Saturday, June 27, 2009

Still No Doctor in the House

Those who know me well really know my disdain of 'our' medical system. They also know that it is very easy for me to rant rabidly over medical policy in this country, usually diverting the conversation away from whatever issue was originally posed. But I have to start there because its an important part of my perspective and I'll try to keep focused.

I am sure that my inability to get reasonable and affordable medical care lead me to seek alternative forms of medical care to meet my medical needs. My response included resorting to self diagnosis and self medication. There's also this little bit of discomfort I had with my body and exposing it and me to insensitive and unsympathetic medical practitioners. Growing up on the streets, I learned quite quickly how to get the medications I needed without following proper 'channels'. Which is how I began my transition, unsupervised.

It was a number of years before I finally decided that I would find a doctor to help 'monitor' my transition. Of course, it was D's persistence in demanding that I see a doctor that really pushed me to that first visit. By that point, my 'puberty' was nearly complete and my first visit's disclosure took my doc by surprise. I had heard about her from another T-Woman and she was this doc's first TS patient. I was her second. She was great, we hit it off very well and eventually became close. Like me, she had a history with Haight-Ashbury FC, liked working with under-served populations and had a very strong interest in helping trans clients.

This past spring she retired. Her reason, too much paperwork. She was finding that she either had to shorten the time she spent with her clients, take fewer clients or both, in order to keep her practice open. So for the past 6 months I've been back on my own and D is again wanting me to 'get supervised'.

So I've been looking for health care and as I googled the net I came across this place, The New Orleans Health Care Clinic. I began reading and it started out pretty good. From their Health Services page:

We are dedicated to providing safe, affordable, high quality, comprehensive sexual and reproductive heath care in a caring, respectful, and confidential environment. Medical and Health services at our Clinic currently include: Gynecological Care, Sexual & Reproductive Health Care, Prenatal Care, Breast & Cervical Cancer Screenings, Abortion Referrals, and Health Information, Counseling, & Referrals.

From their Gynecological Care page:

Although we centered our services on meeting the particular needs of women of color low-income women, and uninsured women, NOWHC’s gynecological services are available to all women – regardless of their race, ethnicity, sexual preference, gender identity and expression, ability, faith, income level, citizenship status, work sector, or age – in a caring, respectful, and confidential environment.

And from their Sexual & Reproductive Health Care page:

NOWHC provides sexual and reproductive health services to all women regardless of their race, ethnicity, sexual preference, gender identity and expression, ability, faith, income level, citizenship status, work sector, or age – in a caring, respectful, and confidential environment. Our current sexual and reproductive health services include: and it goes on listing their offerings of services.

I must have spent about 15-20 minutes looking over the information and thinking to myself, hey this sounds great. They really seem to have their heart in the right place. Why can't I find something like this closer to home? What's wrong with a system where it is so difficult for me to get health care that is affordable, where the staff is knowledgeable and I feel safe going into the facility.

And then I read this:

We provide care to hetero, bi, lesbian, queer, and questioning women; trans and gender non-conforming individuals; and women with DSDs who were female assigned at birth. We are currently working to expand of trans and gender non-conforming affirmative health care services and enhance our health information and referral services to people and families affected by disorders of sex development. We are committed to working with all of our clients to provide care that respects individuals' relationships with their bodies and gender identities. We are currently not able to provide care to trans people who were male assigned at birth or who have had genital sex reassignment surgery. Please call for referrals.

WTF? How is it that one can 'provide care to .... trans and non-conforming individuals....' and not include me? What is it about my kind of transness that makes me so untreatable. I read all the services that they offer and MOST of them could apply to me, just like the majority of women. Sure, I have no need for cervical cap or diaphragm fitting and there is a good chance that I would never need an abortion referral, but I also know many non-trans women that would be just like me.

I tried to understand the justification for this. Perhaps it was that the staff was trained to specialize in women's physiology, that they felt uncomfortable to provide adequate health care to formerly male bodied clients. Or is there something so fundamentally different with my body, that I am unaware of, that having something physiologically male on the inside makes it difficult to provide me with proper care? Maybe it was because, as a women's clinic, does my presence challenge or threaten their clients to a point of where it is unsafe for them to use this clinic?

And then it really hit me, its OK to visit this clinic if you're FTM. Its OK to visit if you're an intersex woman assigned female at birth. A transman with a mastectomy is fine, but me needing a mammogram? No way! I see this as nothing less than discriminatory practices based on transphobia. And under all of this is the sad fact that this clinic is all about serving 'marginalized and under served women', especially 'women of color and low-income women'. Who is at the bottom of the list of this list of under served and marginalized women? Trans women of color.

For me, this is about health care, its not about merit badges proving I'm 'made it' into women's spaces. Nor is it about a woman's space that is focused on sensual and sexual anatomy. In this type of clinic and who the intended clients are, much of the practice will be primary care. Not specialties, those will be referred out and they apparently are well enough connected to already be able to provide those referrals. Does the fact that I have an atypical body automaticly mean I can only be seen by a specialist, if I have a cold, need a stitch or two or need a mammogram? I hope not.

When I go to a doc, there should be no need to even consider whether or not I'm an interloper. I'm not there struggling to rationalize my female identity with a not quite female body. I'm visiting a doc because I have a body, living right now, and I occasionally need some advice or help with it. Choosing a doc is a very personal thing. One needs to be comfortable with that person, needs to feel that you're in a safe place and unfortunately in this time and place, that you can afford it. Going to the doc should not be any more complicated than that. At the end of the day, basic health care should be available to all, not "Women and Trans" unless you're M2F.

And I still haven't found a new doc.


Anonymous said...

Hi, I was going to write to them after reading your post, this is outrageous, but the links provided don't seem to exist, all I get is 'Domain Not Valid'. Could you recheck the URL?

Apart from this, I feel so lucky that all I have to face is patronising pity when I visit the doctor. What you are describing is illegal over here (in the UK) thank God. I'd never be able to cope with that kind of nonsense.

Hope you find a decent doctors soon as possible.

Anonymous said...

As an addendum to my last post, they do appear in a Google search, but I have to read the cached pages. Have they been shut down?