It was 11.30 pm and Aparna Jaswal had just about settled down when she got a message. The director of cardiac electrophysiology and pacing at Fortis Escorts Heart Institute, Delhi, decided to read it as there were no emergencies to handle and her patients were stable. It was from a medical student who wanted to take up cardiac surgery, had even got a seat in cardiology, but was unsure of her choice. “Her friends and family had dissuaded her saying career opportunities were limited as patients preferred men over women surgeons. I told her what I did. I locate what causes arrhythmia or irregular heartbeats, burn and scar the heart tissue that causes them and implant complex devices to save lives. I also told her that we were just 400 women doing this in the country and we could surely use more hands to prevent sudden deaths,” she says. Though there aren’t many women open heart surgeons, the likes of Jaswal are waiting in the wings.
This conversation certainly points to the broader question on the lack of women surgeons in India. Often seen as the preserve of men, there are fewer women cardio, neuro, cancer and transplant surgeons compared to those in gynaecology, paediatrics, cosmetology, dentistry and dermatology, which are seen as women-friendly paths. The gender mismatch seems conspicuous, considering that women in science and research have made significant strides in leading teams and taking on independent projects. Be it cultural conditioning, punishing hours in the operation theatre (OT) that often conflict with family time, the sheer physical stress of the job, trust deficit or the resistance of male peers — women surgeons in India have an uphill task to make their presence, more importantly, their skills, felt.
Global figures too, are dismal. According to an editorial in the Indian Journal of Colo-Rectal Surgery (September 2022), “Despite the fact that the US had its first female surgeon as early as 1855, women still form a mere 22 per cent of the surgeons there.” The Association of Surgeons of India (ASI) has 32,000 members, 4,160 of whom are women, just 12.5 per cent. But there is a story beyond the numbers, says Dr Sanjay Jain, ASI president and professor of surgery, Gandhi Medical College, Bhopal. “Over the last five years, the number of women surgeon members has doubled, which is a positive uptick. Admittedly, fewer women are at the top because the number of girl students was abysmal in the early years compared to today. Even fewer became surgeons, so the pool was small to begin with. Currently, in my institution, more than 25 per cent of medical students are girls and by 2030, I expect the number to go up to 30 per cent. Social biases are changing and there is acceptance that talent is gender-agnostic; give it some incubation time,” says Jain.
Dr Lekha Pathak is India’s first woman interventional cardiologist, who has been on the medical team of presidents and governors (Credit: Amit Chakravarty)
But most women surgeons believe that till there is 50:50 representation in MBBS courses, parity is a distant dream. For the few that have made it to the top, it has taken humongous effort to crash both social and psychological barriers. Ask Dr Lekha Pathak, 78, India’s first woman interventional cardiologist, who has been on the medical team of presidents and governors, and is now head of department, cardiology, Nanavati Max Hospital, Mumbai. “The only factor is resolve. My father died of a massive heart attack when I was just six. I decided then and there that I would save other dads and families. While doing my DM in cardiology at Mumbai’s KEM Hospital, I chose emergency room duty where you had to be on call 24 hours and make on-the-spot diagnosis. I got that because nobody else volunteered. I opted for coronary interventions while training abroad where male teachers encouraged me by taking me on their ward rounds. So, a lot of it was self-motivation and self-initiation. And though my male teachers at KEM nurtured me, my male colleagues undermined me, trying to steal patients and conniving to keep me out of challenging cases,” she says, “They would ask me, ‘Why don’t you do paediatric cardiology?’” So, she volunteered for emergency procedures at night and waited on her patients till they stabilised. Her mother stood like a rock, waiting it out with her. Now she has more men than women as patients. “Cardiology is for women, their thinking and decisive power are better,” says Pathak, who takes a break for immediate stenting in a 17-year-old-girl with blocked arteries. Currently, she is working on compiling data to focus on the increasing cardiac risk among young Indian women under 30.
Jaswal, 52, concurs with Pathak, saying, “Cardiology needs more women, because genetically, women have a higher emotional quotient (EQ) and compassion, which make the patient more comfortable.” Much younger in years and born to an IITian father who nurtured scientific temper in his daughters, Jaswal has faced far less gender bias. Probably because as a cardiac electrophysiologist, she has demonstrated that she is up for physical challenges, wearing the heavy lead apron and radiation protective gear during a procedure, and keeping to the rigour of discipline and focus. “In India, there is no dearth of work. The real issue is passion, drive and commitment, without which you should not be a surgeon,” says Jaswal.
Dr Sonal Gupta, director and head of department, neurosurgery at Fortis, Delhi, self-drove her way into a territory that was forbidden in her time. Even now, women make up just three per cent of the neurosurgical workforce of the country. Coming from a small village of Tuna in Gujarat that had no electricity when she was growing up, the 54-year-old remembers how her parents, the richest people in the village but not educated enough (her father was a class V dropout and her mother studied till Class IX), would bandage the poor when a skin epidemic broke out. “It was 1974 and the registered medical practitioner was charging Re 1 per bandage, exorbitant back then. I was determined that I had to be a doctor to take care of my village,” she says.
