education

2014/03/06

Margaret Bugyei-Kyei

“You’ve got to wear white for three months.” Margaret is a senior ODP at Great Ormond Street Hospital in London.Read more →

2014/03/06

Aisslta Bissang-Kondet

“I’ll tell you the story of a 9 year old girl I can’t manage to forget.” Aisslta – known toRead more →

2014/03/05

Dr Zipporah Gathuya

“The surgeons were screaming they needed to get the baby out.” Zipporah is a Consultant Anaesthetist working in Kenya. Her areaRead more →

2014/03/05

Dr Sandra Leal

“Latin America shares many things, among them a strong regard for family – which constitutes the center for society” SandraRead more →

2014/03/05

Dr Eva Hanciles

“Often the first time a pregnant women come to hospital is when she’s been trying to deliver at home withoutRead more →

2014/03/05

Dr Angela Enright

“Women are the glue that hold the family together. If the mother dies in childbirth, it is a catastrophe forRead more →

2014/03/05

Dr Ronke Desalu

“Safe surgery is tied up with the socio-economic status, political participation and education of women.” Ronke is an Associate ProfessorRead more →

2014/03/05

Dr Nneka Anaegbu

“In the coming decade we’ll be on the frontier and at the helm.” Nneka is a Consultant Anaesthetist at LagosRead more →

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Margaret Bugyei-Kyei

Margaret Bugyei-Kyei

“You’ve got to wear white for three months.”

Margaret is a senior ODP at Great Ormond Street Hospital in London. She trained as a nurse and then in anaesthesia in Ghana.

How do you celebrate a safe C-section in Ghana?

It’s a big celebration! You’ve got to wear white for three months. There has been so much fear that you won’t make it through alive, so everyone is celebrating, rejoicing. “Thank God you’ve come out of surgery successfully,” everyone tells you.

Here you don’t have that tradition – it’s just an everyday fact of life.

Is surgery so unsafe?

There’s a lot of fear, anxiety. People believe that you go into surgery and you don’t come back – because really that happens a lot.

They think it’s the operation that killed you, but surgery is essential when you need to do it. It’s education, transportation, poverty – all these things that delay treatment. By the time you’re ready it’s too late.

What are the barriers to safe surgery for women in Ghana?

Resources, equipment – poverty. Most patients come and they have nothing – but they still need to provide everything. Relatives are sent to the cash and carry to buy the medications, they have to donate the blood before any treatment takes place.

In the U.K. you get emergency care without hesitation. If you need something in the theatre your hands reach out to it, there it is. We have monitors; we have drugs; we have a cupboard of machines to help with difficult intubation, or locating a vein. What do I do back home? How do I get help?

Is equipment a big issue?

Most of the equipment sent to Africa is second-hand – some isn’t even working but it’s dumped on us. There’s a lack of everything. We reuse everything.

Patients die for lack of basic monitoring equipment. Women go into labour and they don’t even have a place to rest their head – a bed is like equipment to put their heads on.

What is it like to deliver care in this setting?

It’s tragic. Tragic for the patient and tragic for the nurse. You are going to let a patient lose their life for no reason – you could have saved them easily with the right equipment, access. So you withdraw; your spirit is demoralized.

And telling the families is so hard. It’s difficult enough to get a surgery. They get there and think – please, now it’s going to be ok.

Why did you train in anaesthesia?

First I trained in nursing. I’m the type who really loves caring for people. But at the time I was working in theatres we didn’t have enough anaesthetists – so I decided I could be a role model for my colleagues. At the time I was the only female who trained as a nurse anaesthetist on the course.

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Aisslta Bissang-Kondet

Aicha Bissang-Kondet

“I’ll tell you the story of a 9 year old girl I can’t manage to forget.”

Aisslta – known to everyone as Aicha – has been a senior anaesthetic and resuscitation technician in Lome, Togo since 1993. She’s a member of many organisations and has held the position of president and secreatary general. She is married with 3 children, and loves to exchange ideas and experiences.

Selon vous, pourquoi l’accès à la chirurgie est-il essentiel pour la santé des femmes? / Why is access to safe surgery essential for women’s health?

