Intersections: Gender, History and Culture in the Asian Context
Issue 3, January 2000

Practising Gender and Practising Medicine:
'Tradition' and 'Modernity' in Post-Colonial Hong Kong [1]

Siumi Maria Tam

  1. In understanding gender theorists have taken approaches from biological to structuralist and culturalist. Those who believe women and men are born differently, assign 'gender-specific' traits to the female and male sexes respectively - namely males are said to be more aggressive, egocentric, authoritarian and rational and women are said to be rather the opposite, characteristically showing themselves to be more caring, nurturant, emotional, and irrational. Consequently sex roles are normalised and naturalised, which in turn tautologically reinforces the idea that women and men are innately different.[2] On the other hand, structuralists emphasise the intervention of social systems in gender behaviour and argue that factors such as the mode of production, education and employment opportunities, and familial division of labour play a more important part than biology in explaining the asymmetrical power relations between men and women.[3] These propositions however, tend to disregard the intricately complex issues in everyday life and how in fact individuals are able to manipulate resources and regulations, and take part in the negotiation of identities for themselves. Culturalists see gender as one of the symbolic systems that people engage in as they make sense of their lives.[4] Seeing gender as behaviour performed by interacting agents, or how gender is 'done' by women and men, situates gender in its empirical form, but nonetheless such explanations project gender as unitary cultural formations.[5] Particularly in fluid socio-political situations typical in Asian countries in the 1990s, a more appropriate approach is to historicise and contextualise the processes of gender negotiation in order to understand its complexity.
  2. As I began to study women doctors in Hong Kong, it was obvious that issues of gender difference and agency interact in a complex way. The women doctors practised medicine which was perceived as 'modern,' 'autonomous' and 'masculine,' while at the same time they were obliged to uphold 'traditional' and 'feminine' motherhood expectations which highlighted female dependence and altruist orientations. Such dilemmas were framed within class membership and complicated by a feeling of individual impotence in the face of political change and professional hierarchy. This paper seeks to examine cultural identities of women doctors against the backdrop of Hong Kong's transition to post-coloniality, as they negotiated an identity from 'tradition' and 'modernity' - two concepts from which they extracted justification but which, at the same time, they constantly re-defined. The paper proposes that it is necessary to examine how gender is constantly manoeuvred as both ideology and praxis, by individuals as they make sense of the everyday world in which they live, and how these are situated in the larger cultural milieu.
  3. This paper comes from a study on five different professions in Hong Kong, namely doctors, lawyers, accountants, engineers and public administrators. Data was collected between 1995 and 1999 using two main instruments: a questionnaire and an in-depth interview. The overall return rate for the questionnaire was around 13%, while the rate of acceptance to in-depth interviews was less than 5%. Only data on the medical profession was used in this paper. This includes 180 returned questionnaires from medical practitioners, two-thirds of whom were male. Invitations were also sent to doctors of both private and public sectors for in-depth interviews. Eventually twelve female and three male doctors were interviewed, in which a semi-structured discussion was carried out for 1.5 to 2 hours each, using a standard protocol. The majority of informants were aged between thirty-five and fifty-four. Workplace visits and observations were also done to complement the understanding of the production and reproduction of the professional institution in everyday practice.

    Cultural Milieu: Prelude to Post-coloniality
  4. In the face of Hong Kong's handover of sovereignty to China in 1997, many Hong Kong people felt their exclusion from shaping the new political structure, and they also felt a sense of insecurity fuelled by the Tian'anmen Incident of 1989. Many decided to emigrate. Middle class families in particular were a conspicuous group who had the means to leave the colony and actually succeeded in emigrating to other countries. Doctors, however, were not a privileged group in this society-wide phenomenon. While they were usually a highly respected group in Hong Kong, in the process of applying for emigration they found that their professional membership ironically became a hurdle rather than an asset. Favoured destination countries such as the USA, Canada and Australia exercised defensive policies against medical professionals. For doctors, emigration was a very negative career move, as their professional qualifications would not be recognised and they would have to undergo a long training program from scratch. Women doctors faced a double difficulty in the process. Men doctors had the choice of becoming an 'astronaut': leaving their wife and children in the host country while continuing to work as a doctor in Hong Kong. This way they did not have to give up their seniority, financial rewards, economic independence, class privileges, and the social prestige that were part and parcel of their professional membership. But women doctors perceived that choice to be unavailable to them. Interviewees believed that it was their major responsibility as mother-wife to be physically with their family. Thus leaving their husband and children in the host country, and working as a medical practitioner in Hong Kong was not an alternative at all. If they did decide to emigrate, they must go with their husband and children together, and thus would have to give up their career. It was clear then that the pre-1997 milieu was particularly unfavourable to women doctors. In the interviews, many of them expressed a feeling of resignation to fate, and often sought to justify their choice of not emigrating with tradition - they were traditional women who put their family as first priority. There was a tinge of resentment in general, but yielding to authority and submitting to the existing system was one and the same thing as the 'apprentice ethos' that was the foundation of vocational training. Being a female doctor could be seen as an extension of traditional expectations for women, and the overwhelming political transition mediated and reinforced that identity.

