A room in the Kosovo University Clinical Centre's gynecology hall. Photo: Leonora Aliu.

Sexual health, a taboo even for health professionals

Medical personnel in Kosovo uphold conservative and traditional norms at the expense of patients’ sexual and reproductive health.

Aurela Kadriu had been experiencing health problems from ovarian cysts. Normally, her first option for addressing her concerns would be to go to a professional for consultation and advice, so she decided to visit a gynaecologist at the University Clinical Centre of Kosovo.

Upon entering the room, before the examination began, she was subject to a ‘pre-examination,’ or more of an interrogation. She was asked to respond to questions such as ‘are you in a relationship?’ and ‘are you engaged?’

Kadriu was not clear on what all this was about. Yet she did reply to the questions. But before the doctor would begin the examination, Kadriu had to respond to the final question: ‘are you a maiden?’ In response, Kadriu shot back, ‘can’t you see that I am? Or do I look like a boy?’

The question “are you married” is an implicit question, used to ask whether the women and girls who visit this public health care facility, as well as private facilities, are sexually active.

A similar experience bothered Suzana Ajeti.

“I went to the gynaecologist for a check-up. The first question was: ‘Are you married?’ I said I was not,” Ajeti recollected. “‘I am sexually active though,’ I told the doctor. The doctor replied, saying ‘Okay… I thought you weren’t married.’ To which I said, yes, precisely, I’m not.”

The doctor kept persisting on the question, despite Ajeti’s clear answers.

Another young woman, who wished to remain anonymous, had a similar experience when her gynecologist asked her to show her stomach. Although the patient insisted that she had no concerns about her stomach, the  gynecologist raised her voice, and with a dose of cynicism said, “yeah, that’s what everyone says,” implying that she assumed the patient was pregnant.

This treatment and language, reflecting narrow-mindedness and conservative views, is not used towards women alone. Although this primarily affects women, it does happen to men as well.

This was the case for Trim Ilazi, who was sent three months ago to a urologist at the University Clinical Centre of Kosovo. Ilazi, 27 years old, was surprised when the doctor had some questions about his marital status.

“I don’t know… it was unclear why he asked whether or not I’m sexually active. And he didn’t stop at that; he then asked, ‘are you a naughty boy, or a good boy?’ I just started laughing. I told him I didn’t know how to answer that,” Ilazi recollected.

For these patients, it’s incomprehensible why professional doctors would have such a conservative approach, discussing sexual health as if it were a taboo. According to them, doctors refer to customs and traditions in which the virginity of a “maiden” is more precious than a woman’s own life, and sex is seen as the transition from being a “maiden” to a woman.

The above-mentioned patients were able to go beyond such unpleasant situations, and have been successful in addressing their concerns. But it remains a challenge to report such cases.

This challenge was underlined by the Executive Director of the Association for Patients’ Rights, Besim Kodra, who admitted that although there is information available for women who faced such situations, there is a poor level of reporting sensitive cases.

Kodra links the low reporting figures with the lack of knowledge on patient rights. And the necessity of promoting patient rights must go in parallel with promoting open, non-denigrating and unbiased approaches by medical personnel.

It takes courage to speak about sexual health in a society dominated by norms of morality, which often center around the value of ‘virginity,’ and which still sees the demand for sexual and reproductive rights as ‘unacceptable.’

Shifting societal views is a complex process that takes time. However, medical personnel have a responsibility to ensure access to reproductive health and rights. Physicians must be able to communicate, fairly and without discrimination, with their patients. A doctor cannot violate the patient’s integrity or the Hippocratic Oath of ethical standards, or, ultimately, the state law on non-discrimination in health care.

This is all known information to the University Hospital and Clinical Service of Kosovo, UHCSK. This centre even disseminates information packages to all units under the management of the service, thereby requiring everyone to uphold the ethical and professional code and applicable legislation.

“The Law on Health Care and other applicable legislation guarantees equal treatment for all, regardless of gender, ethnicity or any affiliation,” said the director of the UHCSK, Curr Gjocaj.

Yet Gjocaj insinuated that the health care institution is relieved from liability regarding reproductive health: “Reproductive health is more an issue for family medicine, which is not a competency of UHCSK,” the director said.

The manifestation of traditional and conservative norms upheld by medical personnel and pharmacists is an impediment to youth and the general population receiving information on sexual and reproductive health.

Meanwhile, despite efforts made to distribute contraceptives in various medical centres or NGOs, pharmacies remain the main source for individuals seeking contraceptives. There is not currently a satisfactory utilization of resources for protecting sexual and reproductive health in Kosovo, and discrimination and stigma from health personnel worsens the situation. This only contributes to patients being irritated, withdrawn, and hesitant to approach the healthcare system.

The general cultural context is an important factor in shaping the approaches of health practitioners, according to sociologist Luljeta Demolli.

“How medical staff approach patients is directly connected to the general cultural context, in which its members are shaped and in which they exercise their vocation,” Demolli said.

Dr. Ilir Begolli spoke about a strong link between traditional manners of communication and the absence of an academic course on communication, or at least its delayed integration into curricula, for health care practitioners.

“Yet this in no way justifies a health care professional failing to understand the language of persons they are in contact with, and not only spoken language, but also local and colloquial terms for body parts,” he said.

A similar issue was raised by Aulone Kadriu, who works in the field of reproductive and sexual health. She said that the issue resides in the conservative order of a society in transition, and in the lack of functional monitoring mechanisms for reporting issues. Yet, she said, there are no excuses for medical personnel who have taken the Oath of Hippocrates and whose positions are linked to the welfare of the population.

The greater the gap is between patients and doctors or patients and pharmacists, the greater the risk to sexual health for the Kosovo population. When patients, who do not want to deal with non-professional conduct, lose trust, problems arise for the healthcare industry. The harder it is to access healthcare services, the easier it is for sexually transmitted diseases to spread. If the population feels insecure about the services offered by medical staff, unplanned pregnancies and sexual health issues become more likely.

There are plenty of pharmacists and physicians who have surpassed these challenges. We need widespread self reflection, to create a system that provides better medical services and ensures access to contraceptives, and to ensure that health institutions and pharmacies are safe and friendly places – not places of prejudice and discouragement. The sooner this happens, the safer Kosovo’s youth and general population will be.

20/12/2016 - 10:54

20 December 2016 - 10:54

Prishtina Insight is a digital and print magazine published by BIRN Kosovo, an independent, non-governmental organisation. To find out more about the organization please visit the official website. Copyright © 2016 BIRN Kosovo.