Les femmes ont recours à la chirurgie pour 2 grandes raisons. Une: parce qu’elles sont malades et le traitement est obligatoirement chirurgicale, et deux: elles sont en bonne santé mais elle cherche à devenir mère ou au moment d’un accouchement par césarienne ou alors à la suite d’un traumatisme suite à un viol.

Women need surgery for two main reasons. One: because they’re sick and like anyone else they need surgical treatment, and two: they’re in good health but require obstetric care, like a C-section for pregnancy or following a rape trauma.

Quels sont les obstacles qui empêchent les femmes à obtenir les soins dont elles ont besoin? / What are the obstacles that stop women from getting the care they need?

Brièvement: l’ignorance; les moyens financiers dans les familles; l’absence de structure de santé à proximité.

In brief: lack of awareness; financial resources of the family; lack of any reachable health facility

Que souhaitent faire les jeunes filles dans votre entourage lorsqu’elles seront adultes ? / What do young women in Togo want to be when they grow up?

Si je fais le tour des jeunes filles dans ma propre famille ”africaine” sur 11 filles qui sont au lycée 3 veulent la santé et 2 veulent être médecin mais pas de chirurgie. Les autres c’est finance, gestion ou droit. Oui il y’a un obstacle : l’importance des études (les matières sont exclusivement scientifique) et la durée de la formation très longue

If I look at the young women in my own ‘African’ family, of 11 girls who are at school, three want to go into health and two want to be a doctor – but not surgery. The others – finance, management, law. But obviously there is an obstacle: the importance of education and the long period of training.

Pourriez-vous nous raconter l’histoire d’un patient qui vous a marqué? / Can you share the story of a patient that has stuck in your mind?

Je vais raconter l’histoire d’une fillette de 9 ans que je n’arrive pas à oublier. La fillette pendant les vacances et les jours où il n’y a pas l’école aide sa mère à vendre des oranges. Les oranges sont dans un plateau et elle se promène avec. Tous les passants peuvent l’interpeler et acheter. Alors un monsieur lui dit qu’il veut acheter tout le plateau et lui demande de le suivre chez lui car il n’a plus d’argent sur lui. Arrivé chez lui il dit à la petite de venir prendre son argent à l’intérieur de sa chambre. De la, il viola sérieusement la petite qui a perdu connaissance. Comment a-t-il fait, personne ne sais mais la petite a été retrouvée non loin du petit marché de son quartier et transportée à l’hôpital en état de choc. Les gynécologues ont réussi à faire l’hémostase et avec la réanimation bien conduite l’enfant a la vie sauve mais avec d’important dégât FRV +FVV (vagin vessie et rectum sont confondu). Il a fallu une intervention chirurgicale pour que cette petite soit sauvée.

I’ll tell you the story of a 9 year-old girl that I can’t manage to forget. When the girl didn’t have school or during the school holidays, she would help her mother sell oranges. She’d take a tray of fruit and walk about with it, so that passers by could see. One day a man told her he wanted to buy the whole tray – but she’d have to follow him home, because he didn’t have any money. He called for her to take the money from his bedroom where he raped her. She was found unconscious near the market and taken to hospital in a state of shock. Doctors managed to revive her and stop the bleeding, but they had to repair her bladder and rectum as she’d received a traumatic fistula. It’s only because of surgery that this little girl was saved.

Quel est votre objectif de feminisation de la profession médicale dans les prochaines décennies? / What is your goal for women in the medical profession in the coming decades?

Faire aimer les matières scientifiques aux jeunes filles en proposant des prix d’encouragement ; en soutenant financièrement leurs études afin qu’elles n’arrêtent pas parce que les parents n’ont plus les moyens Pour les femmes qui travaillent déjà organiser des rencontres internationales d’échanges, encourager les promotions professionnelles ou organiser des voyages de perfectionnement pour améliorer leurs prestations.

I want incentives for girls to love science subjects; financial support for their studies so that they don’t have to stop when their parents can’t afford it. For women already working in the field I want to organise international meetings, encourage them to learn and push themselves and develop their skills.

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Dr Zipporah Gathuya

Dr Zipporah Gathuya

“The surgeons were screaming they needed to get the baby out.”

