A Safe Space to Open Doors For Well-being

- By Simran Bharucha

The spread of the Omicron variant has, yet again, put the healthcare sector to test. Availability of healthcare services may soon become a grave concern for many of us. However, for transgender people, this is a recurring scare.

Access to healthcare services for 4.8 million transgender people in India is overlooked. Curiosity and a gaze of disgust greet transgender people in most rooms. An overwhelming inequality exists in granting them access to not just healthcare, but also employment opportunities and legal services. Transgender people struggle to access the right treatment for illnesses and are forced to self-treat or visit unauthorized and undereducated medical practitioners.

Despite being recognized as the third gender after a landmark judgement in the case of National Legal Services Authority vs Union of India, the socio-economic status of transgender people remains threatened. This stems down from stigma around their occupation, which is sex work for most of them. It is not the case that they do not want to work in other sectors but rather utter neglect in the recognition of their identities, and those of the other genders that pushes them into sex work. Violence against them is commonplace. Cases often go unreported because of systemic bias against them. While struggling to earn a decent living, they also face higher risk of contracting multiple diseases, some of them sexually transmitted.

With transgender people at such great risk, it is imperative that we push for changes in our medical system and make healthcare truly accessible to all. It is crucial that we understand their needs and expectations from the medical sector and come up with tailor-made interventions to cater to this community.

Efforts have been made to reduce the gaps that exist. One such effort is the establishment of the Johns Hopkins University School of Medicine led Mitr clinics – medical facilities run by members of the transgender community, in collaboration with implementing partners, YRG Care, under the aegis of Project ACCELERATE. Mitr clinics cater to the health and well-being of transgender people in a holistic manner. Stigma, discrimination, violence, socio-economic disparities are all left at the doors of these clinics. The cultivation of a safe space begins at its doors, a space where everyone is treated respectfully.

Mitr clinics offer all kinds of healthcare facilities – from basic medication to surgeries, counselling, and mental health assistance. A large part of their work also involves mobilizing community members through sensitization programs. These programs are carried out by trained professionals from the transgender community. The aim is to apprise transgender people of safe practices, varied implications of health issues, and treatments and facilities available to them.

These clinics have been quite successful in making healthcare accessible to the transgender community in India. It is through these clinics that the transgender people feel welcomed and can openly talk about the issues they face, with the medical practitioners, without feeling the pressure of being judged or denied service. Self-treatment and consulting unauthorized and undereducated medical practitioners have reduced in areas with Mitr clinics.

A highlight of the success of the Mitr clinics model is their approach towards the community in running needs-based assessments to understand the expectations of transgender people. At the same time, Mitr clinics’ sensitization program apprises the community of upcoming services that would be offered there. During these sessions, members of the community share feedback on the existing and upcoming services, which is considered to make the clinics more inclusive. This feedback mechanism helps the program expand services. So far, it has helped the clinics include psychiatry, mental health assistance, Gender affirmation surgeries, and many other services, instead of limiting them to addressing HIV and other sexually transmitted diseases.

Transgenders are a large population group, and it is vital that we cater to their needs. Healthcare is a fundamental right. Stigma, discrimination, socio-economic background, or occupation should not be barriers in accessing healthcare services. The Mitr clinic model is a shining example of making healthcare accessible to all. It is a learning on how creating safe spaces can lead to greater wellbeing.

(The author is Director at Transgender Health, Project ACCELERATE)