Challenges faced by Saudi female paramedics in the workplace
Perception of EMS leaders and supervisors towards the challenges faced by Saudi female paramedics in the workplace
Abstract
The public healthcare system in the Kingdom of Saudi Arabia (KSA) accounts is highly valued in the country. The emergency medical service (EMS) is one of the essential services that the government offers in its public health institutions. The present study investigates the perception of EMS experts such as leaders, managers, and academicians towards female paramedics and the challenge that these healthcare providers face in the Saudi Arabian workforce. Phenomenology research design approach was applied in this study because it describes all participants experiences with a new phenomenon which may help comprehensively understanding the perceptions of EMS experts towards Saudi female paramedics. The interviews were conducted in King Khalid University Hospital (KKUH), King Abdullah Bin Abdulaziz University Hospital (KAAUH) and Ministry of health hospitals in Riyadh rejion (Al-Iman General Hospital and Imam Abdulrahman Alfaisal Hospital). Three themes emerged from the interviews that were related to the perception of the EMS experts (leaders and managers) views regarding to the challenges faced Saudi female paramedics included: cultural and family challenges, value of Saudi female paramedics in the workforce and workforce issues. The fact that the current study examined 100 female paramedics at EMS in KKUY, KAAUH and Ministry of Health Hospitals in Riyadh represents the limitation of the study. Women as healthcare providers are facing cultural, physical and societal challenges in KSA that is constraining their professional pursuit and limiting their equal representation in the current health system, especially at the leadership positions.Ensuring that women are equally representing the leadership positions in KSA health system can improve the confidence of women paramedics and reduce the stereotypical gender norms prevalent in KSA society regarding women’s competence in leadership roles.
Introduction
The public healthcare system in the Kingdom of Saudi Arabia (KSA) accounts is highly valued in the country. The emergency medical service (EMS) is one of the essential services that the government offers in its public health institutions. According to Alwidyan, Trainor, and Bissell (2020), EMS refers to the comprehensive system that includes a network of personnel, equipment, and resources that deliver emergency aid to the community (Steeps, Wilfong, Hubble, & Bercher, 2017). The staff in the EMS includes medical technicians, paramedics, dispatchers, and medical directors (Leggio, Miller, & Panchal, 2020). The paramedics should have advanced skillsets to help in the administration of medications, provision of advanced airway management, and physical examination. The government acknowledges that EMS paramedic positions are not reserved for men alone. Women ought to play an essential part in this service; thus, they should be encouraged to join the paramedic roles. The role of females in emergency services has a long history from the times of World War II when they replaced men in firefighting services (Moseley, 2017), where they were regular in the firefighting department. These aspects demonstrate their ability to work efficiently in emergency fields as paramedics.
Patients have a right to choose the person providing their medical service. According to Waldron, Finalle, Tsang, Lesser, and Mogelof (2012),the frequency of declining prehospital care reduces when the provider is a female. The need to recruit women paramedics in the EMS increases globally (Crowe et al., 2020). In conservative cultures such as KSA, this deficiency is more evident (AlShammari, Jennings, & Williams, 2019). The country has high preservation for traditional customs, such as specific roles for a particular gender. Hamam, Bagis, AlJohani, and Tashkandi (2015) investigated the acceptability of care providers by Saudi patients and found out that 17.7% of females were reluctant to have male providers in the absence of male guardians. Besides, the reluctance of some males to care for females may lower the chances of survival of such patients in case of emergencies (MacLean, Hunt, Smith, & Wyke, 2017). Thus, it is essential to train and recruit more female paramedics to save female patients from the embarrassment of receiving care from males and improve their health outcomes.
Healthcare institutions appreciated this challenge and started enforcing measures to save the situation. For instance, hospitals in Kuwait began allowing female paramedics to work in the night shifts to help in occasions when males cannot work (Alharthy et al., 2018). The KSA is a highly conservative and religious country that enforces strict rules regarding the interaction between men and women (Helmold, Samara, Abusini, & Nelson, 2020). It urgently needs to train and recruit females to join the paramedic profession and cover the deficiency gaps. However, little information is known about the perception of key stakeholders in this process – the EMS leaders and managers. It may be of public and patient interest to recruit these healthcare providers, but without a positive attitude from their first-level leaders, their activities may not be as practical. This information is vital to institute and enforce appropriate policies to cushion the paramedics from any challenge on their way.
