On BBC Radio’s Today program earlier this fall, Dr Jyoti Shah spoke about the “hostile environment for women” in operating theatres. She also called for cultural change in the industry. In the interview below, Rhodes Project Executive Director, Dr Susan Rudy, speaks with Dr Shah about women’s resilience in the face of hostile personal and professional environments.
Susan Rudy: On BBC Radio’s Today program earlier this fall, you spoke about the “hostile environment for women” in operating theatres and called for cultural change in the industry. Could you tell us more about what you have experienced and the effects on women of sexist treatment?
Jyoti Shah: When I first started out 15 years ago, only 6% of consultant surgeons were female. It is still only about 8.6% for my own specialty. Overall, the figures at consultant level for surgeons are now 10.5 % and although an improvement, that is still not acceptable. At medical school, over 50 % of those entering the profession are female. The surgical profession is still dominated by male stereotypes. For example, I can operate on a patient, see them every day after, and be the one who tells them when they can go home. But the patient will still say “So when’s the doctor coming to see me?” and “What did they do?” This is because they expect the surgeon to be male. It’s these preconceived notions that we still need to break down.
Susan Rudy: Who do they think you are?
Jyoti Shah: That is an interesting question. Who do they think I am? The British Medical Association ran an online forum called Shit People Say to Women Doctors to which I contributed a piece. Through my reflections for that article, I realised that there has been no study in this country of how prevalent sexism is amongst women doctors. As a result, a colleague and I put together a questionnaire, which we sent out to members of the Medical Women’s Federation. I think the results will be interesting and just reading the comments are fascinating. Because of that blog, the BBC’s Today program wanted to interview me about gender discrimination facing female surgeons.
Susan Rudy: Can you tell us a bit more about your background? When were you born? What did your parents do?
Jyoti Shah: I was born in 1971 and am the oldest child in a traditional Indian family. I have a younger sister and brother. My father was a bus conductor in London in the open bus days and my mother was pretty much a housewife. Once we all went to school she started working part time at a supermarket. I come from a working class family and I went to a comprehensive school. From age eight, I wanted to be a doctor. No one in my family had ever been a doctor.
Susan Rudy: Tell me more about your family and its effect on you.
Jyoti Shah: My family and the community discouraged me from being a doctor because of the long training and long hours, which were not compatible with the expected role of an Indian woman at the time. When would I get married and have babies? If I did not get married and do the expected thing, what would happen to my younger siblings? That was the traditional view and that was my first hurdle. I was even more determined to fulfil my dream when the community discouraged me from following a medical career.
Susan Rudy: Do you remember feeling discouraged?
Jyoti Shah: Yes, absolutely. My school told me, “nobody has ever gone to medical school from here, Jyoti, so forget it.” I still remember thinking, however, that if I didn’t try I would never know whether I would succeed.
Susan Rudy: Did anyone help you?
Jyoti Shah: Not in those days because there was no one to help me. My school discouraged me and my family did not know how universities worked in Britain. My parents had come to England from India in the early 1960s. But I still said, “dad, I want to be a doctor.”
Susan Rudy: And you went to medical school in London?
Jyoti Shah: Yes. I did succeed in getting a place at Charing Cross and Westminster Medical School at a time when educational grants were available. I only moved out of London eight years ago when my circumstances changed.
Susan Rudy: How did you survive your student life?
Jyoti Shah: I got a job!
Susan Rudy: What did you do?
Jyoti Shah: I worked at the medical school library for £5 an hour. I put books back on the shelves from 5:00 until 8:00 pm, Monday to Friday, and from 9:00 am until 12:00 pm every Saturday. In the pre-clinical years, I worked during the summer breaks. In my first year, I got a job as an usher in a cinema at Leicester Square and within a year was promoted to popcorn lady. My rent was £25 a week and my earning was enough to get me through. During my last three years at medical school, I was a warden in the halls of residence, which meant I could live rent-free. I actually came out of medical school with some money in the bank! That is how I got through medical school.
Susan Rudy: Could you tell me a bit more about the cultural issues you faced?
Jyoti Shah: Yes. I was born and brought up in this country and lived a western life but ultimately my roots are traditionally Indian and it was expected that I would be married and I did get married while I was still at medical school.
Susan Rudy: How old were you when you married?
Jyoti Shah: Goodness. I was 22 or 23 and I married someone who ‘fit the bill’ so to say.
Susan Rudy: Is this the man I met earlier today, who took our photograph?
Jyoti Shah: No, that was my second husband. Unfortunately, my first husband was physically violent. It was a physically and mentally torturous relationship.
Susan Rudy: That is dreadful. Obviously, your parents would not have wanted that for you either.
