From misplaced compliments to awful usage of words in banter in locker rooms, women become victims of countless such instances where it is difficult for them to articulate their discomfort, sometimes due to a power struggle, many times due to orthodox and stigmatised homes (especially in the South Asian community) where no one would believe them, and most of the times because people think they ‘didn’t mean to harm’.
The Royal College of Surgeons of England wanted to celebrate 30 years of women in surgery organisation that they began by having a special edition of the Royal College of Surgeons of England bulletin, which is an in-house journal. They invited a guest editor, Rebecca Grossman, to curate that article. She reached out to Dr Simon Fleming, who is a trainee orthopaedic surgeon who has been involved in culture change work in healthcare since 2016. Grossman invited Fleming to write an article about sexual assault, sexual harassment, and rape in surgery, and she did that for a variety of reasons.
Sexual assault - an open secret
Speaking EXCLUSIVELY to Asian Voice, Dr Simon Fleming accepted that he acknowledges his privilege of being a White man. He said, “I'm a straight, white, private school-educated male. So, I get listened to in that way that many other voices do not. Part of the role of an ally or an advocate is to use their privilege to amplify voices that are otherwise an excuse that applies - not heard.”
Dr Fleming decided that he wouldn’t write this article without a woman co-author.
“I reached out to maybe 20 or 30 women who shared experiences of assault and rape with me. When I asked, ‘would you be willing to co-author a piece with me?’
“They all said, no. They were either scared of recrimination, revenge, or consequences. Some said that they didn't want to revisit what happened to them. Some said, ‘Oh, I reported it, and nothing happened. So, I don't want to.” he told Asian Voice.
When Fleming offered anonymous authorship, a woman told him, “But I'm still scared.”
Then he reached out to Dr Becky Fisher, who is the co-author and the supervisor of the paper titled ‘Sexual assault in surgery: a painful truth’.
“I said to Becky if she would be willing to help? Because I know that she has experienced harassment but has never been assaulted. She is impressively courageous,” he told us, and the rest is history.
Recently, the article has regained momentum because Philippa Jackson, a surgeon shared her story of sexual assault amid preparation for surgery while tying her gown. More women picked up Fleming and Fisher’s article and shared far more graphical experiences anonymously.
Fleming said, “These behaviours are sort of an open secret. Everyone knows they happen. And they have been not just normalised but nearly expected. I should add that it's not just surgery that contains these behaviours, it is simply surgery that is currently choosing to address them. They are wrapped up in a culture of the hierarchy of patriarchy, of power of infantilisation. It's important to note that healthcare is not broken, it was built this way. The hierarchy that exists, the patriarchy and hierarchy, the kind of oppressive systems that exist in healthcare globally, are because healthcare was built by straight white men who were old, to potentially support the careers and lives of younger white men that they liked.
“Now we're working on changing that, and that work towards a more diverse, inclusive workforce is ongoing. The foundations are one of the powers of silence. When my predecessors were trying to break glass ceilings, and women were trying to break into healthcare, they needed to fit in a certain way. Jokes were laughed at that probably shouldn't have been and behaviours were normalised, which probably shouldn't have been.
“It's not a woman's responsibility to change these people's behaviours. It is not acceptable that your baseline is ‘I'm not a rapist’. You know, organisations and individuals should be actively anti-racist, anti-assault, anti-harassment, anti-racism, anti-sexism. It's not enough to say, I'm not sexist.”
He mentioned that people of colour “certainly shared” their accounts of surviving sexual assault and that these behaviours do not happen in isolation. “Women of colour experience this more and often there is a certain amount of racism and discrimination wrapped up in the narrative of harassment, assault and rape. Therefore, we need to change the culture from the ground up,” he added.
Dr Fleming says that there needs to be a system in place around accountability. Many times, he said that his subjects made very few mentions of involving the police or going to Human Resources. He also adds that crime discrimination is a crime as well.
According to the co-author, there is a fundamental lack of understanding of the actual nature of harassment and assault. Most culprits can’t differentiate between that. In a rare exception, many years ago, a British Asian doctor of Indian-origin had committed suicide after being wrongly accused of sexually assaulting a colleague. It was too late to save him when the investigation results of the inquiry found that he was innocent after all.
“The NHS has a monopoly employing doctors, nurses and physiotherapists and all the rest pretty much the NHS is the only shop in town. So, fears of courage, changing things are real. And that's kind of where we are we are trying to start those conversations; we're trying to move towards a safer culture. Because there is no place for these behaviours in healthcare whatsoever,” Dr Fleming said.