    'Tradition' and 'Modernity' in (Medical) Practice
  5. The interplay of 'tradition' and 'modernity' was an important theme from which women doctors constituted their identity. The career path of a medical practitioner started in secondary school. In Hong Kong's secondary school system, students had to choose between a science stream and an arts stream. Most interviewees indicated that they chose science because studying science was a status symbol. Science subjects were deemed more difficult; they were 'Western' subjects and therefore logical, advanced, modern, and were a symbol of higher intellect. Females were often discouraged from studying science. Arts subjects were considered female subjects as they were believed to be less advanced/more traditional, requiring rote learning and therefore more passive, and lacking in logical and rational thinking. By choosing to do science rather than arts, adolescent girls at least partly resisted the labelling that they were less able and less intelligent. As a consequence, becoming a science student was to negate femininity. To further prove their ability and assume modernity, female students chose to go to medical school. Doing medicine in university demanded a male standard of achievement, and an approximation of maleness became an index of modernity and intelligence. Interestingly, many female interviewees reported that they chose medical school because they wanted to 'help others,' as opposed to male interviewees who said they did medicine just because they found arts subjects uninteresting. That women chose to be doctors in order to serve others was in keeping with 'traditional' nurturing and caring characteristics that women 'should' possess. Thus while women chose to study medicine to prove their male-like ability, all the time they were keeping themselves in line as proper females. It came as no surprise then that in the process of career development, women doctors would make the choice to go part time or into private practice in order to perform motherhood responsibilities.[6]
  6. Although the binary pair of 'tradition' and 'modernity' was often referred to by interviewees as they discussed their self identity, what constituted tradition and modernity was never clearly defined. Like other guiding principles of social behaviour, these carried an almost mythical power that was uncontested. 'Traditional' roughly coincided with Chinese and 'modern' with the West. But tradition and modernity were not mutually exclusive. Rather they engaged in a sometimes complementary and sometimes contesting interplay. Together with class and professional membership, they were an integral part of the professionals' identity as heunggongyan, or the Hong Kong person.
  7. The heunggongyan identity came from a sense of difference and pride. That Hong Kong had a culture of its own, instead of being a residue of Chinese culture and Western influence, came about in the mid-1970s as post-war baby boomers came of age, and as professionals reaped the benefits of economic and social developments. Since the Sino-British talks in 1983, the search for a Hong Kong cultural identity had assumed urgency as the 1997 Handover loomed large. Hong Kong was to be more than just another Chinese city, and Hong Kong people more than just Chinese. In keeping with this sense of difference and pride, Hong Kong, to this date, has often been represented, officially and otherwise, as a metropolis that has many 'firsts' to its credit, or as a great modern city that 'has it all.' But Hong Kong has not been allowed to forget its Chinese heritage; indeed it sought to adopt an ethos founded on traditional Confucian ideology. Like many Asian cities, Hong Kong's official identity label, 'the place where East meets West' conjured up an image of syncretism, and in practice was a hotbed where traditions and modernities clashed. Such an inevitably conflicting identity was epitomised by the city's professionals who were defined as western-trained, rational, efficient and enjoying a modern lifestyle. The professional code of ethics coincided with the Confucian code that stressed compassion and righteousness, the practice of self-discipline, self-improvement, and broadly defined 'intellectuals' responsibilities.' As the educated class and, in many cases, as government officials, they were hailed as the driving force of Hong Kong's socio-economic development as a colony in the post World War II era. Today, since Hong Kong's return to Chinese sovereignty, professionals still hold strategic positions in public life, are respected for being well educated and financially well off and, in short, are beneficiaries of the colonial and post-colonial system. Their privileged lifestyle includes driving up-market cars, sailing private yachts and playing golf as a regular weekend pastime. Indeed intellectuals personify modernity and success on the individual level. At the same time, they are expected to rise above the material. They must express themselves as a group with 'advanced' scientific knowledge from the West and, at the same time, maintain the high moral code of the Confucian tradition.
  8. In this regard, interviewees of both sexes exhibited a converging identity in which they believed themselves to be professionals who held medical knowledge and skills from the West, and at the same time upheld the morality required of them by Chinese standards. So though tradition and modernity were articulated in everyday discourse as standing in opposition to each other, the dichotomy had become a unifying force in making sense of their individual positions as Hong Kong doctors. But tradition and modernity took on a different level of meaning when it came to gender relations.

    Gendered 'Tradition'
  9. In the discussion of gender roles, 'tradition' implies an asymmetrical gender system in which women are suppressed and 'modernity' entails egalitarian gender relations. Because of their high social status, the respect they enjoy, and the financial rewards they receive, women doctors in Hong Kong are often seen to have shaken off shackles of 'traditional' gender roles imposed on Chinese women. They are prime examples of 'modern' women. 'Modernity' is thus seen to have won over 'tradition' and the medical profession is perceived to be gender-neutral. Yet this modernity and fairness shroud a set of patriarchal relations essentialised in a male-public/female-private distinction. Not only is this binary opposition accepted as a given and defended as a 'tradition' that cannot be challenged, it also serves as a basis on which gender roles and power in everyday life are assigned and distributed; it defines social identities and thereby naturalises gender power relations. The folk saying, nam chu oi nui chu noi[7] (literally meaning 'men take charge of the outside, women the inside') was often quoted by interviewees to justify their belief of gender differences and to legitimise the gender roles with which that they are familiar.
  10. While men were seen to defend the medical system and its patriarchal institution, women were also found to be maintaining the status quo. When female doctors' views of femininity and masculinity are compared, it is found that they largely converge. As professionals both sexes put heavy emphasis on individual effort rather than gender factors in attaining success, but as social members they still largely saw women as mother-wives who belong to the domestic sphere. At the same time there was a clear distinction between how the women and men understood their subjectivities. Women doctors believed themselves to be more traditional and therefore family-oriented, while men doctors were more modern and hence individual-oriented. Male doctors opined that women doctors had become too modern, spent too much energy in career development, and hence were loosing traditional virtues of valuing the family. Women and men in the medical profession acted as important agents that contributed to the reproduction of the stereotyped gender identities through their subscription to the gender dichotomy and through a sexual division of labor in their public and private lives.
  11. In the following sections I shall illustrate, using ethnographic data interwoven with the voices of interviewees, the way in which 'traditional' and 'modern' were manipulated in the construction of individual identities and patriarchal gender relationships.

