Between the Lines interviews a diverse selection of Australian writers to uncover the hidden processes, research, and inspiration that goes into the making of a book.

Dr Joan Arakkal is an orthopaedic surgeon who grew up and trained in India, before moving to the UK where she was admitted as a Fellow of the Royal College of Surgeons. She later migrated to Australia where she currently works. She is the recipient of several academic and research awards in India and Australia. She lives in Perth with her husband and two children. Slice Girls is her first book.

Slice Girls – Synopsis
When Dr Joan Arakkal chooses to specialise in orthopaedics while training in India, a field traditionally occupied by men, she slots into the world of bones with relative ease. But when her career takes her to the UK, and then Australia, she encounters the ‘bonemen’—a boy’s club whose members are easily identified in the hospital corridors by their loud voices and self-assured swagger. Their medieval attitudes wield a stranglehold on the development of orthopaedics, compromising patient care. Joan is totally unprepared for the obstacles and prejudices she encounters—but the tables are turned when she suffers a health scare of her own, which ultimately gives her the perspective she needs to speak and fight without fear. A provocative reflection on the discrimination, sexism and cartelisation entrenched in the surgical community, and particularly the world of orthopaedics, Slice Girls shines light on a surgical path that is made needlessly challenging for women, and finds that while women are ready for surgery, it forces the question: is surgery ready for women?

Credit: Francis Perinjeri

Your story is incredible Joan—from your childhood and education in India, to the Royal College of Surgeons in the UK, two stints with cancer, pursuing a career in Australia amidst sexism and racism, and everything else in between. Can you tell us a bit more about your journey as a writer? In Slice Girls you explore the incredible research on predicting nonunion in scaphoids, and writing with academic purpose, but not how you came to be a writer with a capital “w” on top of being a Doctor.

One day, sitting on my divan, I closed my eyes to get a bird’s eye view of my life—a reflective pause, one might say. Watching the movie playing before me, I was struck by the distance I had travelled, both in time and space. The world was marching forward and so was my life. Yet when I looked at my career path, I realised there was a lot of jogging on the spot and even walking backwards.  In the predominantly male-dominated medical speciality of orthopaedics, the barriers that had been erected to stymie the progress of a woman in the 21^st century had an unreal quality.

In my early days as a young medico I was fascinated reading a book titled “The making of a woman surgeon”. My sense of incredulity at the efforts by an archaic fraternity to “unmake” a woman surgeon had reached a tipping point. I reached for a pen. The words tumbled onto the pages and took a life of its own. Before I knew, it morphed into Slice Girls. 

I’m glad you had that reflective moment and reached for your pen because I gained a lot from spending time inside your world—and I mean your world. Memoir has been becoming more and more popular among readers, did you always plan to write your own story, and were there particular difficulties in exposing yourself—in the vulnerability of this form of literature?

Despite being a private person, I felt I had to tell the unvarnished story. The tale was bigger than me and had ceased to be mine. Hence, I felt no vulnerability having moved into a space where I was confident and comfortable telling the tale.

Slice Girls might appear to be a memoir but the use of plural in the title was deliberate because the narrative was not unique to a particular girl. I felt the book could be a mouth- piece airing a story that would resonate wholly or in parts with many others faced with similar challenges. The book is written to empower, encourage and to reflect on how we could steer away from degenerate behaviour to one that could better serve the individual and the larger society.

It’s incredible that the purpose of your work arrested your vulnerability—especially because the telling of your story involves weaving memories of your childhood. You also weave myth, religion, and the local history of the various placed you have lived in—did you do this retroactively, with intent, or did it form organically as you wrote? What was your process for writing your memoir?

While I did not deliberately think about the style or the prose in writing Slice Girls, I felt the story of the making of a surgeon had to start in her childhood where the stage would have been set. I realised my foray into medicine and later orthopaedic surgery were inextricably linked with my growing up years. Weaving memories into my writing was an organic process. The colours and smells of India holds a particular fascination especially for people who have not grown up in that land. Much as I enjoyed writing about it, I also believed the myth and local history would add a light-hearted flavour to the narrative making it an easier read.

