“With my sports background - I used to be very fanatical in athletics - I actually wanted to become a sports doctor. But after an internship in Ambon, Indonesia, halfway through my medical studies at the AMC, I changed course. There I had to work for people who were really sick and needed help. That ambition in sports medicine didn't feel right after that. It is a luxury form of medicine, in which you look for improvement rather than cure. The heart is something that really matters. Moreover, it also has common ground with sport, after all, it is the body's engine.” Meet Yolande Appelman, one of the few female interventional cardiologists in the Netherlands. Her main area of focus: cardiovascular disease in women.
“As an interventional cardiologist, I perform a lot of angioplasty’s. But before I do that, I look for narrowing in the major coronary arteries of the heart during a cardiac catheterization. These can cause the symptoms, often chest pain. What I began to notice more and more during my work is that I was seeing people with heart problems who had no detectable narrowing of the arteries. Especially women. So in principle, you're done with a patient then, because the heart doesn't seem to be the problem. But the real question is: what is the problem? Because the symptoms are real. This is how my interest in cardiovascular diseases in women began in 2005. This has since led to the development of an expertise center at Amsterdam UMC for patients with symptoms but without narrowing of the coronary arteries. During a cardiac catheterization, I take measurements in the coronary arteries to detect any problems not only in the large but also in the smallest blood vessels of the heart. Women suffer from this more often than men. In this way these patients can be diagnosed and treated more effectively. This technique is only used in a few centers and leads to a considerable influx of women.”
In addition to performing angioplasty’s, Appelman focuses on better mapping the differences between men and women, not only with respect to cardiovascular disease, but for all disease states. “Traditionally, research has been conducted primarily on men. We haven't realized enough that you can't always simply apply the results of studies to women.” In 2008, Appelman founded the national Gender Working Group of the Dutch Society of Cardiology (NVVC). At Amsterdam UMC, she and Petra Verdonk have been leading the Think Tank Gender and Health since 2016, which also focuses on the importance of gender sensitivity in care, education and research. In addition, she holds numerous other positions both nationally and internationally to accomplish her mission. With the Lancet Committee on Women and Cardiovascular Disease, for example, she has just released another groundbreaking report showing that cardiovascular disease in women is still under-recognized, under-diagnosed and under-treated worldwide. “Whether all this fits into a regular workday? Not usually no. But you don't get anywhere by just sitting at your desk from nine to five. Then you know for sure you're not going to change anything.”
“What am I most proud of? Well, that's a difficult question. I believe that if you see something that is not right and that you think you can do better, you should just get to work. So what I do I find no more than normal.” Laughs: “But if you insist. I'm proud that cardiovascular disease in women has become a topic that gets attention. Especially in a male stronghold like cardiology, where for a long time there was absolutely no attention for male/female differences in patients with cardiovascular disease. Eventually, with blood, sweat, tears and hard figures, I was able to turn the skepticism and suspicion into a cause that is taken seriously.”
“First I would like to come back to that gender-sensitive research. To be able to speak of representative and inclusive research, it must always be possible to answer the question whether the outcome applies to both men and women. It sounds logical, but this is often not the case. This is also not the case at Amsterdam UMC.
For care workers in general, and people from minority groups in particular, I think you can achieve a lot with extra guidance in the form of training and mentoring. To become better and more powerful in the healthcare world. It's only going to get harder and more so in the near future. Prepare people for the future so you retain them. The more diverse that workforce, the better the quality of care and research. You are then better able to understand different populations and tailor the research to the participants.” She herself missed that guidance a lot. “I always thought: if you work hard enough you will get there, regardless of whether you are male or female. That was naive of me. Whether you're a man in a women's sphere, a woman in a men's sphere, an immigrant among natives, to get ahead you have to learn the rules and customs, the language of the majority. Look at how the pawns stand and play the political game. Otherwise you won't make it, no matter how hard you work. Guidance in this respect can ensure that you don't lose sight of your ambitions and that an organization doesn't see its diverse workforce dwindle.”