    Hiring a Female Doctor: A Recount
  12. Chris Wong[8] was a medical officer in the First Government Hospital and had been promoted to a new post in the Second Government Hospital. One day he paid a visit to his former colleagues at the First, and had afternoon tea in the cafeteria with them - two female and three male doctors. Wong told his friends that his department at The Second had two vacancies. One of the women doctors, Jessica Young, immediately suggested her junior, Rita Chan, who was a specialist-in-training. The other female doctor Loretta Lee recommended Winnie Poon who had similar qualifications. Both of the candidates were highly praised for their professional skills and work attitude. Wong's first reaction was that he could not hire both of the women because if they took maternity leave at the same time 'the team would be in big trouble.' He was told that neither woman was married and therefore there was no immediate risk of pregnancy. Wong then argued that their unmarried status made the situation worse, because his male juniors would be distracted from their work if there were two single women in his team. Wong decided he could hire only one of them, even though he agreed that both were highly qualified. Then it became a choice of which woman. Young argued that Rita was pretty but already had a steady boyfriend and therefore would not be interesting to Wong's juniors. The other male doctors present suggested that Winnie would be a better choice on the grounds that she was very unattractive and that she was so academically oriented she would probably never get married, and so would not need to take maternity leave. Chris Wong decided to hire the plain-looking Winnie whom he also knew as she had trained under him. He would continue the search - for a male doctor - to fill the other vacancy.
  13. This story reveals several issues of power in the medical profession. In the first instance, the senior-junior relationship affects junior practitioners greatly as they often rely on their seniors' connections and goodwill to secure a desirable job. Secondly, the medical specialties are 'narrow fields' in which people know one another, social norms are non-heterogeneous, and deviance is easily noticed and sanctioned. Thirdly, while professional skills are a necessary condition in considering someone for a medical position, the determining factor is often social-cultural. Fourthly, women in medicine are put in a double bind based on their physical appearance and so-called 'femininity': which are judged according to the needs of the male-defined context. In this case the social definition of all women being potential wives and mothers becomes a discriminatory factor. Lastly, not only do men doctors subscribe to the discriminatory gender stereotypification, women doctors either take it as a given or try to play it to their advantage.

    Power and Gender in the Medical Hierarchy
  14. Gender has long been ignored or downplayed in the medical profession in Hong Kong. This is perhaps best exemplified by the fact that no statistics of gender breakdown of registered medical practitioners are kept by the Medical Council of Hong Kong, the statutory body that accredits, registers and sanctions the local profession. When my research assistants and I first began to work on this project and look for the gender breakdown of the medical population over the years, we were perplexed at the non-existence of what we had thought would be a basic piece of information. We redirected our search to the Medical Faculty of the University of Hong Kong and found that they too had not had a gender breakdown of its graduates. For over a century this was the only medical school and the institution that trained and controlled the production of medical knowledge in Hong Kong.[9] And the administrators certainly did not think that gender was a relevant factor in their student or faculty population. When I told a doctor about this, he responded half-jokingly that it was evident that the medical profession had not discriminated against any sex and therefore had never had the need to statistically distinguish its members on gender grounds. That the medical profession is gender-neutral seems to be a common (mis)understanding of both male and female practitioners.
  15. But the supposed gender-blindness in medical practice is an illusion. In fact the patriarchal hierarchy and values of the profession have an all-encompassing control over individuals who enter the profession. Angela Cheng who is now a senior doctor and a respected specialist, told me in an interview:

      I was very lucky. [When I first started out as a specialist] Dr. James Mok asked me to join his team. He wanted to build up a good team in the new hospital, so I got in with no problems. If not [for him], I would still be wandering around; I won't get anywhere.... In the old days, a certain Section Head Julius Zee ... ordered his juniors to buy newspapers, chauffeur his family members to school, shine his shoes, make tea. But he was the boss. He had the power to not let you be his trainee. If he did not accept you [into his team], you wouldn't go anywhere. He accepted whom he wanted to, so they all worshipped him like a god.... Only when a boss accepted you, you had the opportunity to be trained. (My emphasis.)[10]

  16. Specialist training was the cornerstone of a practitioner's professional development. Cheng went on to explain:

      Of course everybody wants to get training, it makes you a specialist ... [you'll have] higher status.... But training posts are scarce. If you don't get this one, there may not be another one.... It makes the boss so powerful that he is like a warlord.... That was in the old days.... Like Professor Chan ... because he had the power to give you training, he could make you the chair; he could publish your papers. If you went against his wishes, he could wipe your record off. But I think it's not like this any more. Nowadays, young people dare to challenge.[11]