Jyoti Shah: No. But they did not know what he was like. He seemed to be a handsome and successful lawyer with the gift of the gab. In those days (mid-1990s), people would say “Jyoti, what did you do for him to beat you?” I did get divorced but that was quite difficult for everybody. Culturally it was a very stressful and difficult time for me and my family who supported me throughout.
Susan Rudy: Did you have children?
Jyoti Shah: No. I was only married for only a year but it was still seen as a shame on the family and community. It took my self -confidence to the lowest point ever. The violence emerged very quickly in our marriage – a regular cycle that occurred every few days. I remember one episode where he had thrown a plate of food on the floor and of course I got a bit upset and I said, “you’ve made a mess on the floor; why did you do that?” He threw me on the floor and grabbed my hair – I had much longer hair than I do now – and shouted, “You want to eat? Eat it.” He tried to force me to eat off the floor.
Susan Rudy: I am so sorry.
Jyoti Shah: Women go through this even now, don’t they? For me that was a particularly low point.
Susan Rudy: Did you charge him?
Jyoti Shah: Yes. I phoned the police. In those days, domestic violence was not taken seriously. I remember that one time the police came and he managed to talk himself out of it so I was made to look the fool. It was not until I was hospitalised for three days that I finally had the courage to say that I was not going back to him. The Domestic Violence Unit came to see me in the hospital and insisted that I needed to get an injunction against him. My parents didn’t have a clue because they didn’t know what was going on, so it was a whirlwind for everyone. It was so alien to everybody. Where do you go? What do you do? I take the view that God gives you strength when you need it and that’s true resilience. I think as women, we naturally just fight back when we are cornered. He was arrested but all he received was a fine and a criminal record for “common assault.” He tried to appeal because he was a lawyer. Luckily, he didn’t win. Still he ignored the injunction. He would be outside my window and say “Come out you bitch or I’ll set your house on fire.” Injunctions are just a piece of paper to such people. But it didn’t kill me and I survived. I managed to get through medical school and pass my exams. It was a long time ago but I suppose the scars are always there.
Susan Rudy: You have an extraordinary amount of resilience to have carried on in the way that you did. Was this experience connected to the reasons why you became a surgeon?
Jyoti Shah: Throughout medical school, you are exposed to lots of different specialties and through that exposure I realised that I didn’t just want to be a doctor. I wanted to be a surgeon because I liked the discipline of making a difference.
Susan Rudy: How do surgeons make a difference?
Jyoti Shah: All specialties make a difference in the sense that they make people better, but for me there is a quick and more tangible result. When someone comes in poorly and I operate on them, they are better. Here is a simple example. A man comes in to the hospital who cannot pass urine and is in agony. No amount of morphine is going to make them better until you put a catheter in and then they are better. I then operate on them, and they no longer need the catheter. They are now peeing like a 20 year old even if they are 80! These are the people who send me hand-written letters to say “Dear Ms Shah, thank you so much.” “You’ve given me back my joie de vive”. Every year I get around 70 hand written cards and letters from my patients, which is quite unusual and that’s what keeps me going. I love it.
For me, being a female surgeon is a definite strength. When my male patients are sitting in front of me and they’re desperate to cry, I can put my hand out and I can give them a hug and this is something that my male colleagues can’t do that. So that’s, I suppose, how I became a urological surgeon and I love it.
Susan Rudy: Did you feel that, given the difficult experience you have had in your personal life, you have been wary of situations in which men might be badly behaved?
Jyoti Shah: Yes. I spent a long time on my own after my marriage because I was extremely wary of men. Many of my patients are male because of their prostate problems. But yes, I have been wary of men. It has taken me a very long time. I only remarried eight years ago
Susan Rudy: Tell me more about your husband.
Jyoti Shah: He has an unusual background. He earned a Bachelor’s degree in psychology and a Masters in criminology from Cambridge. Then he did postgraduate studies in broadcast journalism, as he wanted to use media as a life-enhancing tool for social development. He was a senior executive at the BBC and, more recently, a media specialist working for public organisations such as the Council of Europe and government-led projects.
Susan Rudy: Where did you meet?
Jyoti Shah: Through a mutual friend who said, “you can’t spend the rest of your life alone.” By then I was already in my mid-30s.
Susan Rudy: Do you have children?
Jyoti Shah: No. By the time Paresh and I met it was too late, I guess.
Susan Rudy: Is he older than you?
Jyoti Shah: He is a little bit older. I was in my late 30s and by the time we married and settled, it just didn’t happen and that was the price I paid for meeting him late in my life.
Susan Rudy: Does it feel like that to you?
