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Doi:10.1016/j.wsif.2004.06.008

Women's Studies International Forum 27 (2004) 261 – 280 Saudi women doctors: Gender and careers within Wahhabic Islam and a dwesternisedT work culture Girija Vidyasagar, David M. Rea Centre for Health Economics and Policy Studies, School of Health Science, University of Swansea, Singleton Park, Swansea SA2 8PP, UK This paper reports on the experience of 28 Saudi women doctors working in Saudi Arabia. It demonstrates the problems they encountered, many of which they share with counterparts elsewhere. In addition, they have also had to deal with problemspeculiar to Saudi society: a constitution and legal system that sanctions male superiority, and segregation of the sexes in all areasof life. This context affected their choice of specialty, their work alongside male colleagues, and their promotion prospects.
Many had encountered what was described as a western culture at work, or in their overseas training. They valued many aspects of this, such as promotion being based on merit, but did not all expect these aspects of western culture to prevail withintheir own context.
Despite the constraints, the older women doctors had achieved professional success and satisfaction—and the younger doctors expect professional success also.
D 2004 Elsevier Ltd. All rights reserved.
elsewhere in achieving professional and careersuccess arising from the use of gender (in law and The place of women in Islam and Islamic states everyday discourse) to define responsibilities.
has generated many publications but, with notable However, they identified constraints and opportu- nities that would differ significantly from women's Doumato, 2000), published work on the current experiences elsewhere and these were frequently status of women in Saudi Arabia is almost non- attributed to gender within their culture, usually existent. This paper aims to contribute to this under- described as Islamic. So, it is important to acknowl- researched topic and to enable comparison. It is based edge that the Kingdom of Saudi Arabia (KSA) is on the experience of 28 Saudi women doctors, unique among Islamic states. It contains the holiest of employed at a major city hospital, at various stages sites within Islam, it is the location of the world's of their medical careers.
largest pilgrimage (the hajj), and is governed accord- The doctors differed from each other in many ing to Shari'a (Islamic law). Contemporary Saudi respects and cannot be considered an isolated Arabia has been strongly influenced by the Wahhabi category. They share similar problems with women movement. Wahhabism rejects reinterpretation of the 0277-5395/$ - see front matter D 2004 Elsevier Ltd. All rights reserved.
doi:10.1016/j.wsif.2004.06.008 G. Vidyasagar, D.M. Rea / Women's Studies International Forum 27 (2004) 261–280 earliest Islamic texts and is therefore at odds with a specialty is then required and is also paid for. For reform. During unification, Wahhabism was used to most, this required study in the west.
forge a sense of common identity intended to super- It is within this context that dBehind the veil, sede tribal loyalties. The current Saudi monarch has silently, women in Saudi Arabia are revolutionizing dinherited a kingdom in which devotion to Islam and their statusT (However, the rise in to himself as the rightly guided Islamic ruler is the conservative fundamentalism which has been appa- glue that holds his kingdom togetherT ( rent in Saudi Arabia since the Gulf War of 1991 ( Congress, 2003a). The monarch is both Prime Library of Congress, 2003b), the recruitment of Saudi Minister and King, there are no elections, and the citizens into al-Qaeda, and the government's response cabinet is appointed by the monarch and contains to the anti-westernism of al-Qaeda, may all present many royal family members. Political parties, labour difficulties in furthering social change.
unions, and professional associations are banned.
Within limits, the experiences of Saudi women There is a consultative council (Shura) but women doctors can be compared with that of women working are not represented ( in other Islamic states ( Women in other Islamic states achieve political Be´lenger, 1996; Khan, 2000; Moghadam, 1988; Sanad & Tesser, 1988). However, medicine has a high status 2003) and high political office (Indonesia, Iran, and and comparisons with other occupations such as Pakistan). As this indicates, there is an immense nursing (are not equally valid.
breadth of interpretation of Islamic sources and Islamic The paper demonstrates that, in some respects, the experience of Saudi women doctors is similar to that of Saudi constitution denies women many political rights, women practicing medicine elsewhere, for example in women have economic and social rights granted to choice of specialty (Like career them by the Qur'an. Long before such rights were women elsewhere, they face discrimination, sometimes attained in the west, women were legally entitled to characterised as a dglass ceilingT ( inherit and bequeath property, and to hold their wealth Booth, Francesconi, & Frank, 2003; Gherardi & in their own names even after marriage, without Poggio, 2001; Riska, 2001; Willis & Yeoh, 2002; obligation to contribute that wealth to their husband Zandvakili, 2000) or a dsticky floorT ( or their family. In KSA, while women have high 2003). In other respects, their experiences are signifi- literacy levels, and professional opportunities, the cantly different. While many were wealthy enough to constitution prevents gender equality by restricting employ maids for childcare, others reported long their freedom to travel, to education, and to work by periods (years) of separation from husbands and other requiring the agreement of a male relative ( family members working abroad.
1978; Keene, 2003).
The doctors were interviewed during 2000–2001.
However, western culture and technology have Restrictions on women travelling alone resulted in the proven highly attractive and influential. The unity of interviews being confined to one city. The interviewer KSA under the Saudi royals was achieved with British was familiar with hospital managers and permission assistance, and the United States has been subsequently was first sought from the Medical Director of the city's influential. There is a professional and technocratic main hospital. He sought assurances over the purposes class who have spent time in the west and have received of the research; that the women's privacy and an education there. Moreover, many westerners work confidentiality would not be abused, and that the and live in the KSA. The Saudi government has been interviews would not interfere with the work of the attempting a policy of dSaudisationT to lessen depend- hospital. Then, he referred the interviewer to his ence on the considerable numbers of non-Saudis Deputy Medical Director who sought similar reassur- working in its economy. This has ensured financial ances. The Deputy then assisted by identifying support for Saudis seeking a professional or scientific potential interviewees, ranged by age and experience, education and jobs. For medicine, an increasing and issued an official ddirectiveT requesting their number of medical colleges have been set up in KSA participation. None of these women responded to his offering initial training over 3 years. Further training in request except to say they did not have time.
