In our third year, a friend of mine had an upsetting first shift in Trauma Surgery: the first suturing she ever did was on a young woman who had just survived corrective rape. Rape is common in our country in general, and so is the “corrective” rape of gender non-conforming women.
A year later, we saw a transwoman being place in a single room, because the hospital had no policy for what to do with her. She did not want to be in a male ward, but strong leadership was lacking and so a patient with no infectious risk was placed in a single room. It did not sit well with us, but we were fourth years. We did not know what we could do.
Tonight I attended a fantastic talk by Dr Alexandra Muller from the University of Cape Town on providing healthcare for Lesbian, Gay, Bisexual and Transgender patients: why we should care and what we can do better.
I won’t be transcribing her talk because she was just too fantastic and I could not do it justice. But I will share what I learned.
The first question is: why should healthcare workers care? To me the most obvious reason has always been that we are in a position of care and in many situations, we hold people’s very human rights in our hands. Healthcare workers have the potential to play a massive leadership role in our communities.
Did you know that 7.5% of women and 7.7% of men have some degree of same-sex attraction? That’s a pretty significant portion of the population, and that’s why it matters. Sexual history is an important part of many consultations, and so too then is who a patient has sex with and how that affects their risk profile – and what we can do to minimise risk. And that’s why it matters.
The data for South Africa suggests that in the region of 60% of South Africans feel that homosexuality should not be tolerated. That’s an insane percentage for a country with as progressive a constitution as ours! And healthcare workers are not exempt from homophobia. In fact, from studies mentioned by Dr Muller, it appears that healthcare workers are often perpetrators and instigators thereof.
The term “secondary victimisation” refers to situations where healthcare workers and the justice system fail to provide services to an individual already victimised: for example, police officers who do not take a rape claim seriously from an LGBT individual, or doctors who inappropriately administer the rape kit.
In a way it is not really a surprise that HCWs are so bad at this: it is simply not addressed in medical school syllabi. At least, not in South Africa. (UCT has started phasing in a two hour session for fifth year students this year.) It is not DIFFICULT to treat a gender non-conforming patient, but in a heteronormative society, there are so many things we do not consider, for example to always address a transsexual individual by the pronoun of their preferred gender. Ask, “Do you have a partner” rather than, “Are you married”. Do not assume that a person conforms sexually to their professed gender identity. (And so lesbian women should still be tested for HIV.)
Did you know that lesbian women are at high risk for cervical- and breast cancer because they are inclined not to attend screenings, because of a fear of stigmatisation and victimisation? And of course, there is the obvious (but one simply does not think about it when you are not taught): transwomen should still have prostate exams. Transmen should still have Pap smears breast exams.
After tonight I can say without a doubt that more teaching regarding LGBT individuals needs to take place at universities – and especially in health-related courses. It is shocking how unintentionally homophobic and restricting we can be without even realising it.
Some more facts from the talk:
- The terms MSM (men who have sex with men) and WSW (women who have sex with women) are used to destigmatise, but it is controversial, because it threatens to reduce a person to their sexual activity.
- Up to 1973, homosexuality was considered a psychiatric illness. It was only removed from the ICD in 1990.
- “Gender Identity Disorder” is still found in the ICD10. This is again controversial, because in order for trans-patients to have access to hormone therapy or gender reassignment surgery, they do need a diagnosis.
- LGBT patients in South Africa are often at further risk due to other socioeconomic risk factors.
- LGBT individuals have high rates of depression, anxiety and suicidal ideation.
- Current South African national health policies make no mention of LGBT patients except for strategies on HIV, STI and TB prevention.
- There are no national guidelines for healthcare to transgender patients.
- Grootte Schuur Hospital, one of only three centres in South Africa who do gender reassignment surgery, only do five surgeries a year because of limited theater time. (Seriously?! So nose jobs take preference. Great. Apparently the wait list is something like 20 years.)
There is so much room for improvement in this regard in our country’s health framework and national policies. And in the rest of Africa’s! 21 March is Human Rights Day in South Africa, and this is certainly one aspect thereof that needs serious attention.
Further reading: (click images to be taken to links)