The present study investigates the perception of EMS experts such as leaders, managers, and academicians towards female paramedics and the challenge that these healthcare providers face in the Saudi Arabian workforce. The government should have this information to inform critical decisions such as public education on the role of women in the medical fields as well as preparing the leaders to relate with female paramedics and enhance their work output efficiently.
Methods
Design
Phenomenology research design approach will be applied in this study because it describes all participants experiences with a new phenomenon which may help comprehensively understanding the perceptions of EMS experts towards Saudi female paramedics. The main benefit of a phenomenology is used extensively in research from sociology, psychology, health science and education which is fit in this study (J. W. Creswell & Poth, 2016).
Setting and population:
The interviews were conducted in King Khalid University Hospital (KKUH), King Abdullah Bin Abdulaziz University Hospital (KAAUH) and Ministry of health hospitals in Riyadh rejion (Al-Iman General Hospital and Imam Abdulrahman Alfaisal Hospital). Pre-arranged face-to-face interviews with seven EMS leaders and supervisors were interviewed, who met the following criteria were recruited. First, EMS experts who are leading or teaching female paramedics in academic organisations and hospitals. Second, holding at least a Bachelor in paramedics, or equivalent medical degree and able to read and write in English and Arabic language.
Ethical consideration:
The study was approved by The Monash University Human Ethics Committee. Also, the study was approved from the King Khalid University Hospital (KKUH), King Abdullah Bin Abdulaziz University Hospital (KAAUH) and Saudi Ministry of health. Also, written consent form was obtained from the participants before the interview commenced.
Data collection:
A semi-structured face to face interview with EMS leaders and supervisors participants was conducted. The interview carried out in a quiet room away from the public, using pre-pared open-ended questions. The interview questions were contacted in English and Arabic languages. The questions were translated to Arabic by using forward translation technique to validate the translated questions.
The participants were encouraged to provide as much details as possible when they answering the interview questions to rich the described experiences. Each interview take approximately one-hour and all the interviews were conducted by the researcher. The interviews were audio-recorded by two devices and also written in the form of taking note.
Data Analysis:
A thematic analysis will be used in semi-structured interviews to identifying patterns or themes within qualitative data, which includes familiarising with the data, generate initial codes, search for themes, review themes, define themes, and write-up the results (J. Creswell, 2014).. The interviews have been conducted with leaders and experts in the field of EMS in Saudi Arabia. Some of interviews were conducted in Arabia language with participants who speak Arabic by the primary author who speak Arabic and English languages, and then it was transcripted and translated to English by a health professional translator agency to be translated to English language by using the methods of back translation translators back translated some of the interviews transcript from English to Arabic to ensure the accuracy of the translation. Then the primary Author checked all data by listening all recorded interviews and comparing them to the transcripts. Then the first author start to analysis the data following Maguire and Delahunt (2017) methods. First step, the recorded interviews were transcribed literally and read several times to be a familiar with the data which means the researcher have to knowing and understanding each word in the transcript, in the interviews and in the notes. Second step, the researcher initiated codes and method that determinate by the researcher perspective and research question. Then in the third step the researcher identified patterns or themes within qualitative data to capture significant or interesting information to the data and/or research question. Fourth step is reviewing themes, which means modify and develop the preliminary themes that has been identified in the previous step. Then in the next step the researcher will define and map the research theme and aim to identify the essence of what each them about. In the end-point the researcher will start to write up the finding of the qualitative data collection.
Result
While number of issues shows during the interviews, which includes 7 EMS experts (leaders and managers) in Saudi Arabian hospitals in city of Riyadh. All interviews were semi-structured questions with open-ended questions and were asked as they were written. Three themes emerged from the interviews that were related to the perception of the EMS experts (leaders and managers) views regarding to the challenges faced Saudi female paramedics included: cultural and family challenges, value of Saudi female paramedics in the workforce and workforce issues.
