- Email: [email protected]
Tales from Tapologo
Perspectives
roles for women; lack of flexibility in the structure of the working day; and out of hours work at times when child care is hard to find. All these become barriers that influence the choice about whether to enter that specialty. Part-time working is a continuing source of controversy in medicine. With the increased number of women coming into the workforce, and their likelihood of working less than full time to complete their families, there will need to be alterations in the current pattern of the working day, and more opportunity for part-time work. It is essential to maintain the workforce, which means keeping women in the workplace. But this means that more people (jobs) will be required to fill the same number of working hours. An alternative approach would be to encourage women to work longer hours, but this would need to be supported by more flexible and accessible child care. Either way, an increase in part-time working will be more expensive.
Here in the UK, a 2006 report called for action in taking steps to increase the number of women in the most senior positions in medicine. A working party chaired by Baroness Deech has been set up and will report later this year. Although women will soon be the majority of medical school entrants, the numbers at the top do not reflect those going in at the lower levels. One of the arguments here is that it is not possible to become a part-time leader, and it is difficult to reach leadership status if you have not invested in the necessary extra activities along the way. The barriers to this—or the “choice” not to do these activities—is influenced by a number of issues. The working week has become longer, and societal expectations still presume that women will continue with the majority of the household chores and the child care. This makes it difficult for women with family responsibilities to participate in the “extras”, which involve going to meetings before or after the working day and participating in international travel.
The gender gap in medicine is narrowing. Gender equality is slowly filtering into the medical workplace, but there is still a way to go. The situation in the UK is better than the USA, with better pay equality, maternity leave provision, and opportunity for parttime working at consultant level, but organisational and cultural barriers continue to inhibit true equality in the medical workplace. Books like this, together with the research completed by the Royal College of Physicians, have presented the data in a usable form. It is now up to the profession to interpret it and act on it. When I first became interested in women in medicine, I thought that I personally had not come across any discrimination in the workplace, but I now think that it was there, but subtle. It is only when you look carefully that you notice problems with the perceived normality around you.
Jane Dacre [email protected]
In brief Film Tales from Tapologo
Tapologo Directed by Gabriela Gutiérrez-Dewar, Sally Gutiérrez-Dewar. Estación Central de Contenidos SL/Uhuru Productions, 2008. http://www.tapologofilm.com See Lancet Infect Dis 2009; 9: 218
1418
Hot dusty roads, ramshackle tin houses with no water or electricity, and 20 000 people. This is Freedom Park in South Africa’s mining heartland. It would seem the miners have a fairly straightforward existence: they go to work, drink beer when they’re done, and hire a sex worker for the night. Life for the sex workers, though, is more complicated. Their clients call themselves their “husbands”, but the illusion of monogamy is just that. In return for giving the women money to live, men refuse to wear condoms— a dangerous bargain in South Africa, where one in ten people are infected with HIV. As a former sex worker in Tapologo says, “if you take the money, you must take the virus too”. In the middle of this “misery, exploitation, and vulnerability”, as
Bishop Kevin Dowling puts it, is a ray of light. The eponymous Tapologo is a health centre, co-founded by Dowling, where HIV-infected women living in Freedom Park can get treatment, counselling, and palliative care. Although the local diocese helped set the centre up, the impetus came from the women themselves. Several of them have trained to be homecare workers and wake up at dawn to visit patients all over the community. Dowling finds it hard to reconcile his faith in the church with its hardline position of abstinence before marriage and fidelity afterwards. Such moral high ground is irrelevant, he rages to the camera, to women whose “only goal is to survive”. For such a politically charged subject, Sally and Gabriela GutiérrezDewar’s elegantly shot documentary
has a noticeable omission. At no point does anyone so much as whisper a word about the government’s failure. Thabo Mbeki’s denial of the HIV/AIDS pandemic that has killed millions, and the resulting delay in access to antiretrovirals, is the backdrop to the current depressing state of affairs in South Africa. And, given the charges levelled explicitly at the Church, and implicitly, at the men who infect these women, it seems slightly unfair that they were not given the chance to justify their actions. But perhaps because the film’s point of view is that of the women, this is as it should be. As one woman simply says “I want to live long enough to be an old woman”.
