The True and Tragic Adventures of Dr. Laura E. Forster

Volume 58 Issue 4 (Dec 2017)
Sydney, Australia
As Dr Laura Elizabeth Forster stood on the platform at London’s Victoria Station, she must have pondered with some amusement the fuss from bystanders over the departure of her medical unit’s doctors and nurses for the war front. It was 4 September 1914 and Great Britain had only been at war with Germany a month when the British Committee of the French Red Cross, the umbrella group supervising Forster’s unit, was established. The train was taking the team to Folkestone for the boat trip across the channel to a Red Cross hospital near the front in Antwerp, Belgium. It would not be Forster’s first time in a combat zone. Although she was a seasoned physician in London, she had volunteered as a nurse – female doctors were not permitted near the front lines – to travel to Epirus in the autumn of 1912 to treat the wounded during the First Balkan War. Then, few Britons seem to notice that a war was raging. The commotion she was witnessing two years later at Victoria Station was an entirely new experience.

Dr Laura Forster portrait

Nine nurses dressed in pristine violet cloaks and sky blue dresses, four male doctors in khakis and four female physicians were on the platform for a send-off by family members and colleagues. Accompanying them were drivers, orderlies and an unexpected quartet of women farmers dressed in crisp officer’s khaki tunics, breeches and sun helmets. At Folkestone the attention was even greater as a film camera operator convinced the group, about 20 members in all, to march down the quay as he cranked his camera to record their departure. They may have been heroes in their mismatched uniforms, but they were not military. Unlike the Royal Army Medical Corps, where only male physicians were sent to the front, women medical officers had no such military support. They volunteered to private organisations to treat the wounded and the rampant diseases among refugees in war zones. While the British Expeditionary Force documented the services of its personnel, many private organisations’ record-keeping was haphazard or lost.

As a result, most independent women doctors were rarely recognised for their sacrifices during the Great War. Forster’s contributions to the war effort are officially documented through the British Committee of the French Red Cross as serving a single month in a combat zone – 14 September to 14 October 1914 – although she worked as a surgeon and epidemic specialist for 29 consecutive months at the fronts in Belgium, France, Russia, the Caucasus and Turkey.

Dr Forster was an independent surgeon travelling from one battlefield to another. She ran hospitals with beds numbering in the hundreds to tiny far-flung outposts with minimal medical supplies and support staff. She treated soldiers with severe battle wounds, farming accident victims and rampant diseases among refugees in war zones. And she died alone in Russia.

This is her untold story originally published in the Australian military journal Sabretache vol. LVIII, no.4 — December 2017. Read the PDF file.

Click to OpenForster.article

GCC Countries Embrace Social, Economic Change for Survival

By Rob L. Wagner

The Arab Weekly

25 December 2016

Jeddah – When General Motors chief Charles Wil­son was misquoted as saying, “What’s good for General Motors is good for the country” in 1953, there was outrage that he put GM’s interests first and the coun­try’s economic welfare second. Yet many observers attending his con­firmation hearing to be US Defense secretary silently agreed with the sentiment.

The same can be said for Saudi Arabia’s $650 billion economy be­cause a robust Saudi economy brings fiscal stability to the Gulf Co­operation Council (GCC), if not to the world. Simply, what is good for Saudi Arabia is good for the GCC.

British Prime Minister Theresa May said as much at December’s GCC summit in Bahrain when she urged Arab leaders to build with Britain “economies that work for everyone”.

“We in the UK are determined to continue to be your partner of choice as you embed international norms and see through the reforms, which are so essential for all of your people,” May told the leaders of Saudi Arabia, Bahrain, Kuwait, the United Arab Emirates, Oman and Qatar.

May singled out Saudi Arabia’s Vision 2030 as a bold step to enact social and economic reforms along with changes proposed by other Gulf countries “for more funda­mental and lasting change”.

At the helm of that engine of change is Saudi Deputy Crown Prince Mohammed bin Salman bin Abdulaziz, second in line to the throne and the first prince in Saudi Arabia’s 85-year monarchy to im­plement radical economic and so­cial reforms.

Saudi Arabia has long been a country of soft diplomacy and a go-it-slow, test-the-waters philosophy in implementing social changes. But Prince Mohammed, faced with a $98 billion budget deficit and oil revenue dropping to less than $30 a barrel in January, has shaken the country from complacency.

His Vision 2030 austerity pro­gramme, at least in the eyes of many Saudis, is severe if not brutal. If that is not enough pressure, other Arab leaders are carefully looking at whether he will succeed.

Promising to force the kingdom to quit cold turkey its addiction to oil revenues, he focused on Saudis’ spendthrift habits. He slashed min­isters’ salaries 15%, government employees’ pay and allowances as much as 40% and planned to priva­tise ministries and force employees to reapply for their jobs.