Zipporah is a Consultant Anaesthetist working in Kenya. Her area of interest is Paediatric Anaesthesia and anaesthesia education.

Why is access to safe obstetric surgery essential for women?

Women are the carers for the family, especially in low-income countries. There are always other people who they are taking care of, despite having just had a baby. And there is certainly not much income to spare for complications.

Most women go for delivery being healthy. For them to continue in that health is paramount.

And if they don’t get it? What is the impact on the baby?

When the mother has a difficult labour the child risks hypoxia [oxygen starvation] or another complication like cerebral palsy, which has such a high infant mortality rate. These children can become a big burden on the whole family, and usually have miserable lives.

I have also seen many children whose mothers died at delivery and whose relatives never came to pick them from the hospital. It is very sad for that child, who will never quite appreciate maternal love.

Is there a particular case that sticks in your mind?

When I was training a mother was brought to the labour ward with severe pre-eclampsia [a life-threatening complication of pregnancy]. She was 33 years old, on her third pregnancy but had no living baby.

Just as she was wheeled into the operating room for an emergency C-section she had a seizure and began vomiting. The surgeons were screaming they needed to get the baby out.

We delivered a live male infant, but the mother went into renal shutdown. It took her three weeks to recover, and she went home with her son after a month.

Access to safe anaesthesia was essential to her survival. Though it has been more than 10 years, the scenario is still very vivid in my mind.

What is the role of education here?

The impact and importance of education to the mothers on access to antenatal care cannot be overemphasized. Caesarean sections are now more acceptable, whereas initially women would have the notion that a Caesarean section was a sign of weakness.

Education and skill advancement of both the anaesthesia and surgery providers will go along way towards minimizing the risk of many mothers dying or suffering complications.

Let’s talk again about the positive aspects of safe obstetric care. What is the long-term legacy?

If the mothers are sure that they will have safe pregnancy, delivery and child survival; even the issue of family planning will be more widely acceptable.

A healthy mother is a healthy community.

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Dr Sandra Leal

Dr Sandra Leal

“Latin America shares many things, among them a strong regard for family – which constitutes the center for society”

Sandra has been anesthesiologist at the Social Security Maternity Hospital in El Salvador for 20 years. She is past president of the Anesthesiologists Association of El Salvador.

How does safe surgery for one woman have a positive impact on more than one life?

Latin America shares many things, among them a strong regard for family – which constitutes the center for society.  In this context women are acknowledged as the bond that holds this nucleus together, and more often than not, are the sole providers of the family income.

Many an individual, call it parents, spouse or offspring, depend on her either emotionally, economically or even both.  Under this perspective, it can be understood why their safety and well-being becomes so important, why safe healthcare is a vital cornerstone.

Access to safe surgery and anaesthesia is essential, though not always possible.

Latinoamérica comparte muchas cosas, entre ellas resalta un fuerte vínculo con la familia, la cual constituye el centro de la sociedad. En este contexto las mujeres son reconocidas como como el lazo que mantiene este núcleo unido, y con frecuencia son el único sostén económico familiar; a menudo muchos individuos, entre padres, cónyuges e hijos, dependen de ella emocionalmente, económicamente o más aún ambos. Bajo esta perspectiva, puede comprenderse por que su seguridad y su bienestar se vuelven tan importantes, y proveerla con servicios de salud seguros es un pilar para ello.

Why is that?

Resources are relatively scarce and sometimes just not available; distances are in many instances broad, or transportation is an issue, which can mean that access to surgery, even if safe, comes too late or doesn´t come at all.

In El Salvador, anaesthesia still plays a significant role in many adverse events for women; most surely, without safe, solid, anaesthesia equipment and anaesthesia provider, no surgery can come out a success.

El acceso a cirugía y anestesia seguras es esencial, pero no siempre posible. Los recursos son relativamente escasos y a veces simplemente no están disponibles, las distancias en muchos casos son amplias, o el transporte es difícil, lo que puede ocasionar que el acceso a la cirugía, aún si es segura, sea alcanzada con retraso o no pueda accesarse en lo absoluto. En El Salvador,la anestesia todavía juega un papel importante en muchos eventos adversos maternos: indudablemente, sin un equipo y un proveedor de anestesia sólidos y seguros, no puede haber cirugía exitosa.

