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August 18-31
VOL.14 ISSUE. 26

A Huge Blind Spot

Nathan Raine
Published Wednesday March 4, 03:18 am
Transgender health care services are sorely lacking in Saskatchewan

Know anything about transgender health care in Saskatchewan? No? Well, you’re definitely not alone.


Protections and services of any kind for transgender individuals in Saskatchewan have long been horribly lacking, although the Province is finally taking at least a few steps forward. This past December, for example, Bill 171 — which added gender identity as a protected ground under the Saskatchewan Code of Human Rights — was passed in the Legislature.


But health care for trans-identified people still leaves a lot to be desired, as a lack of both knowledge and willingness to help often leaves trans-identified persons unable to access health services that meet even their basic needs.


“Health care here for trans people is inadequate and inaccessible — and the services that we do have, there's not enough of them,” says Leo Keiser, executive director of the Pride Centre at the University of Regina. “[Professionals] who have an education or background in working with transgender people are constantly full up, and wait times can be pretty ridiculous.”


The problem runs deeper than just long wait times. Things that a lot of people take for granted, such as receiving health care in a non-condemnatory manner, is all too often a rare luxury for trans-identified persons. Keiser says it's not uncommon for a physician to turn down a patient based on their gender identity.


“I know a lot of [transgender] folks who won't go to the doctor for anything because they’re sick of being pathologized and read in a certain way — even for more generic health concerns, like having a sore throat,” he says. “Health concerns often are not dealt with because they feel uncomfortable accessing health care of any nature.”


On a national level, transgender rights were set back recently when a Senate committee amended a human rights bill [C-279] which sought to fight hate crimes against transgender individuals by adding gender identity to the Criminal and Human Rights code. The amendment exempts places like prisons, crisis centres and public washrooms, and critics are calling the amendment inherently transphobic.


That type of transphobia is certainly reflected in Saskatchewan — in the lack of health care services for transgender individuals and in many other ways, says Miki Mappin, co-chair of TransSask Support Services.


“The barriers to transgender people can include disrespectful admission procedures, medical professionals who refuse treatment, a lack of available information on how to access already-established health services, and few medical professionals with the knowledge to support transgender and gender-diverse individuals.”


On January 15, the Saskatoon Community Clinic (SCC) adopted a resolution to improve access to health care for gender-diverse and transgender people. The resolution, submitted by Mappin, was certainly novel for the clinic.


“The resolution I proposed to the [SCC] board was a bit of a bombshell because a lot of them had never thought about this before,” says Mappin. “But a revision is very much needed. Public opinion is changing; people are learning more and more. The next step is having some meetings about where the deficiencies really lie.”


The resolution is structured around four main points: more inclusive documentation, education among the general public as well as health care professionals, access to information, and concerted investment in bringing in trained professionals specializing in trans-specific concerns.


SCC board president Anne Doucette admits that despite their best intentions to be a progressive and responsive board, improving transgender services hadn't been considered prior to Mappin’s resolution.


“It wasn't even on our radar, which is why it was wonderful that Miki felt comfortable enough to bring this forward to us. In the end it was overwhelmingly accepted,” she says.


In starting to dig into the issue, the SCC quickly realized the extent of the problem for transgender individuals when it comes to receiving proper health care.


“When you really start looking at it, it's scary what people don't know, and what's not available,” says Doucette. “We looked at some of the doctors and staff in the area, and there's a lot of education the medical professionals need to start looking at more seriously.”


Doucette says that the discrimination reported by many transgender individuals can simply be due to ignorance from the health care professionals, whether it's willful or not.


“I do think there is resistance — or there's just a lack of knowledge. I know that for some of the doctors in our clinic, they just don't feel that they have the adequate knowledge,” says Doucette. “I mean, doctors are people too. They're going to come to their profession with their own biases.”


Mappin, who identifies as transgendered, is well aware of the ignorance that clouds much of health care in Saskatchewan.


“It's a mixed bag right now. There's a lot of ignorance in the medical profession because they’re not given any training,” says Mappin. “Also, there are everyone from frontline receptionists, to nurses, to doctors and surgeons who are quite blatantly transphobic. We know about this through TransSask Support Services: we get a lot of people coming to us for advice on what to do. SaskHealth doesn't give you anything, so people come to us.”


One of the other most pressing issues brought to TransSask, says Mappin, is being represented accurately on one's health card and other legal documents. But changing your status in those areas can carry some extreme requirements.


“With SaskHealth, [the thing] is that as it stands right now they won't accept a gender change unless you’ve had a [sexual reassignment] surgery. And in most cases the surgeries that they require involve sterilization, which is sort of a gross infringement on human rights.”


But in order to get a surgery, one needs a referral from an authorized doctor, which Saskatchewan doesn't have. If approved, the only institution in Canada to perform the surgery is located in Montréal. And of course, Saskatchewan is one of the only provinces not to cover the expenses for that surgery, which can run from $20,000 to $80,000.


“Most other provinces cover a lot more of the costs, if not the full cost. There are legal difficulties, [but] hopefully they'll be looking at this soon, because the other provinces have found their way around the same difficulties,” says Mappin.


Essentially, SaskHealth doesn't allow payment for a procedure at a private clinic. They’ll only pay the direct surgical costs, which ends up being about a third of the total. The financial burden makes it very hard on trans people.


“And if accepted, you have to put up all the money upfront. And you're kept on a waiting list for over a year,” says Mappin. “And it's hard because a lot of transgendered people lose their jobs when they come out. I was fired from mine.”


Clearly, it’s an issue that needs attention in an abundance of areas.


“We're not putting enough care and attention in educating our care-providers in the way that we should be,” says Keiser. “I think that comes from the fact that our general population base doesn't know that this is a concern. So I think our social climate plays a huge role in our ability to know that we need to educate these positions. It's quite systemic, I think.”


“The biggest problem is systemic,” agrees Mappin. “My number one request for SaskHealth is that they provide that section on their website of information for what services they do offer. People should be able to find what information and resources are available. We're not the most behind here in Saskatchewan, but there are a lot of provinces in Canada that are quite far ahead, so it's not like the wheel has to be invented.” 

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