Female docs run things

Gone are the days when men used to be in charge of all areas of health care in Jamaica’s public sector.

Now, women have grabbed the reins and dominate the major positions in the Ministry of Health and Wellness, as well as the regional offices, hospitals and other health facilities.

The highly visible Jacquiline Bisasor McKenzie occupies the lead position among medical employees at the health and wellness ministry, that of chief medical officer. She is ahead of nine others, only one of whom is a man — Dr Kevin Goulbourne, who serves as director, mental health and substance abuse services.

The eight other ministry officials are Dr Melody Ennis, director of family health; Dr Judith Leiba, director of child and adolescent mental health; Dr Nadine Williams, director of health services and planning; Dr Simone Spencer, director, health promotion protection; Dr Karen Webster Kerr, director, epidemiology; Dr Adriene Grant, director epidemiological research and data analysis; Dr Nicole Dawkins Wright, director, emergency disaster and special services; and Dr Beverly Wright, director.

Of the four regional technical directors, Dr Patrick Wheatle, who heads the North East Regional Health Authority, finds himself outnumbered by three women — Dr Vitillius Reid Holder, head of the Southern Regional Health Authority; Dr Dianne Campbell Stennett, who is in charge of the Western Regional Health Authority; and Dr Sandra Chambers, who has the loudest say, medically, in the South East Regional Health Authority, which includes the Corporate Area.

Women dominate 11 of the 13 parish medical offices. Those wielding their stethoscopes daily are Dr Tamika Henry in St Ann; her twin sister, Dr Tamara Henry in St Mary; Dr Sharon Lewis in Portland; Dr Francine Phillips Kelly, Dr Marcia Johnson Campbell, Dr Tanique Bailey (St James); Dr Dianne Jackson (St Thomas), Dr Francis Prosper Chen, Dr Pauline Weir, Dr Katherine Gordon Robinson, Dr Kemisha Shaw Kelly, Dr Carissa Burgess, and Dr Gail Evering Kerr (St Catherine), Dr Tonia Dawkins Beharie, Dr Kara Malcolm (St Elizabeth); Dr Nadine Williams (Manchester); Dr Kimberly Scarlett Campbell (Clarendon), Dr Diahann Dale (Trelawny), Dr Marcia Graham (Westmoreland), Dr Heather Reid Jones, Dr Debbie Carrington, Dr Kimberley Myers, and Dr Aleya Virgo Herron in Kingston and St Andrew.

The only male doctors listed as parish medical officers of health are Dr Andre McIntosh and Stephen Figueroa in Kingston and St Andrew; Dr D’Oyen Smith in St Thomas, and Dr Kaushal Singh in Hanover.

The parish medical officers are the ones primarily responsible for leading the fight against the novel coronavirus, in collaboration with the regional technical directors and the broader Ministry of Health and Wellness.

The numbers swing towards women again when senior medical officers at institutions are placed under the microscope.

It is this category that the male doctors show up best, although they still do not outnumber the women.

Dr Natalie Whylie, who is a ear, nose, throat and neck specialist, has arguably the toughest job of any health facility in Jamaica, as she heads the medical staff at Kingston Public Hospital, the largest institution in the English-speaking Caribbean, which has seen more trauma cases than those who built it envisioned it would have.

The other women leading medical procedures at other institutions are Dr Jacqueline Wright James at Spanish Town Hospital; Dr Ellena Codrington at Port Antonio Hospital; Dr Tanya Hamilton Johnson, who is in charge at St Ann’s Bay Hospital; Dr Sharon Walker, who recently took over from Dr Cecil Batchelor at Princess Margaret Hospital in Morant Bay, St Thomas; Dr Dingle Spence at Hope Institute; Dr Michelle-Ann Richards Dawson, the leading woman at Bustamante Hospital for Children; Dr Terry Baker at National Chest Hospital; and Dr Patrice Monthrope at Lucea Hospital.