G. Vidyasagar, D.M. Rea / Women's Studies International Forum 27 (2004) 261–280 Subsequently, one of the more senior of them was Muslim, and not Arabic. She was familiar with medical approached informally, given more information about and health care work in KSA; she was not dwesternT but the research, and she then spread the request among her she shared some familiarity with dthe westT. Moreover, colleagues. They responded eagerly and in addition, high status occupational groups and wealthy people are many others volunteered. One of the consequences of under-researched and the interviewer's non-residential gaining access this way was that many more doctors status meant the power differences were far from were interviewed than initially planned. Our justifica- simple (but it is fundamental tion for this strategy was that more formal approaches that the research process should not oppress ( had foundered, and that the research strategy was 2000). While sharing similar experiences, it is also intended to be ethnographic: a deliberate inquiry fundamental that women's issues are not characterised process, rather than a reporting process guided by a as universal, or to suggest that particular issues are set of formal procedures and techniques ( resolved simply by progress and modernisation ( 1986). We sought more depth than could be achieved & McGrory, 1995).
through a randomly selected sample.
These principles governed the research process and The inherent difficulties of interviewing people of our subsequent writing. Only the willingness with different ethnicity and difference should be acknowl- which the interviewees offered their experiences (described above) and our subsequent representation 1998). It was important therefore that the interviews of their views can ensure the differing dvoicesT are and our subsequent writing would respect the authen- authentic. Our position, as authors, is to quote as ticity of their voices. The interviews were all tape directly as possible and to guard against re-interpreta- recorded, except one, and were conducted in the tion or inference. We therefore attempt to represent privacy of their offices in their hospital. This allowed their views in the way they were expressed. We have them to talk relatively freely, although the interviews not sought to reinterpret their motives, for example.
were time limited in order to respect their wishes. They Where they did not make clear distinctions we were asked to relate their own history in terms of their reproduce their original words. The use of dIslamT early education, the encouragement of their families and the dwestT may infer opposition, embody mutual and the government, their choice of specialty, the misconceptions about both cultures, and may assume restrictions on their advanced training, and in their later both are homogeneous (p. 8). But the careers (where appropriate). All the doctors were interviewees used them as they talked about their lives.
invited to read through the transcript, but only one They talked about western culture and Islam as they took this up. The interviews were conducted under experienced them. Several of the women had experi- conditions of confidentiality and anonymity. We there- ence of non-Saudi Islam and they were careful to fore use pseudonyms when quoting them. Initially, we distinguish this from their Saudi experience. For others, planned to interview a much smaller number than the their experience was limited to the KSA and they spoke 28 finally interviewed. The first women were hesitant of Islam and Saudi cultures as being one and the same.
but as word got around, others actively sought out Our strategy was to allow each to express their view opportunities to take part. We take this as confirmation of their world in their terms. We recognise the that trust had been established among the early imperfections of this strategy. Moreover, reliance on interviewees, and that many valued the dvoiceT being direct quotes is also imperfect because interviews were offered them.
conducted in English, a second language for both Clearly, there are problems in all research where interviewees and interviewer. Nevertheless, the women outsiders attempt to enable others to have a dvoiceT clearly valued the opportunity to discuss their experi- ences and volunteered in depth their various life/career Sanabary, 1993; Hoffman, Snell, & Webb, 1976; stories. The women wanted an opportunity for their Jaschok & Jingjun, 2000; Keddie, 1979; Logan & views to be heard and no previous study of this kind has Huntley, 2001; McCutcheon, 1999; Mullings, 1999; been published.
Reay, 1995; Sherif, 2001; White & Johnson, 1998).
Early Islamic medical practitioners developed sur- Here, the interviewer was female, but not Saudi, not gery and published knowledge of the circulation of G. Vidyasagar, D.M. Rea / Women's Studies International Forum 27 (2004) 261–280 blood by AD 1288 and Islam provides guidelines for speak universally of an Islamic culture ( medical practitioners, including a code of ethics 2003), nor is KSA rigorous in effecting a single cultural governing payment, quality, consent, and confidential- identity. On the other hand, much published work on ity These guidelines are not totally feminism and gender theory is located in the west and inconsistent with the organisation and practice of in western thought. Early feminist theory implied medicine, as it developed in the west. The doctorsT western concepts of human rights, the work ethic, education and practice exposed them to western and equality. Radical feminism and post-modern medical practice, and western forms of work organ- feminism would be impossible without essentialist isation and culture. Many were attracted to western theories of evolution and biology to challenge.
values and culture. As will be shown below, some (not Visser, for instance, debates the relative contribu- all) expressed the view they were comfortable (even tions of culture and the body to conceptions of gender preferred) working in a context where western values (Post-modernism has raised new ques- prevailed. Others expressed strong religious beliefs and tions about the body ( a preference for values which they variously described Useful and interesting to western audiences, debates as Islamic, Saudi, Arabic, and even tribal. They inhabit between post-structuralists and essentialists (say) about a western culture (at work) within an Islamic culture (in the construction of gender ( KSA) within a world that seems increasingly open to De Lauretis, 1987) will speak little to women in a western influence.
society where bodies are seen in private, covered in The paper is organised as follows. We first elaborate public. KSA has no cinema, and censorship is wide- on the tensions described above, showing how the spread. The Saudi state acts to limit the availability of QurTan has been used to subordinate women in KSA images of women. Roald argues that most of the and how the modern Saudi state has nevertheless literature debates female Islamic dress in terms of its encouraged these women to pursue professional sociopolitical implications, although she argues most careers. The potential tensions they face will be Muslim women cover because of their commitment to discussed in relation to feminism as understood outside their religion (Early western feminists of Saudi Arabia. However, the main part of the paper is understood covering as implying shame and disgrace intended to allow the voice of these women to be heard.
on women, but more recently, different feminisms have So, the following section presents illustrative quotes asserted the veil allows women an active role in public from the interviews dealing with their background; the space (p. 201). In KSA, women cover in encouragement they had from family, friends, and the black wearing the ayaba and the niqab (or burga). Men school system; the support they received from their cover in white, with some red in their headwear. In Government; life at medical school; graduation; their contrast to other Islamic states where colours may vary professional status and the prospects for promotion; the and where the requirement to cover is sometimes difficulties they have encountered; and finally the relaxed (the requirement to cover in support they have had from their families since, public spaces (not hospitals) is enforced by the including when they are married. We then attempt a Muttawa (religious police). Saudi women are unlikely judgment on their future prospects. We conclude with a to need reminding that gender is discursive and is discussion of the relevance of these experiences to constructed and learned (They have women and gender studies, and feminism.
the Muttawa to remind them gender roles are dwrittenT.