What are some of the other barriers to safe surgery?

To this scenario, we have to add cultural issues, in many instances so strongly attached that they will work against any conscious and well-intended attempt to deliver good quality healthcare.  This raises the stakes and potentially turns what could have been a routine and relatively safe procedure, into high risk, full blown major surgery and/or anaesthesia for which neither the personnel nor the patient are prepared.

These type of settings are more frequent in rural areas, where education is poor, sanitary facilities are few and hospitals almost always lack even the basics.  It is here where young doctors and paramedics start their practice, which raises their main concern: who or where to go for consultation, and what to do when the resources needed are not available?

A este escenario, debemos agregar aspectos culturales en muchos casos tan fuertemente arraigados que actuarán en contra de cualquier intento consciente y bien intencionado de proveer salud de alta calidad, elevando los riesgos y potencialmente volviendo lo que pudo ser un procedimiento seguro y rutinario en una cirugía y/o anestesia de alto riesgo y grandes proporciones, para la cual ni el personal ni la paciente suelen estar preparados.

Este tipo de situaciones son más frecuentes en las áreas rurales, donde la educación suele ser pobre, las instalaciones sanitarias escasas y casi siempre carecen incluso de lo básico. Es aquí donde los jóvenes médicos y paramédicos inician su práctica, lo que da paso a su principal preocupación: a donde o a quien acudir por apoyo o para consultar, o que hacer cuando los recursos necesarios no están disponibles?

What can we do to change this?

To address these issues we have to understand that it is essential to provide not only the much needed equipment , but also to stimulate a continued medical education program.  Together with a public-oriented education program, this will allow all parties involved to work together and make the most of what they have at hand.

Para poder abordar estos tópicos primero debemos comprender que es esencial proveer no solo el tan necesitado equipo, sino también estimular un programa de educación médica continuada junto con un programa de educación orientado hacia la población que permita a todos los involucrados trabajar juntos y sacar el mejor partido de lo que disponen.

 

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Dr Eva Hanciles

Dr Eva Hanciles

“Often the first time a pregnant women come to hospital is when she’s been trying to deliver at home without progress. She’s in urgent need of a Caesarean section.”

Eva is a Fellow of the Faculty of Anaesthetists of the Royal College of Surgeons in Ireland and of the West African College of Surgeons. She at present heads the Intensive Care Unit at the only Tertiary Hospital in Sierra Leone and lectures Nurse Anaesthetists in that country

Let’s talk about anaesthesia. Why is access to safe anaesthesia important for women?

Anaesthesia isn’t considered a lucrative and fashionable option for post-graduate doctors, but without safe anaesthesia – which also includes post-operative care – there’s increased morbidity and sometimes mortality.

It’s of vital importance to women, especially in low-resource countries. Often the first time a pregnant women come to hospital is when she’s been trying to deliver at home without progress. She’s in urgent need of a Caesearean section.

Can you talk us through how you handle a case like that?

I recall a patient who had been in prolonged labour at home and presented at hospital in a collapsed state. We couldn’t get her blood pressure and her pulse was weak and thready. We could only get a line in through the internal jugular vein.

It was obvious we were dealing with a ruptured uterus.

This is something you would never see in a country with wider access to surgical services and we had to do surgical intervention and resuscitation at the same time because her heart was so unstable.

Of course a dead foetus was delivered and the bleeding was stemmed only after a hysterectomy. But the mother’s life was saved.

What changes have you seen over your career that have made anaesthesia safer?

The greatest change to safe surgical care has been the widespread use of spinal anaesthesia. In settings where there is no oxygen supply, little or no monitoring, poor power general anaesthesia is out of the question – it’s very risky and can contribute to high maternal mortality rates.

Let’s talk about anaesthesia.  Why is access to safe anaesthesia important for women?

Anaesthesia isn’t considered a lucrative and fashionable option for post-graduate doctors, but without safe anaesthesia – which also includes post-operative care – there’s increased morbidity and sometimes mortality.

It’s of vital importance to women, especially in low-resource countries.  Often the first time a pregnant women come to hospital is when she’s been trying to deliver at home without progress.  She’s in urgent need of a Caesearean section.