Among the many non-oil revenue alternatives explored by Saudi Ara­bia is expanding its tourism indus­try by inviting more investors to build hotels and to improve infra­structure at heritage sites.

For the first time, the govern­ment is opening portions of the country to haj and umrah pilgrims who were once restricted to the holy cities of Mecca and Medina. Although non-Muslims struggle to obtain tourist visas, Western expa­triate workers and business- and family-related visitors have freer access to venues once deemed off-limits. Tourism is perhaps the king­dom’s greatest non-oil revenue that has yet to be fully exploited.

Western economic analysts lauded Prince Mohammed’s pro­grammes as a bold move to wean Saudis from cushy government jobs that, in their view, are nothing more than entitlements. Many Sau­di fiscal observers, however, com­plain that cutting workers’ salaries will affect consumer spending, putting pressure on small and me­dium-sized businesses to generate revenue and possibly leading bank customers to default on loans.

Ehsan Ahrari, adjunct research professor at the Pennsylvania-based Strategic Studies Institute, Army War College and chief execu­tive officer of Strategic Paradigms, said he was sympathetic to the challenges the deputy crown prince faces.

“I very much would want him to succeed,” said Ahrari. “The big­gest fly in the ointment remains the Yemeni war, which is eating up Saudi dollar reserves.”

Ahrari said Prince Mohammed’s success depends on the support he is currently enjoying from the royal family and the stability of the gov­ernment.

Some Saudi analysts have warned since April, when Saudi Vision 2030 was announced, that a fiscal aus­terity programme could lead to a recession. Indeed, London-based BMI Research concluded in Decem­ber that Saudi Arabia is headed for a recession in 2017, its first since 1999.

The kingdom’s economy is ex­pected to contract 0.2% as non-oil growth continues its slow pace along with declining oil produc­tion and the austerity drive. Saudi Arabia saw slight growth of 0.8% in 2016.

“There is no way not to expect consequences when consumers stay at home instead of spending their money for goods and servic­es,” one Jeddah-based Saudi econo­mist told The Arab Weekly.

To further complicate efforts to boost the economies of GCC member states is the US Federal Reserve’s interest rate increase. It raised its benchmark interest rate to a range of 0.50% to 0.75%.

The United Arab Emirates, Ku­wait, Qatar and Bahrain joined Saudi Arabia in raising its interest rates to match the Federal Reserve and remain committed to pegging their currencies to the US dollar. As the cost of borrowing money rises, however, it will be more difficult to ease the squeeze on cash that is hindering growth.

Qatar, which is considering spending cuts and eliminating some entitlements, recently report­ed its 2017 budget has a $7.8 bil­lion deficit. It is not on the scale of Saudi Arabia’s but large enough for the GCC member to ponder what the new year will look like without a more aggressive austerity pro­gramme.

Saudi Women Enter Pharmaceutical Retail Industry

By Rob L. Wagner

The Arab Weekly

18 December 2016

Jeddah – In a significant move that prom­ises to level the playing field for women in the pharmaceutical industry, Saudi Arabia’s Minis­try of Health has agreed to issue licences for women to work in phar­macies and herbal medicine facili­ties.

The decision is a boon for female pharmacists looking for employment in a sector that has been unavailable to them for decades. Pharmaceuti­cal jobs remain available for women in the government sector but their exclusion from private employment limits choices of where to work.

The Ministry of Health reported in 2015 that the kingdom, which has a population of 28.8 million, has about 7,000 privately owned pharmacies, twice the number of the global aver­age in which one pharmacy serves an average of 8,000 potential cus­tomers.

The proliferation of private phar­macies stems in part from the Health Ministry eliminating a requirement that pharmacies must be at least 250 metres apart.

A majority of the kingdom’s phar­macies employ Arab expatriates as workers but the government’s Vi­sion 2030 aims to extend job oppor­tunities not only to Saudi citizens in general, but specifically women. The Jeddah Chamber of Commerce and Industry reported that 500 female pharmaceutical students graduated from just one university this year and need jobs.

Ghadi Ghulam, a pharmacist working in a government pharmacy in Jeddah, said she welcomed the advantages jobs in the private sector would offer women.

“It will provide good opportuni­ties for women in general but, in our culture, we must go slow to get peo­ple used to the idea,” she said.

The average salary of a pharma­cist in the private sector is about $20,000 annually, although phar­macists with more than 20 years’ experience can earn as much as $64,000 per year, according to Pay­Sale, which collects data on sala­ries for virtually every profession around the world.

Only about one-quarter of the government-run pharmacies are staffed by women but some private companies are working to boost the number of women working in the profession.