However, consistent with Roald, most of the inter-viewees explained covering in relation to their religious Women in Islam and women in Saudi Arabia beliefs or, if not religious, in wishing not to offendothers. Another said she was ddeeply religiousT but The variety of feminist theories, conceptions of would not follow this custom elsewhere.
masculinity and femininity, and discussions over their Obviously, western feminism is as concerned with appropriate use and fidelity (are women's political and economic status as with the likely to assume a coherence which is unlikely to be construction of gender. However, these concerns are justified here. On the one hand, it is not possible to expressed within a context of western liberal politics G. Vidyasagar, D.M. Rea / Women's Studies International Forum 27 (2004) 261–280 (which may have little validity rights can be adopted within a religious state and within Islam (A variety of feminisms society; and (c) where social change is paradoxically can be distinguished that are non-western ( proscribed and encouraged.
1996; Basu & McGrory, 1995; Jayawardena, 1986;Moghadam, 1994; Raju, 2002; Staeheli & Nagar, Women in Saudi Arabia 2002). Some are specifically non-secular, others arespecifically Islamic (1 In so far as women's issues are recognised in KSA, Islamic feminists have argued that human rights are they are unlikely to be concerned with liberalising not contradictory to Islam ( sexual orientation, representations of the body and the Hosseini, 1999) and that it is the religious institutions construction of gender. Instead, as we anticipated, that are patriarchal (Another approach Saudi women doctors described their careers in terms has been to show how western feminists have too defined by the interplay of Saudi law and customs, harshly misjudged the status of women under Islam Islam, and western values. This interplay is not a simple matter and involves many conflicts and tensions Benn, 2003). Alternatively, western feminists are at both societal and individual levels. The Saudi accused of silence over abuse conducted in the name women doctors varied in the degree to which they held religious beliefs and accepted the prevailing order, There are debates about whether the term Islamic but it is also important to note that most considered feminism represents a new feminist paradigm, or themselves fortunate in having male relatives who whether it is a re-articulation of QurTanically man- permitted and encouraged them to travel and to have an dated gender equality ( education. For some at least, legal restrictions were Muhin, 1992; Webb, 1999). Others argue Islamic experienced merely as administrative irritations.
feminism transcends secular and non-secular, and While the QurTan can be interpreted as supportive categories such as deastT and dwestT, modern and of women's equality—kafaTa (pp. 48– traditional (While concepts of progress 50) and while political toleration developed within and modernity have been used ( Islam (dwesternT morality, and politics are post-modern feminism (raises ques- portrayed by the Saudi state as a challenge to a pre- tions about this and may accommodate Islamic existing Islamic culture. Suggestions from elsewhere feminism's insistence that women's status in Islam that women should not be subordinated and that has been misunderstood.
women's rights should be enhanced can therefore be The focus of this study was the way gender roles perceived as further westernisation and a misinter- were defined within KSA and the impact this had on the pretation of Islam. We would not be the first to make professional and career opportunities of women doc- this point that western feminism can be perceived as tors. It demonstrates that Saudi women doctors part of an overwhelming external force threatening a achieved professional success and satisfaction despite culture. As al-Qaeda's anti-western activities demon- particular constraints. The interviewees spoke of the strate, local Saudi opposition to western influences is as extent to which these opportunities were affected by real as can be imagined, and this opposition is not what they described as Islam (Wahhabi), the Saudi simply about western interpretations of women's culture and economy, and the consequences of con- rights. However, the point is that the Saudi state—not fronting western culture. Their feminism is understood just the state, but KSA's male dominated society—is best as the achievement of a space for themselves, for able to reject western political ideas affecting women autonomy, and a career in a society that inconsistently by asserting that Islam already guarantees equality for forbids and permits professional autonomy and wom- women. Officially, the acquisition of equal rights for an's caring role. Moreover, that society (like many women in the west has also been accompanied by a others) is itself caught between (a) the need most feel to breakdown in domestic responsibilities and western balance valued aspects of an ancient culture against the societies cannot guarantee the safety of many women to power and attractions of globalisation, including (b) the go alone at night ( extent to which internationally recognised human 2003). Despite government statements such as this, G. Vidyasagar, D.M. Rea / Women's Studies International Forum 27 (2004) 261–280 several of the women doctors said the government was between the sexes, dthis implies no superiority or improving opportunities and equality for women, but advantage before the law. .T (pp. 17– that it was the culture and the organisations they 18). Badawi interprets the Qur'an (Sura 2:228) as worked for that were slow to change.
It is difficult to conceive of a Saudi feminist movement: Such a movement implies that women can And they (women) have rights similar to those (of gather and communicate these issues freely. Saudi men) over them, and men are a degree above them.
society restricts the free movement of people andcommunication of ideas. Although women's organ- Badawi comments that this refers to dnatural isations have existed since 1962, they are heavily difference between the sexes which entitles the restricted and cannot openly report abuses against weaker sex to protectionT, not to superiority.
Both the Qur'an and the Hadith have been as authors, neither of whom is Muslim, we cannot reinterpreted by Islamic feminists (but pretend to understand how Saudi women might even a fairly traditional interpretation would advocate perceive feminist thought. Instead, as stated above, women need to work alongside men das educators, we aim to provide a voice for the women interviewed scholars, and expertsT ( and discuss how their views may be used in women's While the Qur'an is generally interpreted as indicating studies, feminist theory, and gender studies. Indeed, men have a responsibility to provide for women, this we have also to be cautious when describing them as does not mean they have unconditional authority over dSaudi womenT because many had more than a passing experience of what might be called a does it mean that women cannot provide for them- westernised lifestyle. Western scientific traditions selves (Nevertheless, the Qur'an is were clearly more important to them than the vast frequently interpreted as saying that women's primary majority of Saudi women. We now move on, there- role is looking after the home. Other activities are fore, to outlining the tensions and context of the lives permitted, provided her domestic responsibilities are of Saudi women doctors.
not compromised.
However, the message is far from consistent because Nagisatan Aqlan Wa Dinan (Trans.: Deficient in the Prophet's wife, Aisha, is said to have been active in Intelligence and Religion) both social and political arenas (man, 1981), and was knowledgeable of medicine. In While the QurTan, Hadith,2 and Shari'a give KSA, Aisha provides legitimacy for women to enter the distinct instruction concerning a woman's role and two professions of teaching and medicine.
position, there is diversity when implementing this As elsewhere, the position of women in practice guidance within Islamic circles both within and differs vastly from interpreted religious texts. In outside the Middle East. While space does not permit practice, around 21% of Saudi women work a full examination of holy texts and the variety of (Saudi law requires a male interpretations available (it should be relative's agreement before seeking work, education, noted that interpretations of the Qur'an are varied and it is sometimes difficult to understand with anyprecision (p. 27).
