Syrian doctor shares his experiences working with female patients

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Last December, Vanig Garabedian and his family were the very first ones off a plane full of refugees arriving in Canada, kicking off the federal Liberal government's rush to bring in 25,000 people from the warn-torn country.

Before fleeing Syria, Dr. Garabedian was a gynecologist in Aleppo for 16 years, treating women and girls not just from the country's largest city but sometimes from rural areas of Syria – and often navigating cultural barriers that can complicate the delicate subject of maternal health and reproductive care.

In rural Syria, he said, girls usually attend school only until the sixth grade and do so separately from boys. They do not receive any sex education, grow up to have an average of 10 children and do not experience gender equality. In contrast, women from urban areas of Syria have an average of four children and live in a more balanced society.

Now, Dr. Garabedian, 47, who is studying to become a licensed physician in Canada, is sharing that experience with doctors in this country, appearing at the Society of Obstetricians and Gynecologists of Canada's annual conference in Vancouver with the aim of helping his Canadian counterparts treat their newest patients as thousands of refugees settle across the country.

"I tried my best in Syria to make them have rights and understand they are humans and are equal, and I failed," Dr. Garabedian said, referring to his experience with women from rural parts of his homeland. "Because there were millions," compared with the roughly 25,000 Syrian refugees who have arrived in Canada from Syria since November.

He said he believes it's important for Syrian people to adapt to Canadian society, but added it can't be something that should be expected of them right away.

Dr. Garabedian suggested that Canadian doctors need to have some flexibility and allow men into the conversation when dealing with female patients, at least in the short term. He noted that some women might not be comfortable consenting to treatment without their husband's approval.

"Nobody should blame those people," he said. "They don't know their rights. We have to educate them that we are human first."But Dr. Garabedian said he's a firm believer women should get to make their own choices. For him, his wife is his equal.

On Wednesday, he delivered a workshop, presenting several case studies to a group of Canadian doctors and health-care workers. He said he wanted to raise the issues of domestic violence, honour killings, adolescence and abortion, in terms of how they have been experienced by Syrian women.

For some at the workshop, some of what he had to say was shocking. "The brutality of it, of the war," Inna Gershtein, a midwife in Langley, B.C., said after attending the session, "I mean, you know it's there. It's just surprising when you're talking with people who have seen it and dealt with it themselves."

She said she thinks it's important for midwives to understand their patients' culture, so they can build relationships with them. And she said that finding ways to connect with the women she works with will be key to making them feel comfortable while introducing them to Canadian practices.

Ms. Gershtein has worked with refugees before, but never with women from Syria. She expects that a new practice she is joining soon will change that. "I'm excited," she said. "I feel like I know more, way more. I feel like I will be able to do a better job."

Jennifer Blake, CEO of the Society of Obstetricians and Gynecologists, said understanding cultural differences and safety is by no means a new challenge for Canadian doctors. While a large number of Syrians have recently arrived, Canada has long been home to people from many different backgrounds and cultures.

But she thinks Dr. Garabedian brought forward a message that serves as a reminder that it's important not to generalize.

"To realize that you can't just say, 'They are from Syria, they are probably Muslim, they are probably this, they are probably that,'" Dr. Blake said. "We have to take everyone from the get-go as an individual and understand where they are from and what their needs are."

She said while she understands the need to be culturally aware, doctors must continue to uphold their obligation to Canadian standards.