Ahmed S. Dahduli, communica­tions director for AbbVie Biophar­maceuticals, which has offices in Jeddah and Riyadh, said interest among women pharmacists in the private sector is growing. The Chi­cago-based AbbVie provides train­ing programmes for student phar­macists in Saudi Arabia and other countries.

“The female Saudi pharmacist tal­ent pool is significantly large,” Dah­duli said. “When students started the programme with us, only 33% of them expressed interest in consid­ering working in the private sector. At the end of the programme, after witnessing the opportunities and career development plans, more than 75% of them are considering working with the private sector after graduation.”

The AbbVie training programme provides Saudi university students a look at the practicalities and ca­reer possibilities of a pharmacist. The company offers daily summer courses that focus on supply chain management, government and reg­ulatory requirements and quality as­surance among other topics.

Dahduli said Vision 2030 “has placed a significant amount of focus on Saudi human talent”.

“Given the number of pharmacy college graduates and the demand for professionals in the pharmaceu­tical industry in the kingdom, the intent of our programme is to help provide female candidates with the skills that can help them compete for available positions within this important sector,” he said.

Dahduli said there is a great de­mand for Saudi women pharma­cists. Ghulam agreed, noting that although the percentage of women working in government pharmacies is low, employment in the field — whether in the government or pri­vate sector — is available.

“Women would be more than happy to work in either the govern­ment or private sector,” she said.

Employment at private pharma­cies is not just limited to pharma­cists but also to support personnel. Many pharmacies, particularly in shopping malls, count most of their sales in cosmetics with about 30% of sales in medicinal products and pre­scriptions. Pharmacists say female customers prefer speaking with an­other woman when discussing de­tails of their prescriptions.

Other medical-related professions are also expected to open more job opportunities to women, including ophthalmology. For example, 60 of the 68 recent graduating ophthal­mologists at King Saud University were women. This year, an estimat­ed 13,000 women were certified ophthalmologists although jobs in the private sector do not exist for them.

Marriage Rate Among Saudis Dropping

By Rob L. Wagner

The Arab Weekly

27 November 2016

Jeddah – One-quarter of Saudis of marriage age are single, the General Authority for Statistics for 2016 said. The trend in the increase in the number of unmar­ried men and women over the age of 15 has prompted the Saudi gov­ernment to implement policies to encourage marriage but it has met with little success.

The government estimates that 5.26 million Saudis are single. Per­haps the most startling statistic from the authority’s demographic survey is that 3 million men over the age of 15 are single, exceeding the number of unmarried women. The population of Saudis in the kingdom is estimated at 21.1 mil­lion. About 8 million foreigners work in Saudi Arabia and they were not included in the survey.

Potential Saudi brides and grooms generally point to high dowries demanded by the brides’ families, the expense of a wedding party and the high unemployment rate among Saudi men, estimated at 10-12%, as reasons for so many single people.

Alawyah Salama Murjan, former administrative supervisor in the social studies department for the Ministry of Higher Education in Medina, said the media and expo­sure to Western culture also play a part in young people remaining single.

“Families put pressure on their children to have weddings accord­ing to their own traditions and cus­toms,” she said, “but young people want more practical weddings and want to spend less. They see that on television and in movies, and the types of weddings they see ap­peal to them.”

She said Saudi men often have unrealistic expectations about the kind of women they want to marry. “They might want someone with lighter skin and different colour eyes because this is something they see in the media and it’s desir­able but can be unrealistic, so they marry later.”

Another underlying and less dis­cussed aspect of Saudis remaining single are the expectations of Sau­di women who find their choice of husbands wanting.

“Saudi women are better edu­cated, hold better, high-paying and prestigious jobs and they are often treated very well at home,” said one Saudi sociologist. “They don’t want to risk marriage with a care­less man.”

Maryam Alyenbaawi, 30, of Jed­dah, said she has had several suit­ors over the years. Although her family vetoed marriage proposals from some, she found that none were compatible because they hinted early in the courting process between families that they sought to control her.

“I have it good at home,” she said. “I have a good job and my own money and a good place to live. I don’t need a man to fulfil me. I might want a husband in the future but not another father. I al­ready have one.”

Magda Muhammad Ali, 39, of Medina, said her father rejected several suitors over the years. She is resigned to a single life but she does not see it as a curse. “There is nobody out there that I’d run to for marriage. There are few men I see that I would tolerate,” Ali said.

Saudi Arabia is not alone in its struggle to have its citizens marry but is part of a trend in Middle East countries in which marriage is of­ten not regarded as the first life choice among young adults.

Alrai of Kuwait reported that 45% of the Jordanian women of mar­rying age remain single. Lebanon ranks first with 86% of its women unmarried. War conditions in Syria have led to 70% of the country’s women being single. About 40% of all Egyptian women eligible to be married are single.

