After the one-year internship, there is still one question that lingers for most doctors: what speciality will you choose?
It is not just a professional choice. It deeply affects the kind of life you will lead.
Most female doctors in Kenya end up picking a speciality focused on women and children.
A recent study done at the University of Nairobi medical school showed the majority of women picked paediatrics, obstetrics and gynaecology.
Neurosurgery fell at the bottom of the list. As a result, there are only four women neurosurgeons in Kenya.
The Star sat with the four of them on Wednesday in Nairobi, during the ongoing fourth Annual Continental Association of African Neurosurgical Societies.
“Initially, it was strange, because surgery was dominantly male,” says Dr Sylvia Shitsama-Nyamweya, Kenya’s first female neurosurgeon, who joined the University of Nairobi’s neurosurgery residency programme in 2008.
“Then I found solace in knowing that while I may be the only one in neurosurgery, there are also women who are in surgery.”
Dr Shitsama graduated from her residency programme in 2015, becoming Kenya’s first female neurosurgeon.
A neurosurgeon is a medical doctor who diagnoses and treats conditions that affect the nervous system, which includes the brain, spinal cord and nerves.
She is currently lecturing medical students at the Jomo Kenyatta University of Agriculture and Technology.
Dr Shitsama is also the chairperson of the association of Kenyan women in neurosurgery.
She had already decided she would specialise in neurosurgery, way back in medical school.
While in medical school, she also attended a conference in Turkey and realised it was not just a Kenyan problem. This field is heavily patriarchal around the world.
“So I came back and said, okay, I have to make a difference. While I may not have mentors who look like me, then I will endeavour to be a mentor. I will work as a team with my peers and see, what difference can we make?”
In total, there are six Kenyan female neurosurgeons but two are practising in Canada and in the UK.
Only four are practising locally and they include Dr Shitsama, Dr Beverly Cheserem, Dr Susan Karanja and Dr Tracey John.
Dr Cheserem, an assistant professor at Aga Khan University Hospital in Nairobi, says Kenya is actually better off than most African countries.
“Kenya has probably higher a high proportion of women than even Western countries,” she says.
In Canada, for instance, there were 333 practising neurosurgeons in 2019, and only 36 were women.
“So it's actually higher than even America, United Kingdom, Germany. Yeah, even higher than South Africa, which has less than 10 women in over 200 neurosurgeons. The only other country that's an exception is Algeria, where apparently 70 per cent of the neurosurgeons are women,” she adds.
Cheserem also chairs the Kenya Association of Women Surgeons.
She says mentorship must begin in primary school where girls should be guided to choose the right subjects.
“But if people are being steered away from the subjects because they are not perceived as what would make women good mothers and wives, then they're less likely to present themselves even at the application stage,” she notes.
She says neurosurgery training also takes long.
A doctor must first practise for two years before being accepted for the six-year residency programme. Afterwards, one will need to practise under an established neurosurgeon for two years.
“So it takes very supportive spouses and parents to support you as you're going through your training. And that isn't always possible. At home, it is a woman who perhaps takes a step back to support the career of their husband, or brother. But here are four women who are telling you, the men in their lives, to support them.”
Dr Karanja, a consultant neurosurgeon at KNH, says many of the traditional gender roles must be broken to bring more women into surgery.“If you ever thought about it, in pictures the doctors, policemen, and firemen were all men. And photos of women have always been nurses, teachers, and caregivers. And so it starts from the very basic foundation of our education system, where we need to show children you can actually be anything you want to be,” she says.
Dr Karanja, who trained at the University of Kwa Zulu Natal, also calls for more flexibility in the training programmes.
“I think we'll get more women coming in if there’s some flexibility for the training to be more friendly to those who wish to start families. And even for our male colleagues. The South Africa system is a bit more relaxed.”
She notes the Kenyan system has a lot of exams every year. “In the South African system, it's more of you driving your training as you read and decide when you're ready for exams.”
Dr John is a consultant neurosurgeon at KNH and deputy director of medical services at the Ministry of Health.
She advises female surgeons to venture further into health management.
“That's one of the areas I also ventured into: health system management. Running and participating in the development and implementation of national policy in matters concerning medicine.”
She adds, “We also have to the purview of what is going on at the management level. How are the policies affecting the care that we're providing to the patients? How are the resources being distributed? Are we getting an allocation of resources in the right places in the right proportions?”
“And for me, that part of management, influencing national policy, or even international policy, it helps a lot, because then I'm able to make an impact or bigger impact by participating in decision making.”