Trans people seek bias-free healthcare
Transgender individuals in conservative small towns are too scared to seek medical treatment
During a support group meeting for transgender women — held in a tiny, two-bedroom RDP house in the rural North West town of SchweizerReneke — one of the women started coughing violently.
“We were all really concerned for her,” says Seoketsi Mooketsi, the trans rights activist who established the group. “I advised her to go to the local clinic, but all she said was: ‘It’s not that easy, chommie.’”
It being her hometown, Mooketsi knows all too well what makes accessing this service “not that easy”.
“There is still a lot of stigma,” she says. “Going into a healthcare facility, telling healthcare workers that you are transgender and facing that stigma is something that keeps many from accessing healthcare.
“You’d go to the hospital and nurses would say things to their colleagues like: ‘Yhu, this one is gay … Must be HIV-positive.’ There is this presumption that if you’re queer and going to the hospital, it can only be because you’re HIV-positive. It can’t be because you have flu or whatever.”
Mooketsi adds that, for queer and transgender people, accessing healthcare in the “extremely religiously conservative”, predominantly Christian town is “still very difficult”.
Anastacia Tomson, a transgender woman and medical doctor, says the principles of medical ethics “demand that we as clinicians treat patients fairly and without prejudice, irrespective of our personal beliefs or positions.
“The reality is, we know that transgender patients benefit tremendously from inclusive and accessible medical care, including surgical procedures, and that encouraging doctors to withhold treatment from trans individuals cannot be considered ethical, safe or efficient. Furthermore, strong scientific evidence exists to dispel the idea that gender identity is at all a matter of choice.”
Ronald Addinall, a clinical social worker and sexologist at the University of Cape Town, facilitates a transgender support group at sexuality healthcare organisation the Triangle Project.
“One of the core challenges faced by transgender people in their journey to coming to terms with who they are is shame,” he says.
“They have often been judged or rejected or told that they are bad or wrong or evil or sick. If a transgender person in that position comes across a health practitioner who holds these conservative beliefs — and, more importantly, acts on those beliefs in a way that further deepens and entrenches this sense of shame — the transgender individual comes away feeling a deeper sense of shame. This can, and does, impact significantly on their selfesteem in a very profound way.”
Addinall says such conservative attitudes exacerbate depression, anxiety and suicide rates in transgender communities, which are higher than those of the general public. A 2008 study found that “the prevalence of attempted suicide was
32% [among transgender people because of] depression, a history of substance abuse treatment, a history of forced sex, gender-based discrimination and gender-based victimisation independently associated with attempted suicide”.
The study found that suicide prevention interventions for transgender persons were urgently needed.
“This is not because depression and anxiety are innate to trans people,
but because they often find themselves in environments in which they have to battle for acceptance,” says Addinall.
He says, although this study is an overseas one, “if one factors in the levels of poverty and trauma in South Africa, this figure would more than likely be much higher locally”.
As with many transgender people who come up against health practitioners who refuse to acknowledge
their innate dignity, the women in Mooketsi’s rural hometown have very little, if any, choice.
“There were times during our meetings when some of the women would break down in tears, saying that if they had the resources — the money — they would pack up and leave this town,” she says.
“It’s the conservatism here, the extreme religious conservatism. It has become too much for them.”