Women in Saudi Arabia: Segregation, sanctions, In KSA, women have to accept they work within a education, work, and equity society where their roles are interpreted as subordinateto men because, according to some interpretation of the Qur'an and the Hadith, men are superior to women Until recently, medical education was not avail- because they have more knowledge and power able within KSA. However, the Qur'an states dit is (While most inter- not permitted for a woman. . to travel the walking preters of the Qur'an accept the notion of radical, distance of three days without a MahramT ( distinct emotional as well as physical differences Hashimi, 1996).3 Written long before the days of safe G. Vidyasagar, D.M. Rea / Women's Studies International Forum 27 (2004) 261–280 air travel, this was originally designed to ensure women's attempt to get into the workforce in the west is protection for women in hazardous times. The widespread, and regarded as pointless if all it means is teaching is used in KSA to mean women cannot they take menial jobs and are oppressed and victimised travel without permission from a male relative, cannot by their employers ( drive a car, and cannot go out in public without a male Others are more encouraging, pointing out that Islam relative. Many domestic workers and Saudi women drewards labour, assiduity, and hard workT ( are locked inside their home at all times ( 1999). Work for women in Islam is a right—rather than International, 2000; U.S. Department of State, 1999).
a duty—and permitted in cases of necessity, when thereis a collective advantage, and when it does not abuse their femininity or dignity. Islamic scholars thereby list The Qur'an specifically sanctions the rights of suitable professions as nursing, midwifery, teaching, women to gain knowledge. The Qur'an also requires social service, and medicine provided they do not come both men and women to seek knowledge ( into contact with men. But, Saudi law does permit But the ahadith are interpreted as stipulating restric- women to work alongside male doctors and other tions on what knowledge it is suitable for a woman to males, and to work with male patients.
acquire (Female education in KSAuses slightly different curricula, co-education is not allowed, and it is felt women should not compete with The Qur'an makes no suggestion that women males in employment. Distance learning ( should not take leadership positions, except in prayer Simmons, 1992), internet colleges, and internet book- (so the principle problem is the stores such as Amazon.com are recent developments attitudes of those in powerful positions within that undermine these restrictions.
organisations. While KSA has signed the UN Higher education has expanded enormously over declaration against discrimination against women, it recent years, although it lags behind other Gulf states.
does not keep any records of employment and Al-Qazzat argues that medicine has proven an attrac- unemployment (Its birth, marriage, tive career choice for women of the Arab world. So, and death records are not reliable. It keeps no they constitute a high percentage of enrolment in records of personal wealth and income. So, the issue medical schools in dEgypt, Algeria, Kuwait, Lebanon, of women working also needs to be set against the Iraq, Syria, and TunisiaT (Despite the unknown numbers of Saudi males who are unem- growth of higher education in KSA, students must ployed and against the estimated 5 million people often go abroad if they need a specialist education, such employed from overseas, ranging from highly paid as medicine. The education of women has been of high experts through clerical and unskilled workers.
priority for the Saudi government to the point where Hospitals typically employ up to 80% of their staff dSaudi women are now more highly educated than from overseas, mostly nurses and clerical workers Saudi menT (Adult literacy is 33% among from poorer countries such as Pakistan and the females against 17% among males ( Philippines, but also senior managers and doctors 2000). No figures are available for Saudi women in from richer countries. Saudi women doctors con- higher education.
stitute a small elite in Saudi society, but are ofgrowing significance within Saudi health care.
Differences in education are unlikely to be experi- enced except where working in a hospital, the one place Being a woman doctor in Saudi Arabia Saudi employment law allows men and women to workalongside each other. Obviously, barriers to women This section summarises the interviews, including working are not unique to Saudi Arabia, but while quotes. Some factual details are tabulated although Islamic law does not prevent women from working, this cannot deal adequately with the responses.
domestic duties are not to be compromised. This is Motivations for example are complex: initial dis- open to wide variations of interpretation. Awareness of couragement could alter with time, one doctor G. Vidyasagar, D.M. Rea / Women's Studies International Forum 27 (2004) 261–280 reporting how her father had initially protested her Medical education studies would take her away from her family. Onceshe insisted, he moved the whole family so she The respondents all differed in their experience could study. Some felt almost compelled by their of education because they included a range of ages.
family to study medicine. The section is subdivided Forty years ago, there were no facilities for higher into comments about their experience of medical education for men or women in KSA. The most education, choice of specialty, views comparing favoured place for an education was Egypt because working in KSA with elsewhere, working with it was affordable, geographically close, and pro- male colleagues and patients, and their prospects vided separate education for women. Later, the Saudi government made arrangements with a Table 1Background as described by interviewees Government fundedinitial training originally Turkish.
Spent early yearsand school in Sudan Moderately religious Not very religious Moderately religious Moderately religious dVery, very religiousT Not very religious (Syrian connections) Not very religious Moderately religious Saudi, Indonesian Moderately religious Saudi, Spent early Not very religious years and schoolin Tunisia Not very religious Moderately religious Moderately religious Moderately religious Moderately religious G. Vidyasagar, D.M. Rea / Women's Studies International Forum 27 (2004) 261–280 college in Pakistan to train Saudi women who concern over too much contact with female students.
wanted to acquire a medical education—while boys from wealthy families were able to go to the US orUK. Higher education in Saudi Arabia has devel- Innocent, unpremeditated offensive behaviour some- oped considerably since then, although most times led to termination of the job for that person.
specialist medical training still requires time abroad.
The male nursing staff kept their distance with the Because many respondents were over 30 years old, Saudi doctors and medical students. (Ahlam, 33 most had experience of study in KSA and abroad.
years, Consultant Paediatrician) Even so, none of the respondents had their initialeducation in a western medical college. One had applied but permission was denied.
Their attitude and behaviour with us was. . aloof KSA does not sanction co-education, and so the and professional. They never got personal with any women did not meet male students during their of us. . they were very helpful. (Fatimah, 39 years, initial medical education.