  17. Dr Cheng could not give me an example of a female 'warlord,' partly because the number of women doctors in 'the old days' was very small, and those who did rise up to that level of power was next to nil. But also, she said that 'male doctors like to think they are gods.' It was obvious that the senior-junior relationship was deeply embedded in a male-centred hierarchy which was intricately interwoven with financial and political interests. Although Cheng claimed that the situation today had improved, there was a touch of irony when she added,

      [Today] if you challenge [your boss] he may transfer you to another position. But you can expose the incident [to the media]. As I always say: if the boss is good the juniors are good; if the boss is bad, the juniors are incompetent.[12]

    Under such circumstances, individuals found themselves powerless in standing up to the system. On the other hand, they did not find it necessary to rebel because they understood that they would climb to that rung of the ladder in due course, and then they would be the boss and would enjoy the power and status that accompanied the position. It was to their advantage, then, to uphold the system.
  18. Females, being especially vulnerable in the system, also found it justifiable to maintain the status quo. I asked Angela Cheng whether there was discrimination against women in the medical system. She gave me a very definite 'yes' and said the she was a victim. She had wanted to do a certain subspecialty in a public hospital but the boss rejected her just because he would not train females. She persisted for a couple of years and finally got the post, not because the boss changed his mind, but because she was the only applicant. Although she was upset about her boss' initial refusal, she was happy that she was able to make it eventually. She repeated two points several times throughout the interview. First, she was very competent. She said, 'I showed them I was better. The boys could not but be convinced that I was a natural. I was fast, I seldom made a wrong diagnosis, I was diligent.... It was hard work, but I did it. Even the boys couldn't do it. After I started, more women are now entering the specialty.'[13] Secondly, she considered herself very lucky. She reiterated quite a few times that if not for her second boss who invited her to join his team, she would not have developed a career. Her professional knowledge and skills led her to think that if a woman had the ability and the will she should succeed. This implied a trust in the system that it was basically fair because it valued hard work and competence. So though a victim of gender discrimination herself, she concluded that 'the most important reason for discrimination against women is that the majority of women always feel they can't do it.' The issues of females having to measure themselves with a male standard, or to work extra hard to surpass that standard because of gender, and in the process having to discard their individuality as women, did not seem to bother Cheng. Like all of the other doctors interviewed (men included), she believed that it was up to the individual to excel by practising self-discipline and self-improvement. Being beneficiaries of the system, none of them regarded the profession as discriminatory.
  19. In addition, the fact that she considered herself very lucky because she was invited by a good boss to join his team indicated reliance on personal networks and on seniors' choice for promotion. This pointed to the system's recruitment and promotion mechanism being built not on principles of equal opportunity, but instead on the whim of individuals in positions of power, in an institution made up of numerous specialties which could become very parochial. In such a system, when females are seen as generic mothers whose rightful place is in the home, they are placed in a disadvantageous position especially in specialties that are protected as male territory, as well as in everyday practices and public discourse.
  20. That men and women have different inherent abilities, inborn characteristics, and pre-ordained destinies is a widely accepted view in Hong Kong. In public discourse 'Chinese tradition' (loosely-defined neo-Confucianism) has been alluded to as sources of such ideas. Frequently quoted folk sayings include nam nui yau bi [men and women are different'] and nui tsi mo choi bin si duc [virtuous are the women who have no skills]. Confucius' saying 'women and petty persons are difficult to keep' is used (often out of context) to strengthen views of female inferiority. And of course a boy is taught to grow up into a nam tsi hon dai cheung fu, [man, real man]. The phrase is culturally equivalent to the ultimate code of willpower, principle and righteousness. There is undoubtedly in conventional wisdom a female-male dichotomy consisting of opposite pairs such as soft-tough, emotional-rational and unpredictable-logical. Along this line of thinking which embraces biological determinism, women are petty, gullible, indecisive, over-cautious and can only manage small things, whereas men are knowledgeable, unyielding, principled, aggressive and have their eyes set on important issues.

