Breaking the Veiled Ceiling
In 2009, Yasmin Altwaijri, the head of epidemiology at King Faisal Specialist Hospital & Research Center in Riyadh, set out with her colleagues to do a groundbreaking study on mental health in Saudi Arabia. They planned to interview 5,000 men and women from all corners of the country, meeting with them in their homes. The data would fill huge gaps in what was known about levels of stress and depression throughout the kingdom.
Naysayers warned Altwaijri, N96, N02, a principal investigator on the project, that it wouldn’t work. “Everyone told me, ‘Don’t do this. It’s a bad idea. Nobody will open their door.’ ” They questioned whether Saudis would talk about such a taboo subject and were skeptical of the plan to use laptops to record the data. “People had doubts about every part of the project, but we challenged them and said, ‘We have to try.’ ”
The survey has hit roadblocks, but not the ones about which Altwaijri was warned. The participation rate has been remarkably high, at 86 percent. So hospitable are the Saudi people, in fact, that they often insist the interviewer join them for lunch and conversation, or expect him to linger over coffee. “Our challenge,” Altwaijri says, “is to get the interviewer in and out of the house as quickly as possible.”
Such surveys are novel in Saudi Arabia because epidemiology is itself a nascent field there. That has put the research expertise of Altwaijri, who earned her master’s and doctoral degrees at the Friedman School, in high demand. In her work and advocacy, she is blazing a trail for epidemiology and for Saudi women in science.
Leading the way can be tiring work. Before she and her team could even begin the Saudi National Health and Stress Survey, they spent a year adapting—for language and cultural differences—a questionnaire that had been used in other countries. For example, “we don’t ask a Saudi person about how often they play golf,” Altwaijri says.
Something as basic as a food frequency questionnaire, a cornerstone for any nutrition survey, does not yet exist in her country. “To develop that instrument is a major undertaking. It’s a doctoral degree.” She has been hoping to persuade a Saudi student studying in the United States to take on that challenge. In fact, whenever she meets a recent science graduate, she is quick to extol the virtues of a career in epidemiology.
She is especially encouraging to women, who are only very slowly entering the Saudi workforce. Although more than half of college graduates in Saudi Arabia are women, less than 19 percent of women held jobs in 2011, compared to 76 percent of men, according to the International Labor Organization. And only 1 percent of Saudi researchers are women, according to the UNESCO Institute for Statistics.
“Personally, I think women can be involved in any career they want, whether it is a petroleum engineer in the middle of the desert or an astronaut,” says Altwaijri. But she recognizes that not everyone is as forward-thinking as she is. In a country where women are not allowed to drive and gender segregation is the norm, “science is very suitable for Saudi females who come from a more traditional Saudi upbringing.”
Altwaijri’s own family has always been supportive of her education. She studied community health in college, but was stymied in pursuing a graduate degree, because it was virtually unheard of for women to study abroad on their own at the time. When her husband finished medical school, she saw an opportunity. “I told him he should be applying to residency programs in the U.S.,” she recalls. “But of course, I had ulterior motives.” She filled out 70 applications on his behalf, and when he accepted a position at New England Medical Center, she moved with him to Boston. She quickly studied for and passed her GREs, and was accepted to the Friedman School. Almost immediately, she found a mentor in Professor Johanna Dwyer, director of the Frances Stern Nutrition Center.
“I just learned so much from her, besides academics,” Altwaijri says. “I learned how a professional, strong female carries herself in her field of work.”
Altwaijri went on to pursue her Ph.D. at the Friedman School, but hit a snag when her husband accepted a fellowship in Houston. Dwyer picked up the phone and called a colleague in Texas. Within a week, Altwaijri had an office at the University of Texas Health Science Center at Houston School of Public Health, was working on a program looking at cardiovascular risk factors in children and was able to continue work on her Ph.D.
Obesity on the Rise
Returning to Saudi Arabia, Altwaijri found that her skills in nutritional epidemiology were urgently needed. An obesity epidemic had taken root, as traditional diets gave way to fast foods (“McDonald’s delivers to your house, here,” she says), cars became commonplace and television and computer screens lured people to sedentary lifestyles. Adult obesity rates climbed from 22 percent in the early 1990s to 36 percent in 2005. Women in particular were gaining at an alarming rate. According to one estimate, 78 percent of Saudi women will be obese by 2022.
“The Ministry of Health realizes that it has to work more on prevention of disease; otherwise, it is going to have a population that is very, very unhealthy, and they will not be able to accommodate all the people with chronic illness in a few decades,” Altwaijri says.
She has advocated for exercise programs for women and children. She applauded the government’s decision this year to allow girls to take physical education classes in school, something long forbidden by conservative laws.
But many barriers to physical activity remain. Private gyms and fitness clubs are very expensive for an average middle-class family. “The weather doesn’t help,” says Altwaijri, because the heat often makes walking or jogging outside impossible.
To keep her own daughter active, Altwaijri enrolled her in a competitive swim team, as she did her son. That’s the sort of decision cultural conservatives frown on, but reaction from other parents has been positive. “They ask me a lot of questions about the time commitment and the effort that is involved,” she says. “They are intrigued, because it is almost foreign to them.”
The first study Altwaijri conducted when she returned to Saudi Arabia looked at rates of overweight and obesity among school children (as expected, they were high), but she had to branch out from nutrition, as people from other health fields asked for her help. One thing she would like to study is how technology has affected health—Saudis are frequent users of Facebook and YouTube and lead the world in the use of Twitter.
Aside from being a role model (she was profiled in the recent book Arab Women Rising), Altwaijri is helping other women take steps toward empowerment. She chairs the Women in Science Committee, a budding national network of Saudi women who work in science and technology. Female scientists, she says, can feel isolated because there are few of them and they don’t have the same networking opportunities that men do.
Most Saudi women who study science end up becoming science teachers, if they take jobs at all. “We wanted to show them there are other opportunities and that we would be there to help support them,” she says.
In that regard, Dwyer continues to be her inspiration. “I try to be supportive to the younger women that I meet in the same way that she helped me,” she says.