Keeping the flag of the men flying are Dr Glenton Strachan (Annotto Bay Hospital), Dr Carlos Wilson (Percy Junor Hospital), Dr Garth McDonald (Victoria Jubilee Hospital), Dr Rory Dixon (Sir John Golding Rehab Centre), Dr Clive Thomas (Linstead Hospital), and Dr Bradley Edwards (May Pen Hospital), among others.

Health officials who spoke with the Jamaica Observer last week in informal and on-the-record discussions believe that the push by women to be less dependent on men in the health fraternity had resulted in them becoming more anxious to get qualified and outshine the rival sex.

Minister of Health and Wellness Dr Chris Tufton suggested, among other things, that women often stretched out a gentler hand in dealing with the sick, and had now commanded the confidence of those seeking medical care.

“The fact is that generally more females than males are pursuing advanced degrees in most disciplines. Unfortunately, our males are dropping out and this speaks to a more fundamental societal problem that needs to be addressed,” Dr Tufton said. “On the issue of more female doctors, however, this can be a good thing purely from the standpoint that women have been, for a long time, a dominant feature of our public health care system and significant contributors to its success.

“My experience is that our women tend to show more empathy to administering care, and this has carried significant therapeutic value. Not to take away from the contribution of our men, but I think our women represent the foundation of our public health infrastructure, particularly at the primary or community health care level, and that’s a big part of our success,” the minister stated.

Dean of the Faculty of Medical Sciences at The University of the West Indies (UWI), Mona Campus, Dr Tomlin Paul, said that nearly three quarters of the students who enter the institution were women, who were selected based purely on merit, which has become part of the norm in the Jamaican society today.

“I have seen the changes over the years. If you go back to the first class of medical students in 1948 about 50 per cent of that class were women. That was a pretty good balance in terms of the ratios at that time, but looking back I would say in the late 80s, early 90s, we began to see a shift in terms of the dominance, or increased proportion of women in the medical school,” Dr Paul said.

“I graduated in 1983 and we had a balance even back then of more males than females. If you look at the way we admit students at the medical faculty, essentially, much of it is based on academic merit, academic performance, so we look at academic scores… we do have some non-academic criteria which pertains to co-curricula involvement, but the dominant factor that we still rely on for entry is the academic performance of the student.

“We actually make no decision whether male or female when we select, but at the end of the day using the matrix of academic performance we end up with more female than male. Right now we are at 70 per cent being women, compared to men.”

Trinidad and Tobago-born Dr Paul suggested that a broad discussion, even a study, should be had on the subject to provide the kind of data that could finalise an informed judgement.

“I think we can track it back to the performance within the high school system where we are seeing girls doing better than boys. Some people argue that boys mature later than girls in terms of academics, but on the whole we need to interrogate the overall education system,” he said.

“We at the Faculty of Medical Sciences are not over-selecting women. We are selecting on merit. We are now in discussion and we have some work being done to look at expanding the balance in terms of the criteria that we look at for admission. So we are expecting in another year or two for us to have a more balanced set of criteria where the academic scores are still going to be important, we can’t get away from that, but we are going to look at some other variables,” the dean said.

Professor of Anatomical Pathology in the Department of Pathology at the Faculty of Medical Sciences at The UWI, Dr Carlos Escoffery, said it was not a surprise that women were dominating the public and private health sectors, as they had adequately positioned themselves for that positive movement from their student days at The UWI.

“It’s not a mystery. It’s a natural progression and a matter of overwhelming representation. The female bias in the medical faculty among the students, the intake of students over the past many years now, two decades or so, is palpable. We have noticed that there are more women coming in as students, and therefore more women graduating as doctors and therefore more women basically make up the working pool, so they saturate all areas,” he said.

“It’s not just the public health sector, it has also crossed over to the private. The question is, why are so many women coming into medicine as opposed to men? The whole university has become female dominant. The spectrum has changed. The women are more focused and getting advanced academically,” stated Professor Escoffery, who is also a consultant pathologist at University Hospital of the West Indies.

