Why We Need to Sensitise Doctors to LGBT Issues

We need to make medicine a safe place for LGBT community by educating and sensitising doctors to their unique challenges and health needs, emphasises Dr. Sweta Jalan.

(LGBT. The term worried the Healthcare Executive team. Don’t get us wrong; we are not transphobic or homophobic in the slightest sense. Only we were unsure how to aptly deliver. Some of us were super pumped to explore this theme. Some were scared. The day the theme was vetoed, I got a call from a colleague who had worked for Humsafar Trust in the past, saying that if go with this theme, things could go very wrong. “We are touching on a taboo topic and none of us have any experience in writing about them in the past. What if we offend them?” she relayed to me. Not only this, we were apprehensive how our audience will respond to it. First week in and we got an email saying we were covering something that is insignificant to public health. This email made me even more zealous to explore and highlight their issues and stories.)

On a frantic Monday afternoon, I hopped on an auto-rickshaw to find Chandni. I have known Chandni for three years now. She showers me with vibrant compliments every time she notices me rushing to work as I impatiently wait for the red light station signal to turn green. She was not at the signal that day but I was directed by her friends to her house in Malwani, Malad. My driver was a chatty Assamese fellow and warned me that a lady should not go alone to this area alone.4, “Madam, it’s not safe. These people are scammers and only want to extort money,” he repeatedly told me. I had heard negative views about them even in the past but I way too keen to know the truth. After a two-hour hunt, searching lane after narrow busy lane of Malwani, I could not find Chandni. Once the community members realised I am a ‘reporter,’ they refused to divulge any information. I had almost given up when we found a group of women from the hijra community sitting on a chattai in a tiny, dingy room. I greeted them with a Namaste and a handshake and directly told them the purpose of my visit. Surprisingly, they did not shoo me away. They politely said, “It’s our lunch time.

Do you want to join us?” I said I was very thirsty and they rushed to pass me a bottle of water. I waited in apprehension, not sure whether they would agree to talk to me; them belonging to a very hush-hush community. After their lunch, most of the women left and I was left with Vasvi.

Vasvi migrated from Andhra Pradesh with her ‘guru’ when she was little. From an early, age she knew her sexuality was different from other boys around her and felt trapped in a boy’s body. She found a sense of belonging in the hijra community. She has always been eager to serve the society and in 2009, joined NACO ’s MDACS program in Malwani area to promote HIV awareness within the hijra community. Today, she is the Project Manger of Triveni Samaj, Malwani’s HIV promotion camp and looks after a population of 1000 transsexual women, all from the hijra community. When I ask her if she feels any discrimination from doctors, she replies, “Of course. Doctors don’t know about our sexuality and how to treat us, socially and medically . Even before admitting, they assume we cannot pay the bill and turn us down. Sometimes, they think we have come to ask for money just because we belong to the hijra community. It’s ridiculous. They don’t even have the slightest idea that we are in the hospital like other patients for our health problems. They are ignorant whether we are operated or not, what is the castration cavity, whether we have periods, etc. The

transsexuals who undergo castration mainly have high occurrence of urine infection. Doctors don’t know how to treat urine infection in transgenders. When we get a cavity surgery, they often botch it up. The ‘pipe’ to pass the urine gets pressed or cut. At least this much they should learn. Furthermore, because of our appearance, we notice that doctors look at us differently and sometimes are apprehensive to touch us. When we go for laser hair removal, the doctors ask the transgender to come at a separate time so that ‘normal’ patients don’t see us. They don’t want their brand to get affected. They don’t easily admit HIV-positive patients. The doctors ask for double or triple the money to operate on HIV positive patients, complaining that they are high-risk patients and other patients might get infected. Why should a doctor be scared of HIV-positive patients?” She pauses and asks me if I want a cup of tea. I was not prepared for her next question. “What do you do when you see hijras begging at traffic signals?” I replied frankly, “I am not superstitious. I give them money sometimes and more often say no politely.” “What do you do with your salary? Schools don’t admit us. Nobody gives us a job. Nobody accepts us, including our family. We migrate to other cities to protect our family’s reputation. We are forced to beg on the streets in the heat and rains in the day, and into prostitution at night. It’s not a choice, you know. We do what we do only paet paalne ke liye, because no one gives us a job. Society has shunned us.” I was truly touched by her resilience and said sorry to Vasvi. “We are used to it,” she brushed it off. Then she asked, “What can you do for our community?” All I can do is raise awareness with your story, I replied genuinely. Once I switched off the recorder, she opened up. She was as curious about me as I was about her. We talked about relationships, discussed sunscreen lotions and criticised the society together.

The previous day, I had the opportunity to speak with another transsexual woman. Sana is a final year student of journalism in Bangalore. She works for Swantantra Organisation, a NGO devoted to human rights

of transgender community. Very recently, Sana visited a hospital because she was suspecting an urine infection. She was listing her symptoms to the doctor, when she interrupted Sana, ‘Is your menstrual cycle regular?‘ to which Sana replied, “Well, I don’t have a uterus. I am a transsexual woman.’ The doctor looked extremely confused but went on to question her. “Have you noticed a white discharge?” This was not the first time Sana noticed ignorance about transgenders amongst doctors. Doctors have handed her prescriptions for regular periods even before. “Come on, I am castrated! The doctors are not aware of our biology, sexual orientation or sexual identity,” Sana scoffs, adding, “It is difficult to explain our problems to the doctors because their lack of awareness and ignorance . Moreover, doctors always assume that my diagnosis is related to a sexual disease even if I walk in complaining of fever or cold.” Her experience overall in hospitals, particularly the government ones, have been harrowing and disturbing. “People stare and look at me disapprovingly the moment I enter the hospital. Patients move away from their seats that are close to mine. The receptionist and administration are so rude and harsh that it near difficult to approach them. They publicly laugh ‘look, look, hijra; look, look chakka.’ It is very traumatic. I visit hospitals only when it is extremely urgent,” she says. Sana was once admitted to the hospital for a complication of her gender reassignment surgery. Although they had special wards for transgenders, she could not afford it. She was admitted in the general ward and faced aggressive discrimination- from the nurse to ward boy to the sweeper. “They refused to clean my bed. Sometimes, they would demand money for routine chores,” she recalls.