The government of the United Arab Emirates reported that 60% of its marriage-age female population were single and that about 20% of Emirati men marry foreigners. There are fewer than 1 million Emi­rati citizens in a nation of 8 million people.

Said Al-Kitbi, a member of the UAE’s Federal National Council, said 175,000 Emirati women over 30 are unmarried. “This is very worrying,” he said.

The Saudi General Authority for Statistics indicated that women ac­count for 49.01% of the Saudi pop­ulation with the total percentage of unmarried females at 34.12%, including single women who are divorced or widowed. Once wom­en reach the age of 32 their chances of marriage greatly diminish, with only 2.8% getting married. About 10% of Saudi women aged 15 or over, have never been married.

The authority reported there were 336,780 divorced Saudis in the kingdom and 411,540 people are widowed.

The authority makes the distinc­tion between unmarried women and “spinsters” for statistical pur­poses. Unmarried women could be widowed or divorced, while spin­sters have never been married and are above the age of 32. The age a woman is considered a spinster dif­fers from one country to another. For example, at the end of 1999, the Saudi government recorded more than 1 million unmarried women over the age of 30, although those women could have been divorced or widowed and are not necessar­ily spinsters.

To encourage marriage the Saudi government implemented a pro­gramme to limit the amount of money a groom pays the bride’s family for a dowry. In 2015, a $13,300 limit was established for a “virgin bride” and $8,000 for a bride who had a previous mar­riage. Khalid al-Faisal, the emir of Mecca, sought assurances from local tribal leaders to agree to the new limits and document the dow­ries and have them ratified by the local courts.

Yet dowries and expensive wed­ding parties remain a sticking point between the younger generation of Saudis and the previous genera­tion.

“This is a social problem that leads to a breakdown in society,” said Murjan. “People don’t want to get married like their parents did. They can’t afford it and Saudi society is family-oriented and be­ing single is frowned upon. There is a lot of family pressure but the young people are resisting that pressure.”

Saudi Women’s Rights Advocate No Stranger to Adversity

By Rob L. Wagner

Gulf News

19 November 2016

Jeddah: Earlier this month, Qatar University administrators forced Dr Hatoon Al Fassi, a leading Saudi scholar instrumental in helping women gain the vote in Saudi Arabia, to postpone a Debate Club discussion on women in Islam at the university where she teaches.

University students launched an online petition demanding her sacking, alleging that her views on women’s rights in Islam are “contrary to the Qatari culture and values” and she sought to “spread poison in students’ brains.”

Twitter users created the hashtag #I’mWiththeExpulsionofHattonAl-Fassi in their efforts to oust the professor. Critics claimed her teachings were against “Islamic Sharia,” although they provided no evidence.

Such is the lot of an Arab women’s rights activist: condemnation, threats, intimidation. And there is perhaps a no more sensitive topic in the Gulf region, especially in Saudi Arabia and Qatar, than the discussion of exactly what rights are accorded women in Islam.

The Qatar incident appears to have boiled over following an article written by two of Al Fassi’s students.

“The problem was they wrote an article and argued there were some laws and gaps in women’s rights in Qatar,” Al Fassi told the Gulf News. “It was done professionally based on evidence. It’s common knowledge. I endorsed them and tweeted how proud I was of them. The girls were attacked and then I was attacked [on social media].”

The irony is that if Al Fassi’s lecture were to be held in Saudi Arabia, a considerably more conservative country than Qatar, it would be unlikely to have raised eyebrows given her reputation as a respected scholar and an activist who works with a soft touch to raise awareness on women’s issues.

Al Fassi doesn’t court controversy, but she is also no stranger to it and does not shy away from a good fight. It was Al Fassi and her legion of followers who worked virtually non-stop since 2005 to help win women’s right to vote in municipal elections.

The first elections were held in December 2015 and saw 20 women win council seats throughout the kingdom. Nearly 1,000 women had registered as candidates and an estimated 132,000 women cast ballots for the first time.

Al Fassi said she keeps in touch with some of the elected council members and their success has had varying results. “I don’t think we expected to change the norms or a lot in the community,” she said.

Women members are hampered by council rules and still must contend with gender segregation, which makes performing their duties difficult.

In Jeddah, Rasha Hefzi has faced marginalisation from her male colleagues, but has battled on.

“She doesn’t submit to that and has kept on working by going into areas trying to meet with the people,” Al Fassi said.

Al Fassi noted that the Saudi government can say it has accomplished its commitment to human rights groups, noting that Saudi Arabia can write in its annual report that women have participation and can stand for elections. The box can be checked there, but the work ahead is to ensure that female participation is not just cosmetic, but actual engagement, she said.