Consultant Paediatric Neurologist) If the men had lectures and clinical rounds in the Relationships with patients was another area morning, we would have them in the afternoon and discussed. The women always examined patients vice versa. It was not considered proper for boys in groups. Teachers, nurses, and other students were and girls. . to be together. . very unIslamic. . It always present and contact was dalways strictly cannot change. But we had the same education, professionalT (Habibah). All respondents recollected same teachers, same curriculum. We might see our their initial embarrassment with male patients.
male classmates in the corridor or something like Habibah recalled: that. But there was no social interaction betweenboys and girls like in other societies and cultures.
Of course first male patient was embarrassing. . from There is some mixing between doctors of both the third year onwards we started going to the hospital sexes in the hospital, but it is never taken to a wards and seeing patients. Got over the embarrass- social level. There is no mixing at the student ment eventually. (Habibah, 45 years, Consultant— level. (Faridah, 36 years, Consultant Paediatric However, most problems related to having to Those who experienced co-education, in Egypt learn English, and learn in English, and home- and Syria, said they had positive reactions from sickness. It was also very hard work and this their male counterparts but did not socialise with was considered the main reason others dropped out. The other reason was early marriage to a All were taught by males. Until very recently, the husband who did not like the long hours students teachers in KSA's colleges were almost all expatri- would spend studying. They dropped out and ates. All the respondents said relationships were opted to become teachers instead. Drop-out rates good: they were always formal. Violations of the were considered to be as high as 50%. Pressure taboos on social interaction were grounds for from husbands objecting to time spent alongside termination of an expatriate's contract, although was another reason most respondents said the teachers were always ready to help them.
Nursing staff in all hospitals in Saudi Arabia are There were 35 girls in my class when we started.
almost all expatriate. Respondents said they felt the Many dropped out. . Many had interruptions in nursing staff were very cooperative and very help- their studies and they naturally take longer to finish.
ful, but their interaction was always on a profes- Only 5 or 6 went through the course without sional level. There were two reasons given for this.
interruption. Many had difficulties in managing One was language, the nurses having just enough studies and. . families. All husbands are not Arabic to communicate with patients; the other was considerate like mine. Most Saudis are compulsive G. Vidyasagar, D.M. Rea / Women's Studies International Forum 27 (2004) 261–280 socialisers. Wives have to go along with their Mahram to go with me. . Mash Allah, I have met wishes. This leaves very little time for studies. In somebody I like to marry. We are not engaged yet.
our class, only my schoolmate and myself did Inshallah, that will happen when our families meet anything serious with our profession. I took up and decide on all the marriage formalities. But we internal medicine and she went to OB/GY. Most meet and talk about various things. (Khalidah, 32 others opted out for primary health care. (Lubabah, 32 years, Associate Consultant—Internal Medi-cine—Cardiology) Another experience is also telling: I applied to go to Canada. . But then the Choice of specialty government did not support me because they didnot want to sponsor my husband because he is Choice of speciality was limited by the prospect Egyptian, a foreigner. Then my husband went to of working with male patients, the increasing UK. I also went with him. (Sabirah, 45 years, availability of training within KSA in specialties Assistant Consultant) dsuitableT for women, and the ability to studyabroad. For most early marriage was desired: They Twenty-seven of the doctors said they had wanted a husband who would support them and go freedom to choose their specialty. One said she with them when going for higher studies. For had drifted into it, following the specialty suggested by her seniors. The majority, said they could havechosen any they wanted, but appeared to have He got accepted in Vancouver, Canada. I went with chosen specialties relating to women and children, him. Also got accepted for the specialisation pro- or non-clinical work where they would not come gramme. I spent 6 months in the programme. Then. .
into contact with adult males (see One My son was very small. I had problems with baby- sitters. I didn't get permission to take my maid. . Soafter 6 months I had to come back. (Fatimah—returned This specialty also helps me work within the later to complete) parameters of Islam. Islam forbids women from The Saudi government has always been suppor- working with adult men. Paediatrics solves the tive, provided the education conformed to social and religious requirements. Initially very generous, dthey A few were in specialties where they came into paid for everything—fees accommodation, books, contact with adult males. They also must conform clothes, airfare—everythingT (Hamidah, 42 years, with Islamic requirements as interpreted in KSA. One Senior Consultant), they even paid for the accom- doctor (with Egyptian parents) who had studied in panying Mahram, sometimes (Salimah, 37 years, Egypt and Scotland said: Senior Registrar).
Now, Saudi law allows travel without a Mahram, The difference between here and anywhere else is provided the family take responsibility, but families here I never see a male patient without a chaperon.4 are not always able willing to take this responsi- And I never close the door of the room when I am bility or pay for the Mahram.
with a male patient. (Kawthar, 44 years, Senior One main problem facing lady doctors is finding a Mahram. . Your getting scholarship depends upon The doctors worked alongside male colleagues it. . (Hadiya, 35 years, expecting promotion to (doctors and nurses), many of whom were non- Arab, or non-Saudi, and so encountered what somedescribed as a western culture at work, or they encountered this culture in their overseas training.
I hope to go. . the US or Canada for more They expressed differing attitudes to this culture, specialisation. I am not married so I have no although many seemed to value the idea that G. Vidyasagar, D.M. Rea / Women's Studies International Forum 27 (2004) 261–280 Table 2Education and career Employment status and specialty Consultant Paediatrician Resident—Primary Health Care Consultant Paediatrician Consultant Paediatric Endocrinologist KSA, plus UK and USA Consultant Paediatric Neurologist Expecting promotion to KSA, intends togo to Canada Project Doctor—plans to specialise in Paediatric Pulmonology go to Canada or USA Resident (fourth year)—Obs./Gyn.
specialise abroad Resident (first year)—Paediatrics Resident (second year)—Family and Community Medicine Resident (fourth year just completed)— Resident (second year)—Internal Medicine Assistant Consultant—specialty not known Senior Registrar—Foetal Internal Medicine Resident (third year)—Paediatrics Head of Department—specialty not known a Not known.
promotion should be based on merit. While this . .not very easy. . to get a scholarship to go abroad.
(and other aspects of western culture) was valued, it The father or the husband has to convince the was not universally expected within their own government that the girl would not be left alone in a foreign country for 5–8 years. Or. . that the girl'sstay abroad is their responsibility, she has their Experience of differences between KSA and elsewhere permission to stay by herself in a safe accommoda-tion arranged by themselves. Many make a lot of The need to go outside the kingdom for compromise between what they want to do and what specialisation after graduating is lessening as new the religion permits. . (Ahlam) facilities are developed. This is convenient forwomen who have difficulty finding Mahrams to Many expressed the view that they would only get go with them.
government help to go abroad now if they chose G. Vidyasagar, D.M. Rea / Women's Studies International Forum 27 (2004) 261–280 subjects where facilities did not exist within the she specialised at her own expense (Jala). The kingdom. So, now, they have to fund themselves.
remaining two went entirely at their own family's Of those still needing to specialise, only one expense Aida and Kawthar).
expressed no desire to go abroad for specialisation.
