Women in Dentistry: Female Dentists in Conservative Muslim Nations Face Challenges and Threats Elizabeth J. Fleming, DDS,



Have you ever wondered about being a female in a Muslim country? How about being a female dentist in a Muslim country? Through social media I met Dr. Asma Sabah and talked with her about being a female dentist in Basrah, Iraq.

Before interviewing her, I asked whether it would be dangerous for her to participate. She said, "No. It would be fine."

I was relieved, but not completely.

Just this past summer, militants captured and executed female dentist Rou'aa Diab along the Iraqi border. The details are sketchy and sparse, as media coverage of the incident was minimal. According to some reports, the victim's father was told that Rou'aa was killed because of her affiliation with a rival political group. Other sources cited the reason for the execution to be "treating male patients."

Imagine being threatened, or much worse, killed, for doing what you were trained to do: dentistry. Would you feel comfortable treating members of the opposite sex in such a conservative religious area? Would your unease force you to limit treatment to women?

What a huge challenge for women in these regions. I feel lucky to be a business owner in a free country, making my own decisions on treatment modalities and patients treated without being fearful of radical terrorists forcing their beliefs on me.

Fortunately, dentistry has gone well so far for Sabah, who I mentioned earlier. According to Sabah, preparation for dental education in Iraq starts in high school, when it's common for a student to choose either a science or literature focus. If a student chooses science and excels (94 percent or higher), government universities will fully fund them. Most high-scoring, high-school-male science students go into medicine or engineering, and the high-scoring female students generally go into pharmacology or dentistry. Iraqis tend to make career choices based on the odds of gainful employment, rather than to pursue their dream career, Sabah said.

There are a handful of dental schools scattered throughout Iraq and they offer the same opportunities for women as for men. For dentistry, the curriculum length is five years beyond high school and the classes include lectures and clinical dentistry. "Repayment" for the education is done by rotations through either the community health-insurance system or government clinics for a two-year time period, after which the student becomes certified to practice. These rotations are paid positions by the Iraqi government.

Sabah graduated from College of Dentistry, University of Basrah, in 2011. Once she was certified, she and a male partner started a private clinic, which was affiliated with the health-care system in Iraq. The mix of clinic patients is 80 percent women, 20 percent men. When working on patients, Sabah wears scrubs, sometimes with a lab coat.

I wondered if she felt discrimination from male patients or colleagues. Asma told me that the discrimination is usually from patients, but that one of her colleagues said that women should stay home because they can't have a career and have a good home life.

She also faced hostility and threats from male patients when she was in the government health-care-center rotation. Sabah said that she explained—with a smile—that the government had chosen her to treat them and if they did not want her to work on them, the patients would need to go to a private clinic. Usually, they would apologize and allow her to treat them.

Being a female dentist in Iraq has advantages and disadvantages, according to Sabah. Because of Islamic traditions, women prefer female dentists, and men prefer their wives and daughters to be treated by a female dentist. Patients with dental anxiety generally prefer female dentists because they feel women may be gentler than male dentists.

In Sabah's clinic there are two staff members, both assistants. There is no hygienist. The most common dental procedures provided are extractions, fillings and simple orthodontic cases. Emergencies are commonplace. Preventative care and hygiene appointments are rare. When these cleaning appointments do occur, Sabah handles them.

The most rewarding experiences for her are when she sees a smile on the patient's face as a result of her work. The biggest challenge, she feels, is to educate patients on various treatment modalities, oral hygiene and on quitting harmful habits. She is working to have her assistants do patient education, but patients prefer to hear it from the doctor, so currently this process takes a lot of her time. Sabah wants her patients to become Internet-savvy so they can find answers online, and that's why she tries to steer them in that direction.

In her clinic, Sabah currently uses film but in her health- center rotation she used digital radiography. She is certified in laser therapy but has not incorporated that into her clinic yet.

The war in Iraq often affected Sabah's practice, sometimes confining her to her home for prolonged periods of time.

Due to terrorist activity it was difficult to get lab work delivered from outside of Iraq, and getting proper equipment to start her practice was challenging. The situation is better now and continues to improve.

She said the health-care system in Iraq is evolving. As a new generation of dentists and doctors come in they are educating the population, taking them from a lower dental and health IQ to a higher one. They're also promoting preventative health measures.

Sabah's dental experiences are extremely different from the experiences dentists have in Western countries, and in other ways are exactly the same. Her words of advice to dental students, for instance, are similar to what many Western dentists would say: "If you don't make mistakes, you will not learn."

Sabah and the late Dr. Rou'aa Diab experienced a changing tide in the Middle East. Rigid tribal codes and strict interpretations of Islam have long dictated what women have been allowed to do in that part of the world. These brave dentists are pioneers in a region that has many more obstacles for women than what we know in the Western world.


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