    Biological Determinism in Medical Institution
  21. Data from this study showed that gender discrimination was alive and well in the medical institution. This was obvious in the various stages of training, in the workplace, as well as in a socio-cultural milieu in which women were valued only insofar they could behave like men and did not naturally belong in the profession. Oftentimes women needed to prove themselves over and over again to gain membership of the profession or the specialty. Indeed the entire career of a female medical practitioner could be seen as a process to prove her abilities, beginning with the day she decided to go to medical school. A number of my interviewees went to medical school to prove that they were intellectually superior - because of peer pressure in high school. Quite a large proportion of female interviewees wanted to be doctors also because they wanted to use medical knowledge to help others by curing their illness. Angela Cheng believed that a lot of her upper class female friends went to medical school because their families thought it was a matter of face; indeed for some of them all their siblings were doctors. For male interviewees it was more obvious that they studied medicine because it was a profession that guaranteed a high standard of living and high social status. This difference in motivation of entering the medical field reflects the larger society's gender role expectations. While a man's achievement lies in his ability to accumulate riches and achieve upward social mobility, a woman's greatest achievement is to be married to a good husband, to support him as he develops his career and to nurture academically successful children.
  22. This kind of thinking was encapsulated in Jenny Lam's interview. She received her medical degree from the University of Hong Kong in the late eighties. She recounted the last year of high school: when her male classmates learnt that she wanted to go to medical school, they scared her by saying that she would turn old very easily, that she would make such a lot of money that no man would dare to date her, and that she would not be as 'cute.' She believed that they gave her this 'advice' out of goodwill, because 'all men wanted to be protective.' Her boyfriend too, asked rhetorically, 'Why make life difficult for yourself?' I asked whether this affected her decision and she responded, 'No! What's the big deal about studying? I'm an expert in exams.' I asked if she met any similar discouragement in university. She said, 'No. We (females) got better results than they (males). What could they say?'[14]
  23. So the journey to prove themselves continued for female medical students throughout their five years of study. When male students were partying and test-driving new cars, female students would be in study groups preparing for quizzes and exams. Jenny Lam, for example, believed that in general female students were more conscientious. The need to prove that girls could also study medicine was keenly felt as an important source of pressure. By the third year when clinical training began, female interviewees found themselves performing better than their male counterparts. They believed that they were more knowledgeable than the boys because they had studied harder in previous years, that they possessed better communication skills as they could finish clerking patients' medical histories faster, and they had better motor skills because they learned 'faster than the guys' such skills as administering injections. In particular, they found that they were more welcomed by female patients in doing physical examinations. Interestingly, they believed that it was 'female characteristics' (i.e. biologically given) that allowed them to achieve these. For example, they thought that their seniors and the nurses were willing to teach them more because the guys would be too arrogant to ask, and because they had better interpersonal relationships as women were 'naturally gentle,' 'sensitive and considerate.'[15]
  24. Such concepts of genetic differences between the sexes coincided with the male doctors' views. Towards the end of the interview and the questionnaire, all informants, both male and female, were asked whether they thought there should be sexual equality [nam nui ping deng] and if they thought it existed in Hong Kong society. Almost all responded that there should be equality between the sexes, but commented that it would never exist because men and women were physically different. Visible physical differences and presumed temperamental differences were seen to combine to give justification to judgmental views of ability and intellect, which served as a basis for a system of gender-specific life goals, rights and responsibilities.
  25. Not only did this gendered divide apply to medical practitioners. It extended into their personal and family lives. The following excerpt from an interview with Clement Tang, a paediatrician with his own private clinic, illustrates this point. He said:

      I don't think there's gender equality anywhere in the world, because men and women simply aren't the same.... The physical structures of men and women are different. I don't think there'll ever be gender equality on Earth. Sometimes women are better, sometimes men are better, but never the same.[16]

    He said this to justify the division of labour at home. His wife was a full time homemaker and he told me this fact with a sense of pride. He insisted that while his wife took care of the 'day to day' work including looking after their two children and taking them to school and extra-curricular activities, he was a 'reasonable father or husband' because he also contributed to household responsibilities. He would write out cheques for utility bills, call the plumber, and help his son with homework. I asked why his wife was not taking care of the son's homework. He said, 'She can't do it. She can't even teach our daughter [properly]. Besides, I like to teach.'[17]
  26. This 'Chinese' notion largely coincides with a 'Western' ideology of gender differences. In her discussion of surgeons in the United States, Cassell notes that surgeons are constantly compared to and comparing themselves to John Wayne, or they have Chuck Yeager ('who walked away from demolished planes to become the first man to fly faster than the speed of sound') as the heroic ideal. And from a newspaper clipping she finds that Hippocrates is quoted to have said: 'He who wishes to be a surgeon should go to war.'[18] Surgeons thus, presumably, like to think of themselves as macho heroes, the diametrical opposite of wimps. The biological deterministic view that there are intrinsic differences between the sexes is echoed by some medical professionals in the West - men and women alike. Professor John Chalmers, President of the Royal Australian College of Physicians and Dean of Flinders Medical School, told a graduation ceremony that women's entry into medicine is important because they are 'so well endowed with the characteristics of caring, of altruism and selflessness which our profession so particularly needs.'[19] A female surgeon wrote in the Journal of the American Medical Women's Association that 'certain female characteristics can be very beneficial, not only in getting through a training program in surgery, but also in the practice of surgery and caring for patients.' And she concluded that 'a combination of male and female characteristics probably work the best.'[20]
  27. The hegemony of a US-UK-centred 'modern' medical culture means that the practitioner in Hong Kong is modelled after the western white middle-class male doctor, transplanted intact with his class aspirations, career paths, leisure sports as well as gender ideology. The resistance to women in the western medical institution is paralleled in the Chinese stereotypical representation of gender identities. Interestingly this is manifested in a confusion between gender equality and gender difference in both Western and Chinese societies. The congruence among the comments of Dr. Tang, Prof. Chalmers, and the American female surgeon who opted to remain anonymous, points to the prevalent idea in the medical field that women and men are biologically different. As such the sexes are born with different talents, so it is natural that they take up different social roles, and therefore they will never be equal.

