Hamilton’s health care system is in the midst of transformational change, but you likely haven’t noticed, unless you’re trans, or gender non-conforming, and even then you may not yet know.
Late in 2016 a few physicians, some social workers, a nurse or two and I got together to discuss how to go about increasing the capacity of Hamilton’s health care system to deliver high-quality, evidence-informed health care to trans and gender non-conforming people.
As many of you know, it has been historically difficult for a trans/gender-nonconforming person (throughout the article I will use ‘trans’ as an umbrella term to denote trans and gender non-conforming people, including those who identify outside the gender binary) to access a primary care physician in Hamilton. Some trans people have family physicians that are uncomfortable and reluctant to offer gender transition care, citing complexity, fear and lack of expertise about trans health issues. TransPulse Project, a comprehensive qualitative research study in Ontario reports that 44% of Trans Ontarians have experienced an unmet health care need because of fear and discomfort (TransPulse, 2017). Other trans people have no family physician at all, and are fearful to reach out because of stigma and discrimination.
One of the more arresting statistics from TransPulse states that around 66% of trans people have ever avoided a public space 3 times or more for fear of being outed, perceived as trans or experiencing violence. A public space is the grocery store, the sidewalk outside one’s home, the bus, the doctor’s office. Just think about it. Imagine what that must feel like.
For the past few years, Quest Community Health Centre in St. Catharines has been running, under the supervision of Dr. Carys Massarella, a trans clinic once a week. This has been a much-needed service, and with over 1,000 patients accessing transition care there you can imagine the wait times for an appointment. Many of those waiting for an appointment are from Hamilton, and the list is now closed because of capacity issues. As every LGB person knows, the coming out process, while ultimately liberating, can be long and painful. For trans people, the prospect of coming out is made more daunting because of hostility, stigma and discrimination, even from presumed ‘allies’ within LGB communities.
To muster up the courage to make an appointment only to be told you won’t be seen for many months in the future, and even after that first appointment you’re not going to be starting hormones until several months later, can be devastating. This is not an indictment of Quest by any stretch of the imagination. They have been a welcome oasis for hundreds of trans people over the last few years, but it needs to be said that one community health centre operating a clinic one day a week for the entire population between Niagara and Toronto is unsustainable and inappropriate in the current context of legislative measures to protect trans human rights and dignity.
The Hamilton Trans Health Coalition (HTHC) came about as a result of that initial meeting late last year. Now composed of more than twenty individuals representing various health care institutions, including Hamilton’s largest Family Heath Team, a bunch of trans individuals, and growing each month, HTHC is rapidly bringing trans health care home to Hamilton.
There is the Gender Diversity Clinic at McMaster Department of Adolescent Medicine, which sees children up to 17 years old. And, the Shelter Health Network has opened a twice-monthly clinic especially for trans patients who do not currently have a family physician, or who have a family physician who is reluctant/new and wants some mentorship. The clinic has been open for less than 2 months and they have already seen more than 10 individuals.
We also have at least one family physician who is only accepting Trans patients for the time being, and she receives several calls a week.
We are in the process of developing a section in Hamilton’s Red Book – a comprehensive listing of all social and community services in the city – dedicated to trans resources, and that will be live soon at http://informationhamilton.ca/redbook
We are still in the infant stages of this project, but the momentum is building. On June 3rd, HTHC set up a booth at the Hamilton Public Library for a 100in1Day event where 35 allies wrote letters to their own family physicians to ask them to accept and support – or congratulate them on already supporting – trans Hamiltonians.
Are you wondering how you can be part of change on this issue in Hamilton? Are you a cisgender person who has a family physician? Why not ask your family physician if they’ve ever read the Sherbourne Protocols for trans health care, and if they haven’t, share the link with them?: http://sherbourne.on.ca/wp-content/uploads/2014/02/Guidelines-and-Protocols-for-Comprehensive-Primary-Care-for-Trans-Clients-2015.pdf. Ask them if they’ve heard of the Hamilton Trans Health Coalition. Tell them you’re an ally and you want your doctor to be an ally too.
Get involved by contacting us at email@example.com
Hamilton Trans Health Coalition: @hamtranshealth | firstname.lastname@example.org
Information Hamilton: informationhamilton.ca