Transgender Healthcare: A Work in Progress

Takepart.com

The incident happened two years ago, but it's still fresh in the mind of Karina Samala. She was waiting to be called for a doctor's office visit, when the unexpected happened.

"They called me by my boy name," she says.

Samala is chair of the City of Los Angeles Human Relations Commission Transgender Working Group, which promotes better understanding between the LAPD and the transgender community. The long-time human rights advocate has worked for years to prevent these sorts of embarrassments for transgender patients.

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Definitions of transgender vary, but a commonly used description is someone who identifies with a gender different from their birth gender. Some have gender reassignment surgery.

Transgender patients often face the kind of humiliation Samala did when seeking health care, surveys suggest.  "It's getting better now," she says,  "with laws passed regarding non-discrimination with health care." But those in the trenches say more can be done.

That "more" goes beyond legislation. Also making a difference is the launching of centers dedicated to transgender health care, or centers that care for a wider population with trained staff who are sensitive to the needs of transgender patients.

One of the latest examples is the new Transgender Health Care Program at St. John's Well Child and Family Center in Los Angeles. Samala is helping Jim Mangia, the center's president and CEO, with fundraising efforts.  

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Head Over Heels, the center's upcoming fundraising gala in L.A., will feature Dr. Marci  L. Bowers as its emcee. Bowers is a pioneer in gender reassignment surgery.

Mangia says he wants to reach out to the county's estimated 22,000 transgender patients. Estimates of the number of transgender patients nationwide are difficult to come by, but the National Center for Transgender Equality believes up to 1 percent of the population may be transgender.

"The transgendered patient is one of the most underground, marginalized and underserved populations in our city and we want them to have a home with us," Mangia says.

St. John's is an independent community health center and federally qualified. Its 11 sites are located in downtown and South Los Angeles, Mangia says, where many transgender patients reside.

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They plan to reach out, however, throughout the county.

Transgender patients tend to be underinsured and lack access to care, Mangia says.  Rates of HIV are high, as many resort to sex work to support themselves. His center will provide primary care and preventive care, with referrals to specialists as needed.

The new center, he says, will be patterned after Fenway Health's Transgender Health program in Boston, regarded as a national model, and will work with the Transgender Law Center in San Francisco, among other partners.

Mangia cites other examples of programs offering competent transgender care, including the Los Angeles Gay and Lesbian Center and the Lyon Martin Clinic in San Francisco, another partner.

Many health care providers don't understand the needs of the transgender community, Mangia says. For instance, a transgender patient born a man who has transitioned to female but not had surgery still needs check-ups of male anatomy.

And doctors need to learn, say Samala and others, to use the correct pronoun when talking to transgender patients.

How can healthcare facilities better serve the transgender community? Let us know in the comments.

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Kathleen Doheny is a Los Angeles journalist who writes about health. She doesn't believe inmiracle cures, but continues to hope someone will discover a way for joggers to maintain their pace.

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