As part of my post retirement ob & gyn activities, I spent two years in the early nineties, working at the Aga Kahn Medical School in Karachi, Pakistan. That is a most modern facility with excellent staff and resources and great medical students. One can imagine that the majority of obstetricians and gynecologists in a muslim country, like Pakistan, are female and that male ob & gyn might encounter some difficulties It was my distinct impression that often it is not the woman herself who objects to being examined and treated by a male, but rather the husband. An anecdote of a real situation which I encountered will illustrate this. One day I was sitting in my office next to the labor and delivery suite as one of the more junior female residents came running into my office, quite excited. “Doctor Le Maire, could you please come quickly? One of the laboring patients has some very major drop in the baby’s heartbeat. I am worried but cannot reach her private doctor and the doctor on call is in the operating room.” I ran over to the delivery suite with the resident and into the patient’s room. She was obviously in much discomfort and her husband was at her side. One of the first things an obstetrician may do when a woman in labor shows signs of some problem with the undelivered baby as evidenced by a drop in the baby’s heart rate, is to examine the woman vaginally. In doing so, the he or she can determine if the baby can be quickly delivered or if there is a reason for the drop in the baby’s heart rate, such as a loop of the umbilical cord being compressed by the head, in which case an immediate C- Section might be necessary. So I immediately put on a pair of sterile gloves and got ready to examine the woman. She herself was perfectly ready to let me do this, but her husband stopped me and told me that he objected to his wife being examined by a male. This was even in the face of a serious situation with potential for harm to his unborn baby. There was no time to be lost trying to reach one of the female attendings, so I did the next best thing and told the very junior resident to take the patient into the operating room and examine her there and let me know the findings, while I was getting the operating room organized to do a C-Section, if called for. The strange thing is that the husband would have let me do a C- Section on his wife, but not a vaginal exam. As it turned out, by the time the patient ended up in the operating room, her private doctor had been located and was in attendance. The outcome was good and a healthy baby was delivered soon after. However the situation could have been quite different and catastrophic. Even stranger to me was that the woman’s husband was not a lay person but actually a chief resident in anesthesiology in the same hospital, with whom I had worked together in the operating room on a number of occasions. I would never have thought that an educated person and a medically educated person at that, would jeopardize the well being of his unborn child and wife, based on cultural and religious beliefs. Later on in the year this same anesthesiology resident came to ask me for a letter of recommendation as he wanted to apply for a specialized fellowship in the USA. I hope that the reader can understand why I politely (perhaps not so politely) refused. Those interested can read more about my experiences in an e book, entitled "Crosscultural Doctoring. On and Off the Beaten Path." One can down load it for free to the reader device of your choice from Smashwords at: http://smashwords.com/books/view/161522. Or just Google Crooscultural Doctoring.
DR William LeMaire
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