It was during her internship at Baroda Medical College that she got to work in a neurosurgeon’s nursing home. “It was a small facility, so I assisted him in the OT as well as administration. I even qualified for AIIMS, NIMHANS (Delhi) and Sri Chitra Institute of Medical Sciences (Thiruvananthapuram). I chose the last but in the second year, a teacher told me that I was wasting a seat in neurosurgery,” recalls Gupta. She worked hard to prove him wrong, despite losing a year to tuberculosis, and became an assistant professor at AIIMS, New Delhi. That run did not last either as her husband moved to the UK. When she came back three years later, having divorced him, she couldn’t get her AIIMS job back. That’s when she decided to start private practice and become a consultant neurosurgeon at hospitals in northwest Delhi.
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Dr Aparna Jaswal says cardiology needs more women, because they have a higher emotional quotient, which makes the patient more comfortable.
She found her mentor in Dr Ved Prakash at Maharaja Agrasen Hospital in Punjabi Bagh, New Delhi, who groomed her and let her in on all his surgeries. That’s how she got into the thick of things and learnt how to manage complex procedures with limited infrastructure. “Back in the day, be it Agrasen or Tirath Ram, none of the hospitals in west Delhi had trained staff, neuro ICUs or after-care facilities. So, I would do 12-hour surgeries, then wait another four hours monitoring my patient’s progress and supervising care protocols,” says Gupta. That dedication won her people’s faith.
“There was a time when the mother of a 21-year-old boy with a severe head injury and a life window of just 30 minutes wouldn’t let me touch him until Dr Prakash showed up. The initial years were tough. Now, my patient base of 15 years sustains me and today, they even call me to their family events. Their girls seek advice, asking what sub-specialisation they should take up. This guidance is valuable, something I never had much of, as a student,” Gupta adds. And though she still wants to go back to Tuna, she assists an organisation that subsidises brain surgeries.
Dr Ramesh Sarin battled both gender and race bias on her way to becoming a respected surgical oncologist. Now among the most sought-after experts at Indraprastha Apollo Hospital, New Delhi, she was one of the 17 women medical students in the third batch at AIIMS (1965), and a rather impatient one at that. “I wanted immediate results and see the transformative power of medicine before my eyes. There’s immediate gratification about surgery,” says the 80-year-old, during a break from an overflowing OPD.
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“Cancer surgery happened when I was pursuing my FRCS degree in the UK. For the six years I worked there, I saw no female surgeons who were White. A prized job would anyway go to a White person, no matter how skilled or talented a non-White person was,” says Sarin.
She would report at 6 or 7 am, one hour before her senior would begin his ward rounds, complete all investigations and reviews so that he had very little to do. “I worked that much harder, to get a close understanding of complicated cases,” says Sarin. That gave her an edge. Her senior would ask her to close up the patient as thyroid and glandular surgeries cause a lot of bleeding. “I was good at stopping bleeds and they couldn’t do without me,” she says. “Now 98 per cent of my patients only consult me. That’s the trust I have got.”
Her colleague in the same hospital, Dr Sarika Gupta, senior consultant, oncology and robotic gynaecology, feels now is a good time for women in the medical field to consider surgery as a first choice. “Even toppers do not choose surgery courses,” she says. Coming from an orthodox family in Meerut, she devoted six years to gynaecology as she was told it had the lowest risk and she could set up a home clinic. “I hated it and took up oncology and onco-surgery after I got married to a progressive doctor from AIIMS and became a mother. That’s how I broke the gendered stereotype,” adds the 44-year-old.
Dr Sonal Gupta, a neurosurgeon, worked in west Delhi hospitals at a time when they hardly had trained staff, neuro ICUs or after-care facilities.
But does the exhaustive nature of a surgeon’s work come in the way of family commitments? Or, is setting up one’s own clinic in gynaecology, dentistry, ophthalmology or cosmetology more rewarding financially? “Surgery is not a time-bound job. You cannot take a call from home in the middle of a surgery; your family has to come second. You may not be able to drop your kids to school or cannot give in when they say, ‘Mom, I need you now.’ But dads are surgeons, too. So, women must help their kids develop equal respect for the hospital duties of both parents. Of course, one needs to build a support system, be it with family or caregivers, and share stories of each of your patients. That’s how you shape their perspective,” says Sarika.
Sarin, who is married to a non-medical professional, feels the sense of parental guilt has increased nowadays because schools are demanding. “In our time, parents blissfully sent their kids to school. Nowadays, parents have to be there at PTAs. But you have to develop a bit of a thick skin, do the job and come back with a clean mind. Don’t bring the hospital home and don’t hate your job if you want to be a surgeon. Just because it doesn’t come easy, doesn’t mean you are not going to try it,” she says.
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As we take leave, her interns mill about her seeking advice. Some want to be uro-surgeons while some are considering gastrointestinal tract, orthopaedic and out-of-the box surgeries where they, as women, can leave a mark.
Ahead of International Women’s Day, a look at why there are so few women surgeons in India - The Indian Express
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