the broken promise of trans health care: 'i foolishly thought i was going to get the care i needed by calling 911'
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"for a racialized person, there can often be a reliance on a disability to justify their needs and build a sense of trust with their health-care provider," says jaye garcia. supplied
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*jaye’s pronouns = they/them
*julia’s pronouns = she/her
it’s a night ingrained in jaye garcia’s mind. it was 4 a.m. they were experiencing a panic attack — something they were familiar with, having had a history of them and through having worked as a social worker — and were worried it may have even been a heart attack. to be safe, they called an ambulance.
on the way to the hospital, as they relayed this information, garcia was ignored and told that what they were actually experiencing was a “substance use-induced psychosis” brought on by addiction. this, despite the paramedic knowing nothing of garcia’s medical history. they were denied an ativan as requested and, despite being emergency aid, the paramedics provided none.
“they saw my distressed racialized trans non-binary identity and assumed rather than believed,” garcia says. “that paramedic had the audacity to tell me, ‘i hope you get the help you need with your addiction issues.’ when that by no means was why i was there. … to be a person in crisis alone, to be assumed to be telling a lie, and then being presented a damage-based narrative as i feared that i was dying of a heart attack is a difficult thing. i foolishly thought i was going to get the help i needed by calling 911.”
once garcia arrived at the hospital, and after being assessed by psychiatric services, they met the resident doctor, who surmised what had happened and offered up an apology.
‘you are the expert of your own illness, your healing, your trauma’
it was a reminder, says garcia now, that “you are the expert of your own illness, your healing journey, your trauma,” and that the canadian health-care system can sometimes be “a violent place where you have no rights, no privileges, and no say in what happens next, where police act as psychiatrists in blue to make a community seem deviant and outcast.”
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the anti-violence advocate is referring to the 2slgbtqqia+ (two-spirit, indigiqueer, lesbian, gay, bisexual, trans, queer, questioning, intersex, asexual, and other sexually and gender-diverse people) community, which has long had limited access to health care in canada, and an even lower degree of trust when it comes to its health-care workers. that, of course, has had dire consequences, particularly highlighted during the covid-19 pandemic, when gender-affirming care was labelled “nonessential.”
julia chronopoulos, an assistant clinical professor at the university of alberta and clinical lead for the rainbow clinic at macewan university health centre, says the situation is more severe than many realize, with access to care for the trans community being “inconsistent to nonexistent.”
“a lot of the time, gender-diverse folks have found the pursuit of gender-affirming care very marginalizing and pathologizing,” she says. “most folks can see their primary care practitioner for most of their health-care needs, but if you’re a trans person, often you feel like you’re segmented; you see your endocrinologist to get your hormones, your gynecologist, which in and of itself is a bit invalidating because here you are seeing a classically female doctor for your hysterectomy as a man, you’re seeing your plastic surgeon, and you’re seeing your psychiatrist just to tell you that the gender that you know you have is your gender. that whole experience is invalidating in and of itself and can be traumatizing.”
historically, this lack of equitable and compassionate care has commonly led to inadequate aid for such conditions as diabetes and hypertension malignancies, while some resort to buying hormones online or off underground markets in order to bypass the health-care system entirely, with others pursuing surgical procedures by untrained workers, all of which can lead to further issues down the line due to the lack of medical monitoring.
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this also means that basic medical issues often go untreated. consider, according to the landmark 2019 trans pulse project, that 23 per cent of canadian transgender and non-binary youth do not have a primary health-care provider.
the resistance on the part of the trans community is also due to health-care workers’ lack of knowledge about their needs and their identities, along with outward judgment and discrimination everywhere from the primary care doctor’s office to the pharmacy to the emergency room. gender-diverse individuals often find themselves not addressed by their names or pronouns, ultimately feeling as if they are not seen or welcomed in spaces that are explicitly meant to be safe and welcoming.
“most of us don’t have to talk about our genitals when we go into the doctor’s office or emergency room with a broken arm,” says chronopoulos. “but people who might be somewhere along their gender journey can experience that sort of probing, which makes for a really uncomfortable health-care experience. the barriers that people run into are multi-tiered, multi-faceted, physical to emotional, to even traumatic at times.”