    Parallel Times and Double Bind
  28. Within this milieu, institutions and individuals mould females and males into their 'proper' positions and roles. According to the Medical Council of Hong Kong, the number of women entering the medical profession has gradually increased over the years. However, women have been disproportionately channelled into what doctors called nui yahn yeh or 'women's stuff.' These included such subspecialties as obstetrics/gynaecology (O & G), paediatrics, community and family medicine, as well as into those that men considered less desirable such as psychiatry and radiology. This sex segregation among specialties coincides with research findings in the US where it was found that females are concentrated in the 'lower-paid, lower-prestige specialties' such as family and general medicine, paediatrics, O & G, anaesthesiology, psychiatry, and public health.[21] These 'female specialties' reflect, or are an extension of, women's domestic role as mother-wife. They tend to be related to a generic provision of care and especially to babies, children and women.
  29. As at March 23, 1999, in Hong Kong there were nineteen females out of a total of 637 practitioners in the surgical subspecialties (excluding O & G), or roughly three percent. Obviously it was very unusual for a female to practice as a surgeon or to be admitted for specialist training. The sex segregation within and among specialties was reaffirmed by interviewees. Many of them opined that women would not be admitted to such 'male' specialties as orthopaedics and only recently were female specialists appearing in ophthalmology. Due to such perceptions it was at least partly a self-selection process where women chose not to enter certain specialties. It was only when the interest in a 'male' specialty was so intense that women would venture to force their way in. As one of the female surgeons said, 'it is ve-e-e-e-ry tough [ho nan ai]. But if you like it, you just have to do it. Now it's all right for women to do surgery, but there's one thing: if women show weakness [si yuek] ... like, if you are afraid of getting dirty or blood, or you can't go without sleep etc, you'll have to quit. It takes six years to train a specialist ... if you don't stay in the specialty it's a waste.'[22] Here she stressed the overwhelming institutional control that individuals should yield to, and the institution's right to demand performance from individuals. A 'waste' in the system meant a failure of individuals to play well according to the rules of the game. What she did not mention, however, was that the institution was not a level playing field. But most interviewees did not connect an individual's struggle in the medical profession to the differential social and cultural expectations to which women and men were subjected, and how the difference in such expectations constituted a very different working environment for female and male doctors.
  30. In fact many married female doctors had two full time jobs which competed for their energy and time. They had to fulfil two demanding roles that ran parallel to each other in time, and which were not allowed to be given priority over the other. Married female doctors were caught in a double bind in which high commitment to both jobs was expected. On one hand they must perform well as a competent doctor, while on the other they were scrutinised for signs of being irresponsible mother-wives. So while women doctors often worked a fifty-six hour week, plus resident calls, they were expected to simultaneously fulfil their twenty-four-hours-a-day, seven-days-a-week motherhood obligations as well.
  31. In Hong Kong people in general defined employment as 'do work' [cho yeh] and domestic matters [ga mo] as 'do not work' [ng cho yeh]. From the women doctors interviewed it was clear that ga mo should be considered proper work instead of non-work. It took up physical time as well as emotional time. The most extreme case was Maurine Ng, a general practitioner who reported an average of fifty-six hours of housework per week, compared to thirty-eight hours in the clinic where she was employed. An in-depth interview with her showed that this was 'a compromise' after four years of struggling between two very demanding roles - mother-wife and medical practitioner. She found herself being pressurised to the brink of neurosis, and had to go through a series of 'self exploration workshops.' She decided that since her husband was a much more senior doctor who would not be bothered with the children, she would give up developing her career so that he could continue developing his. So she opted for a part-time job in a clinic. In a similar vein, Linda Ho, a female O & G specialist, said the system in Hong Kong 'will not bend for you. Not because you're a woman and you have family commitment.' She explained with personal experience:

      Once I had to take leave to see my child's teacher on Parents Day. It's only once a year, once a year.... It was a Saturday morning.... But my boss wouldn't approve because he said there must be a priority.... Children is not counted as a priority.... Absolutely not [to him]! [23]

    I asked whether her husband went instead. She said,

      Yes, ... but I wanted to go!... In Hong Kong society, the father's role in child-rearing, he plays a very little part. Since the role is accorded to me, my husband doesn't pay much attention to the children's matters. He's very 'dumb,' he doesn't know any of the kids' things. So if the teacher asks him anything about our kids' behaviour at home, he won't be able to answer.... So I must go. But it turned out he went finally.... I just had to ask him to go. (My emphasis.)[24]

  32. Dr Ho was adamant that meeting with the teacher was the mother's duty. This coincided with the questionnaire results in which 66.7% of female doctors (compared with 4% male) claimed they were the principle parent that liased with the children's school teachers, and 55.6% (compared with 4% male) were doing the bulk of tutoring the children's homework. The survey also found 20% of female respondents said they were the major parent who spent leisure time with their children, with the other 80% doing it together with their spouse. This contrasted to only 1.8% of the male respondents being the principle parent who spent leisure time with their children and 89% who did this together with the spouse. The difference between the sexes was biggest in giving instructions to domestic helpers, with 75% female doctors and only 8.6% male doctors managing how housemaids worked. It was obvious that female doctors took up the bulk of domestic work whether it was mental, physical or emotional labour.

