Chair’s Report: WIN-WFNS in Global Neurosurgery
Souad Bakhti, Nabila Tighilt
Department of Neurosurgery, EHS Ali Ait Idir, Algiers
Neurosurgery has 100 years of existence as a specialty. Colossal progress has been made since the birth of the specialty. However, we must ask ourselves the question:
“What is the place of women in neurosurgery?
Several women have been early pioneers in their respective countries and have opened the path to others – but unfortunately the number of women neurosurgeons is still very low. Fortunately, Women in Neurosurgery are getting more and more attention and the abbreviation WIN is now widely used in publications and meetings. This is mainly due to women who realized that their numbers in neurosurgery were far below their worth and skills and so the world’s first WIN group was born in the USA in 1989 (1). The main concern of this group was to promote female neurosurgery. Another important group of women in neurosurgery is the WIN-WFNS committee, which has been chaired by women leaders in neurosurgery: Yoko Kato, Ling Feng, Najia El Abbadi. This committee has contributed greatly to the promotion of female neurosurgery worldwide by organizing sessions dedicated to women in order to expose the problems encountered in their professional progression and to propose solutions.
After that a new concept emerged in the WIN-WFNS Committee – the organization of scientific sessions with women speakers during several international meetings such as the 7th Maghrebian Congress (Nouakchott, March 2018), the 12th Panarab Neurosurgical Society Congress (Marrakesh, October 2018), the WFNS International Meeting (Belgrade, March 2019), the 3rd Arab Pediatric Neurosurgery Society and 8th Maghrebian Neurosurgery joint conference (Tangiers, June 2019), the Special World Congress (Beijing, September 2019) and the Interim Meeting of the Panarab Neurosurgical Societies (Dubai, October 2019). For the first time in its existence the WIN-WFNS committee organized a course on myelomeningoceles on the sidelines of the 2nd Maghrebian Neurosurgery course (Nouakchott, February 2020).
Although the COVID-19 pandemic has stopped physical presence at meetings, the WINWFNS Committee has continued its activity by collaborating with the Pakistani Society of Neurosurgery, and by organizing – with the Algerian Society of Neurosurgery – webinars entirely led by women neurosurgeons (Fig. 1). The movement of WIN groups has grown across the world with the creation of several WIN groups, including the WIN-ACNS chapter officially inaugurated during the 6th WFNS Symposium (Kuala Lumpur, August 2018), the WIN section of the Brazilian Neurosurgery Society in September 2018, and the WIN section of CAANS in July 2019. The WIN-ACNS chapter has given in collaboration with the WINWFNS Committee the best abstract of the year 2019 to Dr Noor Ul Huda Maria from Pakistan during the WIN-WFNS session of the Special World Congress of Beijing.
Women in neurosurgery are in contact through social networks such as Whatsapp groups created by Nelci Zanon in July 2018. These groups have allowed us to have relationships with women neurosurgeons all over the world. We have been able to disseminate information regarding fellowships, scholarships, surveys, and documentation.
Women have been in key positions in neurosurgery in recent years include Shelly Timmons (1st woman president of the AANS in 2018), Ling Feng (1st woman president of a WFNS world congress in 2019, and Najia El Abbadi (1st woman president of Panarab Neurosurgical Society). We must also note the essential role of Gail Rosseau in promotion of women in neurosurgery. Other pioneer women neurosurgeons in their countries include Heba Sharafeddine in Lebanon (2018) and Claire Karekezi in Rwanda (2019). Our apologies to for not being able to quote all the others.
Despite all the great achievements of women neurosurgeons, our overall percentage of the total number of neurosurgeons in the world remains very low, e.g. 8% of practicing neurosurgeons in the USA (2). For many years Karin Murasko was the only woman head of a neurosurgery department in the USA. Fortunately since 2017 some women have joined her (1). In Italy, where the percentage of women neurosurgeons is higher (21.9%), they are only 6.7% in academic positions with no women full professors (3). In Algeria, the percentage of women neurosurgeons is 23% (data from Algerian Society of Neurosurgery). Although few women are in positions of responsibility, it is important to note that women are heads of 2 the 5 biggest departments in the country. The “dean” of women neurosurgeons in Africa and the Middle East is Faiza Lalam from Algeria; she began her training in 1977 and became certified neurosurgeon in 1982 (Fig. 2). Currently 54% of neurosurgery residents in Algeria are women, much higher than in the USA (17%) (4).
What are the explanations for gender disparity in neurosurgery? They are different from one region to another. In many countries it is mainly due to the method of recruitment: on the CV gender is identified and many heads of departments are afraid to have women because of their potential for future pregnancies (5, 6). Another cause is salary discrimination such as in the USA (2). Harassment is also a cause in all countries but it can be difficult to quantify because a lot of women do not want to mention their experience with harassment officially. In countries such Algeria and Morocco, and many other low- and middle-income countries (LMIC), the residents are recruited based on exam results only and there is no difference in salary. In these countries the inequality in gender is mainly due to societal stereotypes rather than to laws: many women neurosurgeons consider themselves first of all as caregivers and this can hinder their careers. Finally, the lack of mentorship, essential for promotion to leadership positions, is frequently a hurdle for women neurosurgeons.
The problems experienced by women in neurosurgery are the ones that women all over the world struggle with daily. That is why we all must participate actively in women’s emancipation. A great hope may come from countries such as Mauritania, where despite the youth of neurosurgery the number of neurosurgeons is 10 and the number women is 2 among 5 residents (data from Mauritanian Society of Neurosurgery).
This report is dedicated to the memory of Jeanne Winatku, first women neurosurgeon in Indonesia, who died of COVID-19. She taught neurosurgeons the importance of emancipation and how women neurosurgeons can improve patient care with a gentle touch.
Fig. 1: Flyer of the webinar organized by the WIN-WFNS Committee in collaboration with SANC
Fig. 2: Prof Faiza Lalam first resident in neurosurgery in Africa and Middle East