A Wholesome Health Care for Transgenders: Sex Reassignment Surgery

This article was exclusively written for The European Sting by Ms. Purva Shah and Mr. Poojan Thakkar, two final year MBBS students at Medical College, Baroda, India. They are affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

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After decades of keeping their heads down followed by years of protest, the LGBTQI+ community has finally found its place in the Indian constitution by revoking the fateful article 377, which criminalised them instead of acknowledging them. Having said that, the crucial question is, will society welcome the LGBTQI community compassionately, when the judicial system took almost a hundred and fifty-five years to give them recognition? Will this ostracised community be able to fulfil their basic needs, let alone receive equitable healthcare? Transgender is an umbrella term that describes people whose gender identity or expression does not match their sex at birth.^[1] Transgenders have been cross-dressing and masquerading as the opposite gender since time immemorial but the first one to undergo medical intervention recorded in history is a German transgender named Karl M. Baer, who was born a male but raised as a female. Sex Reassignment Surgery (SRS) consists of a series of technically demanding and life-threatening procedures which are unreasonably overpriced, complemented by a lifelong hormonal therapy. Out of 7 lakh transgenders willing to undergo SRS in the Indian state of Karnataka, only 200 were able to go through with it, because of lack of fundings.^[2] Due to a lot of legal hassles associated with such operations, the few doctors in the country who have specialised in this field also shy away from providing timely and appropriate care to these patients. However, the Indian medical diaspora is turning over a new leaf with the state governments in Chennai and Kerala providing SRS free of cost.^[3] SRS is just one facet of the diverse health care requirements of people from this community. The medical and psychological conditions associated with transgenders is different from those suffered by the general population. Sexual assault and sexually transmitted diseases are very common amongst the people from this community, along with a poor quality of life and depression. Although transgenders who have undergone SRS face less social stigma, they are more prone to a variety of cancers due to long term hormonal therapy.^[4] Since medical students are not exposed to such patients early on in their career, it becomes all the more difficult for them to understand and deal with such varied and divergent health problems. Hence, in order to provide better healthcare to transgenders a part of the medical curriculum must emphasise on the health care requirements of these people and thereby attempt to instil a streak of sympathy for them. Government health budget for medical care must include financial aid for transgenders willing to undergo SRS and must also sponsor research in this field. In addition to the conventional female and male wards, a special ward may be created for the LGBTQI+ in hospitals. Counsellors must be available at hospitals to prevent mental illnesses and thereby strive to lower the suicide rates among these patients. Starting with the eradication of discrimination and social stigma against these patients, we have a long way to go in providing wholesome and customised care to the patients from community “RAINBOW”. References

• Science, L. (2019). What Does ‘Transgender’ Mean?. [online] Live Science. Available at: https://www.livescience.com/54949-transgender-definition.html [Accessed 28 Jun. 2019].
• The Times of India. (2019). Though willing, many can’t undergo sex-change operation: Transgenders | Bengaluru News – Times of India. [online] Available at: https://timesofindia.indiatimes.com/city/bengaluru/though-willing-many-cant-undergo-sex-change-operation-transgenders/articleshow/60493344.cms [Accessed 28 Jun. 2019].
• Sinha (2019). Kerala offers free sex change operations to transgender community after Tamil Nadu. [online] India Today. Available at: https://www.indiatoday.in/india/story/kerala-tamil-nadu-free-sex-change-surgery-transgender-1311137-2018-08-10 [Accessed 28 Jun. 2019].
• org. (2019). Indian Journal of Anaesthesia (IJA)- Perioperative anaesthetic concerns in transgender patients: Indian perspective : Download PDF. [online] Available at: http://www.ijaweb.org/downloadpdf.asp?issn=0019-5049;year=2019;volume=63;issue=2;spage=84;epage=91;aulast=Shah;type=2 [Accessed 28 Jun. 2019].

About the authors Ms. Purva Shah is a final year MBBS student at Medical College, Baroda, India. She worked under Dr. August Lynne for her distant paid internship where she collected information from previously published articles and standard books and developed new ideas related to lipids and minerals. She is the LORE (Local Officer for Research Exchange) in MSAI, IFMSA and the State Joint Secretary in AIMSA (All India Medical Student Association) for the year 2019-20. She is the medical head for a local NGO where they are trying to improve the health and sanitation of slum kids and have organised various medical camps for the same. She is an avid reader and an even more dedicated writer having been the content writer for Stemjar, an online information portal and having published some articles like a recent one in MSI40 (Medical Students International). Mr. Poojan Thakkar is currently studying M.B.B.S at Medical College Baroda and S.S.G. Hospital. His hobbies include quizzing, playing sports and reading. He has secured top positions in quizzes of various specialties (Pediatrics, Psychiatry, Community Medicine) and held the leadership of the Sponsorship, Public Relations, and sports teams for his college fest. He has written case reports and presented it at various competitions. He has attended various conferences and workshops concerned with the skills in medicine and emergency. He has written many articles for the college newsletter and one of his articles has been selected to be published in MSI40 (Medical Students International).