Cultural and family challenges
Most of the participants described the challenges between cultural and family issues, which need to maintaining a balance with required career choices. Some of these issues related to a family planning.
Challenges such as married female paramedics who have children or pregnancy and that she will not be able to provide the paramedics services during her pregnancy completely such as moving patients and using heavy tools.
This challenge requires the EMS managers to assign the female paramedics simple tasks such as office missions.
One of the female paramedics was married and then she was pregnant so we transfer her form the field tasks to simple tasks such as recording in computer.
Another participant claimed that number of female paramedics faced challenges with their families in term of working hours ‘shifts’ “Some of them face problems with night shifts” and another participant believed:
So one of them was this, “I can only work between these hours of the day.” And I would assume it’s probably a family thing. So 9:00 am to 9:00 pm – even 9:00 pm is late. Some of them were saying 6 o’clock, I can’t work past 6 o’clock in the evening.
In order to Saudi cultural and traditional challenges, All participants shows that the Saudi female paramedics are needed in the EMS field to attend any female cases from their family members.
In Saudi Arabia we have strong social customs which were refusing the female paramedics at the beginning. However, the society started to accept the idea and the importance of working as a female paramedics and most of them are encouraging their sisters or girls to work in this specification.
Another participants confirmed that.
I think that the society now are supporting the idea especially when we say that a female paramedics can deal with both male or female patients but males paramedics cannot deal with both males and females patients due to our tradition.
Value of Saudi female paramedics in the workforce
Many participants confirm that Saudi female paramedics are very important to be engaged and work in field of EMS where they are practicing their knowledge inside the hospitals. One of those participants said that “very important to involve female paramedics in our field”. Also, other participants stated that the Saudi female paramedics recommended attending with female cases.
Female paramedics are very important especially with female cases and conditions for their privacy, our traditional and our religion.
Another participant stated that Saudi culture and tradition play in such this mater and said that:
Participation of female paramedics in KSA is very important since our customs and traditions makes some female patients desires to deal with female paramedic as she can understand her better than males paramedics specially with a sensitive cases such as delivery, physical check and psychological issues.
Workforce issues
Most of participants confirm that Saudi female paramedics face number of challenges in the workforce, some of these challenges comes from their selves and the other comes from the organisations. Number of participants stated that Saudi female paramedics face a physical fitness issues specially with lifting and moving the ambulance stretcher and carry heavy bags.
The paramedic job is really a muscular job, it’s needing big muscles, it’s need a good endurance, carrying a bag, pushing a trolley, lifting the patient from the floor to the bed and so on.
Another participant confirm that some of the Saudi female paramedics has issues with preforming cardiopulmonary resuscitation (CPR) duo to their body fitness.
Some of Saudi female paramedics are weak in preforming a CPR especially when we have a cardiac arrest cases, so we prefer male paramedics rather than female paramedics to do CPR.
Another participant conform that driving the ambulance is one of the important task that the paramedics mast can do and he stated that the Saudi female paramedics still not driving the ambulance car and said:
The driving challenge as they lack skills and license for driving ambulance car then to reach their task.
On the other hand the Saudi female paramedics faced a huge challenges with the health organisations from their views, policies and conditions. A participant L1 said that the organisations should develop their infrastructure to be suitable environment for the female paramedics.
One of the most important challenge is the infrastructure in work directions such as Red Crescent or hospitals in providing suitable environment for the Saudi female paramedics.
Also another participant L2 confirm that:
it is important to provide suitable work condition in order to provide them with privacy and I think this is the first thing they need.
A participant L7 claimed that stakeholders need to change their vision against Saudi female paramedics and he said:
Stakeholders has to change their vision to suit the female paramedic role in their companies. I think still some people, they don’t believe in female paramedics and it is consider as a big challenge that the Saudi female paramedics faced.
Participant L5 agreed and said:
I think it needs support from the Government side, for sure. They need to encourage employers, maybe provide incentives to employers to employ the female paramedics in their system.
