The doctor brides of Pakistan: Fact or myth?

I happened to meet a Pakistani mover and shaker a while back. You know the type: They talk about Pakistani problems in a distinctly firangi accent.

Their offices are decorated in enough Persian couplets and shiny diplomas to showcase their foreign qualifications and eastern aesthetics in equal measure.

They drop hints at every turn in the conversation about the number of projects they have been recently directing.

The moment they get a chance, they tell you about how many American journalists have asked for their interview.

By way of introduction, I mentioned that I had recently completed my PhD on women doctors of Pakistan.

Then, I held my breath for the predictable response.

“Oh? So, you must know about these ‘doctor brides’ who become doctors only to be able to find good matches, right?”

Ah…

Ever since I started my fieldwork in Pakistan back in September, 2015 ‘doctor brides’ is a phrase that has been chasing me.

The story goes something like this: A Pakistani woman becomes a doctor. An amazing achievement, right? Well, think again. As it turns out, it is quite likely she will never practice.

Because she is a doctor, she is quite a catch in the marriage market. Pakistani mothers-in-law would do anything to get a doctor bahu for their precious sons. It is a sign of self-importance and prestige to have a lady doctor as a wife or daughter-in-law.

Rafia Zakaria used the term ‘doctor brides’ to describe this phenomenon back in 2013, and the term stuck. Even though the idea of a doctor bahu has been silently percolating in the society for quite a while, it exploded into mainstream media after that.

Adding fuel to the fire, in late 2014, the Pakistan Medical and Dental Council (PMDC) tried to impose a quota on admission of women in medical colleges (restricting them to 50% of available positions) in a perverse affirmative action for men. The decision was later struck down by the Lahore High Court.

Everyone jumped on the bandwagon. Local and international media did sensational pieces on these remarkable (or pitiable?) women who, despite being highly educated, continued to act on the age-old script of patriarchy and backwardness, getting a degree for marriage, leaving their careers for family and tradition.

I heard it all. I have been hearing it since before anyone talked about it.

I was a doctor once. I sat on the benches crammed with eager medical students in a lecture hall. It was no ordinary institution either. Its iconic brick buildings and verandas designed in the style of an Italian villa, practically dripped with tradition.

We were a fairly even batch, just about half of us girls. The fact was mentioned to us many times, sometimes in slightly disappointed tones.

I secretly felt proud, as if taking over a ‘masculine’ profession was something of my personal doing.

Then one day a teacher stood in front of us and told us in an emphatic voice that each and every one of the girls has usurped that seat from a ‘more deserving boy.’

“What use is that degree to you?” he asked. “Medicine requires hard work and devotion. You are all going to get married and leave the profession. The degree will go to waste. A boy could have fed his family with this education.”

I was a coward that day. I wanted to stand up and tell him that he had no right to judge us.

I did not. I only secretly vowed to someday be much, much better than him.

The subject of women dominating the medical colleges kept resurfacing again and again. Sometimes, almost jokingly: “This was a better place when there were fewer girls here.”

At other times, in hints bias: “You know that professor doesn’t fail girls because that delays their marriage. But he won’t give them medals either; what use would that be to a girl?”

Perhaps these not-so-subtle jabs, and an uneasy feeling of something unsettlingly wrong with my society, made me switch from medicine to anthropology.

When the time came to decide on a research area, not surprisingly, I picked women doctors in Pakistan.

When I started my work, I was almost instantaneously hit with a barrage of statistics, all equally dismal and disheartening.

Women comprise more than 80% of enrollments in Pakistan’s medical colleges. That is a number unmatched even in the US and the UK. But more than 50% of these women doctors do not go on to work.

Pakistan’s health sector is in dire straits, yet women doctors continue to choose medicine only to be good matches in marriage. What a neat little narrative! Shame on women doctors indeed!

Only, that is not the whole truth.

Nobody knows what percentage of women doctors are working. I should know. I tried to find out. No medical institution, college or university, tracks the career progression of their graduates.

The PMDC does collect some data: They know when a doctor registers with them to practice, or enrolls in advanced specialisation programmes.

According to them, in 2016 alone, 66% of the doctors registering with them to practice, were women. And this percentage has been rising almost steadily every year.