The co-author also told the newsweekly that training has taken a huge hit in the pandemic. He said, “It has made that power dynamic, even steeper because trainees are desperate to progress to get ahead to get the signatures they need. It is potentially a toxic, dynamic if the person of the fun end of the power dynamic decides to abuse it.”
Asian Voice reached out to Dr Becky Fisher but did not hear from her by the time we went to print on Tuesday. The British Medical Association (BMA) wrote back to us saying, they were “not sure” if they could help with this. A spokesperson from BMA added that if it’s something they might have some detail on in future though, they’ll be sure to let Asian Voice know.
However, we did manage to speak to several Asian doctors, who confirmed that this culture, unfortunately, exists in the NHS.
International medical graduates are constantly under stress
Speaking to Asian Voice about sexual assault in the medical profession, Dr Jyothi Srinivas, a Consultant Paediatrician and Chair of the BAPIO Women's Forum said, “Women make up 77% of the NHS workforce. The proportion of women and men as doctors is approximately equal however this varies in different specialities. It is well known that men occupy most senior positions in clinical and managerial areas.
“Recently we have seen many women speak up about their experiences of sexual abuse at work. This includes women from different backgrounds including BAME. We should remember that IMGs (International medical graduates) are constantly under stress about their visas and need a good reference that they seldom feel they are able to speak up against racism or abuse at work. Add to this the lack of support network with no family or friends in the country, they feel vulnerable in raising any issues.
“The GMC (General Medical Council) data shows that BAME doctors are disproportionately referred for concerns. A few BAME male doctors underwent detailed investigation by GMC although there was very little evidence against them to proceed.
“What can we do? - This is like the 'MeToo' movement. We need to make a safe environment for women in NHS to share their stories without judgement. Many of these abuses are small acts in everyday working life (patting on the back/bottom, standing too close, texting out of hours for no reason, making inappropriate jokes, commenting on dress/hair etc). We cannot pretend to understand the huge mental and psychological implications these everyday actions have on women. We need more women in fields this abuse is rampant eg. surgery so that there are strong senior role models.
“Giving women space to talk about their experiences, taking allegations seriously supporting women who decide to complain and ensuring adequate punishment to those convicted of sexual abuse at work helps to address this issue.”
Women doctors from BAME feel disadvantaged
Dr Aaliya Goyal, GP and Primary Care Clinical Lead told us, “Dr Fleming and Dr Fisher’s report highlights the experiences of many female surgeons who have been victims of sexual harassment in the workplace, particularly in training posts. The power that trainers hold, and the fear that they can use this power to halt career progression, prevents women from speaking out. Women doctors from our communities often already feel disadvantaged due to systemic barriers, impacting career progression and exacerbating the gender and ethnicity pay gap, so it can be even more challenging to report harassment.
“Some of us have grown up seeing how sexual harassment has been normalised in public spaces in our countries of origin and had a tacit understanding that certain environments “aren’t safe” for us to be in alone, so there may be generationally embedded layers of cultural shaming, victim-blaming and silencing which affect our ability to speak out on sexual harassment in the workplace. I am glad we are having uncomfortable conversations. I agree with the authors’ call to action of a clear and unambiguous zero-tolerance approach to sexual harassment, with those perpetuating it being held accountable for their behaviour. This must be underpinned by strong leadership from the top to make the workplace safer for us all.
“It’s really difficult to find somebody to speak out about sexual harassment they have experienced. Even at the end of the report in the “authorship” section, they mention that no victim was willing to co-author.”
Professor Partha Kar OBE FRCP, Consultant Endocrinologist Portsmouth Hospitals NHS Trust, National Specialty Advisor, Diabetes, NHS England GIRFT, and Director- Equality, Medics, NHSE told Asian Voice, “It’s great that this is being talked about more openly. I have heard from colleagues of such behaviour from fellow male colleagues and part of the role of the system is to talk about it, as well as ensure that those who do - can do so without fear of retribution.
“Are we there yet? No. Is there evidence that individuals are challenging the status quo? Yes, for sure and I would encourage more people to do so - thus clear support from the NHS and royal colleges are much needed
“It’s something the NHS has been asked to look at by the Secretary of State for health- and hopefully will be tackled with all the seriousness it deserves. In my personal local role, I would be more than happy to support any trainees or colleagues who face such issues.”