What changes have you seen over your career that have made anaesthesia safer?

The greatest change to safe surgical care has been the widespread use of spinal anaesthesia.  In settings where there is no oxygen supply, little or no monitoring, poor power general anaesthesia is out of the question – it’s very risky and can contribute to high maternal mortality rates.

Who is it important to educate?

Everyone.

In rural Sierra Leone, anaesthesia services are provided by nurses, who must be constantly updated.  Failure to provide continuing education can make anaesthesia very unsafe.

At the same time, further education of pregnant women to encourage them to visit ante-natal clinics would lead to further reductions in mortality.

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Dr Angela Enright

Dr Angela Enright

“Women are the glue that hold the family together. If the mother dies in childbirth, it is a catastrophe for her and for the children.”

Angela is Head of Anesthesia for Vancouver Island. She’s a past president of the World Federation of Societies of Anaesthesiologists and the Canadian Anaesthesiologists’ Society, and a trustee of Lifebox Foundation.

Why is access to safe surgery and anaesthesia an important issue for women’s health?

In low-income environments, emergency obstetric surgery such as Cesarean Section and ruptured ectopic pregnancy constitute a large part of the surgical volume. Women also endure other surgical conditions such as trauma, cancers and bowel obstructions that require surgical intervention.

Often they present late to the hospital and are in a high-risk state. The rate of complications such as severe blood loss is high.

But if a woman in a low-resource setting needs a surgery?

The challenges are huge. Poor transportation, long distance from a surgical facility, lack of money to pay for surgical care, distrust of the care available and late presentation all affect the ability of the patient to access timely and appropriate surgical care.

In addition, women may have cultural issues which may prevent them going to a hospital for surgery – such as requiring a husband’s permission, which may not be freely given or delayed if he works away from home.

Has global surgery kept pace with developments in medical knowledge and technologies?

There are improvements in some areas – for instance education of women, which makes them more aware of what they need and how to access it. Provision of local health care workers, such as in Malawi, has improved care and resulted in earlier referral to a surgical or obstetrical centre. Cesarean section is now most frequently performed under spinal anesthesia. That provides a measure of safety over poorly managed general anesthesia.

But you need early access, resources and skilled providers to be able to treat these patients successfully. This is still a problem, as well as practical issues, like a functioning blood bank for life-saving transfusion during a crisis.

Does surgery in these conditions become unsafe?

Yes!

What are the repercussions?

Women are the glue that hold the family together. If the mother dies in childbirth, it is a catastrophe for her and for the children and also for the husband, who now has to figure out how to care for his family whilst trying to work to support them.

Many women have ‘cottage’ jobs – something they can do from home which brings in some money, like weaving baskets sold to tourists. This type of income often pays for the children’s education.

Late management of surgical problems such as breast cancer results in increased morbidity and early mortality for the woman. Often other problems such as an enlarged thyroid may be left until it presents a major airway problem. Bleeding from untreated uterine fibroids can result in severe anemia and a mother bereft of energy and the ability to care for the family.

Do women play a role in delivering care too?

I would say that women provide the backbone of care in anaesthesia and nursing. Most surgical care is still provided by men.

Does this crisis get much recognition?

There is a belief that surgery is expensive and unaffordable but that is not the case. Routine surgical conditions should be treated early to return people quickly to the workforce.

Major agencies such as WHO have invested much time and effort dealing with public health issues and communicable infectious diseases. Obviously these need attention but much has been done to improve their status and it is time to turn some attention to surgery.

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Dr Ronke Desalu

Dr Ronke Desalu

“Safe surgery is tied up with the socio-economic status, political participation and education of women.”

Ronke is an Associate Professor and Consultant in Anaesthesia at the Lagos University Teaching Hospital. Her sub-specialty interests are paediatric anaesthesia and Training in CPR. She is happily married with 2 grown-up children.

Why is access to surgery essential for women’s health?

A third of the 4500 surgeries performed at my hospital in Lagos last year were related to women’s reproductive health. This is a substantial percentage for one ‘special group,’ and emphasizes the importance of ready access to safe surgery for women.