So where does the misconception, that a majority of women doctors end up not working, originate?

It turns out, these statistics are just bad science. The number these movers and shakers like to cite is the aggregate percentage of women doctors in the current workforce. They forget that women doctors have only recently overtaken men in the medical profession.

The first time more women than men registered to practice with the PMDC was in 2004, after centuries of male dominance which did not create any discomfort at all.

This sure but gradual change will take some time to reflect in overall numbers, a process aptly called demographic inertia.

Even though that should put some dent in the argument of doctor brides, it is still not the whole truth.

The high school enrollment statistics in Pakistan indicate that male students overwhelmingly opted for non-medical tracks. It’s not just that women want to be doctors, it is also that men do not want to be doctors anymore. And it is not difficult to see why.

Sarmad, a medical officer in a public hospital, explained the phenomenon to me: “A doctor, after five years of study, is nowhere financially. Nobody hires a simple doctor, you have to be a specialist.

During specialisation, you are lucky if you get paid Rs 70,000-80,000 per month. That is not enough to support your family. An engineer, fresh out of university, earns ten times more than that.”

The fact that, medicine, a humble and low-paying profession for new entrants (as it has become in Pakistan), has lost its appeal to men, is seldom mentioned.

And the coveted men doctors, where are they, you ask? They leave Pakistan to work where work is good.

Do you know how many men doctors leave Pakistan to practice in UAE, Saudi Arabia, UK, Australia, and US every year?

According to a study, in Aga Khan University, 900 out of 1,100 graduates in 2004 left Pakistan after graduation. Only a few ever returned.

Pakistan is the third-largest exporter of health personnel to developed countries. Most of these doctors go on visa programmes that require these doctors to work in under-served, rural areas. Ironic, isn’t it?

But you won’t see these facts being paraded in the media when someone mentions shortage of health personnel in Pakistan.

You won’t see a mention of recovery of fees, or a hefty fine, or quota on men because they are kamao poot: the sons who earn (foreign) remittances.

Make no mistake, the consequences of attrition of doctors are heart shattering. Pakistan has one of the lowest doctor-to-patient ratio in the world, and (except Afghanistan) the highest maternal mortality rate in the region.

One in 89 women in Pakistan dies of pregnancy- and childbirth-related complications. It seems Pakistani women end up paying the price, whether they are doctors or patients.

So, to answer your question, dear person, being asked of me for the umpteenth time: Yes, I know a lot about the doctor brides of Pakistan. I think they do not exist.

I think it is a convenient story that people like to tell because it allows them to remain oblivious to the harsher truths about the status of the medical profession in Pakistan. It allows them to ignore that medical education in Pakistan has scarcely changed in the past century.

Also, the fact that an eight-hour work day (a norm for medical workers everywhere else in the world) is still an unachievable utopia in Pakistan, is cast aside.

It lets our training institutions pride themselves on their gruelling work schedules and load, and our surgical departments still carry on the tradition of ward weeks for young trainees.

We like retelling this narrative because it allows us to feign ignorance to the fact that only teaching hospitals are required by law to provide day-care centres to their employees. These are barely functioning, threadbare facilities which operate only during office hours for kids of school-going age.

We never seem to want to talk about that sacred cow: Our pride and our joy, our traditional family system and our values, which have allowed men to escape any responsibility towards their parents and their children.

It is this system which shifts the burden of care to next generation of younger women while men are only expected to bring in the money and pay the bills.

We like to revel in the story of doctor brides because it seems familiar to our ears, because that is what we expect of our women, isn’t it? Giving it all up for family, quietly, and happily.

We do not want to acknowledge that Pakistani women can have ambitions other than getting married, having children, and squabbling with their saas.

We want to remain blissfully unaware of the struggle a doctor endures every day, at home and at work, till she gives up, exhausted, and demoralised.

We also do not know the tears and restless nights these women spend, trying to make their career and their families work, in a society that has been stuck in an anachronistic time loop.

Let our women doctors be.

Because in the end, when Pakistani men left for greener pastures, it is the women who stayed home and worked.

 The Article First Appeared In Dawn

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