Inside Medicine: Mixed feelings after lecturing for Saudis

The large, modern, wood- paneled hospital auditorium was filled to capacity as I finished my lecture at a new medical school in Riyadh, Saudi Arabia.

I had decided to make a special effort not to ignore the distant back-left corner of the auditorium. That is where the 100 or so female doctors were sitting. They all appeared to be dressed alike, wearing the jet-black abaya (robe), a head shawl, and a feesha, or facial covering. All that could be seen were their dark-brown, inquisitive eyes. Just below the hem of their robe was the only fashion statement visible – shoes of all sorts of designs and colors from shimmering gold and silver to a pair of bright-red sneakers.

Following the lecture, there was a flurry of questions from the audience, but none from the women. During the short break that followed I was surrounded by women who had insightful, informed medical questions. Many of the women spoke English far better than their male counterparts. It was an odd feeling, as not one person looked me in the eyes when they asked a question. After 20 minutes there was only one woman left. Her veil was unusually low on her face – almost to her neck – allowing me to see her entire face. She wore dark mascara and tiny, gold earrings. Below her robe I could barely make out the hem of her white slacks.

She shook my hand – the men all greeted me with a handshake as they introduced themselves. But such contact between a man and a woman is strictly forbidden in Saudi Arabia.

"I could see you are making a special effort to speak to the women doctors," she said.

She introduced herself to me as Anna, and appeared to be in her mid-30s. She asked permission to ask me a personal question, then went on to explain that for nine years she had lived in California, where she and her brother went to school, hoping she would learn the skills of an American pediatrician and bring them back to Saudi Arabia to train future doctors.

This effort to send physicians abroad is part of a major government effort to build Saudi Arabia into a regional powerhouse of medical care and research.

Anna had been back in Saudi Arabia for two years. As we spoke, we strolled toward the back of the auditorium and sat down on two folding chairs. She described how much she appreciated having a chance to train in the United States. She reported learning so much – some of it medicine, but some not. She made a number of friends, learned to drive a car and to have the confidence enough to socialize as an equal with men, to wear western clothing, and to learn about other religions and worldviews. She also learned to advocate for herself.

But the blessing was mixed. She now finds her life in Saudi Arabia intolerable – both personally and professionally. She cannot build her career because men are threatened by her knowledge and her ideas for change; they won't even meet with her. Socially, she can't go out at night or socialize with men. Professionally, she must sit in the back of the auditorium, she can train only females, and she must wear traditional attire.

Her question to me was simple: Should she stay and try to change the system so other women would benefit? She described this route as amounting to a lifetime of battles, a stagnant career and the likelihood that she might never find a husband who would tolerate her free spirit and western thoughts.

Or, she could return to the United States, where she would be welcomed back to her old job and live her life as she wished, although this would bring shame to her family.

I explained that I felt uncomfortable offering an opinion because the issues were so complex. There were tears rolling from her large, dark- brown eyes.

Out of nowhere, an older woman came up to Anna and whispered something in her ear. As the woman walked off she told me, "I must go. It is not proper for me to be sitting here with you without another woman present."

We were, after all. sitting in the back of a 500-person auditorium. I asked if she'd prefer to step outside the building, where there were many women (the men were all congregating in the air-conditioned lobby).

"No, this would not be proper for you to join the women."

I asked if we could talk later, but she didn't reply. Over the next week I looked for her in the auditorium.

Each time I spotted her she gave me a little wave. But she never came up to me again.

As Americans reach out to train foreign doctors, nurses and researchers, our intentions are great, and in most cases I hope that their society ends up the better for our efforts.

But I wonder how often we create internal chaos for those who come to learn science, but also learn about the American way of life that can not be duplicated back home.

About the writer:

• Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Identifying characteristics of patients mentioned in his column are changed to protect their confidentiality. Reach him at drwilkes@sacbee.com.