Eight doctors had no experience of the west, but The remainder felt the Saudi medical system was not the rest all held favourable opinions of western mature enough yet and they would benefit from medical and training facilities. They were all of the exposure to other cultures. Two felt those with a opinion that the western way of life was incompatible higher western qualification would get promotion with Islam and they could not accept or follow that way of living.
Seven doctors did their entire postgraduate What can I tell you about the western culture? It is specialisation abroad. One had been brought up in their culture. It is all right for them. It is not Islamic Egypt and her parents had no wish to return to culture. We cannot follow that. We have to live like Saudi Arabia. Another had qualified many years ago how Islam had told us. That is all. (Hanifa, 36 years, There was no restriction on female education is Sudan then. My family also followed the pattern. Sudan wasunder British rule at that time. Religious restrictions We are familiar with western culture and western came in the last decade or so with the advent of ways of life. But that is not our way. They follow Islamic rule in Sudan. (Aida, 53 years, Staff Physi- their way, we follow our way. (Inaya, 40 years, cian—Primary and Family Care) Project Doctor—plans to specialise in PaediatricPulmonology) Most of the others had married doctors and had been able to travel with them overseas, with govern- Another was less comfortable with this divide: ment funding. One who was not married had taken her . .don't like the social system here, but I also cannot mother with her as chaperon, with father and brother accept the western system completely. I am between helping them both settle. She still travelled abroad professionally and took her mother with her. All ofthese doctors who studied abroad were over 33 years While valuing their own culture, they clearly res- old. At the time, there were no facilities in Saudi pected western ways of working more than their own: Arabia and the government had funded them. Studyabroad is particularly expensive because women have My social life outside the work place was strictly to be accompanied and many needed additional within the tenets of Islam. I had very little time for financial help from their families. They usually social life. . studies, work and my son took up all travelled with their maids to help with babies and my time. I had nannies and maids to help me housework. They travelled under their husband's passports because Saudi women cannot have inde-pendent passports. The unveiled face of a Saudi What impressed me about the western work culture woman could not be photographed, nor could a male was that if you worked hard and proved your worth, official see it.
you got where you wanted get to. Being a woman did Additionally, the generous funding of the past is not hamper you very much in the western culture. But now severely reduced because the KSA economy is I am not resentful of the western woman's freedom dependent on falling oil prices, and because more because I have great faith in my religious beliefs. I facilities exist in KSA. Five doctors did their was always prepared to go along with what my specialisation at their own expense. Two of these, religion dictated. (Ahlam) though Saudi, did not enter the Saudi health care system until after their postgraduate qualification(Badra and Jala). One doctor was not helped I did not imbibe all the western ways in my personal financially because she had married a foreigner, so life. But my professional life was completely influ- G. Vidyasagar, D.M. Rea / Women's Studies International Forum 27 (2004) 261–280 enced by the West. I feel that the western culture is While Saudi law now allows women to travel more open. People can express their ideas and provided they have permission from a male relative, opinions openly. Women are accepted as serious most were unwilling to break with this custom.
workers. Women do not have to fight for their A Muslim woman has to be always escorted by a position at every step. I also accept that things have proper Mahram—an escort allowed by Islam. So changed a lot for the women in the last two decades in when a woman applies for funds for postgraduate the Middle East, especially in Saudi Arabia. (Aida) studies abroad, she has to show that she is accom- Others were keen to distinguish between working panied by a Mahram. If the Mahram is the husband, cultures in Saudi and other Islamic states: then it is very easy if he also wants to study abroad.
(Salimah) I am an Arab and a Muslim, but. . if my husband'sbusiness interests were not here, I wouldn't have Working alongside men stayed past my probationary 3 months in the hospital.
And if {he} hadn't supported me throughout, I A hospital is the only place where women work wouldn't have survived. It was not easy for my alongside men in KSA: it is a relaxation of normal husband either. It is difficult, very difficult for anyone employment law. So, it is potentially a contradictory who has lived outside all his or her life to stay here in situation for the people concerned. Moreover, most of Saudi Arabia. (Kawthar—Egyptian by birth, Saudi by the senior women had gone abroad for their higher training and had become used to working alongside Speaking of their return to KSA, five said they wanted to because the Saudi people are so badly in Only three reported bad relationships with col- need of medical help and their country needs to leagues and three described relationships as become less dependent on expatriate westerners. Eight dindifferentT. They were similarly positive about their returned for family reasons or because of their working relationships with expatriate colleagues. Only employment contracts. A few had to return without two reported bad relationships with expatriates. All finishing their courses because their husbands had reported good relationships with their patients and finished earlier and would not wait. Another said: only two reported bad relationships with their femalecolleagues. The majority said they had good working If he had finished before me, he would not have relationships with men, but this tended to mean the stayed back for me. I would have had to return back men didn't interfere or impede them in their work. But without finishing my fellowship programme. . That they were also comfortable with the distance afforded is how things work in our culture. (Ahlam) All who returned had high positions and rapid I have no irritations from my male colleagues. I do my promotion. Fresh young postgraduates were posted to work, they do theirs. Because there is not much social senior consultants' positions without any experience, interaction between men and women in our culture, replacing expatriates, in accord with Saudisation.
there is less harassment of women. . like you see in Fifteen had not gone abroad for specialisation.
other cultures. (Faridah) They were the younger doctors and while they all saidthey hoped to go abroad for specialised study the Most of the women doctors said they had good likelihood is that only those with independent funds working relationships with the nursing staff, which will be able to do so. Some Saudis have dropped the was predominately expatriate until recently. Three custom of being accompanied by a Mahram: doctors recalled how, initially, the nurses looked downupon them as new doctors and there was friction over About going abroad, now people are not strict about who gave instructions to whom.
Mahram. My father will not stay with me all the time.
