“Coming to a medical establishment as a patient often translates into being harassed or humiliated. Both the public and even some medical/support staff, are still unable to accept us as human beings who are in this space for treatment,” says 23-year-old Ruchi (name changed), seeking sex reassignment surgeries (SRS) at India’s first dedicated transgender out-patient department clinic at Dr. RML Hospital on September 29.
The facility is aimed at batting for inclusive and easily accessible healthcare system for the LGBTQ+ community and has a panel of doctors from across departments, including medicine, urology, psychiatry, dermatology and burns at this weekly OPD which was inaugurated earlier this month on September 17 and is open every Friday from 2 p.m. to 4 p.m.
The OPD besides having trained medical staff also has tailor-made infrastructure aimed at making the patient comfortable while they are helped to access healthcare with dignity.
“The initiative was started understanding the difficulties encountered by transgender community to access healthcare services, largely due to discomfort and the fear of discrimination and social apathy,” said Dr. Ajay Shukla, director, RML Hospital, about this new venture.
Waiting outside the RML examination room on Friday afternoon, Veronica, 23, who is seeking transition from male to female adds: “While this is a good initiative, there is an urgent need to explain the protocols to us and also gender sensitise the support staff.”
Recalling an insensitive reference by the hospital guard during her previous visit, she says that government intervention is vital for the community as private hospitals are out of our budget. “In private hospitals or clinics, a sex reassignment surgery can range between ₹2 to ₹5 lakh for a male to female (MTF) transition, and for a female to male (FTM) is anywhere between ₹4 to ₹8 lakh. We are looking forward to the help offered by the government set-up,” says Veronica who is pursuing her graduation online to avoid discrimination at educational institute.
Anamika, who is with a local NGO that is helping people from the LGBTQ+ community to access healthcare at this government facility says: “Building trust and being treated in a humane manner will be key to sustaining this venture. Members of the community are marred with the shabby treatment that they get at healthcare facilities and are often exposed to very dangerous situations because of this. We want to change this for them.”
She adds that even routine medical procedures such as getting a registration card at a hospital, getting blood collected and getting a report often become an uphill task because of the stigma attached to the community.
“It is very tough for them to be out in public and claim their right as a citizen,” she said. Meanwhile, the main features of the venture includes – free treatment and investigations facility, sex change surgery, endocrinology facility with clinical-psychological assessment, plastic surgery and dermatology facility for various related surgeries and paediatrics facilities among others. It also has a separate washroom facility (toilet for gender neutral/transgender) etc.
India’s total population of transgenders is around 4.88 Lakh as per 2011 census and though some States of India have wards and private medical care facilities for people from the LGBTQ+ community this is the first Central government venture.
“Evidence suggests that transgender people often experience a disproportionately high burden of disease, including in the domains of mental, sexual and reproductive health. Some transgender people seek medical or surgical transition, others do not,” explained the on-duty doctor at RML who said that the number of people reaching out for medical help is slowly increasing and that working to build trust right now seems to be the most important goal.
According to the World Health Organisation (WHO) transgender people are around 13 times more likely to be HIV-positive than other adults of reproductive age. It adds that overall transgender people have low rates of access to health services due to a range of issues including violence, legal barriers, stigma and discrimination.
“Violence against transgender people is common,” said WHO, which is working to address the varied health needs of transgender people, including HIV, viral hepatitis and STI prevention, diagnosis and treatment and developing a guideline on the health of trans and gender diverse people.
It will focus on 5 areas — provision of gender-affirming care, including hormones; health workers education and training for the provision of gender-inclusive care; provision of health care for trans and gender diverse people who suffered interpersonal violence based in their needs; health policies that support gender-inclusive care, and legal recognition of self-determined gender identity.
According to Government data in India transgender population remains one of the most marginalised groups despite the fact that in 2014, the Supreme Court of India recognised that transgender people are distinct from binary people and declared them as the third gender under the Indian Constitution.
They are also often ostracised by the society and sometimes, even their own families view them as burdens. Experts note that while transgender people share many of the same health needs as the general population, but may have other specialist health-care needs, such as gender-affirming hormone therapy and surgery.
