Rafa, Renad, and Loulwa, KAU medical students wearing lab coats, and ID, inside KAUH (King Abdul Aziz Hospital)
This article, “Alternative to abaya? Try lab coat”, originally in Arab News, which was included by Ahmed of Saudi Jeans in one of his Issues posts, inspired me to write this. While Ahmed found it “Awesome”, I am more conflicted in my response. On the one hand, I do believe that appropriate cover that helps alleviate "abaya angst" is to be applauded, as is abaya/hijab creativity. On the other, I have concerns about non-medical personnel wearing medical garb, and medical personnel wearing it outside a medical setting.
This stems in part from the demands of my own medical training, and in part from being the daughter of a current inpatient (probably will be in hospital a total of 3 months). Mostly, it has to do with my personal and professional concerns around medical ethics generally, and patient safety ultimately.
Duha, KAU medical student inside KAUH
The article warrants being copied here in full, before discussion.
Alternative to abaya? Try lab coat
Fatima Sidiya I Arab News
JEDDAH: Nouf wears a lab coat instead of an abaya when she is in public. She likes people to think she is a doctor. But she is not. In fact, she is a 24-year-old geography graduate.
Nouf is part of a growing crowd of young women who have taken advantage of a loophole in the system which demands women wear an abaya in public. The one permitted alternative for them is a white medical lab coat — but of course, only for doctors and medical personnel.
But it is not only medical personnel who wear lab coats in public; students in different parts of the Kingdom who are studying architecture, art, biology, home economics and other subjects are now going along with this trend.
What pushes these students to take off their abayas in public and wear a lab coat is mainly to feel “easy going.” While it now looks normal in the morning in public places including coffee shops, restaurants and malls in Jeddah, Dammam and Dhahran, the case is, however, different in Riyadh, Abha and Madinah.
Madinah medical students are allowed to take off their abayas only inside hospitals and it would be not acceptable for a woman to wear a lab coat in public unless she has her abaya on.
In Abha, and even inside hospitals, students have to put their lab coat over their abayas.
Riyadh girls, however, have their own tricks, said Abeer, a student majoring in hospital administration, adding that though the women guards at the university do not allow students to leave without abayas students normally wait until they are in the car park and then take off their abayas before heading elsewhere.
According to Abeer, there are different styles of lab coats and students may spend up to SR200 for a body-hugging design in special material, and their families might not know that they take off their abayas in public.
“Part of it is fashion and also for others to know that I could be a doctor and not just another person. I also hope it is a revolution against the abaya,” she added.
Khawla, a medical student in Jeddah, often wears her lab coat. “Because I don’t usually have a long break and I go home for lunch, I don’t bring my abaya because it is heavy and a bother to carry around the university.”
According to Khawla, “Some art students put on lab coats so they can wear jeans or trousers because it is not permissible to wear pants at the university unless the student is wearing a lab coat.”
She added that her lab coat, on some occasions, makes people give her respect, listen to her and even give her priority.
Khawla said she did not go shopping when wearing her lab coat because she has been harassed by young men several times. She said at the university students are told that their lab coats “must be below the knee and not tight. They also prefer that we don’t go out in it, but there are no firm rules.”
According to Khawla, lab coats are better than tight abayas.
An administration employee at a hospital in Dammam who was against publicizing the matter said she did wear an abaya over her lab coat while in the car and while eating lunch in public places. “We go out during our break time; we have never been harassed. The bottom line is that we are following the proper dress code.”
Badriya Al-Bishr, a Saudi author and columnist, said though there are agreements on dress code and fashion that when it comes to modesty and ethics particularly in Arab and Islamic communities, dress codes do change over time.
“Islam calls for modesty for both men and women,” she said, adding that the mere size of the lab coat is already considered hijab in some countries such as Turkey and Syria.
Commenting on the acceptance of lab coat in some areas while others have yet to accept it, she said, “Traditions stay the same in remote regions and rural areas. When the area is away from a city, tradition is strong. Traditions have always been stronger against women. Women tried 20 years ago to change this color — black — but it was not acceptable.”