He will come, Inshallah, for some time, you know to Some of the nurses were treating us really badly. They see me settle. Then he will return. (Rashida, 27 years, were looking at us like inferiors. I used to cry everyday. . insulting. (Fatimah) G. Vidyasagar, D.M. Rea / Women's Studies International Forum 27 (2004) 261–280 She explained her feeling insulted as resulting from are not involved, even our opinions are not asked for. I the nurses being foreigners in her country, although will never be the chief of the department even when I the nurses were largely British males (not necessarily am the best qualified. . There is a lady. . who is white) she did not explain her feelings in gender, senior to me and very well qualified, but she is not even racial or ethnic terms.
considered for acting chairman's post when the chair- Another felt attitudes were conditioned more by man is absent. . But this way of thinking in very deep- uncertainties over whether knowledge was sufficient rooted in our social system,. . I sometimes feel it isgetting worse. It is not a policy, but the most common They did not treat us well in the beginning. They practice. (Badra, 37 years, Consultant Paediatrician) thought we knew nothing. They did not want us totouch the patients. (Sabirah) Another put it this way: It is not uncommon elsewhere for young doctors to . . like everywhere in Saudi Arabia, men get have difficulty being accepted as reliable, but in Saudi promoted before women. The general feeling is men the position was slightly different. Even the most are better and they have to be above women. The senior Saudi doctors are the first generation of doctors.
administration is full of men. They support other men.
Young women doctors were being appointed to senior Men get promotions but don't work hard like positions soon after their training and this would women. . So they get high positions and women probably not have been acceptable elsewhere. So, the do all the hard work. (Makarim, 29 years, Resident— expatriate staff were willing to question the validity of Family and Community Medicine) the actions of the new doctors. This could be taken as Another was arguably less pessimistic rudeness, compounded by language problems. Therewas some friction over this and Fatimah, a Consultant . .educational facilities and working conditions have Paediatric Neurologist, reported the hospital's Director improved a lot for the girls entering the medical of Education had resigned when some new appoint- profession. With the present rate of Saudisation, more ments were made at Registrar level.
jobs are made available to the girls and also boys.
Saudisation does not extend to nurses because Discrimination against women for promotion etc is nursing is considered an inappropriate profession for a also less. You cannot totally rule that out, but that is a Saudi woman. Saudi female nurses are very scarce, universal phenomenon, wouldn't you say? (Kawthar) although increasing in paediatrics, obstetrics, gynae- Another said she would like a more senior position cology, and female wards.
but would not get it because these jobs tended to be Of the 20 who had taken up female or child administrative, not medical.
specialties, all said they had good relationships withpatients. Others were in non-clinical work. Those few The authorities assume that senior administrative who were treating both male and female patients had positions will be tougher to manage for females. .
found ways of handling this and none said there were that. . females would find it difficult to devote full any complaints over this.
attention to their profession because of their domesticobligations and so male candidates are more eligible Professional status for these posts and so promotions become verydifficult. This is going to be a big battle for the Unsurprisingly, 20 of the 28 said they were happy serious female Saudi doctors. (Aminah, 28 years, with their present positions and achievements. They Resident—Primary Health Care) were in senior positions and acknowledged theywould not occupy them but for Saudisation. But, A very senior doctor (Aida) said she was several felt the existence of a dglass ceilingT: dissatisfied with her present standing but recog-nised she had opted for easier jobs to take care of The main difficulty we face is. . discrimination. Gov- family and children, and had taken time out to ernment promises equal opportunities, but that does not work for the World Health Organisation. Another really happen. At the decision-making levels, women felt she had been held back by being outspoken G. Vidyasagar, D.M. Rea / Women's Studies International Forum 27 (2004) 261–280 over the lack of back-up facilities necessary for her totally. I also don't accept that our way of life is 100% correct. I have to find a middle way when I am in the Most felt they would have few opportunities for West. But when I am here, I follow the Saudi way of promotion. The more senior felt they would not life. Otherwise my family will suffer for my different progress beyond their present positions because the next step up would be an administrative position, the Lack of vacancies is also a factor, of course, and this prerogative of men.
may worsen because Saudi staff can no longer step into The main difficulty is the attitude that woman is not an expatriate's job. There are more qualified Saudi capable of thinking and working like man. It is said by doctors competing for senior positions. Privileges are many that woman is emotional and not objective and being reduced and the possibilities for promotion are rational. This is wrong, but many people still believe affected. This is particularly important in the city be- that. This is a stumbling block for administrative jobs.
cause it was a popular place for Saudi people to live, but some felt they might do better elsewhere because insome areas no Saudis have yet been employed as These attitudes are common elsewhere and it is difficult to assess the extent to which they can be Six doctors expected to go no higher than their attributed to the prevailing interpretations of Islam present positions. They felt women would be unable where, as was noted earlier, the hadith have been to fulfil official obligations because they could not interpreted as denying any leadership role for women.
travel and sit in meetings with men. Others felt the For some there was a clear link between these hospital management viewed them as more con- attitudes and Islam: cerned with their families. Another issue is that . .this difficulty in accepting women as equal to men Saudi men would have difficulty taking instructions will also change with time. I don't mean in all ways.
from a woman and so women heads of department Many differences will be there for a long time socially would not get co-operation from male colleagues because Saudi Arabia is a religious country and Islam and subordinates.
started here. We have to maintain Islam as it started.
I have problems with the chief of surgery, medical But in place of work it will change slowly. Women director and so on. Once I had some problem with one will get promotions like men and they will get treated of the consultants. . problems accepting me as the like equals in work. (Faridah) head of the department. There was an incident where my authority was totally ignored and I complainedabout this and resigned from the position as the HOD.
It is the religion and the culture, which is making But my resignation was not accepted because they women's life very difficult. (Hadiya) didn't find anyone to replace me. (Wafa, 27 years, Head of Department) . .we have no woman heads of the department in this Women doctors said they were not viewed in the hospital. This is because it is said in the Qur'an that same way as male doctors. Society did not give them woman cannot be at the head. . It is followed here equal status, whatever their qualifications. One doctor because it suits the men. It gives them more oppor- tunities for promotion. . there are many examples of Sometimes they don't look to the female physician like differences between the western countries and here. If I the male physician. This is a problem of our society start comparing the two, I shall become very frustrated.
also. Our system does not give equal status to man and So I accept many situations. We have to.
woman. Sometimes women are more qualified, but Outside the workplace things are very different. You they don't get the same status. I have asked my cannot compare because everything here is according mother. . whether she has seen any change. She tells to the Holy Book. It is not at all so in the West or me that there is change in the attitude to women's anywhere else. I cannot adopt the western way of life education, but not much in their social position. So G. Vidyasagar, D.M. Rea / Women's Studies International Forum 27 (2004) 261–280 maybe the social position also will change in some manage my home, and also manage my profession.
