This is a guest post by Indrani Kar, Shuvojit Moulik & Somya Tyagi
Any dominant, mainstream model undoes the very idea of multiple modes of living and diversity which excludes the real demands of the minority groups and contributes to their social exclusion. Whereas everyone is entitled to equal and inalienable rights and opportunities set forth in the Preamble to the Constitution of India without distinction of any kind, such commitments are yet to be translated into action. Although Article 21 of the Constitution guarantees ‘Right to life and personal liberty’ to all, of which the Right to Healthcare forms an integral part, a large section of the society is still insensitive to the healthcare needs of the transgender community.
The transgender population faces grave misunderstanding, prejudice, harassment, ridicule, rejection and even exploitation at the hands of health service providers as they do not fit into the society’s prescribed, rigid gender roles. Though the transgender community is hardly a homogeneous entity and is considerably diverse in terms of gender identity and livelihoods, in public imagination such complex identities of gender ranging from hijra to transgender are all lumped into one category, which becomes extremely problematic. Unfortunately, government policies also seem to feed on these generalisations, making use of such umbrella terms rather than focus on the specific needs of different groups.
Moreover, by relegating minority issues to the margins, perceiving the queer as the ‘other’ and evading responsibilities towards promoting their well-being, the dominant forces of the society largely contribute to the constant deteriorating health condition of the society as a whole. In case of India, this becomes all the more crucial issue against the backdrop of rampant rise in Sexually Transmitted Diseases including HIV / AIDS etc. Society’s apathy and inhuman treatment of transgenders or those who transcend sex categories is clearly evident in their personal histories that make the heart quake. Anecdotal evidence indicates that this transphobia manifests most commonly in health care settings, but few studies address the forms of mistreatment experienced in this context. This study is designed especially to explore the various negative experiences of the transgender patients within the health care sector.
Participants’ descriptions of mistreatment coalesced around themes like gender insensitivity, displays of discomfort, substandard care, denied services, verbal abuse, mishandling and forced care. The most significant concern that emerged out of interviews with transgender persons was the apathy of government hospitals towards them due to which individuals belonging to sexual minority groups seldom visit doctors. Saikat, a transgender who met with a train accident died since the hospital could not decide whether to treat Saikat in the male or female ward while Tanushri, a transsexual met with a similar apathetic treatment when the doctors refused to examine or treat her post her gang rape incident during her field work in an NGO.
Comprehending the significance of promoting transgender health in Kolkata and its centrality in maintaining public welfare, Civilian Welfare Foundation (CWF), a city based NGO consists of young and enthusiastic social workers who pledge to stand up against anything unjustified, undignified and corrupt that punctuates the growth of a city, nation or mankind. It ventures to resolve the medical and health problems faced by the transgender population of the city including transsexuals, hijdas and kothis. The NGO aims to provide them a basic healthcare clinic with doctors, testing facilities and free basic medicines and most significantly, a well-informed and empathetic environment wherein a transgender may walk in during illness without having to face any discrimination or prejudice. CWF engages with numerous trangenders via NGOs such as Pratyay Gender Trust, People Like Us (PLUS), Amitie Trust etc. in order to assess the nature and magnitude of healthcare discrimination that they encounter on a daily basis.
These discussions brought forth two main dimensions of health which require immediate medical intervention that includes the psychological and physical health of the transgender community. The former is quite crucial to transgenders who face identity crisis right from childhood as their biological sex assigned at birth does not coincide with their gender identity. Unlike gays, lesbians and bisexuals who confront questions of sexual orientation during adolescence, the transgenders have to deal with the more fundamental and serious issue of self-identity. Transsexuals, a subset of trangenders on the other hand, have to undergo surgery to change their bodies in order to assign themselves the gender to which they internally identify with. Thus, Transmen and Transwomen are ‘female to male’ and ‘male to female’ transsexuals respectively.
Boys who are effeminate and express interests akin to girls, in dolls, household work, make up, singing and dancing during their childhood, needless to say are thought to be deviant, diseased or mentally unstable. They are often subjected to ridicule and harassment at home, school and neighbourhood by everyone including their family and friends. Such a predicament affects their psyche to the extent that they inevitably suffer from acute depression and feel suicidal. This ultimately compels them to leave their school, home and locality and hence become imprisoned in a Kafkaesque world of social exclusion and isolation.