Born in 1964, Al Fassi is a member of the Sufi Al Fassi family of Makkah and is a descendant of Qutbul Ujood Hazrat Muhammad Al Fassi, the spiritual leader of the Fassiyah branch of the Shadhiliyya Sufis. When she retired as associate professor of women’s history at King Saud University in Riyadh with a full pension, she accepted a post as visiting professor at Qatar University. A mother of two children, her husband is Dr Abdul Aziz Abu Hamad Aluwaisheg, the assistant secretary-general of the Gulf Cooperation Council.

Among Saudis she is instantly recognised for her traditional Hijazi-style hijab that honours the history and traditions of the Hijazi tribe and inspired by an aunt. Her parents, she once told a reporter, infused her with “the spirit of Islam, about what is the essence of being a Muslim woman.”

Her pride in her history and Hijazi tradition is evident in how she wields her influence in women’s rights.

While younger and more militant Saudi women have emerged using blunt language to advocate for their peers, Al Fassi uses a less confrontational approach that has garnered important allies. Her rhetoric is minimal and she relies on fact-based research to argue her point. It makes her popular among the more traditional and conservative Saudi women who view with skepticism aggressive activists who are often perceived as posturing with their attention-getting language usually spoken by Western activists.

But even gaining acceptance among Saudi women to accomplish her goals is a challenge. A vast cross-section of Saudi women claim no interest in voting or running for elected office, mainly because they perceive the council as having no relevance in their lives and their voice would not be effective.

“I see no advantage to being a member of a council or asking them for anything,” said one female Saudi academic who holds a doctorate. “If they can build a park that is not a safety hazard, fine, but that is like asking for the world.”

Al Fassi said she understands their position. Even the 30 seats on the Shura Council granted to women in 2013 does not change perceptions among some women.

“It’s very hard to see the result and the impact of women on the Shura Council and you really have to follow closely to see what is going on to have a real grasp of what they are doing,” she said. “And they don’t relate easily to the issues of what the municipal councils do. Women feel their opinions don’t count and it’s a cultural problem.”

Al Fassi points to the councils for failing to be more transparent, but also the Saudi media. She credits Saudi newspapers for their growth and maturity in journalism over the last decade, but problems persist. Journalists generally don’t cover specific beats, leading to a lack of expertise.

Saudi journalists cover issues in which they lack understanding, she said.

“It depends on the journalist,” she said. “You have progressive newspapers and you have people who mix things up. Somebody does an interview on a hot topic and then it’s published after the interference of the editor-in-chief and you have a very provocative title of just the opposite of what you are saying.”

However, she said there are more female journalists than 10 years ago. “There are a lot of new voices and new journalists who are doing a very good job.”

Al Fassi is less active in the #IAmMyOwnGuardian campaign, which seeks to eliminate male guardianship rules that require women to obtain permission to receive an education, marry, seek medical treatment or leave the country.

Yet she is vocal about its control over women and supports the movement by keeping in touch with its organisers.

Aziza Al Yousuf, a leader of the campaign, argues that guardianship applies to issues of marriage in which the husband serves as the breadwinner and protects his wife and nothing more.

But in her 2007 book, ‘Women in Pre-Islamic Arabia,’ Al Fassi goes further. She contends that Arabian women in the pre-Islamic Nabataean period had immense rights. The concept of male guardianship is rooted in Greek and Roman law and is neither Islamic nor Arabian.

Simply, contemporary clerics have misinterpreted the origins of Islamic law, she said.

“I dispute that marriage is a part of guardianship,” Al Fassi said.

“It’s not compulsory and when talking about a divorced woman, there is definitely no need for a guardian. As for compulsory consent from a minor [guardian], I oppose it. If a woman needs a guardian for a marriage, it’s only for support, but it’s not up to him [the guardian] to decide who she must marry.”

Meanwhile, cooler heads have prevailed over the Al Fassi’s discussion dust-up at Qatar University.

At the moment, the Debate Club event is on hold as university administrators seek a more “comprehensive” view on women in Islam “that takes into consideration its religious, social and academic aspects.”

Saudi Government Employees Face Austerity

By Rob L. Wagner

The Arab Weekly

6 November 2016

Jeddah – Saudi government employ­ees have received their first pay cheques since the an­nouncement that salaries would be slashed as part of a fiscal austerity programme.

The new salaries, deposited in bank accounts at the end of Octo­ber, provided Saudis — including all ministers and Shura Council mem­bers — with their first glimpse that belt-tightening was a stark, and per­haps permanent, reality.

“The economic programme will affect the lower- and middle-in­come people and won’t affect the wealthy,” said Assad Jawhar, an eco­nomics professor at King Abdulaziz University in Jeddah.

