Across the globe, women are made vulnerable by modifiable determinants in their homes, communities and cultures. In “Barriers to healthcare for female patients in Papua New Guinea,” Klaver and Coe address some of this risk. The authors present the case of a 25 year old woman who had complaints of abdominal distension, exertional dyspnea and amenorrhea. Despite trying to address these symptoms early on, she “had been turned away… [d]ue to limited resources and high levels of tribal fighting in the area…. The closest hospital where elective surgery was available was a 10-hour journey by dirt road for which she had neither transport nor funds to allow her to travel.” Her husband had left her and taken a second wife due to her illness, and she had moved back to her family and was raising her child alone. “She currently had no contact with or financial support from her husband.” She was diagnosed with HIV, treatment was initiated, and three months later had an ovarian cyst of 5.3 kg (12% of her body weight) removed in an uneventful elective surgery.
While there are multiple reasons for her delayed presentation to care and the severity of her symptoms, the authors make clear that tribal violence in the highlands of Papua New Guinea was a major factor in her delayed presentation. First, “Women are commonly targeted in the tribal fighting and subjected to rape and sexual violence as part of the conflict.” Second, “Due to high levels of trauma and significant numbers of patients requiring emergency surgery… [the hospital] did not undertake elective procedures.” Both of these facets of the tribal violence conspired against this patient to ensure she would remain in poor health.[1]
Papua New Guinea is the only country in the pacific where women have a lower life expectancy than men. As described by the authors, “Many women are only allowed to attend… hospitals with the permission of their husbands, and any surgical procedure would certainly require… [his] consent.” Many women in abusive relationships have no other options but to return to their abuser.[2] Her amenorrhea caused her husband to abandon her for a second wife, and she was forced to provide for herself despite her condition. The author’s hypothesize, “Had [her ill health]… not prevented her from working, she would likely never have voluntarily attended the hospital.” These gender disparities are worsened in diseases associated with cultural stigma, such as HIV.[3]
While the outcome from this case can be construed as positive, this woman still suffered for years because of discrimination against her gender. This is not only a problem in Papua New Guinea, but worldwide. Health professionals can act as advocates for these patients by ensuring they receive the proper care, being aware of the gender biases present in each culture, and fighting for their patients on a local, national and global level.
BMJ Case Reports invites authors to submit global health case reports that describe the disparities of healthcare based on gender. These cases could focus on:
-The factors contributing to these disparities
-The methods used to ensure equal care for all
-The unique contributions made by female practitioners in areas of gender disparities.
Manuscripts may be submitted by students, physicians, nurses and allied health professionals to BMJ Case Reports at www.bmjcasereports.com. For more information, review our guidance on how to write a global health case report and look through our online collection
To read more about gender disparities at BMJ Case Reports, please review:
- ‘The more we change, the more we remain the same’: female feticide continues unabated in India
- Barriers to safe abortion access: uterine rupture as complication of unsafe abortion in a Ugandan girl
- HIV in India: the Jogini culture
To read more about gender disparities globally from other cited sources, please review:
[1]ICRC report, 2016. The old ways are gone: Papua New Guinea’s tribal wars become more destructive. Available at https://medium.com/@ICRC/the-old-ways-are-gone-papua-new-guineas-tribal-wars-become-more-destructive-ade38205196f
[2]MSF, 2016. Papua New Guinea Report- “Return to abuser”. http://www.msf.org/sites/msf.org/files/msf-pngreport-def-lr.pdf
[3] Wardlow H. The (extra)ordinary ethics of being HIV-positive in rural Papua New Guinea. J R Anthropol Inst 2017;23:103–19.doi:10.1111/1467-9655.12546