Ending the Invisible Discrimination in Healthcare
Small steps toward equality for all
An edited version of this article is also published on Indonesia’s English daily newspaper The Jakarta Post on May 23, 2015. (Link at the end of article)
Sir William Osler, one of the fathers of modern medicine, said that medicine is “a calling in which your heart will be exercised equally with your head”. Indeed, the heart to serve humanity should be the core of medical practice and healthcare in general. Thus, in line with the Universal Declaration of Human Rights, discrimination based on sexual orientation, gender identity, and gender expression by health professionals and in healthcare facilities is grossly unacceptable.
The International Day against Homophobia, which falls on May 17 annually, should call to our attention the challenges faced by LGBT (lesbian, gay, bisexual, and transgender) people in accessing and making optimal use of the healthcare system.
In many societies, including Indonesia, those belonging in the gender and sexual minority faces an atmosphere of discrimination, which often crosses the line into outright violence and abuse, not to mention threats of criminalization. Coming out of the closet entails a massive emotional toll, so the majority of LGBT patients do not disclose their sexual orientation. Consequently, they become an ‘invisible’ population to healthcare providers; their needs are not sufficiently documented and addressed.
Even in places where LGBT people have received relative acceptance, health disparities still exist because bias and discrimination have not been completely erased. Additionally, not all health professionals are sensitive and knowledgeable enough to cater to the population, despite their best intentions.
Surveys show that LGBT populations have a higher risk of experiencing substance abuse and mental health issues, including a high rate of suicide ideation in LGBT youths, attributable to the overwhelming stigma against them. Fear of discrimination also drives LGBT population to defer medical treatment for many diseases. This makes them less likely to get adequate information on health, including sexual health, and to utilize preventive services; for example, lesbians are not as frequently screened for cervical and breast cancers compared to straight women.
Those who do seek treatment are sometimes turned away due to their sexual orientation, or often have to endure disparaging remarks from their doctors. Moreover, the conversation would unnecessarily center on their sexual behavior, as if sexually-transmitted infections are the only diseases affecting the LGBT population.
Ending discrimination and erasing bias against LGBT patients in healthcare seems like a tall order in Indonesia, where sex and sexuality still carry a negative connotation, even in the sexual majority. Being a straight ally for LGBT friends and relatives is also seen as a strange thing that often places allies as victims of bullying too.
Nevertheless, the time for compassion and fulfillment of human rights is always right now, and any step toward that noble goal should be appreciated.
Even as government policies continue to lag behind, the medical and allied health professional communities can take the lead in several ways. First, medical schools must reaffirm non-discrimination policy for their students and teaching staffs. By instilling non-discriminatory values from early on, it is hoped that the values will carry on into their medical practices. Additionally, studies show that unsupportive campus life negatively affects the well-being and academic performance of LGBT students; hence, erasing discrimination will bring benefit to the school itself.
Second, the medical curriculum — and perhaps the national curriculum too — must reiterate that sexuality is a normal part of personal development and embrace the diversity of human sexual orientation, gender identity, and gender expression with all its complexities. Today, many doctors continue to confuse those concepts, like assuming a patient’s sexual orientation from the way he or she acts. The discussion of sex and LGBT must not be confined to topics like sexually-transmitted diseases.
Third, physicians must develop cultural competence to serve the LGBT population with sensitivity and knowledge of their physical and mental health needs, keeping in mind that these patients are much more than their sexual orientation. Even as they are ‘lumped’ together in the acronym, each LGBT patient is his or her own person with different values, experiences, and preferences. Subsequently, physicians must adapt their patient communication skills in order to eliminate bias and assumptions, such as when inquiring about a patient’s spouse or sexual history.
At the end of the day, physicians can be effective allies for their LGBT patients through many ways; from running a culturally-competent medical practice to advocating changes in health policies to improve the lives of LGBT Indonesians. Once again, the medical profession must prove its commitment to serve humanity to the best of its ability. Change will not come easy nor fast, but to quote Osler one more time: “to have striven, to have made the effort, to have been true to certain ideals — this alone is worth the struggle.”
Update #1: The New England Journal of Medicine published an editorial titled “In Support of Same-Sex Marriage” which includes the line “Same-sex marriage should be accepted both as a matter of justice and as a measure that promotes health.”
Update #2: Irish voters made history as the first country to legalize gay marriage through referendum.
Update #3: The US Supreme Court struck down states’ same-sex marriage bans, effectively bringing marriage equality to the entire US.
