Many trans persons such as myself were hesitant to get vaccinated for COVID-19 due to the lack of information provided to us. No concrete efforts were made to dispel these myths about the vaccine among the community. We did not have access to any information on possible side-effects of the vaccine on those who take hormones or are looking to get sex reassignment surgery (SRS).
When the vaccines were made available in a public camp, I hesitated to go talk openly about my situation and clarify my doubts. Those administering the vaccine would also likely not know the answers to these questions. I did not feel comfortable or safe enough to bring this up and hence avoided taking the vaccine. Since I am by myself and do not have anyone to care for me, that too played into my hesitation.
This is just one example among many of the lack of awareness and outreach that is hampering access to healthcare among the trans community in Chennai.
Experience of trans persons seeking healthcare in Chennai
Textbooks and training for healthcare professionals do not cover how to care for the trans community. The only angle from which healthcare for trans persons is looked at is on the subject of HIV and AIDS.
What trans persons want is not to be gawked or ogled at when we approach a healthcare professional or go to a hospital or clinic. Whether the person is trans or if they are a sex worker, there should be no discrimination or judgement.
Many trans persons undergo sex reassignment surgeries without doctors even getting to know their complete medical history. Trans persons are also not made fully aware of what the complete implications are of a sex reassignment surgery and what to expect after. Right from making the patients feel comfortable and not fearful during the experience to taking care to prevent any post-surgical complications are all key aspects of care that are lacking.
Even as charges for sex reassignment surgeries and getting silicone breast implants run into lakhs, the treatment of trans persons in a healthcare setting leaves a lot to be desired.
In terms of accessing public health facilities, the government’s approach towards trans persons is evolving. The view of the government on trans persons used to be myopic, where they only saw us as people who could potentially spread Sexually Transmitted Diseases (STDs). However, this scenario is changing.
Sex reassignment surgery and implants are now available free of cost at government hospitals for the past few years. But the process can take between 3-6 months. The reason the process takes so long at government facilities is that they undertake psychological evaluations and have multiple consultations. While I cannot speak for the community as a whole, personally, if I make my mind up to undergo the surgery I would not want to wait for many months. This is an impediment to trans persons being able to access public health facilities.
Trans men who undergo top surgery also face these issues.
Those who take hormones are sometimes not explained the process, its potential side effects or aftercare.
A bad experience one of my peers had was that her implant had been damaged over the years and made her uncomfortable. But the surgery for removal cost Rs 60,000 at a private facility. This is a very high amount that trans persons may not be able to afford.
There is also extensive delay faced by trans persons who seek medical care. If a trans person has issues with their kidney and needs dialysis you would not find anyone from the community seeking this care as they come up against a hostile and expensive system.
Despite the threat of COVID-19, many members of the community stepped up to help the city. The trans community’s service to the people of the city during COVID-19 through their tie up with the civic body in spreading awareness and distributing necessary aid has finally provided us with some acceptance among the general public. Only after people realized that trans persons were in the frontlines of the fight against COVID-19, even during the lockdown, have they started paying attention to our own troubles with accessing medical care.
Mental health of trans persons ignored
The physical health of trans persons also affects their mental health and healthcare professionals must understand this. The mental health of trans persons is a highly neglected subject.
Options for counselling must be offered, this will make the healthcare available comprehensive, so far there is no structured approach to this. There needs to be the availability of care and resources for those even below 18 years of age, even setting up a dedicated helpline could be explored to help people navigate their feelings and make informed choices about SRS.
An app with these resources or a helpline to connect with qualified professionals could be a huge help to those trying to navigate this stage of their lives
Suicides are a huge issue among members of the trans community. There needs to be a special focus on mental health, especially for those below 18 years of age. Setting up helplines and apps that provide resources and support for those navigating their feelings at this age would be helpful. This can also help people make informed choices about issues such as options of sex reassignment surgeries. Options for counselling for trans persons must be offered widely. At present, there is no structured approach and we find only one on one sessions that deal with any health concerns but no long-term support.
Connecting trans persons with qualified mental health professionals could be a huge help to those trying to navigate various stages of their lives.
Despite the strides that have been made in health care access and availability, there needs to be more sensitivity in dealing with the issues faced by trans persons.
Making small strides
I started Born2Win, a welfare organisation for the members of the trans community, in 2013. We’ve been engaged in supporting trans persons with finding jobs, social support and also medical aid.
During COVID-19, we saw many medical camps being conducted, but these were not open or accessible to trans persons. On observing this, the organisation has taken up a project under the banner “Trans Arogyam”. As trans persons are already discriminated against, any disease burden they carry further stigmatises them. The lack of ready access to medical care prevents many from the community from seeking help for any illness and they view even conditions such as diabetes as taboo.
The ultimate goal is to start a clinic that caters exclusively to trans persons. If a trans person has any issues they can visit this clinic, just as they would any other clinic and get medical care that is sensitive to their needs and is affordable. At this clinic, we also aim to have counsellors and psychiatrists as well. Setting up a private clinic is possible when we raise enough funds.
As a precursor to this, to assess the interest among the community, we held a camp for trans persons for a general check-up and also to clear up any questions on gender reassignment surgery with the support of Saveetha Medical College, Department of Community Medicine. This is one of the first camps, with more in the works.
The medical camp is just a preliminary step. We would like to conduct a master check up programme next for trans persons. The camp is a way to gain the trust of the community and understand their needs and plan for a larger health check up.
As of now, we hope to see the clinic take shape while also working alongside healthcare personnel so that getting medical care becomes less of a harrowing experience for members of the trans community.