HALIFAX — A new provincial campaign is looking to get universal healthcare coverage for transgender Nova Scotians.
The Trans Liberation League, a collective of local activists, kicked off TRANS*form Healthcare last month, with demands of comprehensive coverage of trans health needs, mandatory training for healthcare professionals around trans health and consent issues, and funding for transition procedures.
The collective saw the addition of gender identity and gender expression to the Nova Scotia Human Rights Act in November 2012 as a spark for its health demands.
Laura Shepherd, a transitioning woman, sees improved healthcare services for transgender people as a human rights issue.
“The culture (in Nova Scotia) is not given to full participation in society and self-determination, even when it provides equality,” she said, citing the three principles of the act at a TRANS*form Healthcare event Feb. 6.
The event, held at the Halifax Infirmary, provided an overview of the status of trans healthcare in Nova Scotia and what remains to be accomplished. In sum: a lot.
Shepherd detailed her experience transitioning as a middle-aged woman from the South Shore. The beginning of her transition coincided with many changes in her life: a break-up, her teenage boys moving out and problems with addiction.
Faced with limited options for help with her transition, she sought out an addictions counsellor, who in turn looked into a specialist at Capital Health. Eighteen months later, Shepherd discovered the specialist her counsellor was trying to contact had retired.
“I have never put a timeline on (my transition),” said Shepherd, who is now seeing an hormone therapist, “because I knew it was unpredictable.”
The serious disconnect between health districts when it comes to specialists dealing with transitions is at the heart of trans health issues is Nova Scotia, said Cybelle Rieber.
As the co-ordinator of prideHealth, a partnership between Capital Health and the IWK to provide primary healthcare services to the LGBTQ community, Rieber deals with the frustrations of trans clients firsthand.
“I would like to say that we have this pathway that’s open and clear,” she said of accessing transition services, “but we don’t. We just don’t.”
She explained that trans health services are available in the Capital Health District Authority, covering the HRM and parts of Hants County, and are progressing in Annapolis Valley Health.
“If you don’t live in one of those districts,” said Rieber, “you’re kind of S.O.L. [shit out of luck].”
Healthcare practitioners aren’t supposed to take on patients outside of their district, so they rarely advertise their specialties, such as endocrinology (those who prescribe hormone therapy). That means that practitioners in a district without trans services often don’t know who to refer their patients to in another area.
“That’s one of the biggest issues is that people are seeking healthcare over here, over here and over here and health professionals have no idea how to help them,” said Rieber.
Haligonians looking to transition aren’t much luckier.
Rieber walked the audience through the step-by-step process of accessing transition services in the Capital Health District Authority, from the first assessment to seeing an endocrinologist. Each step takes two to upwards of ten months, and frequently patients stalled or sent back for more assessments. For those who make it to the hormone therapy stage, they face yet more waiting.
“There is one endo(crinologist) in Nova Scotia who prescribes hormone therapy. She does it part-time,” said Rieber, “and her waiting list is three to four months.”
Transgender people wishing to avoid the snail paced public route can opt for a private practitioner, but these are costly and their referrals still bottleneck at endocrinology.
General practitioners have the capacity to prescribe hormone therapy themselves but are allowed to refuse should they not feel adequately educated on trans health.
This lack of knowledge amongst many healthcare professionals is too often the problem, said Rieber, and something she is trying to change with prideHealth programs.
In March, prideHealth is teaming up with the Canadian Professional Association for Transgender Health to educate those professionals who are in a position to assess transgender people for treatment. Rieber said she hopes the workshop, which will engage transgender people, will help to “demystify” trans and gender non-conformity issues.
If questions by Capital Health workers and medical students in the audience were any indication, this type of education is in demand.
“Transgender is an umbrella term for people whose gender identity differs from the sex or gender they were assigned at birth, and for those whose gender expression differs from what is culturally expected of them. The term transgender is not indicative of sexual orientation, hormonal makeup, physical anatomy, or how one is perceived in daily life.” (Source: Really Awesome Trans Glossary)