These challenges caused a shortage of opportunities to the Saudi female paramedics, which let some of them to work in a private institutions and following other guidelines. Participant L1 confirm that:
We face some challenges now is the ratio of unemployment for paramedics have increased although colleges are graduating many of them every year.
Increasing of unemployment Saudi female paramedics caused they practicing their knowledge in different guideline as participants L7 said:
Female paramedics, they are trained to do the paramedic job and putting them in another job, it will be unfair for both sides. It will be unfair for the paramedic staff and unfair for the nursing staff that they are having another practitioner who is not trained in the nursing field.
Also participant L5 confirming that the issue lies in the lack of practice for the EMS.
I think one of the biggest problems we have is there’s no defined scope of practice for EMS in the kingdom.
Other participant L2 mentioned that duo to a self-study done by the department of EMS in their hospital the female paramedics have a highly impact to burnout.
Burnout among male and female paramedics. According to the results, we have a risk between male paramedics and female paramedics for the cases while I have one case as (burnout) which was for a female.
This result has been agreed by the participant L5 who said:
Male paramedics I think are more designed to handle that stress and we can compartmentalise our experiences a lot better than female paramedics do because they’re very emotional.
With all of previous mentioned challenges all participants confirmed that the monthly wages for all paramedics in both genders are equal and the differences only in the allowances such as driving allowances. This point has been agreed by the participant L2:
There are some allowances given to persons who have ability or skills such as driving for those who can drive the ambulance even if she is a female. So the difference is according to the allowances only.
Discussion
In the current study, the aim was to identify the challenges faced by the female paramedics in the leadership roles in KSA. It was found that the EMS in KSA currently employs more male paramedics. However, the female patients have been seen to be experiencing delays in providing hospital care due to conservative culture and family issues. The need for trained female paramedics is higher than ever as more and more universities have started to offer the structured EMS training just for the female students. For instance, the King Saud Abdulzaziz University have been providing women with EMS bachelor’s degree for women aimed at providing them with knowledge so that more well-trained female paramedics can be emerged.
Due to cultural and religious beliefs, the female paramedics in KSA are facing issues while discharging their duties efficiently. The gender segregation norms (guardianship system) at KSA have been hindering the process of medical guidance and paramedic’s access in the emergency situations. Due to cultural barriers and society’s reluctance in accepting women as paramedics, many women’s medical care has been reportedly compromised in cases of emergency. To date, limited statistics are available on assessing the consequence of the women’s guardian refusal to allow medical care from other than the same-sex providers. In KSA, the change in the women’s perception about the gender roles with exposure has increased the tension and stiffness between the gender norms and the society’s expectations.
In order to improve the public awareness regarding female paramedics in KSA, the misconceptions regarding the role of and need of female paramedics must be uncovered and catered for. The need for female paramedics has risen in KSA due to conservative culture as more female patients demand for female medical officers for inspection. As indicated from results above, most people in KSA have already started to realize the growing need of employing female paramedics in KSA due to high demand of women’s privacy and the cultural & religious beliefs in KSA. At many times, the female patients have refused to get required medical attention due to no female paramedics being available.
The demand for female paramedics is rising as more female participants require the presence of females in situations like pregnancy. The existing literature has also highlighted the rising refusal of hospitals attending due to sex preferences set by the guardians or the female patients themselves in KSA. It has also been noted that the male participants (male guardians) strongly refuse to get the male paramedic for attending their wives, mothers and sisters in KSA. However, the reluctance has been found to be reduced when male paramedics are accompanies with the female paramedics due female patient treatments. It was also evident from the current study that the public concerns regarding women’s privacy and the religious beliefs were common in KSA.
The media has played a significant role in reducing the gender resistance as many female patients experienced serious complications caused by delayed medical care due to cultural and religious limitations(Alharthy et al., 2018).. At many times, the female paramedics are also considered to be able to deal with sick patients more efficiently. The resistance by patients in receiving paramedical care is very low in the cases when the care provider is female as compared to when the medical care providers are male.
