CHENNAI: Five years ago, Ramachandran Srinivasan set out to donate blood for the first time in an attempt to do a good deed on his birthday. Little did he know that the hospital required more than just a sample from a healthy donor. When the bi-gender, gay person proceeded to submit forms, excited to donate blood, he was met with an unexpected volley of questions.
“I was asked whether I have had sex with men and other intrusive questions — Was it penetrative? What was your role? When I refused to answer some of these questions, I was denied the opportunity to donate blood,” he begins, sharing that despite having taken an STD test recently, the stigma that gay people are likely HIV or AIDS positive coloured the judgement of the medical personnel. This unfortunate incident now marks the memories of his birthday.
“I was looking forward to it, so you can imagine I was very upset by this. I was disappointed,” he reminisces morosely. The next time Ram returned for a blood donation for someone in dire need, he was forced to hide his sexuality. “I am a metrosexual person. They tend to notice if someone has feminine traits and ask them these questions. The last time I donated blood was in 2019, and then, they just rephrased the same questions. The situation is slightly better now, but there is still a lot of stigma and discrimination,” explains Ram, the founder of LGBTQIA+ support group Pink People.
This story reveals one of many battles fought by the queer community in their quest for unbiased healthcare. While the Right to Health is a fundamental one of every citizen, the reality of this is far less ideal. In a country that took 71 years of freedom to acknowledge the legal existence of the LGBTQIA+, a non-discriminatory healthcare system is a distant dream.
However, this dream became a little less ambitious on October 13, when the National Medical Commission (NMC) of India issued an advisory urging institutions and universities to revise their textbooks, for many medical books contained unscientific information and derogatory remarks against the LGBTQIA+ — featuring cross-dressing as “sexual perversion”, the antiquated term “sodomy” with no differentiation between consensual and non-consensual sex, for instance.
“The information currently in our textbooks goes against all the advances in science and medicine, and has been a consequence of them being printed with hardly any update (till now). This information translates into bias on the field,” narrates L Ramakrishnan, vice president of NGO SAATHII and an LGBTQIA+ activist. “There are three things to be taken into account. One, derogatory terms. Two, outdated information (such as referring to homosexuality as a ‘psycho-sexual disorder’ and trans people as having ‘gender identity disorder’).
And three, the absence of essential information about the LGBTQIA+. Of these, the first two have been mentioned in the advisory. The third, however, is yet to be addressed. It refers to the lack of representation for same-gender attraction or transgender identity in a non-pathologising way in pediatrics, for example,” shares Ramakrishnan.
While the announcement was based on a Madras High Court judgement from September, we saw inklings of the same in an earlier order in the S Sushma vs Commissioner of Police case. For the latter, Justice Anand Venkatesh had an interaction with several members of the queer community, including Ramakrishnan and Dr Trinetra Haldar Gummaraju (Karnataka’s first trans woman doctor). The report, written by Dr Trinetra, discusses social rejection, harassment, conversion practices, healthcare and much more, “...He also acknowledged...that the institutions of this country have absolutely no right to interfere in aspects of one’s identity which are but natural, and integral to their overall existence. It is perhaps time that the pillars of democracy, law enforcement, the medical fraternity all acknowledge the errors of their ways, and make reparations.” Subsequently, the NMC, Ministry of Education, School Education Department and Department of Higher Education were suggested to change school curricula and conduct outreach programs.
Stigma and the plague of fear
Sensitisation and awareness camps for the medical fraternity were mentioned as well, which are necessary to erase unsavoury practices and build healthy communication with the queer community. This is much needed, according to Dr Sneha Rooh, a palliative care professional who identifies as a cis gender bisexual woman, “We need to train our ground staff on how to deal with the LGBTQIA+. A watchman once told my friend, a trans woman and intensive care doctor, ‘tu kya hain, main jaanta hu’ (I know what you are) There are other practices like calling someone by their dead name, using the wrong pronouns or misgendering them.”
This, however, also extends to doctors and nurses whose treatment has left many with a sour taste. “Most of us refrain from visiting hospitals for fear of judgement and embarrassing questions,” says Sharan Karthick Raj, co-founder of Tamil Nadu LGBTIQ and a gay man. In 2006, Sharan took residence in a boy’s hostel in Chennai. With residents not washing bathrooms or cleaning up, bacterial and fungal infections became common. “When I first saw the signs of an infection, I was worried that it was a sexually transmitted disease and was hesitant to visit a doctor. I went to a hospital nearby where they treated me for two months but I remained uncured. I hid my sexuality then because I had no back-up and was afraid of them informing my family (despite being an adult).”