“My parents took a lot of trouble to cure me at first, showed me to various doctors, took me to Vellore as well”, says Sourabbh Das, a transgender at Amitie Trust. “Even doctors in Vellore did not know about transgenderism and I was given electric shocks and even put in an asylum to be cured. Now my mother understands that this is not abnormal or a disease and she participates in workshops to understand it more.”
Sohini, a beautiful transwoman also recounts her heart wrenching story. “My father never understood who I was or what I was all about. Since the time my mother was ill, I had taken up all responsibilities at home and looked after my two younger sisters. But father never understood or accepted me and finally asked me to leave since my being a transgender would create problems for my sister’s marriage later. To create problems for my sisters however, was the last thing that I would want to. So, I left home and don’t keep in touch. Whenever I stand in front of the mirror, it’s a fight with myself because the mirror shows a body which I do not relate to. It is not who we are from inside.”
Physical health of transgendered individuals ranging from the common health problems like cough, cold, loose motion, malaria, typhoid, etc. to specific health issues like SRS (Sex Reassignment Surgery) and STD (Sexually Transmitted Diseases) is the dimension where actual, palpable discrimination takes place. “We too have self-respect and the way the staff laughed at me and ridiculed me in a hospital once has forced me to stop going to hospitals and doctors. That happened in 2007. I have never gone back to a hospital since!” says Sohini.
In the words of Tanushri, yet another beautiful transwoman and a wonderful singer, “Doctors are considered second to god who give other human beings the gift of health. But for us, doctors too discriminate. They do not want to examine us, or asks us to come in the wee hours of morning or late night so that other patients do not object. There are doctors who unnecessarily examine our private parts and ask demeaning questions or make invasive inquiries about our genitalia. I had diarrhoea once and the doctor made comments related to my anus and my sexual practices then. When I was gang raped, the doctor there did not even examine me, didn’t even suggest the anti HIV infection PEP Drug that I should have taken within 24 hours to combat infection if any. Usually doctors do not want to see us and even if they do, they just prescribe sleeping pills to get rid of us from their premises.”
If a clinician is not aware of a patient’s gender identify, he or she may fail to accurately diagnose, treat, or recommend appropriate preventative measures for a range of conditions. Jaya, a strong and confident transwoman in Amitie Trust exclaims “Doctors don’t even know the difference between trangenders and transsexuals, leave alone treating them for their specific medical issues! “ Sohini, Jaya, Tanushri, Bhanupriya, Mausam and almost all of them recalled having taken pills and other hormone injections to develop feminine characteristics just on the basis of word of mouth or hearsay. To quote Jaya “We have never been guided by any endocrinologist. Who will we go to? Who will tell us? We just hear from our friends and take them.”
Deshopriyo from Amitie Trust says “While castration is totally illegal in India, SRS does not have any proper guidelines. It is not clearly stated anywhere whether it is legal or not and there exists no proper guidelines regarding the same. So, all trangenders go to quacks for the surgery which results in high chances of serious infections, severe side effects and even death sometimes.” Konkona, Piyali and Deshopriyo, office bearers of Amitie unanimously state that only with extensive sensitization programmes for doctors and staffs, and increased platforms for expression of who we are, will this large gaping unfair divide be bridged. Till then, a separate medical clinic having supportive environment and sensitized staff with basic medical facilities is the best alternative.
Many in the transgender community are ostracised by their biological families and they receive emotional and physical support from people in the hijra settlement with whom they forge familial bonds which sadly, the government fails to accept as familial. Private health insurance companies also deny coverage to transgenders and exclude them from related services as such companies clearly rely on the gender binary. Infrastructural problems such as lack of a separate ward for individuals who do not fit into the constructed mainstream gender roles leads to their rejection in hospital admissions, delay in health services and a life of complete segregation. Thus, considerate and respectful treatment, together with equitable access to health services including routine physical examination and counselling, contraceptive management, HIV testing, immunizations etc. can help protect the lives and health of the vulnerable.
The discourse of welfare for transgenders needs to transcend mere tokenism to address their complex issues of identity and healthcare. With a view to improve the community’s health standards, a separate medical clinic having basic amenities such as well-informed doctors and staff, basic testing facilities and medicines for the sexual minority groups is a must.
Shuvojit Moulik is Research Scholar, Department of Receptor Biology & Tumor Metastasis, Chittaranjan National Cancer Institute , Kolkata, India; and President, Civilian Welfare Foundation
Picture Courtesy: Sutanuka Gupta, Civilian Welfare Foundation, Kolkata, India.