The less senior doctors felt there were insufficient Nevertheless, the idea of both husband and wife vacancies to accommodate their hopes for promotion.
working has become more acceptable because some They would have to wait a long time or move to find it difficult to manage on one income. It is also another hospital. A few expressed the view that male very dprestigiousT for a family when both husband and competitors would always be favoured: wife are doctors (Faridah, a Consultant PaediatricEndocrinologist). Even so, some expect their working Promotions to higher posts than that are almost wives to attend to them after work. One doctor said impossible for women to get because of the Saudi this about her husband, also a doctor: mindset about females in top positions. (Habibah) Others were frustrated because people were pro- My husband likes the idea of me working and earning moted on the basis of good connections. A few said a good salary and helping financially. . but when he there were no problems, accepting they had got as comes home tired, he wants me to do everything for high as they would get. They said they were happy to him even if I am tired. . I love my children and my focus on patient care.
family. I love my work, but managing everything isdifficult. (Hadiya) Inshallah I may not have any problems because I wantto be in direct patient care. If I want administrative Managing domestic responsibilities in KSA is position, then there might be problems. Most male quite different from elsewhere because husbands are doctors want to be in administration. It makes them feel the only ones permitted to drive and because women important. For such appointments, men are preferred.
need a male with them in public. Husbands will drive children to school and be involved in shopping.
However, eleven also said they had help from their A majority of the doctors were married. They parents. All the married doctors had maids to help combined marriage, childcare, studies, and their them with their households, some more than one.
profession. It was not always easy: Some took the maids with them when they travelled . .my husband is not happy if I don't do the cooking.
abroad. Some of the unmarried doctors also had Also my kids they like food cooked by me. I don't maids. All the maids were expatriates.
want to make them unhappy. So I do the cooking. The The doctors all felt under pressure to work fewer maid helps me in many ways with the cooking too.
hours, and that this damaged their careers and She gets everything ready for me to cook. I just do the prevented them from being taken seriously.
actual cooking. So it is not very difficult like you Young children were unlikely to be able to help.
imagine. I think you can say I am 80% successful in They were considered cooperative if they did not combining profession, marriage and family and kids.
make a fuss about their mothers not being with them That is all I can say. (Ghadah, 35 years, Associate all the time. They were left in the care of maids or the hospital cre che. The doctors considered the cre che thebetter option—it was good and they were less anxious Some worked even though their husbands had not about leaving them there than with maids. They were allowed them to. However, a majority said their able to visit during lunch.
husbands were cooperative but may have consideredtheir husbands to be cooperative when they simply The future for women doctors in Saudi Arabia left them alone to pursue their profession.
One doctor who summed up the situation said: All agreed the future looked bright for Saudi My husband is very affectionate to me and the women doctors, although there were challenges ahead children. . He has his own life and I have to manage too. Eleven said they had good expectations of everything. He doesn't take any active interest in the promotion; 14 said these were dreasonably goodT.
family. I have to do everything for the children, Asked to judge the future for Saudi women doctors, G. Vidyasagar, D.M. Rea / Women's Studies International Forum 27 (2004) 261–280 four said the future was good, none said it was bad, and the rest said it would be good dwith conditionsT.
One said her generation had to dbreak the social These accounts are remarkable in several barriers downT, but they also faced a diminishing respects. Clearly, Saudi women have the same sorts labour market, and financial limitations. A drop in of difficulties that many women face in many parts the price of oil added to their anticipated difficul- of the world. However, they are in an almost ties, in that it affected hospital budgets and their unique position within a highly restrictive society prospects for promotion. More positively, one and culture. Many considered Islam defines gender doctor argued, future doctors dwon't have the roles and responsibilities and these are taken very problems of going outside the country for educa- seriously. Gender roles have been constructed very tion, etc.T (Hamidah, Senior Consultant). Another differently elsewhere, in western nations for exam- said their society was changing and it was becom- ple, as they industrialised, built empires and now ing accepted that women could have jobs and again with the modern welfare state and a new families. She said: world order. In KSA, a Wahhabi interpretation ofIslam shapes modern lives but is increasingly Girls have more job opportunities. They have more questioned. Travel restrictions on women affect freedom. . but every time something changes, some both genders, and many believe they will be less good and some bad comes with it. (Faridah) strongly adhered to in future. There is no doubt Most took the view that Saudi society faced social that women are more constrained by these than and religious restrictions but that these were not men. However, these Saudi women have found likely to lessen because they were based on the encouragement too, in pursuit of a highly presti- writings of the prophet Mohammed and the Qur'an.
gious and well-paid career. Work has given them So, women will have to work around it. A lot of great satisfaction. Perhaps many western women problems were peculiar to their society, but as one would envy the ease with which they gained a career opportunity and senior positions within it.
Saudi women, not just these, are protected from When the situation here becomes like everywhere domestic drudgery and low-paid menial jobs else, girls will still have problems, but a new set of (because the economy can afford to import cheap problems. (Badra) labour). Their lives have great limitations, but also In addition to managing home and family at the same time as their work, they felt they faced unfair This makes it difficult to conclude that they are competition in their careers. One said: discriminated against in any simple way. They sharewith professional women everywhere else in the This gets tougher as one gets higher professionally. .
world a difficulty in reaching the highest positions Very often a less efficient male colleague would be within their careers. But, unlike some women promoted for the simple reason he is a man and so elsewhere in the world, they live in a society (as more eligible for the rank. (Aminah) with other Islamic women) where the Qur'an Saudisation is nearly complete in city hospitals, obliges the society to guarantee their property so positions once occupied by expatriates can no rights, an education and particular employment longer be taken by newly qualified Saudi doctors.
opportunities. As elsewhere in Islam, these obliga- There was a shortage of jobs for those qualifying in tions are interpreted and mediated by legal and the new medical schools. So while most of the religious institutions that are predominantly male.
women doctors were pleased with the progress they Wahhabism may continue to affect these processes had made in their careers, and felt optimistic about and anti-westernism (al-Qaeda) poses an important their futures, their views were tempered by doubts new threat. Nevertheless, encouraged by the process about how economic difficulties might affect the of Saudisation, they receive state sponsorship of medical labour market and about how far gender their education, to the highest levels, and career roles might change in the longer term.
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