Priya Shetty [email protected]
www.thelancet.com Vol 373 April 25, 2009
roles for women; lack of flexibility in the structure of the working day; and out of hours work at times when child care is hard to find. All these become barriers that influence the choice about whether to enter that specialty. Part-time working is a continuing source of controversy in medicine. With the increased number of women coming into the workforce, and their likelihood of working less than full time to complete their families, there will need to be alterations in the current pattern of the working day, and more opportunity for part-time work. It is essential to maintain the workforce, which means keeping women in the workplace. But this means that more people (jobs) will be required to fill the same number of working hours. An alternative approach would be to encourage women to work longer hours, but this would need to be supported by more flexible and accessible child care. Either way, an increase in part-time working will be more expensive.
Here in the UK, a 2006 report called for action in taking steps to increase the number of women in the most senior positions in medicine. A working party chaired by Baroness Deech has been set up and will report later this year. Although women will soon be the majority of medical school entrants, the numbers at the top do not reflect those going in at the lower levels. One of the arguments here is that it is not possible to become a part-time leader, and it is difficult to reach leadership status if you have not invested in the necessary extra activities along the way. The barriers to this—or the “choice” not to do these activities—is influenced by a number of issues. The working week has become longer, and societal expectations still presume that women will continue with the majority of the household chores and the child care. This makes it difficult for women with family responsibilities to participate in the “extras”, which involve going to meetings before or after the working day and participating in international travel.
The gender gap in medicine is narrowing. Gender equality is slowly filtering into the medical workplace, but there is still a way to go. The situation in the UK is better than the USA, with better pay equality, maternity leave provision, and opportunity for parttime working at consultant level, but organisational and cultural barriers continue to inhibit true equality in the medical workplace. Books like this, together with the research completed by the Royal College of Physicians, have presented the data in a usable form. It is now up to the profession to interpret it and act on it. When I first became interested in women in medicine, I thought that I personally had not come across any discrimination in the workplace, but I now think that it was there, but subtle. It is only when you look carefully that you notice problems with the perceived normality around you.
Jane Dacre [email protected]
In brief Film Tales from Tapologo
Tapologo Directed by Gabriela Gutiérrez-Dewar, Sally Gutiérrez-Dewar. Estación Central de Contenidos SL/Uhuru Productions, 2008. http://www.tapologofilm.com See Lancet Infect Dis 2009; 9: 218
1418
Hot dusty roads, ramshackle tin houses with no water or electricity, and 20 000 people. This is Freedom Park in South Africa’s mining heartland. It would seem the miners have a fairly straightforward existence: they go to work, drink beer when they’re done, and hire a sex worker for the night. Life for the sex workers, though, is more complicated. Their clients call themselves their “husbands”, but the illusion of monogamy is just that. In return for giving the women money to live, men refuse to wear condoms— a dangerous bargain in South Africa, where one in ten people are infected with HIV. As a former sex worker in Tapologo says, “if you take the money, you must take the virus too”. In the middle of this “misery, exploitation, and vulnerability”, as
Bishop Kevin Dowling puts it, is a ray of light. The eponymous Tapologo is a health centre, co-founded by Dowling, where HIV-infected women living in Freedom Park can get treatment, counselling, and palliative care. Although the local diocese helped set the centre up, the impetus came from the women themselves. Several of them have trained to be homecare workers and wake up at dawn to visit patients all over the community. Dowling finds it hard to reconcile his faith in the church with its hardline position of abstinence before marriage and fidelity afterwards. Such moral high ground is irrelevant, he rages to the camera, to women whose “only goal is to survive”. For such a politically charged subject, Sally and Gabriela GutiérrezDewar’s elegantly shot documentary
has a noticeable omission. At no point does anyone so much as whisper a word about the government’s failure. Thabo Mbeki’s denial of the HIV/AIDS pandemic that has killed millions, and the resulting delay in access to antiretrovirals, is the backdrop to the current depressing state of affairs in South Africa. And, given the charges levelled explicitly at the Church, and implicitly, at the men who infect these women, it seems slightly unfair that they were not given the chance to justify their actions. But perhaps because the film’s point of view is that of the women, this is as it should be. As one woman simply says “I want to live long enough to be an old woman”.
Priya Shetty [email protected]
www.thelancet.com Vol 373 April 25, 2009