It felt organic, and it made for a balanced reading experience. How about the publishing process? How did you get from point A to point Z—from deciding to write you story, and having it delivered to the hands of eager readers? Was there any part of this process that you were unprepared for, or surprised by?

The book was not written in a chronological fashion. That came later. I started out by writing snippets which was then converted to stand-alone chapters with a particular end in mind. I had initially weaved in and out in an almost dizzying fashion. The chapters were then put together giving the narrative a linear structure. I was fortunate to have a mentor in Stuart Kells, who guided the process—which included finding the publisher. Serendipity did play a significant role in painlessly bringing it all together and birthing the book.

Well it’s birth has been received well by the literary community. But how has the book been received by the medical community, and, more specifically, by the ‘bonemen’—a boy’s club that wields an absurd amount of power in the orthopaedics industry? You refused to accept the status quo in the orthopaedic community and ruffled more than a few feathers, has this book had a similar effect? And has it helped or hindered your journey to realise your dream to be a hand surgeon?

The overall response from the medical community has been quite positive. Many young women aspiring to do orthopaedics have got back saying they have been inspired by the book and realise orthopaedics is not the purview of men. The book’s foreword by the world class orthopaedic pioneer, Augusto Sarmiento and the afterword by Noble Laureate Barry Marshall are reflections of the sentiment of the medical community that has long been aware of a problem within the speciality of orthopaedics. As you rightly point out the bonemen wield an absurd amount of power—which makes them feel invincible.

The book naturally would ruffle feathers and make some surgeons uncomfortable. Though some feeble infantile attempts at “surgical shaming” (the equivalent of slut shaming) has been attempted, by and large the response to the book by the fraternity has been subdued. (A few men though have attempted to justify their billing practices!). I hope the book serves to reflect on the outdated behaviours that are largely self-serving while disadvantaging the larger society. The emperor has no clothes and it is time to call it out. I have embarked on a path aimed at achieving an orthopaedic service which is affordable, ethical and compassionate.

Your drive to make a difference for patients is inspiring—but there’s a great deal else to be inspired by. You conclude your memoir with a powerful message about gender equity, as opposed to equality. More than 96% of orthopaedic surgeons worldwide are male, but you don’t argue that this figure should be necessarily be reduced to 50%—you simply want women to be afforded the same opportunity as men. Where did you learn, and who inspired, your feminism?

Feminism was not something I sought or actively thought of. Having had the good fortune to grow up in a climate where gender was not an issue in pursuing my aspirations, I had little need to go looking for equality. Looking back, I realise, unbeknown to me, my father was the biggest feminist. His treatment of my mother reflects the attitude he has towards women. My brother and I grew up with no barriers placed on us as to what we could or could not do based on our gender. I enjoyed being a girl and later a woman. I see it as a privilege and would not swap it for anything. I have no desire to be equal to a man. Gender is biology and biology is sacred. Men and women are different—intellectually, physically and emotionally. If each played to our strengths then we would not have to aspire to be like the other.

So, while equality is not my clarion call, equity is. For a boy or a girl to pursue his or her dreams is a birthright we should all respect. If a girl wants to be a seamstress she should. If she wants to be an astronaut, allow her to pursue her dream and, as I argue in my book, if she wants to be an orthopaedic surgeon she should not be thwarted. The attitudes towards women aspiring to be orthopaedic surgeons is shameful. Many men in the fraternity have to travel some distance to arrive into the 21^st century. Orthopaedics needs women to usher it into modernity.

Orthopaedics not only needs women, but women of colour. Your experiences, which relay, and your active commentary on, ‘Western culture’ and how those who are perceived as outside of it, struck a cord with me. As someone who slips between my white family and my brown family, between versions of myself, between being viewed as white enough and not white enough, between cultures that are considered antithetical to each other, it was heartening to read something that touched on this subject. Do you think Australia and other ‘Western’ countries are sufficiently tackling their collective misconceptions, their racism, and how do we drive towards a more inclusive orthopaedics industry, publishing industry, country, world?