As for the men, Professor Escoffery, who rose from a poor background in Kingston Central to emerge as Kingston College’s top graduate of 1971 and transform into one of the foremost practitioners in his field, said that different priorities had engulfed young men, forcing them to seek alternative economic paths, thus squeezing their medical ambitions along the way.

“To a large extent the men are contemplating their financial existence as man and provider and they are quick to move away from straight academics and get into business and other stuff to earn more, rather than hang around in a faculty like medicine which is gonna take five years before you graduate, if you don’t fail anything, and then another year of internship which is hard work and low pay.

“Then, if you want to specialise you are going to do another four years, some of them another five years of post-grad. That kind of lag time isn’t attractive to the average young man, even the bright ones. They want to get up there, set up in business, do other things that turn around fast. My God, you become a practising attorney in the time it takes to graduate as an ordinary medical doctor. It’s three years in the law faculty, roughly two years in the law school, and bam! you are an attorney-at-law, capable of practising at the bar,” said Prof Escoffery.

From the perspective of women, Dr Bisasor McKenzie put the inequality in context.

“Women make up the majority of health professionals in the world and certainly in Jamaica where we see more women entering medical school than men. Generally, we do see that men, over the years, end up taking the leadership roles.

“Definitely at the political level we have seen men as ministers of health in Jamaica and right now across Caricom the majority of ministers with the health portfolio are male,” she said.

“Technically, however, we have seen a shift, certainly in public health, where women have taken the lead. The last WHO (World Health Organization) director general prior to now was female and the director for PAHO (Pan-American Health Organization) is female. Across Caricom, the present director for CARPHA (Caribbean Public Health Agency) is female and about half of the chief medical officers are female.

“In Jamaica, there is definitely a female preponderance in public health and primary care, but not so for secondary care where the majority of senior medical officers are male, Dr Bisasor McKenzie said.

“In public health, over the last 10 years, the post of chief medical officer has been occupied mostly by females. At the next level, presently, the four principal medical officers are female and at the RHA there are three female officers and only one male regional technical director.

“It is perhaps true that women tend to lean more towards public health than men, based on the ratios that I am seeing now. And perhaps the reasons for this stem from wanting to have some stability in life. However, it is not an easy road. Public health is a very demanding area of medicine. It is the public health arm in every country that sets the priorities and determines what your health system becomes at all levels. I worked hard as a consultant emergency physician for several years but this is all-consuming. I have great respect for all specialities but it wasn’t until I immersed myself in public health that I truly understood the nobleness and worthiness of this sometimes disregarded speciality of medicine,” she said.

The SMO said that the foundation for women’s success was laid by others before.

“The contribution of women in public health is not new. There are several public health leaders in this country that are men and have made outstanding contribution. There are several women as well who have made just as great contribution but I don’t believe that they are recognised as much. Women like Christine Moody, Deanna Ashley, Sheila Campbell Forrester, Marion Bullock Ducasse, Denise Eldemire Shearer and so many more have done outstanding work that is now the solid foundation that we stand on. It is perhaps just the times that we are in now where there is more publicity in these times of social media, where public health is now in the spotlight. But make no mistake, public health has been the silent, unnoticed strength and backbone of our health system for years. Public health has managed outbreaks of swine flu, polio, malaria successfully in the past. Whether noticed or unnoticed, the work continues,” Dr Bisasor McKenzie said.

“I believe, however, that women are in a good position in public health to show that we are capable of strong leadership. I believe that the nurturing nature of women allow us the patience to see a vision develop into reality while understanding and attending to the immediacy of urgencies and emergencies, but not allowing them to overwhelm the efforts of organisations to grow. Multi-tasking is second nature for many women. We put it to good use in medicine on a whole. A woman’s role in medicine is no less than a man’s. And yet we have so much more that we have to contribute to the well-being of our families. Yet we do it well, I believe with a lot less accolades, but nevertheless our best is just as great and sometimes greater,” she said.

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