The salary cuts are a bitter pill for many Saudis to swallow. Basic sala­ries are not particularly high in the government sector but allowances for housing, transportation, com­puter skills and other competencies vital to performing duties can add up to 40% to the total salary pack­age.

By eliminating allowances, some public workers saw their take-home pay reduced almost half. In some cases, Saudi workers had previ­ous deductions of up to one-third of their basic salary to repay gov­ernment overpayments. With the elimination of allowances and up to one-third in deductions from their basic pay, some employees saw their monthly income drop as much as 60%.

The Saudi middle class has been steadily shrinking and the cuts in wages among government workers will have a significant effect on the growth of middle-income bread­winners.

The salary cuts are just one av­enue Deputy Crown Prince Moham­med bin Salman bin Abdulaziz Al Saud and his advisers are pursuing to boost government coffers. It also raises the issue of whether austerity programmes work, especially when sacrifices from lower- and middle-income workers serve as the back­bone of the programme.

Economists caution that Saudi Arabia’s economic woes cannot be compared to those of the European Union or the severe austerity plan that caused considerable upset in Greece. Consumer confidence, high among the desirables to produce a robust economy, does not necessar­ily apply to Saudi Arabia.

Charles Schmitz, professor of ge­ography at Towson University in Baltimore, Maryland, and a special­ist in Gulf economic policies, said Saudi Arabia’s austerity programme and salary cuts are painful but nec­essary.

“State employment in the king­dom is welfare,” he said. “The state’s bureaucracy is bloated as a means of passing the revenues from the state to society.

“The Saudis are used to a high standard of living that is based upon rents from oil, not labour produc­tivity. The prince’s programme is to help Saudis get used to the idea of tying their level of living to their productivity. It may be hard landing for a lot of Saudis but it is a neces­sary one.”

While salary cuts among minis­ters and the Shura Council and the recent sacking of Finance minister Ibrahim al-Assaf and replacing him with Mohammed al-Jadaan have garnered attention, most of the ministries have quietly reduced the number of expatriate workers, cur­tailed travel to seminars and confer­ences and discouraged extra train­ing at the employer’s expense.

In October, the Civil Service Min­istry’s Replacement Administration rejected 478 out of 516 contract re­newals for expatriate medical work­ers at King Saud University. The de­cision affects employees on the job for more than ten years and paves the way for the university to hire Saudis with postgraduate degrees.

Jawhar said the burden of the government’s programme is placed squarely on the average worker. He said spending is higher among the low- and middle-income Saudis in proportion to their monthly salaries compared to the buying habits of the wealthy.

He said a priority should be to eliminate corruption but also to ensure high-income earners con­tribute revenue to the government through taxation.

“They should go to the rich and target companies,” Jawhar said.

“The question is who is going to be affected negatively by the deci­sion? During the past ten years, the middle class has been shrinking. [The programme] will affect them.”

The Saudi government is deter­mined to eliminate entitlements to reduce the country’s $98 billion fis­cal budget deficit. The International Monterey Fund is optimistic that the government can cut the deficit to 13% of the gross domestic prod­uct in 2016 and to less than 10% in 2017.

To help accomplish this, Saudi consumers have been encouraged to curb recreational activities and spend less on luxury items and even curtail how much they spend at the market.

Schmitz said he is optimistic the strategy will be successful. “De­mand comes from two sources: Consumers and investors. The Sau­dis want to shift the demand from the consumer market to the private investment market so that there is more investment in the non-oil pri­vate sector. Investment can drive an economy just as much as consumer demand.”

A Conversation with Saudi Women’s Rights Advocate Aziza al-Yousef

By Rob L. Wagner

The Arab Weekly

6 November 2016

Jeddah – When Aziza al-Yousef registered as a student at King Saud University in the Saudi capital Riyadh in the 1980s, she did not need her father’s permission. When her daughter enrolled in the same university in 2001, she was required to have her father’s signature on the permis­sion slip.

Yousef, 58, the mother of four sons and one daughter, has seen many changes in how Saudi women are treated in public and private institutions. She has witnessed a reduction of women’s rights in reaction to the 1979 Islamic revolution in Iran but has observed, in recent years, restrictions eased ever so slightly and slowly.

The retired professor — she taught computer science at King Saud University for 28 years — is leading a campaign to abolish male guardian regulations that require Saudi women to obtain permission from their father, brother, son or closest male relative to attend a university, travel or seek medical treatment.

“We are just asking to remove the government rule that affects our daily lives,” Yousef told The Arab Weekly.

Yousef recently attempted to deliver to the Royal Advisory Council a 14,700-signature petition seeking to abolish the guardianship regulations but she was rebuffed and told to mail it. She sent the document but has yet to hear back from the government. Whether the government is taking the petition seriously — it has ignored similar efforts — is unknown but a Twitter hashtag, #IAmMyOwnGuardian, has gone viral to help gain support for the cause.

