Covered, but Not Sterile

Field: Health Professions (Health Sciences)

First used in the Qur’an to describe the separation between public and private life, the Arabic word hijab can be translated as “curtain” or “partition.”1 Over time, the hijab has come to mean the veil or headcovering some Muslim women choose to wear, often also encompassing modest attire. Those who choose to wear hijab do so for various reasons, including interpreting the religious commandment of modesty to include covering the hair. This piece presents the perspectives of 4 hijabi women at 1 academic medical center. It is not meant to speak for all Muslim women who wear hijab, but to raise awareness about the challenges of those in medicine who do. WHAT HIJAB MEANS TO US Although we began observing hijab at various points in our lives, it has become something more significant to us than just a piece of cloth covering our hair. The hijab has become the way in which we carry ourselves daily, maintaining a certain level of modesty and dignity. It is the choice to adorn clothing that covers us from head to toe and to wear pieces that fall off of us – distracting from the shape of our forms. The hijab is a declaration of our independence, allowing us not to conform to what society dictates about how women should look and dress. It highlights our character, talents, and knowledge rather than our outward appearance. In a world that sexualizes women, the hijab reminds us the God we believe in wants us to be seen as something more. To the western world, the hijab represents the Islamic faith, which can create hasty and easy categorization into negative connotations associated with Islam. Some may fear the headscarf, equating it to terrorism – an ironic interpretation considering the word “Islam” translates to “peace” in Arabic. Others may interpret the hijab as a sign of oppression, which may be true in countries that mandate that women wear the headscarf. However, this is not the experience of all hijabi women. As of 2017, 3.45 million Muslims lived in the United States, and by 2040, Muslims are projected to be the second largest religious group after Christians.2 Considering increasing evidence that Muslims face more discrimination than any other religious or immigrant group, it is crucial to reflect on how to be more inclusive of Muslims in medicine and surgery.3,4 Not all Muslims experience the same degree of mistreatment, with those easily identified as being Muslim more often facing islamophobic abuse.5 Muslim women experience harassment more often than men, with the likelihood increasing with greater degree of headcovering.5 A Belgian study investigating perceptions about women wearing hijab found that individuals who prioritized values of power, achievement, and conformity expressed greater negativity toward the hijab.5 Given the frequency of these values in medicine, recognizing how the hijab shapes interactions and communication is imperative. HOW HIJAB HAS SHAPED OUR EXPERIENCES IN MEDICINE The headscarf may lightly drape our neck and shoulders, but along with it comes the weight of representing the entire Islamic faith because we are often labeled as one entity. No matter what we may individually do to differentiate ourselves, we have each experienced being called the name of another Muslim who may not even wear hijab. We thought this lifelong experience would not occur in medical school, a place with few hijab-wearing women. However, grouping all Muslim women as one individual has remained a recurrent theme in medicine. Knowing this, the responsibility to constantly act in the best accordance becomes draining because one mistake will be conflated into an error made by all Muslim women. Added to this is the challenge of overcoming imposter syndrome. For most incoming medical students, imposter syndrome means not feeling smart enough to enter medicine, but for many hijabis, imposter syndrome extends to worrying that others feel our acceptance was contingent upon an effort to increase the institution's diversity. During the first week of medical school, a fellow classmate shared her initial impressions, stating she had felt threatened by the hijab, perceiving those who wear it as radicals. This and other micro and macro-aggressions contribute to our feeling of “otherness,” as if we do not belong or have a place in medicine. Thinking about islamophobia and how others perceived us as hijabi women was not what we had envisioned would be a significant struggle pursuing medicine; nonetheless, this is exactly what occupied most of our thoughts. As medical trainees, most of us can attest to moments where judgement from others preceded the opportunity to showcase our capabilities. During clinical rotations, comments from attendings referring to hijab being a disservice because “patients will not take you seriously” and “it's already tough being a woman in surgery, you’re not making it any easier for yourself” were disheartening. Whether it be patients asking where we are really from, commenting on our “great English,” or claiming, “you should go back to your country,” these were reminders that we would always be defined first through our headscarf, regardless of our occupation. Were we naïve in thinking that attending medical school would earn us a level of respect that would surpass the prejudice we had previously experienced? For those of us leaving medical school and applying for residency, the experience was simultaneously exciting and terrifying. Although there were few women in medicine wearing hijab who could directly relate to our experiences, faculty members at our institution went out of their way to support and encourage us through surgical rotations and the application process. In the Match process, we sent more applications than peers, knowing that some programs might not look past the application photo. When the chance for interviews arose, at times we were cross-examined and scrutinized over our religious covering, instead of discussing our applications and career goals. These institutions saw our faith as a barrier, not realizing that being Muslim and wearing hijab was what motivated us to do better and strive to become excellent surgeons. We appreciate that Islam balances having a personal and hidden aspect of faith with a tangible and visible reminder. Wearing hijab is a daily reminder that we represent much more than the medical student or resident. We walk through the hospital and bear the responsibility of portraying Islam in the best manner, recognizing that we may know nothing about the people we pass in the hallways, but they all know something about us and our personal religious beliefs. We have learned to flourish under the reminder this piece of fabric brings, while bearing the weight of its responsibility. HOW HIJAB HAS SHAPED OUR EXPERIENCES IN THE OPERATING ROOM The sense of estrangement we feel in medicine also extends to the operating room. According to a cross-sectional study examining the impact of dress code politics on workplace opportunities, over half of the female hijabi participants felt uncomfortable wearing a headscarf in the operating room.6 Third year students’ fear and anxiety about scrubbing in and maintaining sterility was nominal compared to our confusion and uncertainty about how to cover our heads while satisfying sterility guidelines. The lack of information about how to observe religious headcovering while fulfilling sterility requirements was a reminder of how few American hijabi physicians make it to a career in the OR. Due to lack of guidelines addressing how to observe hijab while maintaining sterility, some of us have felt forced to change the arrangement of our headscarf so that it fits under a bouffant. Being able to hide the headscarf under a bouffant has created a paradox in which we receive preferential treatment with this adapted style, yet internally we are unrecognizable to ourselves. At times, faculty and staff have made negative comments about Muslims without recognizing the person standing in front of them wears a headscarf underneath her bouffant. Although wearing the headscarf under a bouffant can lead to better teaching opportunities, it is disheartening to adapt the headscarf style to be better received by others. As soon as we leave the OR and we wrap our headscarf the way we find appropriate, we return to being comfortable in our garb, yet discomforted by the looks of others. As much as we love wearing the hijab, we would be lying if we said thoughts of removing our hijab never crossed our minds. The burden of having to be the best version of ourselves as flag bearers of the Islamic faith while mitigating micro and macro-aggressions can be too demanding, especially in a climate where the true focus should be directed at patient care. Oftentimes, we are reduced to “that woman with that thing on her head,” without consideration of the other aspects that make us individuals. We wear hijab because we want to be judged for our inner qualities, but struggle to get others to see past the headscarf. We simply want to feel like we are seen and medicine has space for us. With that said, we have made it our personal mission to create that space for ourselves and others like us who observe hijab.