Leading the Unseen Shift: Women, Emotional Labor, and Emergency Care in Low-Resource Settings

A powerful conversation on leadership, resilience, and the invisible dimensions of care took center stage at the ACEP International-AAWEP Empowered Women Speaker Series, where Dr. Saima Ali represented Indus Hospital & Health Network (IHHN), Pakistan. Her talk, “Leading the Unseen Shift,” highlighted the often-overlooked realities of emotional labor in emergency medicine and the unique challenges faced by women leaders in low-resource settings.

Opening with a thought-provoking quote by Anais Nin, “We don’t see things as they are; we see them as we are,” Dr. Saima set the tone for a deeply reflective session. As Head of one of Pakistan’s busiest emergency departments, the first female Emergency Medicine (EM) program director at IHHN, and among the limited number of women EM leaders in the country, she shared her journey of balancing clinical excellence with research, education, mentorship, and family responsibilities.

Drawing on the work of Arlie Russell Hochschild, emotional labor was described as the effort required to manage one’s own emotions while supporting others, an essential yet under-recognized aspect of emergency care. In high-pressure environments, this includes comforting patients, mentoring colleagues, and maintaining team harmony. Despite its critical role, this labor often remains invisible, undervalued, and disproportionately carried by women.

The session further explored leadership dynamics through Alice Eagly and Steven Karau’s Role Congruity Theory, which explains the bias women face when navigating between traditionally “nurturing” roles and assertive leadership expectations. This “double bind” continues to shape perceptions in emergency medicine, where authority is often unconsciously linked with masculine traits.

Adding depth to the discussion, theories by Carol Gilligan and Ruthellen Josselson highlighted leadership rooted in empathy, connection, and meaning-making. For Dr. Saima, leadership is not defined by authority but by service, mentorship, and impact, principles that guide her work in one of the most demanding healthcare environments.

The session also shed light on systemic challenges in low- and middle-income countries (LMICs), including underfunded emergency departments, limited training opportunities, and institutional structures that can unintentionally reinforce gender disparities. Data from Pakistan and global studies revealed persistent gaps in pay, recognition, and leadership opportunities for women in emergency medicine.

From a national perspective, IHHN’s expanding footprint, comprising 12 multidisciplinary hospitals, 3 rehabilitation centers, 4 regional blood banks, and over 100 primary care sites, demonstrates how large-scale healthcare systems can serve as platforms for change. Dr. Saima emphasized the importance of integrating global best practices while addressing local realities, reinforcing the idea of “thinking globally and leading locally.”

A significant part of the discussion focused on practical reforms: creating gender-safe emergency departments, ensuring psychological and physical safety, supporting working parents through policies like paid leave and childcare, and promoting inclusive workplace cultures. Addressing cultural narratives, such as the “doctor bride” phenomenon, and increasing women’s representation in decision-making roles were highlighted as critical steps toward sustainable change.

The session concluded with a powerful message: leadership is service, not status. Emotional labor, often dismissed as a soft skill, is in fact a critical strength that sustains healthcare systems, especially in resource-constrained environments. Quoting Paulo Coelho, Dr. Saima reminded the audience that culture and human spirit have the power to rise above structural and economic barriers.