How often does someone meet an accident and go to a hospital and undergo trauma surgery in an emergency? The chances are very rare and similarly, the chances of ending up under the hands of a female trauma surgeon are rarer. In fact, in all of Pakistan there is only one female trauma surgeon.

Dr Madeeha Ali, 36, is the first female to graduate from The Aga Khan University Trauma Surgery Programme, the only trauma programme in the country. She graduated from the programme’s ninth batch since 1999.

As a General, Trauma, and Laparoscopic Surgeon, Dr Madeeha’s hands dance between chaos and order, bringing together broken lives in the operating theatre. She and her team are the everyday heroes at the centre of busy Karachi where accidents require the urgent attention on a daily basis.

The eldest of three sisters, young Madeeha was burdened with the responsibility of fulfilling her parents’ dream of having at least one doctor in the family. “I was the eldest and was good in studies, which is maybe why I was chosen for this,” she told The Express Tribune. However, her duty became a passion quickly. “Eventually when it was time to enroll into an MBBS programme, I wanted that and nothing else,” she shared. The surgeon’s journey of following a common dream of becoming a doctor ended up arriving at a bigger milestone of becoming the first female surgeon in Pakistan.

Dr Madeeha chose to specialise in aspects that usually are not commonly chosen by many surgeons. Her fellowship in keyhole surgery in laparoscopic advance similarly has a small ratio of women. “At first when my parents shared their wish that I become a doctor, I never thought of any other option and wanted to succeed in the field. However, it was my curiosity that led me to choose surgery and learn the subject intensively,” she explained.

The five years of doing MBBS meant commuting daily from Naval Housing Society in Hawkesbay to Hamdard University in Hub Chowki, a two hour drive each way. “My struggle was no different from many others,” she said. “The goal was to complete a house job which I was interested in doing from any government sector,” she said, adding that getting into a government facility wasn’t easy unless you have a recommendation or bribe. She applied for the house job officer post in Jinnah Postgraduate and Medical Center. The then Executive Director (late) Dr Seemin Jamali approved her application.

As it happened, the moment she went to the administration with the letter, they slashed off the paid house job to an unpaid one. “I was told that’s how it works and that I will not get paid. But the experience was what I wanted so I agreed and started working. JPMC is a facility where the learning experience is phenomenal in terms of variety of cases,” said Dr Madeeha, who is also FCPS (Surgery) MRCPS (Glasgow), General Surgery and Trauma Fellowship (AKUH), Assistant Professor of General Surgery at Dow Medical College, Dow University of Health Sciences.

Meanwhile, when she got the JPMC offer, she also appeared for the AKUH test. Passing that test is what changed her life and expanded her horizon. “In 2011, when I got a house job in AKUH, it was like a new beginning for me and I never looked back since then. Meanwhile doing my house job I also prepared for my FCPS part 1 in surgery because that is what I wanted to get my specialisation in,” the trauma surgeon explained.

When in 2012 her house job finished, she started working with Dr Rufina Soomro in Liaquat National Hospital and applied for the General Surgery Residency. “I was exempted from the test because of my house job from the same hospital but taking out time to appear for the interview from the LNH clinic was a big task given that the OPD for the clinic can go beyond 12 hours sometimes,” she explained.

When Dr Madeeha was accepted into the AKUH residency programme, her previous Head of Department denied releasing her but after a week of denial, they eventually accepted the resignation. In those times, many of my senior colleagues helped me to take the residency programme. They knew how passionate I was about trauma surgery,” she shared.

When it came time to choose a residency programme, her father encouraged her to opt for gynaecology or pediatrics because from his perspective these the two fields commonly employ women and, therefore, have more scope for women in terms of career. However, Madeeha sat her father down and explained what she wanted to do and how her interest was more in trauma surgery.

The five-year residency programme at AKUH gave her courage which she hopes other women will emulate and opt for subjects which are male dominant. “Being a woman, the most common idea is to get specialisation in gynaecology. However, in a field like trauma surgery where victims of accident cases, head injuries, burn victims, and bomb blast victims are handled, being a female one has to put double effort to prove our mettle,” she opined. Every other department and surgery can be pre-planned and timed or surgeons can schedule and get time to prepare but with trauma surgery the decisions and surgery are done instantly. “One can get calls at any moment of the night to cater to any accidents such as road accidents, blasts, or any other trauma cases. For example, I can get a call at 3am that there is a case of gunshot that requires surgery and such surgeries are done on spot,” she added.

