“The right to health must be enjoyed without discrimination on the grounds of race, age, ethnicity or any other status. Non-discrimination and equality requires states to take steps to redress any discriminatory law, practice or policy.”
In Asia Pacific where society and the government’s acceptance of transgender people is at an incredibly harmful stage, the need for healthcare facilities to be non discriminatory can mean the difference between life and death for transgender people – specifically when a medical condition requires treatment or early diagnostics but is ignored due to fear of discrimination . Medical facilities after all are not just ones who provide hormone related therapy or surgical procedures for transgender people but every sector of the healthcare industry.
The Oath
We understand that it is risky in some countries for businesses, and even health care providers, to openly show support to the LGBT+ community seeing as how you may not have the law or society on your side. However, health is a basic right and is included in the constitution of most countries – not only that, but credible scientific and medical organisations worldwide show overwhelming evidence in support of the trans community community. This stance alone makes it easier for the medical community to speak up against this discrimination.
We implore you, if you feel you are unable to put your clinic at risk in public, then reach out to NGOs (or APTN) and ask them how you can assist them instead. They may also have a list of trans friendly clinics that you can be a part of so that the transcommunity is at least aware in private that they can visit you. If the transcommunity in your country does not have a list of friendly medical facilities, perhaps you can work with them to create one. The medical community is a very important component in keeping trans lives safe and is an invaluable asset to the movement.
In the meantime, please read on to see what you feel you can change within your clinic that is within your risk profile.
The Safe Space
Let’s talk about what a safer space is all about, in summary it includes:
- The promotional materials – including internal and external ones
- Websites & Social Media accounts
- The appointment making process
- The waiting rooms/reception area
- The provided reading materials
- The bathrooms
- The language and training of staff
- During physical examinations
- During treatment
- The follow up and post-visit services
- The referral services to another clinician
Your messaging
The promotional materials such as pamphlets and brochures you send out and the social media posts you create on all your social media accounts can very well be the first contact a patient has with your clinic. If you can openly state that you are LGBT+ friendly, that is always a good start. Make sure, the language on these materials are as inclusive as possible such as using gender neutral terms (ie: people with vaginas, people with penises etc). Another way to show support and inclusivity is by adding pronouns to the profiles of your doctors.
The booking process should also be as inclusive as possible. If yours requires adding details from official documents (such as name listed in an identity card) then make sure to also include preferred names and preferred nouns as a section. Similarly, on the phone never assume the gender of a person based on voice alone, if you are unsure, it is always better to ask. And if you make a mistake, apologise, correct and move on.
A Welcoming Environment
Similar to your messaging, if you can be explicit with your support such as putting up a pride flag or any other way of clearly indicating you support the LGBT+ community, that’s always a great start. Compliment that with reading materials that are LGBT+ inclusive and maybe even posters that promote LGBT+ content(such as NGOs, communities, events, merchandise etc).
The documentation process might need updating if you haven’t done so already. Ensure that documents contain a section for gender identity, assigned sex at birth, preferred pronouns and preferred name. As a general rule, leaving a blank to fill in rather than using checkboxes is a better option. Bathrooms should also be gender neutral, this could also be a good chance to include inclusive signs like a non-binary sign to show support.
The Staff
Sex Orientation, Gender Identity & Expression (SOGIE) training should be provided to staff so they can better understand terms like sex, gender, sexual orientation etc. You can learn about terminology, SOGIESC and terms specific to this region on topic 1 of the Asia Pacific Transgender Network’s trans health module here.
When calling out patients, please use preferred names and preferred pronouns. Staff should also understand using gender neutral language like not calling people by their designation (Sir, Miss etc) and stick to purely polite communication such as “excuse me” vs “excuse me, miss/sir”.
The general rule is that if you aren’t sure, if it wasn’t listed, or if you don’t remember, it’s always better to ask and with zero judgement.
During Treatment
When a patient has entered the doctor’s office, along with the past recommendations, make sure to only ask appropriate questions related to the health concerns of the patient and purpose of the visit. This goes double for physical examinations. If a physical examination is necessary however, please inform the patient exactly what is going to happen and always request for consent.
An experience that a lot of trans people go through at medical facilities is called the “broken arm syndrome” – a term that comes from a patient walking into a clinic with a broken arm and having a doctor incorrectly correlate all ailments to that broken arm. It is a common occurence for trans people to get every ailment blamed on their gender affirming hormone therapy (GAHT) or surgery. Please don’t do this, it can be incredibly frustrating. If it is genuinely related to GAHT or surgery, because of our bad experiences with this, please explain why and provide references.
If you are a provider of GAHT or surgery, always look for the latest guidelines. It is unethical to put a trans patient on low dose hormones where changes are minimal without letting them know. We also really appreciate you taking the time to listen to our worries and to give us your genuine thoughts on new information we may have encountered. GAHT is really important to us and it being a lifelong regiment, some of us try to be as updated as we can with it. Thus, having a doctor on our side to give their trained opinion and to look up things with us is a huge blessing.
The final thing to pay attention to, is related to your list of referral doctors. These referral doctors should always also be LGBT+ friendly and inclusive. If there is no choice, please let the patient know.
That’s the gist of it!
Asia Pacific Transgender Network has an entire module that we made specifically for the healthcare sector, please have a look, its called “Towards Transformative Healthcare”. For more information specifically on creating inclusive spaces are in Topic 4.
Please do read up on other parts of this site as well like the GAHT and Surgery section, if there are any parts that you find are misrepresented, please let us know. We also have a list for Asia Pacific doctors to network and be a part of, let us know if you want to take part or if you want to add other clinics to the list.