I believe racist attitudes demonstrated by institutions stem from fear and ignorance. When people’s lifestyles and privileges are threatened there is disquiet and panic. Ignorance stemming from lack of education and knowledge is a significant contributor to misconceptions about people who do not look or sound like them. In an evolving world especially in continents which have been colonised, people from different countries will continue to arrive and those with a greater sense of entitlement will continue to display racist attitudes. We can only address this by acknowledging the first people of the nation and learning the history of how modern Australia has come to be. A complete history, warts and all, has to be a compulsory part of our education. Healing comes with acknowledging the right and more importantly the wrongs on which the current nation has been conceived. As long as we fail to concede that we are all guests on this soil who have failed our hosts miserably, racism will continue.

The sexism and racism that you experienced are often connected, I found the subtlety of some of this distressing; and when other women, specifically white women, tore you down in their desire to be a part of the boy’s club, I was horrified. I enjoy the privilege of identifying and being identified as a man, but I have experienced overt and subtle racism and homophobia. What message do we send to those with privilege, but especially those with privilege who wield it against the disempowered, and how do we encourage the disempowered to feel comfortable taking up space, as you have in boardrooms and through your memoir?

The orthopaedic community has been forced to acknowledge discrimination, bullying and sexual harassment after millions were spent on an investigation by an External Advisory Group in 2015. Two knee jerk “solutions” to the damning indictment have been offered. The first is instituting a ten-year program to address it. This smoke screen is nothing but a getaway plan for the perpetrators who continue to be active members of the College. The other solution offered was affirmative action, co-opting more women into the Council. This is neither an organic process or a healthy response. The paternalistic approach, which views gender as some kind of weakness that can be ameliorated through quotas and mentoring, is demeaning.

However, the greatest danger with these band aid measures lie in the fact that it merely treats the symptoms without addressing the underlying disease. The main problem is the monopoly that the College of Surgeons wields. Their cartel-like behaviour restricts the number of specialists and keeps competition at bay. While it ensures a wealthy life style for the surgeons, this discrepancy in supply and demand, results in mediocrity being fostered. Patients are forced to pay extortionate prices to access this service. Long public hospital waiting lists and huge gaps for the privately insured patients are fall outs of the monopoly. Racism, sexism, homophobia, xenophobia and other non-inclusive attitudes should be viewed as weak weapons of oppressors. The problem wholly rests with them and the targets of their unsavoury behaviour should not choose to feel disempowered. Speaking up, calling out and collective action will go a long way to address these issues. School yard bullies back off when they are faced squarely and so it is with men and women with infantile mindsets who inhabit grown up bodies pumped up by their egos and immaturity. In areas where the impact can be widespread, there is a role for civil society to step in and ask for a Royal Commission just as we did with the Catholic Church and the Banks.

 Thank you for that. Other writers, like myself, have a great deal to learn from you and your work. Lastly, I’ll ask you for another message. It seems like those outside of the literary profession or the literary communities of their towns, cities, or countries lack the confidence to write, even if they have the desire to do so. And those of culturally and linguistically diverse backgrounds face many obstacles on their journey to voice their words and worlds. You have faced both of these challenges—what advice would you offer to those in a similar situation?

For those who have a story to tell (and most of us do!) I would say, “Just write”. Cultural and linguistic diversity adds interest and enriches the writing. It should be viewed as an advantage and not otherwise. Put pen to paper and see where it goes. You would be surprised the places it could take you to. “So open your mouth, lad! For every voice counts”—courtesy, Dr Seuss.

You can purchase Slice Girls from Ventura Press.

Jay Anderson is a professional writer and editor, with a background in Literary and Cultural Studies. He’s currently completing an Honours of creative writing at Curtin University—where he is the Chief Editor of the campus’ student publication, Grok Magazine.

This interview was originally published on 4 July 2019.