Dr Madeeha is also a Minimally Invasive Surgery Fellow (NUH-Singapore). “I left for one year on study leave from Civil Hospital on a fellowship to Singapore to learn minimal invasive surgery on January 15, and I believed that it would enhance my expertise and enable me to serve my country and patients well,” she added.

A case that has left a long-lasting impression on her is of a young man who suffered a head injury in a fight over a property dispute. He was stabbed around 50 times and his injury was blunt. When he arrived at the emergency, he had no pulses, a nil blood pressure reading; his liver, spleen, kidneys were injured and all organs had bleeding. “In his situation, we did damage control surgery and removed his kidney. We packed his liver with gel to stop the bleeding and shifted him to ICU and after packing him well, we closed him up,” she said. Recently, Dr Madeeha saw the man again. He told her he had named his baby after a doctor from her team as a gesture to recognise the efforts that team made in saving his life.

While her career flourished and she made a difference for her family by achieving so much, her life was not without its ups and downs.

In 2018, while she was doing her residency, her youngest sister who was 18 at that time —13 years younger than Dr Madeeha — had high-grade fever. With her condition worsening, she was rushed to the hospital and, after few tests, she was diagnosed with blood cancer.

“I was already in AKUH so I had to take care of everything. I also knew what should be done and what shouldn’t,” she said. Once the diagnosis was done her sister had to have a bone marrow transplant and Dr Madeeha was the best match among the sisters. Many advised her against donating, but in January 2019, she made the sacrifice for her sister regardless.

The whole process was four days long but aftercare and other aspects required her to take a month’s leave as she was the primary caretaker of her sister at the hospital. “That one year after all the issues, complications, and reactions, I got back and completed my residency,” she added.

The change that Dr Madeeha wants to make is to lessen the mortality rate in trauma surgery. In fact, within six months of her tenure in Civil Hospital, there was a significant improvement in trauma care and eventually a decrease in mortality and morbidity in trauma patients.

“I was sincere with my work and committed to my path. Eventually, opportunities kept coming up for me but in such fields where there are few women. It gets difficult to prove our worth and we are mostly told to choose subjects that are more female-oriented or we are discouraged mostly when opting for male-dominated subjects,” the trauma surgeon added.

Dr Madeeha takes pride in her team who operates in emergencies where patients require immediate on-spot care and surgeries. “There is no time to prepare yourself because the time frame is hardly minutes before the patient can expire or other vital organs can be damaged from bleeding or the injury,” she explained.

Why trauma surgery need’s a woman’s touch

Trauma surgery, a specialised field of medicine dedicated to treating injuries resulting from accidents, violence, or emergencies, plays a pivotal role in saving lives and restoring health. It involves the prompt and effective management of critical injuries, encompassing fractures, internal organ damage, bleeding, and life-threatening wounds.

Trauma surgeons are highly trained medical professionals who operate in emergency settings, responding to severe cases such as car accidents, falls, gunshot wounds, and other traumatic incidents. The medical care they provide follows the concept of the ‘Golden Hour’, the critical time frame within which prompt trauma care significantly improves patient outcomes. Rapid assessment and intervention during this period are essential.

Trauma surgeons not only play a key role in patient resuscitation, stabilising vital signs, and optimising overall patient condition for further treatment but also leverage advanced technologies like imaging systems and minimally invasive surgical techniques to enhance precision and speed. Extensive training, including general surgery residency and trauma surgery fellowship, prepares trauma surgeons for managing complex cases. Collaboration with various medical specialists, including anesthesiologists, radiologists, nurses, and rehabilitation experts, ensures a comprehensive approach to patient care, from immediate interventions to recovery and rehabilitation.

In socially conservative countries like Pakistan, the inclusion of women in trauma surgery is of paramount importance. Cultural norms may dictate preferences for healthcare providers of the same gender, and the presence of women trauma surgeons addresses these preferences, ensuring that individuals, regardless of gender, feel comfortable seeking emergency medical care.

Women in countries like ours may face barriers to seeking medical attention. Having female trauma surgeons helps break down these barriers, providing a pathway for improved healthcare access. The presence of women trauma surgeons also contributes to improved patient comfort, especially in situations where patients may feel more at ease with a healthcare provider of the same gender. Additionally, women trauma surgeons may play a vital role in addressing the psychological impact of traumatic injuries on patients and their families, collaborating closely with mental health professionals.

Beyond promoting gender equality, women trauma surgeons offer unique perspectives that enhance cultural sensitivity in patient care. Moreover, women trauma surgeons serve as powerful role models for aspiring female healthcare professionals, inspiring them to pursue careers in medicine and challenging traditional gender roles.