Yet not all women are lucky to get this professional treatment; the maternal mortality rate in Nigeria is approximately 585 per 100,000 live births.

Why did you become an anaesthetist?
I always wanted to be a doctor, even as a young girl growing up in Lagos in the 1960s. With two aunties showing that women were just as capable as men, and could be doctors, my mind was made up.

I’m passionate about helping the vulnerable and the sick, and it gives me great satisfaction to see the outcome and the value one person’s actions can have on another person.

Can you tell us about one of your most memorable cases?
I’m in a profession that has its fair share of risks, but I like to look on the positive side of my work, the good we do and the relief we bring.

Many years ago we treated a 5-year-old child with a large cystic hygroma [a growth that appears on a baby’s neck]. The surgery was difficult, and afterwards she was unable to breathe on her own. We admitted her to our intensive care unit, which didn’t have a functioning ventilator at the time.

The trainees and technicians took turns to manually ventilate her for 100 days.

The case emphasizes the importance of teamwork, perseverance – and above all, commitment to your patient.

What is the government doing to reduce maternal mortality?

In the last six years, the Lagos State Government opened six specialized maternal and child health hospitals, with full surgical facilities. This means more theatres, more surgeries, more training and better health service delivery.

What is the role of women in the surgical ecosystem?

Safe surgery is tied up with the socio-economic status, political participation and education of women. We need to support groups that advocate for women’s health issues – women shouldn’t have to travel such long distances for basic care.

I take as one of my critical roles in life, to uplift and raise the bar for young women. To show them that it is indeed possible to have both a happy home front and a sky that is the limit in their career.

 What is your goal for women in the medical profession?

I want them to realize that they’re part of a unique team. Many organisations assume that women can’t cope with the top positions and we need to change that mindset. We need to be amongst the counted when it comes to doing our job well.

Women need to be fully involved in the implementation and management of healthcare, as well as in the policy and mapping of future health plans for their community – and indeed the world.

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Dr Nneka Anaegbu

Nneka Anaegbu

“In the coming decade we’ll be on the frontier and at the helm.”

Nneka is a Consultant Anaesthetist at Lagos State University Teaching Hospital, Nigeria.

Why is access to surgery essential for women’s health?
The woman’s role is vital in the maintenance of the family. Since the family is the smallest unit of the society, their function is essential for society at large.

Inability to get access to safe surgery can lead to unnecessary demise of a woman, a tragedy and a great disaster to her children and husband. Children who lose their mothers are negatively affected psychologically, which may affect their behavior in the society.

Does a woman’s role in society affect her ability to get surgical care?
There are various challenges that women face while trying to access health care. They include financial, educational, cultural, gender inequality, poor governance and religion.

In my culture the young girls are usually at a disadvantage due to gender inequality – their parents may not send them to school because they believe it is a waste of resources. Girls are soon married out to end up in a man’s kitchen, seen and not heard.

This leaves women financially dependent on their husbands for every need, including healthcare support. A woman whose husband does not provide money for her to access healthcare when needed is a woman at risk.

Is surgery seen as a safe option?

Education about safe surgery is vital, and sometimes lacking.

In our environment some women run away from Caesarean section for various reasons. Some believe they may die during the surgery, others feel that their family and friends will look down on them for not delivering naturally. Others feel that it means that they are not prayerful enough.

I remember a woman who was pregnant and attended antenatal care at the hospital. The doctors noticed that she had pre eclampsia, therefore she was told that she would require surgery to deliver her baby. Instead she went to a traditional birth attendant to deliver.

She eventually developed eclampsia, and by the time she came to the hospital the baby was dead. She still had to have a Caesarean delivery and died in intensive care after about 10 days.

What can women around the world do to support safer surgery?
Women should strive to educate their girls to enable them have a brighter future and be independent. Many of the young girls I know want to be professionals in various fields, and have a passion for healthcare. But there are many barriers –parents lack the financial capacity, while some girls get pregnant in secondary school and can’t further their education.

Women should be supported by other women to achieve their goals. My aim for women in the medical profession is that in the coming decade we’ll be on the frontier and at the helm of activities in the industry. Taking decisions that will favor women, in order to improve women health and prevent avoidable eventualities that may affect women.