To complete the picture, other non-clinical, non-laboratory hospital staff wear lab coats in Saudi hospitals and sometimes outside. Some seem to relish the idea of being mistaken for clinical or laboratory staff, as does Abeer cited in the article, a Riyadhi student of hospital administration, who "could be a doctor" in her lab coat.
Abeer, who is a medical student, and will be a doctor, wears a lab coat inside KAUH
Before I go further, let me say that I never enjoyed wearing a lab coat, particularly not the boxy, awkward fitting short ones we were required to buy and wear as medical students to make sure everyone knew that we were student doctors, and not to be mistaken for doctors. In a fit of rebellion, late in my clinical clerkship (ie 2 months left to"MD"), I had one made in decent material, from a Vogue pattern, with much better styling, including nice looking but serviceable pockets, and 3/4 length for bottom hem and 3/4 sleeves--much nicer and more comfortable over my chosen fashion of skirts and tops, and the highest, most colourful sandals I could manage. I got away with it because by then I was well labelled as "special" (LOL :) ), and well protected (hard earned). Besides, in other circumstances, my particular surgery superviser and I would have had a better relationship than the master-slave dialectic we were forced into. The absence of lab coats in psychiatry was a plus in favour of my chosen specialty.
Lab coats do serve positive functions, however. Besides the obvious one of protecting street clothes from medical spillage, a lab coat also protects the inside of the hospital from the "flora and fauna", the fungi, viruses, and bacteria, of the outside world. Except for washing, lab coats are supposed to stay inside the hospital, and some hospitals have their own laundry service which includes this. They are designed with large pockets for medical paraphernalia and notes.
Lab coats also identify medical personnel, and are most often worn by medical doctors, and laboratory personnel. The short ones are often worn by medical students, and nurses now like to wear a lab coat as part of their general rejection of the classic nursing uniform and their sense of professional status. This in itself can lead to confusion for patients and families, as well as other personnel from other services, about who is whom.
Zain and Lujain, medical students in the classroom, showing my favourite white and blue combo
In KSA, not only is the issue of medical professional identification at stake, but perhaps more so the reputation of women as medical professionals. If, as the article states, non-medical personnel are wearing body hugging lab coats and passing themselves off as doctors, this reflects negatively in the public eye on female doctors. Saudi Arabia doesn't seem to need more discouragement about women physicians, nor does any society for that matter, where they are still a minority and in lower positions generally within the medical specialty hierarchies, medical administration, research, and academic medicine.
A further concern, which has already been raised by Saudis, is that women in medicine will suffer, or at least be reprimanded because they are not allowed to wear lab coats outside of the hospital, except maybe for a quick dash somewhere close by or between buildings. Another worry is the Muttawa. If this becomes more prominent, or more prominently covered by the media, there is a risk of a crackdown on the nonmedical offenders, and the innocent medical staff in lab coats. As the article describes, there is regional variation in where lab coat substitution for the abaya is occurring, and how well it is tolerated, or not. Certainly Faculties of Medicine may well issue reminders and oversee students and women physicians and professors more closely on this matter. Rather unjust and unfair to their sisters, on the part of those seeking abaya freedom and to pass as doctors, by wearing medical cover in the form of a lab coat.
Though not mentioned in the Arab News article, perhaps because the fashion hasn't yet caught on in Saudi, scrubs are another whole issue of medical attire, or "cover".
Roah, medical student, daughter of a surgeon, and based on the scrubs...headed for a surgical specialty?
These days in North America, surgical scrubs can be purchased easily from department stores, and are fashionable sleepwear, lounge wear, and casual wear, particularly the "greens". They do, however, come in a variety of colours. The original, and ongoing medical purpose though, is for easy to get on and off, easily washable surgical garb that is reserved for the operating theatre and environs, as part of infection prevention protocols, that include a fresh sterile "gown", gloves, and surgical mask over the scrubs plus surgical hat and booties. Scrubs really shouldn't be worn to the hospital library, gift shop, coffee shop, cafeteria, etc, and certainly not outside.