Jyoti Shah: Yes. I would have loved to have children. But we don’t get everything we want in life. You’ve got to move on and say “that wasn’t meant to be. I am grateful for what I have. I’ve got to do other things.” I have a wonderful nephew and niece who come and spend time with me.
Susan Rudy: Can you tell me a bit more about your workplace context now?
Jyoti Shah: I work in a district general hospital now. I also examine, teach, and have several editorial roles. That has made a huge difference in my life. When I teach and when people are hungry to learn, both the trainees and teacher get inspired. That is what helps to create the next generation of high quality doctors.
Susan Rudy: How do you manage all of these responsibilities?
Jyoti Shah: Well, they are all different roles and I will just keep going as long as I am interested and I can make a difference. I have taken a pay cut to do more voluntary roles for the wider public good. As a principal, I do not do private practice because I do not want money to influence how I look after my patients; it is what I want to do. I just want to give back something for the greater good.
Susan Rudy: Your work sounds extraordinarily important to you.
Jyoti Shah: Yes. I take it very seriously because it involves people’s lives. My mum, my dad, your mum, your dad, someone we love. I have always said, I will do for you what I would do if you were my mother or father sitting in front of me - what would I want for them?
Susan Rudy: How many hours a week do you think you work?
Jyoti Shah: I have no idea but my day usually starts at about 6:00 am. I do some of my daily chores early in the morning. For example, this morning I hoovered my house because my cleaner phoned in sick. Paresh thought I was completely insane but it had to be done,
At least five times a week in the morning I go to the gym as staying physically fit helps with my mental fitness. That’s my time. I get home after 7.30 pm or most likely later followed by a quick supper and more work or chores. It is always a long day.
Susan Rudy: And is your husband’s life as busy?
Jyoti Shah: He is busy too, partly because he travels a lot and, working in the media, there are no set times.
Susan Rudy: Do you have women friends?
Jyoti Shah: Yes, that’s been quite key for me. My core group of friends are my school friends from when I was nine years old. We are like sisters. There are three of us and I gravitate toward them when there is really a problem. They are my trusted inner circle. At work there’s a core group of us who meet each other regularly for support. When in need, we call on each other anytime. Supportive friends are, I think, essential for any woman in any walk of life. It stops the isolation. But the biggest and the most powerful support for me is Paresh at home. He is absolutely my rock.
Susan Rudy: Can we speak a bit more about your appearance on the BBC Today program? I was so moved by what you said and your unequivocal call for change.
Jyoti Shah: Yes, it needs to happen.
Susan Rudy: In your view, what needs to happen?
Jyoti Shah: There are gender disparities in many, many vocations. It is not just surgery. But as a surgeon, I want to know why in 2015 we still have only 1 in 10 women at consultant level. The problem I think is that, as women, we doubt ourselves, don’t we? I think that certain behaviour denigrates women and devalues us - particularly in the professional workplace. We end up losing our self-confidence and self-belief.
Susan Rudy: Is your speaking out a form of resistance to treatment that denigrates you?
Jyoti Shah: I think women have to speak out. Otherwise, how is this situation going to change? If we do not challenge it, we allow it, and it becomes normal and then it becomes ingrained in behaviour. If you do something and get away with it, you will continue to do it. Opening up the discussion as we have done this year is a big step and I am now in a position where I can speak out. For instance, I have recently been asked to speak at an emerging leaders program for women at the Royal College of Surgeons.
Susan Rudy: Did your decision to stand up to your abusive first husband have an effect on your decision to speak out now?
Jyoti Shah: I got divorced in 1995. I did not speak up about my domestic violence background publicly. Only my close friends knew about it. I am now able to say to people that domestic violence transcends boundaries. It transcends vocations, professions, social classes. It can happen to anyone. What is important is to say that although it can happen to anyone, you can survive it. I did. If one woman is able to walk out of a violent relationship by hearing my story, I will have made a difference.
If someone wants to be a surgeon, and their mum, dad, community, school or anyone says “don’t be silly, you can’t be a surgeon,” I say, “oh yes you can. Come and knock on my door, I’ll show you how.”
Dr Jyoti Shah is a Consultant Urological Surgeon in the West Midlands. After graduating from Charing Cross & Westminster Medical School, she completed her postgraduate urological training in London before taking up a permanent consultant post in 2008 at Burton Hospital. Dr Shah is also an academic and has published dozens of articles, book chapters and books. She is Editor-in-Chief of Medical Woman, Commissioning Editor of the Annals & Bulletin of the Royal College of Surgeons of England, a reviewer for 13 International journals, an examiner, a Royal College assessor for urology consultant interviews, a mentor and a teacher. Recent honours include the Chairman’s Award at the 2015 Asian Women of Achievement Awards.