The lack of knowledge and sensitisation in the medical fraternity can often lead to invasive questions. “I was able to have access to doctors who are not too intrusive through friends but if I were to randomly go to a gynaecologist, they would ask me why I am not married — I am 36 years old — and other uncomfortable questions. If a person has a different gender presentation, they are asked weird questions; weirder if you are non-binary,” rues Deepthi K, a cis gender lesbian and core team member of Chennai Queer Club. Questions of marriage may seem commonplace on the face of them, but in such situations, they are often used as euphemisms to pry into a queer person’s sex life, shares Ramakrishnan who has heard of troubling cases where doctors impose their notion of femininity and reproduction. “A surgeon, regarding a hysterectomy, once told a trans man, ‘How could I remove the uterus for someone who has not experienced the pleasure of childbirth,” he says.
Ignorance and information
Social ostracisation of the LGBTQIA+ aside, distasteful practices are often born out of ignorance, many from the community report. Curious medical students aren’t particularly sensitive, creating uncomfortable moments for queer patients. “There is also a lot of curiosity because of lack of exposure. For instance, a check-up for an STD would include questions like: Did you have sex with a man or a woman? How did you get this? Something a straight person would not hear. Or otherwise, do you have a uterus? Can you penetrate? And everyone looks at them. It’s understandable that they are trying to learn but they should also consider the trans person’s point of view,” sighs general manager of NGO Sahodaran and trans woman, Jaya.
Ramachandran concurs, but also observes that Tamil Nadu is more active than most other states. Several NGOs work with the medical fraternity for training and workshops. “There is still a long way to go and a need to make provisions for minorities and alternative genders. Many NGOs here have tie-ups with local doctors for check-ups, so, the community often depends on them. Some on their list are also quite expensive, but some are flexible to give a discount,” he says, referring to lists of LGBTQIA+ friendly doctors made by NGOs. These lists of vetted professionals or queer networks are necessary solutions for some in the community, who fear visiting doctors otherwise, according to Deepthi.
Lack of skills and resources
Sneha, the founder of Orikalankini and a vetted doctor, has witnessed unfavourable conditions of the healthcare system from the inside. “When it comes to infrastructure, very few hospitals have neutral wards. Even on forms, there is a box for husband and wife, but none for spouses. This also is an issue when it comes to decision-making,” she says. The same can be said about washrooms, mention both, Sneha and Ramakrishnan. “The SC has asked all hospitals to be gender-neutral but that is not yet a reality. All restrooms are male and female, so transgender and non-binary people and more are often excluded,” the latter shares, adding that there are challenges in medical education, combined with socio-cultural bias against anything that is heteronormative and eventually contributes to substandard service and unethical practices.
With the Tamil Nadu Aravanigal (Transgender) Welfare Board, schemes for insurance, education, employment, provision for sex reassignment surgery and transgender clinics are now more accessible but that does not guarantee a satisfactory experience, as Heena, a trans woman, can attest. For her sex reassignment surgery, Heena opted for a government hospital due to financial reasons but was met with disappointing efforts from the medical fraternity. According to Heena, despite having the same implants, treatment and care at the government and private hospitals were not comparable. The former lacked experience and did little to follow up after her surgery.
“When I got my breast implant surgery done (four weeks post the check-up), there was a problem post-operation. But when I revisited the hospital for a follow-up, there was no response. They kept delaying the date and finally, after a week, I stayed there for 10 days before I got the implant removed. Two months later, I had to spend over `1 lakh to get it done at a private hospital that did it successfully in one week. Wouldn’t I have saved and gone to a private hospital first?
The government hospital said that the 250 g implant didn’t set (to my body), but then how did the 300 g implant set at the private hospital?, she questions. Conditions may be imperfect but with time, more people are becoming allies, accepting the queer spectrum — albeit at a snail’s pace — and working to restore the rights of the LGBTQIA+. Today, we have begun with medical textbooks and medical lists. Hopefully, there is more change to come.
LGBTQIA+ friendly medical resources
SAATHII-Varta Orinam Safe Access
In principle, the Right to Health is a fundamental one for all citizens, but it seems to be a distant dream for the LGBTQIA+ community that frequently faces discrimination and disappointing treatment from the healthcare system