Yousef said she is optimistic that changes can be made.

“We are used to 26 years of making demands,” Yousef said. “There is nothing we can do but to continue this thing. I hope the government treats this as an economic situation and we hope to get more allies. We have a young population with 50% under the age of 26. It’s time to listen.”

Saudi Arabia’s efforts to diversify its economy mean it must help female university graduates obtain employment in the private sector. They are an untapped resource that women’s rights organisers say can help turn around the kingdom’s sagging economy. The government hopes to increase women’s employment from 22% to 30% by 2030. Women have made progress in obtaining some rights, including appointments to the Shura Council and the right to vote and run for office in municipal elections.

However, the broader issue facing Saudis is not simply allowing women to travel without a man’s permission but how to interpret women’s rights in Islam. In a country where Saudis often ask foreigners to make the distinction between religion and culture, even Saudis can blur the lines. Throwing in government mandates affecting every female citizen only adds to the confusion. Where religious obligations end and culture and tradition, backed by government regulations, take over is often a mystery.

To Yousef and the signatories of the petition the difference in religious obligations and government mandates is stark.

“In Islam the man should be the breadwinner and the woman who gets pregnant and takes care of the household is not responsible for money,” Yousef said. “Islam does not say that women should not work or study but that she is responsible for her own actions and if she has a debt, she is responsible for that debt.”

Yet the very essence of guardianship in Saudi Arabia has morphed over more than three decades into one in which a man who earns the household income “must control the woman”, she said.

A woman under any interpretation of Islam is responsible for her own actions, Yousef noted. She added that if a woman “committed a robbery she doesn’t get half the punishment of a man” because she is female but “in the eyes of the government she is treated the same as a man”.

Conventional wisdom among Western observers is that educated Saudi women understand the difference between male guardianship as defined in Islam and arbitrary government regulations that limit women’s rights, but Yousef said supporters and opponents cannot be pigeonholed into one category.

“We have very educated women who are suffering because of the guardianship laws but we also have a lot of educated women who are firmly against eliminating guardianship,” Yousef said. “We have ladies who go abroad to study, get their PhD and then return and oppose what we are doing. There is no general rule of who is with who.”

She also noted that Saudis are pragmatic when it comes to opposing the petition’s goals: “People may understand the difference between rights for women in Islam and what the government is doing but they hold positions in government and they don’t want to risk their interests.”

Yousef grew up in a free environment in which her father was open-minded. She said she did not suffer the rigid patriarchal control that many of her peers experienced. “We were the lucky ones,” she said.

Yousef enrolled at King Saud University when she was a teenager. She dropped out after one semester to attend Virginia Commonwealth University in the United States, a 178-year-old institution known for its medical research. She was a wide-eyed, 19-year-old with limited English but became a fluent speaker possessing boundless self-confidence during her seven-year residence in the United States. She earned a bachelor’s degree in computer science and returned to King Saud to complete her master’s degree.

Yousef said the changes she has seen gave her hope for the future but some of the changes can be discouraging; a two-steps-forward-one-step-back process that can be both frustrating and exhilarating.

She said since the mid-1980s she has seen dormitory rules, which kept female students as virtual prisoners, relaxed. It is a small, but nonetheless important, change in campus life. She has also seen that women, who in the 1980s could arrive and leave campus any time during the day, face restrictions.

“Now the gates are closed, so if a student finishes a class at 9 in the morning, she must wait until the gates open at 12 noon to leave,” she said.

It is a system that treats women as children with maddening inconsistency but it has not always been that way.

In the 1980s, Saudi Arabia was a closed society with strict cultural boundaries and specific, yet unwritten, rules for the roles of men and women. However, women conducted their lives relatively freely only to see that freedom slowly ebb away.

Yousef points to the 1979 Islamic revolution and the Afghanistan war in the 1980s as turning points.

“We had people making statements to young men that they had to fight the Afghanistan war, which brainwashed a young generation. It wasn’t even our war,” she said. “After the war finished, everything became corrupted and now it is difficult to correct it.”

Saudi Arabia Looks to Build on Medical Tourism as Austerity Bites

By Rob L. Wagner

Gulf News

4 November 2016

Jeddah: When Faisal Banjar founded Arabian Gulf Medical Tourism Agency he secured what he thought was an important contract with the 600-bed Dr Soliman Fakeeh Hospital to bring foreign patients for treatment and capitalise on the $40 billion-a-year (Dh147 billion) medical tourism industry.

Eighteen months later he is still waiting to bring his first client to the hospital. Instead, he is sending as many as 20 Saudis a month to foreign countries — mostly to Turkey and Germany — for medical treatment.