    'Traditional' Women in a 'Modern' Profession
  33. Linda Ho said she placed family above work and that was why she opted for private practice. When she worked at a public hospital she found herself working till eight o'clock every evening and then she had to attend a lot of committee meetings which started at 8:00 p.m. This meant she would not see her children for days. She decided that having her own clinic would give her the flexibility of work hours and she could schedule it around her children's needs. Now she worked in her own clinic until 5:00 or 6:00 p.m. every day. The desire to be a perfect mother was obviously strong for her. She told me she only agreed to sit on the council of a specialist college because its meetings were held on Tuesday evenings once every two months; and Tuesday was the day that she had the afternoon off and when she could take care of her children before going to the meeting.[25]
  34. I asked her if it would be the same for male doctors. She answered, 'No, I think they won't. In Hong Kong? Not now. Not in the near future. If you have a child and if one of the spouses have to stay home to look after the kid, it'll be the woman who quit working [ng cho yeh].... If my work prevents me from taking care of my children, I'd rather quit.'[26] She did not quit her work, however, because it would be considered a 'waste.' Like many female doctors, she chose to go into private practice which allowed her to continue the medical practice that she loved and was good at, and at the same time let her fulfil the social requirements of motherhood.[27]
  35. Medicine is one of a few long-established professional institutions in Hong Kong - a product of power based on a monopoly of life-saving knowledge and technology. As a female doctor said, 'in our field, we are very conservative ... and everyone has a role. You can't be ignorant. You can't say you don't even know how to prescribe a drug, you'll kill someone.... Yes, knowledge is power.' In addition, female doctors believed that professional ethics was as important if not more so than professional knowledge. Interestingly the dual criteria of knowledge and ethics was of prime importance in both the profession of medicine as well as in motherhood. Maurine Ng whom I discussed above, said the following:

      In our training, we were not taught to handle everyday life. No one taught us how to deal with our marriage relationships or our relationship with our children. But we all have to face these every day. Although people think we are very professional so we should know how to handle these, actually we are doing it by trial-and-error.... Now I find it easier to tell [patients] that there are things that I don't know. In the past I always felt that when people thought I should know, then I must know. I couldn't tell people that I really didn't.... I think I learned step by step how to be a mother, how to be a wife.... Like being a doctor, there are many things we learn on the way after we graduate.[28]

  36. Other married interviewees also found it frustrating to have to learn the homemaking skills that they were told to be natural to them, and that they were the ones, not their husbands, to sacrifice all or part of their professional career in order to maintain a family. They found themselves in a dilemma between a public-medical profession and a private-family career. Jenny Lam who was single said, 'I admire Professor Chu and Professor Fong. They are so very intelligent.... But one was divorced and the other single. I don't want to be like them. It's too extreme. It's so difficult to choose between the family [and medical practice].' She expected to be married to her long-time boyfriend soon, and had this to say of her prospective married life: 'I think I can [cook] well if I invest the same amount of energy in the family as I invest in my work.... But I don't have the time.' When I asked what she would do after she had children, she hypothesised,

      We'll eat at my mother's place, hire a Filipina or part time worker to do the housework, but I want to spend more time with my child.... But if you make me choose, I may have to work less, maybe work part time, but I won't give up [my career] entirely![29]

    I asked if she thought it appropriate to ask her husband to work part time to help with the homemaking, she said,

      I won't ask my husband to go part time. If he's successful in his career, I'm happy too. I think if I can help my husband and be good to my children, that's one of my careers too. (My emphasis.)[30]

  37. This paper uses Hong Kong's female doctors as an example to demonstrate that gender configures as both ideology and praxis as it is constantly manoeuvred by individuals to make sense of the everyday world in which they live - a world in which tradition and modernity are not mutually exclusive but rather engage in a complementary and contesting interplay. After graduation and especially after getting married, the female doctors I interviewed changed their life goals from dedication to a career to raising a family and helping their husband and children develop - in general these women became the person 'who takes charge inside,' just as their husbands 'take charge outside.' This, however, had not stopped them from having a trust in the medical institution which they believed to be gender-neutral. As many of them said, 'the system is fair. You just have to work hard.' In trying their best to be good doctors that are both professional and moral, women doctors as individuals and as a class, reconciled the conflicting demands, made personal adjustments and negotiated a gendered identity. They took part in the making of a lifestyle appropriate to professionals; one that was defined as modern, in which equal opportunity for both sexes was guaranteed. In the process they contributed to the reproduction of a stereotyped gender ideology that is defined as traditional, that saw women as peripheral both in the public and the private spheres. At the same time these women construed it to be western and modern.
  38. While it is true that working women in Asia typically have a double burden to cope with as socio-economic development takes place, from this study it is clear that women doctors in Hong Kong were reconciling their subjectivities and behaviour to cope with social expectations of the double burden within the local context. They were faced with both opportunities and responsibilities that came in the guise of having the best of both worlds: Western modernity and Chinese tradition. Rather than being diametrically opposed, tradition and modernity were jointly manipulated in the construction of individual identities and gave new life to patriarchal gender relationships in Hong Kong. In this sense the female doctors had in fact not shaken off the shackles of traditional gender ideology. In practice femininity as performed by the female doctor had to be sanctioned within the family, by her husband, children and parents, and enforced by other actors in their work environment such as the nurses and her superiors. They made use of popular discourse to give justification to their individual behaviour, and as a collective submitted to the patriarchal ideology and division of labour both within the respected medical institution and in the despised career of homemaker. In the end the women sought to combine two roles according to differing expectations for each: the traditional woman and the modern doctor.


    [1] This study is part of the research project 'Gender and the Professions in Hong Kong: the Politics of Work and the Social Construction of Gender' funded by an earmarked grant from the Research Grants Council. Earlier versions of this paper were presented as 'Between Professionalisms: Motherhood and Medical Practice in Hong Kong,' at the 'Tradition and Change: Identity, Gender and Culture in South China,' International Conference, 3-6 June 1999, Chinese University of Hong Kong, and as '"Tradition," "Modernity" and Gender Politics: Identities of Professionals in Hong Kong,' at 'Chinese Identities,' the Sixth Biennial Conference of the Chinese Studies Association of Australia, 8-10 July 1999, Murdoch University, Perth, Australia.