On the other hand, Rakshitha, another transexual woman from Sana’s city, says she has faced no discrimination in hospitals. “In fact, MS Ramiah Hospital has a separate ward for transgenders. There has been a great improvement in awareness of the LGBT c ommunity within the medical community. Look at Kerala today. That’s a model to replicate in all states,” she says. However, she was not too happy with her counsellor before undergoing her sex-change operation. “The counsellor asked ‘why do you want to undergo surgery?’ and tried to brainwash me against the surgery,” she remembers. Though, fortunately, Rakshitha has not been a victim of discrimination like Vasvi and Sana, her friends have been harassed in hospitals, she says.

I asked many of my clinician friends whether LGBT health was covered in their medical curricula and all of them answered in negative. This hints that the LGBT population avoid hospitals or do not not reveal their sexual orientation to doctors. Some have never attended to a LGBT person in their practice. The ones who have seen folks from this community claim that they treat them no different than non-LGBT folks. “Why should we treat them any differently? They too are humans and walk in with same complains such as COPD and asthma,” says Dr. Abhinav, a pulmonologist in Chandigarh. Dr. Shaibya Saldanha is a gynaecologist and founder of Enfold. She has seen many LGBT patients in her practice. “I treat them as I would treat a any other human patient. Sadly, many LGBT folks do not get to see doctors. Transgenders are often turned away by security guards at hospital entrance. They then seek healthcare from private practitioners maybe in some corner of a red light district. Furthermore, many doctors are unaware about sexual minorities,” she says. She agrees that there is an urgent need to sensitise doctors to this population’s health needs, adding, “They need to also learn how to communicate with them in a politically correct manner, using the right words and pronouns.”

We Need LGBT-Sensitive Healthcare

Vasvi and Sana’s testimonials are proof that clinicians need to be sensitised to LGBT health needs and their social-cultural as well as psycho-social issues. There are no anti-discrimination laws or policies in relation to discrimination on the basis of sexual orientation or gender expression or ide . The healthcare issues of transgenders and LGBT community as a whole have often been overlooked due to stigma and discrimination. The high risk of sexual and mental diseases of this population is well-documented. A report released by UNAIDS ahead of World AIDS Day (2016) claims that there has been a decline of 66 percent in new HIV infections in India since 2000, however the stigma surrounding the disease continues. All key populations — injecting drug users, men who have sex with men, transgender and sex workers continue to suffer criminalisation under the national laws.

What can be done?

According to a report titled Health Care System Barriers Faced by Indian Transgender People In Accessing HIV/STI Prevention and Treatment, & What Can Be Done? Venkatesan Chakrapani, M.D., Centre for Sexuality and Health Research and Policy (C-SHaRP), proposes trans-friendly policies within Indian healthcare setting.

Just as this trans-friendly proposal, it is also crucial to have LGBT-friendly healthcare policies in place to curb the rise of their health issues. “It is imperative that clinicians ask all patients in an open and non-judgmental fashion about their sexual behaviour and provide routine HIV testing and STI screening and treatment. Clinicians should be comfortable to routinely ask about sexual practices, focusing on what the patient does, rather than how the patients identify themselves,” states a study titled Men who have sex with men in India: A diverse population in need of medical attention. It is also ethical and professional duty of doctors to extend their services to all persons without discrimination. They need to improve their knowledge and skills to effectively provide clinical care to persons belonging to diverse sexualities. Hospitals need to be open-minded and their moral values should not interfere with the quality of care they provide.

Best Practices

10 years ago, US introduced the Healthcare Equality Index (HEI), a national LGBTQ benchmarking tool that evaluates healthcare facilities’ policies and practices related to the equity and inclusion of their LGBTQ patients, visitors and employees. The Index evaluates medical facilities in four key areas of “LGBT patient-centered care”:

  • An LGBT-inclusive non-discrimination policy;
  • An LGBT-inclusive visitation policy;
  • An LGBT-inclusive employment non-discrimination policy; and
  • Staff training in LGBT patient-centered care.

A record 590 healthcare facilities actively participated in the HEI 2017 survey. This year, 303 of the 590 HEI 2017 survey respondents scored 100 in the new criteria of the HEI 2017 and acheived the coveted status of “2017 Leader in LGBTQ Healthcare Equality.

A few hospital systems in the US, such as Mount Sinai Health System in New York City, have launched specialized medical and sensitivity training for healthcare professionals and staff. But this type of intensive training for physicians and other healthcare professionals remains uncommon.

In this regard, some strides have also been made in the right direction in India. Punjab recently saw the opening of its first HIV/AIDS testing clinic for the over one lakh members of the LGBT community in the state. The clinic has hired a doctor and a nurse from the LGBT community to help put LGBT community members at ease to come forward and get tested for the disease at an early stage. We need more of LGBT-sensitive practitioners.


Author : Dr Sweta Jalan

The editing wizard, Dr Sweta Jalan, has a penchant for perfecting stories. A pro at multitasking and incessant follow up, she ensures that deliverables are met in a timely manner. She has completed her dentistry from Manipal University and has a MPH form Sheffield University, UK.

Healthcare Executive

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Healthcare Executive is an exclusive online Healthcare Business magazine based in India .

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