International Transgender Day of Remembrance: Care Providers Have a Role to Play

Being transgendered is such a singular experience, how can you adequately explain it to someone who isn’t transgendered?  There is no common frame of reference.  I can go on and on talking about the years of wandering alone in the darkness, searching, lost and confused and the blissful sense of serenity and peace of mind that I feel at this instant.
–Ashley, quoted from My Right Self

Sunday, November 20th was the 13th annual International Transgender Day of Remembrance, a day originally set aside to mark the murder of Rita Hester that has become an occasion for people around the world to honor and memorialize those lost to anti-transgender hatred and prejudice.

While the day takes as its primary focus the hundreds of murders of transgender people that happen world-wide every year, it is also an opportunity to take stock of other ways that hatred, bias, and ignorance contribute to poorer health and premature death of transgender people. It is an opportunity for health care and social service providers to reflect on how they can make sure they are part of the solution and not part of the problem.

A recent post to the New York Times Health blog acknowledged what many patients and advocates and some care providers have been saying for years: very few health care providers receive the kind of professional training necessary to enable them to provide high quality, thorough, and sensitive care to LGBT patients in general, and to transgender patients in particular. Extreme insensitivity, discrimination, and inadequate care cause many transgender people to postpone visits to health care providers or to avoid them entirely, resulting in poorer health outcomes. Even when trans people do seek care, a history of exclusion has lead to large gaps in our medical knowledge: The Institute of Medicine acknowledges that although they are often grouped together, the needs of LGBT patients are not uniform and far more research is needed if health care providers are going to be able to adequately address the needs of all of their patients in the future.

Thankfully, a number of creative projects, organizations, and professional groups are working to address some of the many gaps in our current system:

My Right Self  is a documentary photography project created with transgender individuals and couples that is working to “help viewers understand the experiences of transfolks and foster interest in learning more about taking care of trans and LGBT patients.” (The thumbnail images and quote in this blog post have been used with permission from Arthur Robinson Williams, a medical student at the time he created My Right Self who is currently working with the Psychiatry Department at NYU.)

The Center of Excellence for Transgender Health, a part of UCSF’s Department of Family and Community Medicine, provides a range of resources for health care providers (as well as transgender people, community activists, and researchers), including the detailed Primary Care Protocol for Transgender Patient Care, and has hosted important events, such as the National Transgender Health Summit.

New York’s Lesbian, Gay, Bisexual, and Transgender Community Center offers a variety of helpful tools, including the excellent video Transgender Basics to help providers and community members get up to speed.

The National Center for Transgender Equality advocates on behalf of transgender people and offers tips on how you can do the same.

And for those working with older patients, The National Resource Center on LGBT Aging offers cultural competency training as well as links to a variety of other resources. (Additional links can also be found among the extensive “Resource Links” on the Graying of AIDS website.)

There is far more to be said and done if we are going to combat the direct and indirect threats to the health and welfare of transgender people in our communities. If you aren’t already working to make a difference within your health care practices, non-profit agencies, and larger communities, the time to start is now.


UPDATE (12/1/11): The American College of Obstetricians and Gynecologists has called for all ob-gyns to be prepared to offer routine treatment and screening to transgender patients or be prepared to refer them to other clinicians who are able to offer them quality care. It also offers suggestions on how to create medical practice environments that are welcoming to transgender patients. Kudos to the organization for this important step towards providing quality care for all patients.

UPDATE (12/4/11): Thanks to Jamie McGonnigal from LGBTQ Nation for this piece on the power of language and the need for education, including an excellent breakdown of words that are transphobic and why and links to the GLAAD Media Reference Guide – Transgender Glossary of Terms. As McGonnigal notes, many well-intentioned people who might even consider themselves allies are still unaware that they are using language that can be hurtful; thankfully there are an increasing number of readily available resources out there to help all of us transition our language and culture to be more inclusive and respectful.

UPDATE (12/4/11): In honor of World AIDS Day, GLAAD took a closer look at the impact of HIV on transgender people, citing a report by The National Center for Transgender Equality that notes that HIV infection rates are four times higher among trans people than among the general adult population, and higher still among transgender people of color. The report, Injustice at Every Turn: A Report of the National Transgender Discrimination Survey, is chock full of troubling statistics and insights into the impact of widespread discrimination and marginalization (“50% of the sample [of 6,450 individuals] reported having to teach their medical providers about transgender care”). This report should be required reading for all educators, health care and social service providers, and human resources professionals working today, and is strongly recommended for anyone who cares about social justice, equality, and human rights.

UPDATE (2/28/12): The Gay & Lesbian Medical Association’s website offers a number of helpful links and tools for making health care practices more LGBT-friendly in general (including its “Provider Guidelines for Creating a Welcoming Environment”), and more transgender-friendly in particular. Health care organizations also need to ensure a safe and supportive working environments for LGBT health care professionals; Human Rights Campaign has released a new White Paper, “Transgender-Inclusive Health Care Coverage and the Corporate Equality Index,” that encourages work places to become more equitable for their transgender employees and insure options for transgender-inclusive health care coverage.