43% of transgender individuals have attempted suicide
in fact, according to the trans pulse project, in ontario, 43 per cent of transgender individuals have attempted suicide, and more than half experience symptoms consistent with clinical depression. when it comes to the 2019 survey, 34 per cent of respondents were living in poverty, compared to 13.5 per cent of all canadians, which contributes to poor health. we also know that trans people are at greater risk for hiv and for poorer physical and mental health outcomes.
here’s why it all matters: the completion of gender-affirming medical treatment has been associated with reduced suicide risk among among trans people in ontario, which means that understanding how to break down the barriers keeping health-care inaccessible is crucial — and this begins with collecting more data all over the country, more education, and more of a focus on the community itself and its experiences in the system so far.
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this is why, in april, the community-based research centre (cbrc), egale canada, the enchanté network, and 2 spirits in motion society joined forces to launch a national survey to investigate the current state of health among 2slgbtqqia+ canadians.
the survey, which can be taken anonymously, asks participants about their mental and physical health, sex lives, relationships, experiences with caregiving, community connection, discrimination and violence, substance use, economic impacts, housing, and how they have been coping during covid-19. the hope is that the resulting data will help provide a more intersectional lens when it comes to health research and providing adequate care for diverse canadians, while also being used to advocate for programs, services and policies that support their wellbeing.
for instance, says garcia, who was part of the team that created the survey, for a racialized person versus someone who doesn’t have to navigate colourism, there can often be a reliance on a disability or chronic health marker to justify or to advocate for their needs and build a sense of trust between themselves and their health-care provider.
“that means something, especially in the degree of trust, because health-care systems, governments, police don’t have every community’s trust in mind,” says garcia. “there’s something to be said about verified information provided by the community itself, with nuance.”
but it’s also time for health-care providers to act and to take responsibility, says chronopoulos.
“it’s not about what will happen, it’s what’s happening now, in canada, one of the countries that purports to be supportive, and accepting and affirming of gender-diverse folks,” she says. “the system has relied upon people to be strong self-advocates, but then people fall through the cracks. if you do not have that ability to keep pushing and pushing and pushing for what you need, and there’s trauma in and of itself to having to be the poster person for diversity, we need to be there for you. the onus should be on the rest of us, to educate ourselves and to be available and ready to help and take that pressure away from what is already a difficult process.”
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in recent years, progress has been made, and has included more educational platforms for providers, along with greater insurance coverage for gender-affirming surgical care. and, of course, the 2021 census became the first to provide more data on the size of canada’s transgender population. it is, in other words, a start.
moving forward, what garcia and chronopoulos hope to see is a more holistic approach that encompasses not only the mental and the physical, but the socio-economic factors shaping the experiences of marginalized patients.
trans people often have multiple marginalized identities
a similar discussion was sparked in the last two years when it comes to people of colour, for whom racism itself is a social determinant of health. it’s worth noting, then, transgender individuals often have multiple marginalized identities, compounding their lack of trust in the health-care system.
“diversity and inclusion become the new flavour of the month again and again, and it ends up feeling like the same broken promises,” says garcia. “queer and trans people feel gaslit, all while we should be grateful that we’re getting that airtime. but systems often consider us problems to be dealt with that they never wanted to deal with in the first place.”
and the work needed to build that trust is considerable.
it begins with no longer considering gender-affirming care to be “specialized care,” says chronopoulos, and for seemingly simple things like waiting room posters, pamphlets and bathrooms to be more inclusive and break the stigma that is at the root of the issue.
with this new survey and by taking the problem into their own hands, garcia hopes the stories that come out of it are not just about resilience, but strength and true power and what it means to constantly be denied but keep going.
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“because there are so many of us that still choose life, still take those risks embedded in the roots of the gay liberation front and the hiv/aids movement, and are standing up for what’s right despite health-care systems neglecting us and leaving us behind,” says garcia. “we are still here. we’re still queer. and we have a lot to say.”
sadaf ahsan is a toronto-based writer.
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