Toronto
— When Michelle B. booked an appointment with a
renowned Toronto plastic surgeon, she wasn't expecting to
be shown the door so quickly.
In fact, every time she
enters a situation with a health care provider - be it a
surgeon or a general practitioner - there's a risk she'll
be treated differently. But she says some reactions are
impossible to ignore.
According to Michelle B.,
it took the doctor just one fact to determine that he
couldn't treat her: she was a transsexual.
The doctor is not trained
to operate on transsexuals and does not accept them as
patients.
"In a private clinic, I
have the right to choose who I can safely look after,"
Michelle B. recalled him saying.
Michelle B. claimed the
doctor slammed his book down and yelled, "I don't do you
people," before tearing out of his office.
She didn't let him get
away. She stopped him and yelled right back, "You can't
treat people like that."
Michelle B. has since
filed a complaint with the Ontario Human Rights
Commission <http://www.ohrc.on.ca/>
about Dr. Robert Stubbs. Stubbs cannot comment on the
incident or say whether Michelle B. was ever a patient
due to doctor-patient confidentiality laws. None of the
allegations have been proven true.
Regardless of what the
Human Rights Commission determines about the case, the
findings of the Ontario Public Health Association's Trans
Health Project <http://www.opha.on.ca/>
show that a huge chunk of the health-care system in
Canada has adopted attitude that it just doesn't "do
transsexuals".
The findings point to
huge gaps in trans-specific health-care that have
resulted from major cuts in funding since the `90s.
Marked among those are the removal of funding for
electrolysis in 1992, the subsequent removal of sexual
reassignment surgery (SRS) in 1998 and most recently, the
conditioned funding for hormone therapy - all services
that trans people deem invaluable to live comfortably in
their own bodies.
Susan Gapka, one of the
principal investigators for the project, said trans
people have been erased from the health-care system.
"There's such an absence,
a volume of misunderstanding ( . . . ) Our needs are not
being attended to."
Martine Stonehouse knows
it too well. When SRS was de-listed, she was halfway
through her transition. She said there was no
consultation with the trans community on behalf of the
government around the issue. She, and the rest of the
Ontario trans population, were shocked to read an article
in the Toronto Sun on Oct. 4, 1998, saying that SRS was
gone. They had been assured only months earlier by
government health officials it would not be
cut.
Stonehouse launched a
case against the government the next year. In 2002, her
case was linked to three more transsexuals who were left
without the funds to transition once SRS was removed.
Operations can cost up to $50,000 each. It wasn't until
2003 that they reached a basic agreement with the
government. But, less than 24 hours later, she said,
Dalton McGuinty stepped into power and crushed
negotiations, sending the case back to tribunal
hearings.
Finally, in late 2005,
after more than seven years, the government agreed to pay
for her surgery. Two others who filed the case were
granted the same funding. The fourth was refused because,
unlike the others, he wasn't enrolled at the Gender
Identity Disorder (GID) clinic at the Clarke Institute
way back in 1998. This was one of the major restrictions
the government set for funding.
Not that many
transsexuals would blame Andy McDonald for steering clear
of the institute until 2001. Now held by the Centre for
Addiction and Mental Health (CAMH), the clinic is
affectionately dubbed Jurassic Clarke by trans people. A
large part of the community point to its mandatory
"real-life test" as a prime example of the medical
circle's lack of understanding.
The real-life test
requires clinic patients to live one to two years as
their desired sex before being cleared for SRS. But, said
Stonehouse, the time periods don't allow for flexibility.
Some trans people have been living as the opposite birth
sex for years, she pointed out, and know they are
ready.
Despite being granted
funding, there are other obstacles in her way. Part of
the condition in her contract with the government, she
said, is that her surgery has to be done the way it was
back in 1998. Since there are no publicly-funded surgeons
in Ontario who will do SRS,that means she has to travel
to England. Which might have been okay,she said, if the
SRS surgeon there hadn't retired, leaving no likely
successors.
But not all
discrimination in the health-care system surrounds
trans-specific care, warned Michelle B. The other
problems, she said, are with basic needs and treatment in
the ER.
Michelle B. remembers
going to a Toronto with a nasty case of food poisoning.
When she arrived, staff were "scrambling to get IV bags"
to hydrate her. As soon as her history became clear
though, she said, she was suddenly left alone. Michelle
B. stayed there overnight, receiving the occasional glass
of juice.
"And I never saw another
doctor after that," she said.
Gapka added that many
general practitioners will leap to the conclusion that
any complaints are trans-related. You can go in with a
sore throat, she said, and the doctor will say, "Oh, it's
got to be your hormones."
And if you don't hear
something like that, Michelle B. added (she also worked
on Trans Health Project <http://www.vch.ca/transhealth/>
with Gapka) you'll get transferred from doctor to doctor
like "a ping-pong tranny."
In her ideal world, there
would be a central repository of information on
transsexuals and health care. This would not be a place
to send trans patients, but a place where physicians
could go to get the answers they needed. Especially those
in rural regions, areas where the project shows have
higher instances of trans-health ignorance.
These health-care
barriers become layered if you're a trans person of
colour, said Rupert Raj. Raj, who is of Polish and South
Asian decent, has been a trans activist for over 30
years. Currently, he works at the Sherbourne Health
Centre <http://www.sherbourne.on.ca/>
as a counsellor for gay, lesbian, bisexual and
transgender people (GLBT), one of the only places in
Ontario that actively provides trans-positive health
care.
Raj appeared in a movie
called Rewriting the Script: A Love Letter to Our
Families, which dealt with the experiences of GLBT South
Asians and their families. He said people need to
understand that trans people don't live in a vacuum; they
have family, friends, culture and religion just like
anyone. And if you're coming from a background where your
family doesn't understand, you could wind up leading a
fragmented life, being a different person everywhere you
go.
It's harder to access
health care when you feel ostracized like that, Mattioli
said. Young trans people of colour with no family or
community support especially, have trouble accessing the
system. Their parents generally don't want to help them
do something as deviant as changing genders.
And when parents do get
involved with their child's health care, it's often to
"fix" them.
Mattioli recalled a group
session he facilitated at the Vancouver Transgender
Health Program <http://www.vch.ca/transhealth/resources/tcp.html>
between parents and children. There was a Chinese mother
who was adamant that her daughter, who identified as
male, was mixed up.
She didn't want him to be
a he, Mattioli said. She also didn't want him to be in
group therapy, he added, since she was convinced "we were
going to brainwash him."
Reece Lagartera, a trans
man of Filipino decent, said his circumstances are
different because he has been in the public eye for years
as a drag king. His parents want him to live the way he
wants, but there's still little things like using the
correct pronouns. They brush stuff like that off as a
North American thing, he said.
But not all trans people
of colour are so fortunate, he added. Lagartera knows
landed immigrants who are trans that have difficulty
accessing the health system. Not only are they likely to
come to the country with no job and little money, he
said, there are also huge language barriers. In some
languages, like his parents', the word "transgender"
doesn't even exist - so how would they even know where to
begin?
That's the reason why,
Lagartera explained, he hasn't had the formal discussion
with his father.
"He wouldn't even know
what the word meant. How do you explain being a
transsexual? There's no concept."
