Learning Objectives--At the end of this module, you will be able to:

1. understand the challenges encountered by LGBTQ2S youth as they access and navigate the healthcare system
2. understand how homophobia, biphobia and transphobia may cause some LGBTQ2S youth reluctant to access medical care.
3. support LGBTQ2S youth to find appropriate medical services (by asking important questions of healthcare providers)

Health care can be a challenges for youth. “Due in part to negative past experiences, many LGBTQ people may delay or avoid seeking health care or choose to withhold personal information from healthcare providers. In general, LGBTQ people end up receiving less quality health care than the population as a whole” (Rainbow Health Ontario, ND).

The following is an excerpt from the introduction from “Trans Liberation” by Leslie Feinberg. Feinberg was a LGBTQ2S activist and writer. This excerpt details one of Leslie’s interactions with the healthcare system.

I’ll give you a graphic example. From December 1995 to December 1996, I was dying of Endocarditis — a bacterial infection that lodges and proliferates in the valves of the heart. A simple blood culture would have immediately exposed the root cause of my raging fevers. Eight weeks of ‘round-the-clock intravenous antibiotic drips would have eradicated every last seedling of bacterium in the canals of my heart. Yet I experienced such hatred from some health practitioners that I very nearly died.

I remember late one night in December my lover and I arrived at a hospital emergency room during a snowstorm. My fever was 104 degrees and rising. My blood pressure was pounding dangerously high. The staff immediately hooked me up to monitors and worked to bring down my fever. The doctor in charge began physically examining me. When he determined that my anatomy was female, he flashed me a mean-spirited smirk. While keeping his eyes fixed on me, he approached one of the nurses, seated at a desk, and began rubbing her neck and shoulder. He talked to her about sex for a few minutes. After his pointed demonstration of “normal sexuality,” he told me to get dressed and then he stormed out of the room. Still delirious, I struggled to put on my clothes and make sense of what was happening.

The doctor returned after I was dressed. He ordered me to leave the hospital and never return. I refused. I told him I wouldn’t leave until he could tell me why my fever was so high. He said, “You have a fever because you are a very troubled person.

This doctor’s prejudices, directed at me during a moment of catastrophic illness, could have killed me. The death certificate would have read: Endocarditis. But by all rights it should have read: Bigotry.

As my partner and I sat bundled up in a cold car outside the emergency room, still reverberating from the doctor’s hatred, I thought about how many people have been turned away from medical care when they were desperately ill — some because an apartheid “whites only” sign hung over the emergency room entrance, or some because their visible Kaposi’s sarcoma lesions kept personnel far from their beds (Feinberg, 1998: 1-3).

The following is from Qmunity’s I Heart My Chest: A chest health resource for trans* folks (pages 6-8).

Choosing a service provider who is trans*-competent can be difficult and intimidating. Some folk have had negative experiences with health professionals that make them reluctant to take a chance on a health professional again. Many people are not confident that a health service provider will understand their needs. Most of us are exposed to public health messages that are mostly ciscentric, and it can be easy to feel that the information they contain is not relevant to trans* folk, leading people to miss out on vital health information.

Some ways to find service providers who will give you the trans*-competent care that you deserve include:

• Calling or emailing ahead, and/or making an initial visit to ask questions. You might feel more comfortable doing this with a trusted support person. Some starting questions that might help you gauge this include:
  • How many trans* clients have you worked with, and for how long?
  • What has most informed your practice with trans* people?
  • What is your experience and what are your policies and practices regarding referring trans* folk for surgeries and other treatments?
  • Will substance use, involvement in sex work, and/or mental health issues affect my ability to obtain hormones or surgeries from you?
  • If you are not currently aware of trans* health care needs/issues, are you willing to consult medical guidelines established by the Transgender Health Information Program to provide appropriate trans* health care?
  • What washrooms are available on site? (e.g. Gendered? Single stall? Do they require me to ask for a key?)
  • Are gendered questions part of the intake process or admin, and if so do I have options other than the male/female binary for my responses?
• A trusted peer may be able to make recommendations. If you aren’t in contact with other trans* folk, you can make connections through local social and support groups, which you may be able to locate through QMUNITY, Prism, The Transgender Health Information Program, The Catherine White Holman Wellness Centre, WISH, PACE, HUSTLE, Directions, or a trans*, 2 Spirit or LGBT organization near you. If someone you trust has used a service, they may be able to tell you about the service provider’s approach, style, and attitudes towards trans* folk
• There may be an online forum based in your area where trans* folk share information and resources related to health care
• LGBT centres such as QMUNITY, and any trans*-specific service providers such as the Transgender Health Information Program are likely to have a list of local trans*-competent service providers they can refer you to, and may offer services such as counselling and some medical services for free or at sliding scale cost
• On-site at your prospective health provider’s premises, you can look for rainbow stickers or trans* health literature as signs of inclusiveness, or ask in person
• If you are already in contact with one type of trans*-competent service provider, such as a doctor or counsellor, they may be able to refer you to other types of trans*-competent service providers in their network

Making sure that you’re getting the most qualified and respectful care you can is important. It can make the difference between feeling comfortable going for potentially life-saving health check-ups or not, and benefiting from ongoing counselling, naturopathy, acupuncture or other valuable services. As well as finding trans*-competent services, this may mean switching from one provider to another if you do not feel that they are right for you. If you feel comfortable doing so, you may want to discuss your reasons with your health care provider, either in person or over the phone, or through an email or letter. With your feedback, and their own efforts towards increasing their trans*-competency, a provider may be able to improve their work with you to better meet your needs; however, in some client-service provider relationships, you will benefit most from moving on to another.

Working with a service provider you trust can help to avoid situations where you feel you need to withhold information that may impact on the services, referrals and recommendations that they will provide. Experience with service providers who don’t meet your needs can be frustrating and emotionally draining, and can discourage you from looking for better ones. However, in many places trans*-competent and -inclusive service providers can be accessed (Qmunity, 6-8: 2013).

Sources:

Feinberg, L. (1998). Trans liberation: Beyond pink or blue. Boston, Mass.: Beacon Press.

Rainbow Health Ontario. (n.d.). About LGBTQ Health. Retrieved February 8, 2015, from http://www.rainbowhealthontario.ca/about-lgbtq-health/

Qmunity. (2013, December 1). I Heart My Chest: A chest health resource for trans* folks. Retrieved February 7, 2015, from http://www.qmunity.ca/wp-content/uploads/2011/07/I-Heart-My-Chest-Dec-2013-English.pdf

 

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