September 3, 2010

Universal Access?

Barriers to accessing health care persist for transgender people in Nova Scotia

by Kaley Kennedy

The Dominion - http://www.dominionpaper.ca

While hormone treatments are fully covered by provincial health insurance in Nova Scotia, access is limited because the only endocrinology clinic that administers hormones is in Halifax. Photo: Linden Tea

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HALIFAX—For Chris,* going to see a doctor can be a frightening experience.

Chris, who lives in Antigonish, Nova Scotia, first came out as a trans person two and a half years ago. Even though he was assigned female at birth, he identifies as trans and presents as a male. Going for a check-up, getting a prescription, or even trying to fill out a general intake form can turn into a huge production, often without any sympathy from hospital or clinical staff.

"I’m always scared. There’s always an element of fear going to visit a health professional. I can’t help thinking ‘am I going to have a bad experience?’” he says.

For Chris and other transgender people, it is difficult to access health care services that many of us take for granted.

Last year, Chris had to be taken to the hospital in an ambulance, and the paramedics didn’t know what pronoun to use to refer to him. He was almost forced to go for a psychological evaluation because he was identified as not “gender normative.” More recently, he decided against getting jaw surgery because of concerns of how he will be treated.

“There’s no place for a preferred name on forms,” says Chris. Hospital and clinic staff, he explains, often refer to you by your legal name, and by the pronoun associated with your sex, regardless of your gender presentation.

Dr. Suzanne Zinck, a childhood psychiatrist who is part of the two-person Transgender Health Team at the IWK Hospital in Halifax, agrees that there continue to be challenges to accessing care for transgender people. But she says she remains optimistic: that with education and training, these can be overcome.

Zinck notes that many transgender people might struggle with dealing with the health risks associated with the sex they were born in. For example, trans men who do not get hysterectomies are still required to get pap smears.

The Sherbourne Health Centre in Toronto, which administers hormone therapy for transgender people, recently launched a public health campaign to promote transgender men getting pap smears.

Zinck says these types of campaigns do more than provide public health information to transgender people.

"Making it into a public health campaign shows that this is as valid a part of the community as anything else," she says.

The IWK Transgender Health Team, which includes Zinck and a social worker, was formed four years ago, when the IWK identified a need for more specialized care for transgender youth. The team is mostly responsible for clinical work related to gender-questioning and transgender youth, but is also involved in educational programming on trans issues, and in consulting with doctors in different disciplines related to specific cases involving transgender or gender-questioning youth.

According to Zinck, the Capital District Health Authority has also been doing advocacy and policy work with Parents, Families and Friends of Lesbians and Gays (PFLAG) and the Nova Scotia Rainbow Action Program (NSRAP) to better serve transgender patients.

“There are many barriers that have come down in the past four years, not only due to our work, but due to all the educational work being done,” says Zinck.

However, she adds, there is still significant room for improvement.

While hormone treatments are fully covered by Nova Scotia health insurance, access is limited because the endocrinology clinic that administers the hormones is in Halifax. This can make it difficult and costly for patients who have to travel into the city for treatment. The clinic also will only see people who are 18 and over, meaning youth who wish to transition earlier have difficulty accessing hormones.

Other services remain “completely off the radar for most people,” says Zinck. For example, there is no coverage for trans women who need to access voice training. For trans women such training can be essential to their ability to present as female.

The opinion of medical professionals on covering these services “run the gamut,” but for Zinck these are essential services.

“If someone looks gender ambiguous or mismatched in terms of who they present as and what they look like, that can lead to lifelong problems of discrimination, not to mention mental health and self-esteem issues,” says Zinck. She adds that transgender people continue to be underemployed based on their education levels and have lower educational attainment than their non-transgender peers. This, for Zinck, is closely tied to “whether or not a person can pass [for the gender they present as].”

Sex reassignment surgery (SRS), which is the largest cost related to transitioning is not covered by public health insurance in any of the Maritime province. SRS was also recently de-listed by the Alberta government as a service covered by provincial health insurance. Last year, Manitoba rejected a proposal that would fully cover SRS surgeries.

Many provinces require people who are interested in having SRS to travel to the Canadian Association of Mental Health Gender Clinic in Toronto in order for it to be covered by health insurance. Most provinces, however, do not cover the associated travel costs.

In December 2009, Chris traveled to Ontario get chest surgery related to his transitioning. While he received some help from friends, he covered the bulk of the cost out of his own pocket. This experience is not uncommon.

Two years ago, Sandra Bornemann helped start the TransAction Society of Nova Scotia, after organising a fundraiser to raise money for chest surgery of a friend. It was the first fundraiser of its kind in Nova Scotia, and raised about one third of the surgery’s $6300 price-tag.

After that first fundraiser, Bornemann says TransAction re-evaluated its priorities, realizing they could make more of an impact helping with the everyday costs transgender people face for things like chest bindings; gaffs, which help trans women hide their genitals; breast forms; and packers, penis forms sometimes worn by trans men.

The decision not to raise money for surgery was also a political one, says Bornemann.

“We believe surgery should be covered [by provincial health insurance], so we’re not going to give the government an out by paying for that service,” says Bornemann. She says that the members of the society also realize that many transgender people don’t want to have sex reassignment surgery.

Over the past two years, the TransAction Society has provided chest bindings and gaffs free of charge to dozens of people in Nova Scotia. They are hoping that through additional fundraising, they will also be able to provide breast forms and packers in the near future.

“It’s little things,” says Bornemann, “but they are expensive.”

For Chris, social and structural changes are necessary if access to health services are going to improve. He says there needs to be more education, better training for health professionals on transgender issues, and more visibly trans-positive spaces to access care.

Until then, small improvements, like better access to hormones and more accessible information forms, could go a long way.

“I’m really frustrated by the lack of people able to administer hormones. It’s possible to get [better access to hormones], but its not happening.”

Bornemann says she hears the same thing from transgender people—that small improvements make a big difference.

“We’ve had so much support. People have come to us and say they are supporting of the fact that we’re filling these everyday needs,” she says.

*Name has been changed.

Kaley Kennedy is a feminist activist living in Halifax. She is a member of the Halifax Media Co-op, where this article was originally published.

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