Increased public awareness could reduce much of the challenges including cultural and religious barriers faced by female paramedics. In order to improve the public awareness, it is required to uncover the current level of knowledge prevalent in the KSA society regarding EMS system (Aldosari, 2017). The choice of tradition over patient’s life can be altered by the intervening help of religious authorities and proper religious education. A proper religious law in this field can also aid the hospital and medical care industry in employing the female paramedics while breaking the traditional and cultural resistance prevalent in society. In order to change the cultural beliefs regarding the issue, a proper religious education and teaching of the general society regarding EMS is required(Aldosari, 2017).
Women physicians and paramedics were also found to face career development challenges caused by marriage responsibilities and lacking support of their male guardians(Aldosari, 2017). During the literature review, it was also found that women paramedics in KSA also experience glass ceiling in their professional development as they find difficulties in being promoted to the leadership or administrative positions. The major cause of this limitation was also due to prevalent male-dominated culture and rigorous Islamic beliefs that push the society to view women as unfit in leading and are being pushed to consider the domestic duties as priorities.
Other than the cultural and religious beliefs, other factors like physical fitness, emotional ability and the competency of the female paramedic to work in an uncontrolled crowd were also prevalent as observed in the survey conducted above. Generally, the public is aware of the occupational hazards and occupational fitness challenges faced by the female paramedics. Most evident physical fitness challenges faced by female paramedics include muscular disorders, injuries to neck, shoulders and back (Harthi & Rachman, 2019). Most of the discomforts can arise to female paramedics while moving and lifting the patients or equipment in the EMS. In the above survey and literature, it was evident that the female paramedics found repetitive lifting of patients and heavy equipment in times of emergency to be harmful for their health. In order to prevent such injuries, the female paramedics in KSA must consider eating healthy meals and follow physical fitness routine for minimizing the occupational injuries at work (Harthi & Rachman, 2019).
As observed through the results achieved above, the physical fitness of female paramedics appeared to be one of the most significant challenge faced by female paramedics in KSA. It is recommended for them to adopt correct lifting strategies, relaying on mechanical lifts and testing the transport equipment. Moreover, the hospitals can incorporate training and education programs for the female paramedics dealing in EMS in order to reduce their work-related injuries (Harthi & Rachman, 2019). Other than physical fitness, the exposure to harmful substances is also few of the challenges faced by the paramedics (regardless of gender) at the EMS. Protection can be done by wearing the personal protective equipment while dealing with patients in EMS.
Limitations
The fact that the current study examined 100 female paramedics at EMS in KKUY, KAAUH and Ministry of Health Hospitals in Riyadh represents the limitation of the study. It is speculated that one of the reasons why some female paramedics refused to be a part of survey was due to fear that it could reveal their low level of fitness, cultural beliefs or religious preferences. Although much of research has been conducted on understanding the challenges generally faced by the female paramedics across the world, yet public knowledge and the overall perception of female paramedics in KSA has not been explored previously. Therefore, despite of its limitation, the focus of this study on perception of female paramedics has made this study unique. The findings clearly indicated that with changing time, the perception of employing female paramedics in KSA has changed as there is more need and demand for the female paramedics in hospitals.
Conclusion
Women as healthcare providers are facing cultural, physical and societal challenges in KSA that is constraining their professional pursuit and limiting their equal representation in the current health system, especially at the leadership positions. It is only in recent years that the females have been accepted as the service providers as paramedics and whilst the gender ratio is rapidly moving towards the parity, much of the founding culture and religious norm is prevalent today. Ensuring that women are equally representing the leadership positions in KSA health system can improve the confidence of women paramedics and reduce the stereotypical gender norms prevalent in KSA society regarding women’s competence in leadership roles. Due to religious nature of the KSA society, the health care administration and women’s health beliefs and attitudes are being influenced. The overlapping of health practices with the religious and cultural opinion poses the ethical challenges as prevalent in the KSA society, particularly in the decisions on patient’s rights. The present manual guide for the medical practitioners in KSA is also heavily influenced by the religious norms pertaining to females being treated by men. Therefore, it was not surprising for the current study to identify the issue of “dealing with the opposite sex” as one of the top medical ethical challenges in KSA. This has not only driven up the need for having more female paramedics available in the medical facilities, but is also shaping up the education industry.
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