Accessing Health Care
The weekend of October 19-21, I attended Transcending Boundaries: Celebrating the Spectrum of Sexuality, Gender, and Sex, held in New Haven, CT on the Yale University campus. This conference, which grew out of a tri-state bisexuality conference held annually in the area, concentrated on bisexual, intersex, and transgender issues: the most ignored people under the LGBTI umbrella. (Disclaimer: One of the sponsors of Transcending Boundaries was BiZone, an organization I was involved with at the time of the conference. I’m on the 2002 Board, elected in December 2001, serving as the Secretary of the organization for a two-year elected term.)
Two sessions I attended concentrated on health care access for trans people: Health and Human Services for the Bi-Gendered, presented by Bobbi Williams (who appeared in our first issue) and Queer People Accessing Medical/Mental Health Services, presented by Hawk Stone.
Queer People Accessing Medical/Mental Health Services
Hawk Stone is a therapist from Albany, NY who trains health care providers on providing medically correct services that are sensitive to the diverse needs of GLBT people through the Rainbow Access Initiative, a two year-old program funded by the New York State Department of Health. In this session the participants, who were nearly all there as representatives of organizations that provide care or services to trans people, shared ideas on educating local health care providers on trans issues. Following are a few of the suggestions made on approaching a care provider about providing care to trans people in the community:
- Be prepared to answer questions, rather than preparing for the resistance of a flat refusal to listen or care for trans patients (Stacey Montgomery)
- Bring materials with you (Bobbi Williams)
- Don’t be afraid to use shame or guilt, and tackle the issue of care providers getting educated on trans issues as a justice issue (Hawk Stone)
Of course, being able to create materials to give to local health care providers costs money. Stone recommended writing grant applications to private foundations and municipal organizations. While there are more restrictions on the use of municipal funds and radical private organizations are more likely to fund trans programs, there is often more government than private money available.
Stone gave advice to individuals who are seeking to improve care for trans people in their communities: talk to your own doctor and let him or her know that by refusing to provide services to trans people, they are violating their oath to “do no harm.” Find the most open-minded doctors in your area, and bring them informational materials. You can do this in a separate appointment: ask for a half hour exploratory diagnosis appointment, which is covered by most insurance, to talk with the doctor. One way to find the open-minded providers is by finding those who advertise in local GLBT or women’s papers. If one of those doctors won’t agree to provide care to trans people and to help make the local health care community accessible to trans people, ask him or her, “If you’re not the doctor, do you know one who can help our community?” And if they’re nasty in their refusals, report them to their licensing boards.
Go to workshops that teach you how to advocate: as Stone says, advocates all start out as “just patients.” Find the local organizations that advocate for health care access for other underserved communities, such as migrant workers, HIV positive people, and people of color, and talk with them, building on the commonalities the trans community, as an under-served community, has with their groups. They may help you by showing you how they advocate for their groups, or join you in your struggle to open up health care access to trans people.
If you find yourself in the position of educating your own physicians, educate them the same way you educate your partner, family, and friends: teach them the appropriate words to use in referring to you and your body. Ask the doctor to educate his or her own staff: for example, when you are called from the waiting room, you should be addressed with the appropriate name, pronouns, and titles. If your doctor violates professional ethics, such as by violating your confidentiality or not treating you with respect as a patient, stand up for yourself. It is a doctor’s responsibility to ensure that his staff act according to the standards of medical ethics: treating patients with respect, not gossiping about clients, and protecting patient confidentiality. “Doctors are not used to being held accountable, and they need to be,” says Stone. And just because a clinic has set itself up with the express purpose of serving the GLBT community, doesn’t mean that you should not hold them accountable. Gunner Gurwitch said, “If your community has a bad gay/lesbian or gender health center, don’t be afraid to call them on that.”
Many thanks to Hawk Stone, Bobbi Williams, Gunner Gurwitch, Danielle Askini, Rick Feely, Jeff Johnston, Anna Corwin, Martina Downey, Katy, Derek Brown, Stacey Montgomery, and Kyle Haven for their participation in this discussion and they ideas they contributed to this article, whether they were directly quoted or not.
Intersexed Adults’ Access to Care
The keynote speaker at Transcending Boundaries, Emi Koyama, brought up a barrier to care that intersex and trans people both experience: access to SRS. According to Koyama, after age 16, intersex people typically can’t gain access to SRS without going through the same gatekeepers as transsexuals. After that age, insurance companies are also far less likely to cover the costs for intersex people who want genital surgery. This is particularly significant, according to Koyama, because the procedure for vaginoplasty has a 90 percent failure rate as it’s performed on intersex people, typically around age 2, and “the procedure used to be done this way on trans people and it didn’t work on them, but they still do it this way on us.”
Health and Human Services for the Bi-Gendered
Bobbi Williams presented the facts from her article, What We Don’t Know: The Unaddressed Health Concerns of the Transgendered, which appeared in our first issue. In addition, she mentioned a few facts that aren’t mentioned in her article: for instance, that the addition of Gender Identity Disorder to the DSM IV in 1973 was the result of a trade-off to remove homosexuality as a mental disorder. She also detailed the areas in which we need more study on the risks to trans people: correlations between being trans and smoking, drinking, drug use, depression, suicide, stress disorders, stress-related illnesses such as diabetes and cancer, eating disorders, and self-mutilation. Williams closed with a to-do list for those present, to help raise awareness of the need for further study on these issues:
- Come out to your doctor: you are protected by confidentiality
- Schedule a separate appointment with your doctor to educate him or her on trans medical issues
- Lobby your representatives: the National Health Coalition has information to help you do this
- Ask the medical licensing boards in your state or jurisdiction to include questions relevant to trans people in their examinations
- Encourage academia to include education on trans issues in their medical training
- Access to Health Care for Transgendered Persons in Greater Boston, available in PDF format on the The Gay, Lesbian, Bisexual, and Transgender Health Access Project website, lists barriers to care, as determined from four focus groups of trans people in the Boston area.
- FTM International provides a resource guide, updated annually, of health care providers by location and specialty who are trans friendly.
- Transgender Health Concerns are addressed on LBGT Healthchannel.
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