    [2] In her discussion of the formation of feminine and masculine personality as a result of the mother's role in socialisation, Chodorow refutes a simplistic argument for the universality of biological sex differences (p.43). But by asserting that women's motherhood and mothering role are universal, and that the structure of personality in turn perpetuates gender roles (pp. 45, 66), she ironically reinforces the normalisation of sex differences. See Nancy Chodorow, 'Family Structure and Feminine Personality,' in Woman, Culture and Society, ed. Michelle Rosaldo and Louise Lamphere, Stanford: Stanford University Press, 1974, pp. 43-66.

    [3] Rosabeth Kanter, 'Some Effects of Proportions on Group Life: Skewed Sex Ratios and Responses to Token Women, American Journal of Sociology, vol. 82 (1977): 985-90; Judith Lorber, Paradoxes of Gender, New Haven and London: Yale University Press, 1994, pp. 1-10.

    [4] Sherry Ortner and Harriet Whitehead, (eds), Sexual Meaning: The Cultural Construction of Gender and Sexuality, Cambridge: Cambridge University Press, 1981, pp. 1-27: 1.

    [5] Joan Cassell, 'Dismembering the Image of God: Surgeons, Wimps, Heroes and Miracles,' in Anthropology Today, vol. 2, no. 2 (1986): 13-16; 'The Woman in the Surgeon's Body: Understanding Difference,' American Anthropologist, vol. 98, no. 1, 1996: 41-53; 'Doing Gender, Doing Surgery: Women Surgeons in a Man's Profession, Human Organization, vol. 56, no. 1 (1997): 47-52.

    [6] Siumi Maria Tam, 'Private Practice and Gendered Power: Women Doctors in Hong Kong,' in Hong Kong Institute of Asia-Pacific Studies, Occasional Paper no. 99, The Chinese University of Hong Kong, 1999.

    [7] All transliterations in this paper are based on Cantonese which is the lingua franca in Hong Kong and also the medium of communication in this research.

    [8] To assure anonymity all the names of individuals are pseudonyms. For the same reason certain details which are not crucial to the analysis, such as the institutions and departments where they work, are also changed or unidentified.

    [9] In Hong Kong the bachelor's degree in medicine can be obtained from only two universities. Both provide a five-year curriculum. Medical training at the University of Hong Kong has a history of over 110 years, and today graduates acquire the MB BS degree. The Chinese University of Hong Kong's Faculty of Medicine produced its first graduates in MB BCh in 1986.

    [10] Interview with Angela Cheng, 11 April 1999, in her home, Hong Kong.

    [11] Interview with Angela Cheng, 11 April 1999, in her home, Hong Kong.

    [12] Interview with Angela Cheng, 11 April 1999, in her home, Hong Kong.

    [13] Interview with Angela Cheng, 11 April 1999, in her home, Hong Kong.

    [14] Interview with Jenny Lam, 28 January 1999, at the University of Hong Kong.

    [15] Interview with Jenny Lam, 28 January 1999, at the University of Hong Kong.

    [16] Interview with Clement Tang, 22 March 1999, at his clinic, Hong Kong.

    [17] Interview with Clement Tang, 22 March 1999, at his clinic, Hong Kong.

    [18] Cassell, 'Dismembering the Image of God,' p. 15.

    [19] John Chalmers,1992, quoted in Rosemary Pringle, Sex and Medicine: Gender, Power and Authority in the Medical Profession, Cambridge: Cambridge University Press, 1998, p. 9.

    [20] Anonymous, 'Why Would a Girl Go Into Surgery?' in Journal of the American Medical Women's Association, vol. 41, no. 2 (1986): 59-61.

    [21] Linda Grant and Layne Simpson, 'Women Physicians,' in Women and Work: A Handbook, ed. Paula Dubeck and Kathryn Borman, New York and London: Garland Publishing, 1996, pp. 153-56: 153.

    [22] Interview with Angela Cheng, 11 April 1999, in her home, Hong Kong.

    [23] Interview with Linda Ho, 9 October 1998, at her clinic, Hong Kong.

    [24] Interview with Linda Ho, 9 October 1998, at her clinic, Hong Kong.

    [25] Interview with Linda Ho, 9 October 1998, at her clinic, Hong Kong.

    [26] Interview with Linda Ho, 9 October 1998, at her clinic, Hong Kong.

    [27] Tam, 'Between Professionalisms: Motherhood and Medical Practice in Hong Kong,' paper presented at 'Tradition and Change: Identity, Gender and Culture in South China,' International Conference, 3-6 June 1999, The Chinese University of Hong Kong.

    [28] Interview with Maurine Ng, 30 October 1998, at her clinic, Hong Kong.

    [29] Interview with Jenny Lam, 28 January 1999, at the University of Hong Kong.

    [30] Interview with Jenny Lam, 28 January 1999, at the University of Hong Kong.


This paper was originally published in Intersections: Gender, History and Culture in the Asian Context, with the assistance of Murdoch University.

This page has been optimised for 800x600
and is best viewed in either Netscape 2 or above, or Explorer 2 or above.
From February 2008, this paper has been republished in Intersections: Gender and Sexuality in Asia and the Pacific from the following URL:

HTML last modified: 20 March 2008 1239 by Carolyn Brewer.

© Copyright