Medical students Shahad and Sara, wearing lovely hijab variations with their lab coats
Unfortunately scrubs in various colours have become de rigueur attire for all personnel in the teaching hospital where my father is currently a patient. I say unfortunately because it is now difficult to distinguish who is a doctor, a nurse, a ward clerk, or cleaning person. It turns out the imperious man in the "greens" working each of the 4 days we spent 9hrs in the ER, is a cleaner--obvious when he is cleaning, not obvious when he is discussing patient bed assignments with other staff. The ladies lounging in maroon? Ah, it depends on the ward--either cleaning staff on break, or nursing staff on break. Turquoise--definitely reception by the woman's office placement at a glass window onto the reception area, but a triage nurse as well? Maybe. Greens but handling a mop--cleaning staff for sure. The guy in blue jeans and polo shirt--the ER doc.
Haneen, in neither an operating theatre nor a performance arts one, but rather in the medical auditorium
In fact, I can usually tell by demeanor, conversation, and other accessories who does what even when they aren't actively doing it. Still, in a patient emergency one would like to know whom to address immediately, and in general it would speed up and improve communication if one didn't have to guess. Not to mention that there is a certain professionalism that goes with not wearing scrubs, which are generally ill fitting and very casual looking when not covered by a surgical gown or lab coat. Hopefully, Saudi Arabia will not discover the scrub craze, or at least not have it become part of an abaya alternative, as the "pants" beneath the lab coat.
Noura, in dramatically contrasting black and white
Ironically, for someone who has been there and worn that, the current fashion in KSA with lab coats, and the one in North America with scrubs just brings back memories of difficult to keep clean white polyester, with little room for clothing options underneath, and fighting to get a pair of men's, AKA doctor's, greens --the women's greens (scoop neck, tapered waist, and top back belt) were for nurses primarily, and resulted in added stigma in the operating room from the surgical staff.
I definitely needed something considerably smaller than a men's X-Large, which always seemed to be the only size left--so that the pants wouldn't fall down, and the V-neck reveal too much of whatever cleavage might be there. Hoarding scrubs, and commenting on students, interns, and residents who "made off with them", "used them when they were on call for medicine", "slept in them during cat naps on overnight call" seemed to be the personal mission of obgyn nurses/ midwives, at least on the service I trained on. Indeed, psychiatry, what with its scrub-free, and largely lab coat free, attire, has definite pluses as a specialty!
Very serious medical students, Ahad and Asmaa (Souma, Soumz)
The examples of the female KAU medical students in appropriate attire, including lab coats, inside KAUH (King Abdul Aziz Hospital) are courtesy of Asmaa's excellent photography and post, Donate A Smile For KAUH-Snapshots, on her always excellent blog, Chapter One. I would like to thank Asmaa for graciously agreeing that her photos be part of this post, and wish her and her fellow students a very enjoyable 7th Scientific Conference for Medical Students in the GCC Countries to be held at KAUH in Jeddah, February 13-16, 2010. Hopefully they will find time eventually to read and comment here. In the meantime, do view the wonderful video that is part of the Donate A Smile for KAUH project, and which contains other (co-ed) photos of KAUH students, physicians, hospital personnel, and staff, all smiling beautifully to an outstanding rendition of the song "Smile (though your heart is breaking)" .
What impressions do you have reading the Arab News article?
Do you have any concerns about medical attire in or out of the hospital?
What have been your experiences of hospital staff and identification by "uniform"?
Do "the clothes make the professional", so to speak?
What are other ways of creatively staving off "abaya angst"?
If you are Saudi, and in medicine, how does this impact you?
Any other comments, thoughts, experiences?
Hemlines: Fashion, Modesty, Abaya Wearing, and Cross-Cultural "Wars" (Conjugal and Other)