“Visas are hard to come by for people to visit Saudi Arabia for medical treatment,” Banjar told Gulf News.

Arabian Gulf Medical Tourism is one of a handful of Saudi businesses that offer domestic and international medical liaison services between Saudis and foreign patients and hospitals. But virtually all of their clients are Saudis leaving the Kingdom for medical treatment elsewhere. Few foreigners are coming into the country.

Saudi Arabia’s nearly $100 billion fiscal budget deficit and its depressed economy is forcing the government to implement a severe austerity programmeme and seek non-oil revenue. The health sector is part of that revenue plan and has been toying with the idea of developing a medical tourism programme.

Boost revenue

Medical tourism involves patients actively seeking low-cost medical care not available in their native country. It does not include accidents or illnesses that require medical treatment while abroad, but to travel to a foreign country to seek specific care.

To boost revenue and create a thriving tourism segment in the private sector the Saudi Commission for Tourism and National Heritage has endorsed a proposal that combines religious and medical tourism to attract the world’s 1.6 million Muslims who often seek spiritual solace during a health crisis.

Saudi Arabia has developed a five-year plan to encourage medical tourists to seek treatment in its government and private hospitals, but there has been little input from the private sector to engage in a public-private partnership.

According to the Medical Tourism Index (TMI) the Kingdom ranks 37th among the most desired countries to receive medical care. Canada ranks first in global ranking followed in order by the United Kingdom, Israel, Singapore and India.

Rankings also show that Saudi Arabia trails Jordan, the United Arab Emirates, South Korea, Thailand and Malaysia, all of which have established specific medical specialities marketed to foreigners. The International Medical Travel Journal reports, for example, that Dubai projects that it will receive 500,000 medical tourists annually by 2020.

Although Saudi medical visas remain the primary obstacle to receiving a steady flow of foreign patients, services are available to any individual already in the country on a Haj, Umrah or work visa.

Competent treatment

Valorie Crooks, Canada Research Chair in Health Services Geographies at Simon Fraser University in British Columbia and scholar at the Michael Smith Foundation for Health Research, cautioned that patients should not be seduced by the perception that one country is more popular than another. Rankings do not necessarily reflect a country’s ability to provide competent treatment, and the reported number of patients visiting a country may be exaggerated, she said.

“I do think it’s important to question the numbers that are reported,” Crooks told Gulf News. “Is the UAE truly attracting medical tourists [such as] people who travel there for the expressed purpose of medical care, or are they including others in these numbers [like] ill and injured vacationers, expats living there who need care? Some clinics also report numbers of procedures rather than patients, and patients travelling from abroad may have multiple procedures and so can be double- triple- or even quadruple-counted.”

Crooks said she cannot speak specifically about Saudi Arabia, but she noted the kingdom is not “missing out” on large numbers of international patients travelling each year.

“In reality, the true numbers of people travelling abroad for medical are likely far less than what those in the industry report,” Crooks said. “Unfortunately this has resulted in many clinics finding difficulty in filling their international patient wards.

Once Saudi Arabia sorts its visa issues it is more than ready to accommodate international patients. The country has 95 hospitals — out of a total of 400 countrywide — and 74 medical programmes accredited by the Joint Commission International, which provides accreditation to medical facilities worldwide. The kingdom has also gained international recognition for its separation of conjoined twins. Since 1990, 34 sets of twins from 20 countries have been separated at the King Abdullah Specialist Children’s Hospital in Riyadh. Transplants

Perhaps more important is Saudi Arabia’s organ transplant programme. Dr Faisal Shaheen, director general of the Saudi Centre for Organ Transplantation, said transplants jumped 40 per cent in 2015 over 2014. Saudi government hospitals, he said, conducted 1,031 heart, lung, liver and kidney transplants in 2015.

But Shaheen said it’s virtually impossible to bring foreigners into the kingdom for surgery because of the 6,000 Saudis and expats already on transplant waiting lists.

“Only about 5 per cent of the cases for transplants are non-citizens,” he said. “Patients here on a visitor’s visa are not accepted for transplants.”

Yet visitors who hold Haj, Umrah or business visas will discover that costs for other treatments such as paediatric, obesity and eye care, are relatively low in Saudi Arabia compared to its European or even Gulf competitors.

Ashok Laguduva, founder and CEO of Anavara Ltd, a London-based medical tourism agency, told Gulf News that low-cost treatment is the primary factor in patients seeking foreign medical care.

“I have seen that by and large cost is the predominant consideration for folks when travelling for medical treatment,” Laguduva said. “The second most important thing they look for is referrals or word of mouth. The latter plays a very important role.”

Crooks said that, “Costs are certainly a consideration, but patients are heavily concerned about their health as well as factors such as language, [having] medical documentation provided in the language they speak at home.”