this male dominated field. Instead of acknowledging, appreciating and encouraging our efforts and deeds, we are always compared with male counterparts in the department.

Women have been engaged in activities that demand fine motor skills such as knitting or quilting since time immemorial. I believe this microscopic attention to detail and unwillingness to accept errors is of great benefit to patients – in the quality of our work, tying of our knots – the mechanical parts of the job in this most handson of medical professions. People still haven’t realised and accepted this fact of life.

In Nepal we are still struggling for acceptance to prove that even females are capable surgeons and leaders. We need to work harder to change the entire paradigm.

What do you do to establish better patient-doctor relationship?

Empathy, communication and patient care are the biggest tools to establish a better patient and doctor relationship. Even researchers have found that female doctors were more likely to spend time talking and listening to a patient and get more involved in patient care.

What does success mean to you?

Success is peace of mind which is a result of self satisfaction. To me success is not defined by prosperity or performance but by inner peace and happiness. It’s being able to sleep peacefully at night without guilt and getting up in the morning with a smile.

How do you maintain work-life balance?

My duty hours are very chaotic. Whenever I get time, I spend it with my family and close friends and I try to take out time, three times in a week to go to the gym. I avoid scheduling surgeries on Saturdays unless it’s an emergency.

What do you do for fun?

Socialise, watch movies and spend time with friends and family. I like to take part in breast cancer awareness programs as well and go for free health camps whenever feasible.

Something you would like to see changed in the medical field in Nepal?

  • The attitude of people towards the health sector and female surgeons. We have doctors who are more qualified than those outside of the country.
  • Females can be excellent and successful doctors.
  • Make health services available and accessible to all in rural and urban areas.
  • Open and promote medical insurance, and facilitate and also make the sectors accountable for its practices and policies.
  • There is stronger need of laws to identify and deal with unlicensed practitioners.
  • Empower women surgeons and physicians and provide them an amicable environment to work.
  • Representative sponsorship of individual doctors and regulate it with a policy and system at government level.
  • Cut down the cost price of drugs.
  • Encourage doctors to focus on clinics and patient care during office hours.
  • Have a reward and punishment system in all institutions.