Women in Saudi Arabia, who suffer heart attacks, are delaying life-saving treatment because they need a man's permission to travel to hospital, new research by the University of Ulster has revealed.
Female patients surveyed at three hospitals in Riyadh, the capital city of Saudi Arabia, waited five times as long as men to attend hospital, researcher, Hassan Alshahrani, from the Institute of Nursing and Health Research has discovered.
He said: "Women and men took a similar length of time to realise their symptoms were serious and decide to call for help. However, once they made that decision women took five times longer to transfer to hospital – 0.5 hours for men and 2.5 hours for women.
"Findings from this study confirm that cultural factors are implicated and the fact that females need permission of a male relative to travel and that they cannot do so unaccompanied is contributing to their long delays.
"The speed of treatment during a heart attack greatly enhances survival so the findings of this study suggests that women's chances of surviving a heart attack and receiving prompt care are dramatically reduced by cultural issues."
In the survey 189 patients, both men and women, who presented with a diagnosis of myocardial infarction, (a heart attack), were questioned between March 2011 and August 2011.
Subsequently, 18 patients (9 males and 9 females) took part in one-to-one interviews. Some of the women described their experience in their own words:
B5 said:"Nothing stopped me except the absence of my son (Osama); this is the truth, because I and Osama's wife are females, and moreover, were without Mahram (male relative to escort woman)."
B7 said: "I was worried because my deceased husband preferred me not to go alone with a taxi driver, as I am female and I did not have a Mahram. Also, my daughter did not like to go by taxi, because my son will be angry; as he told me only to go with the private driver."
B3 said: "It is not acceptable, socially. The majority of people they did not accept this (women going alone without close relative)."
"My husband said: 'your voice cause us scandal' - social taboo. I was crying, because of pain, and he was saying don't cause scandal for us. Also the same thing happened at the hospital, he was saying you will scandalise our family crying like that."
The survey is part of Hassan's PhD research, Dr Donna Fitzsimons, at the Institute of Nursing and Health Research on the Jordanstown campus, is his supervisor.
She said: "The results of this study are alarming. We know that fast treatment saves lives and reduces damage during a heart attack. In this study we found protracted delays for women compared to men. It is clear that cultural issues make it difficult for women to get tohospital quickly. The female patients themselves told us that they delayed longer because they could not travel without a male relative or even decide to call an ambulance without a man's permission. We need to highlight this issue and conduct further research in this area."
Before studying at the University at Ulster Hassan Alshahrani was Head Nurse of Cardiac Care Unit and Supervisor of Critical Care Units in Saudi Arabia.
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