Sex reassignment surgery and price of a rebirth

Ananya was not an introvert. She was the state’s first radio jockey, activist and the first transperson who contested in an assembly election.
Members of the transgender community during a protest in Kochi on Wednesday
Members of the transgender community during a protest in Kochi on Wednesday

KOCHI: The plight of Ananya Kumari Alex, the first transgender radio jockey in the state who died by suicide after drawing attention to her harrowing experiences of undergoing a sex reassignment surgery (SRS) in a city hospital in Kochi, reveals how apathetic the society is still towards them. Ananya was one among the many who have faced serious health issues post surgery, reveal her friends. However, social stigma and  fear of humiliation from society keep them silent.

Days before her death, Ananya had posted a video, explaining the trouble she had undergone post surgery, the humiliation she faced when she requested the hospital for a re-surgery and the harassment she faced when she demanded her treatment summary.

Ananya was not an introvert. She was the state’s first radio jockey, activist and the first transperson who contested in an assembly election. She had extraordinary talents and her voice speaks how transparent and certain she was about herself. She was hurt, physically and emotionally. From the family, her father was the only one who stood by her. And it is strange to see that many of the activists among the transgender community did not come forward to offer her unconditional support in her fight with the hospital. Her body was buried in the presence of her family members  on Thursday. Three days after her death, her partner also died by suicide on Friday.

Allegations by her friends
Queerythm, a registered organisation of the LGBTIQ (Lesbian, Gay, Bisexual, Transgender, Intersex and Queer) people, who fought with Ananya for her cause, alleged that the hospital and the doctors who led the surgery should be held responsible for her death. 

President Prijith P K said the government did not intervene to stop the ongoing SRS at the same hospital, pending investigation. “A petition was submitted at Palarivattom police station after the public relations officer hit her. However, when we enquired about the case, the officer concerned told us that he was new to the office and was not aware of the case. We fear that her post-mortem report as well as the investigation into the death would be jeopardised,” Prijith said.

He alleged that the particular hospital scheduled an SRS even a day after Ananya’s death. “The doctor who led the surgery is attending to multiple patients and they are concerned only about the fees. This hospital does not follow any guidelines on giving counselling to the patient. They immediately send the individual to the surgery.

Ananya Kumari Alex
Ananya Kumari Alex

Competency of hospitals in question
Friends of Ananya and activists alleged medical negligence in performing the SRS at Renai Medicity a year ago. According to Bismi Gopalakrishnan,  head of School of Indian Legal Thought, Mahatma Gandhi University, there should be a monitoring body to check the competence of the hospitals as well as the doctors who perform the surgery.

“Here, the surgery was a specific procedure. We should check if the doctors and the hospital were competent enough and if there was any negligence in performing the surgery. I understand that there was negligence in the post-operative treatment. There was not a urologist and a gynaecologist while conducting the surgery,” she said.

What is SRS and why do people undergo it?
Sex Reassignment Surgery refers to procedures that help people transition to their self-identified gender. Today, many people prefer to use the terms gender affirmation or confirmation surgery. People may have surgery so that their physical body matches their gender identity. People who choose it do so because they experience gender dysphoria — the distress that occurs when your sex assigned at birth does not match your gender identity.

What happens during SRS?
It varies depending on the procedure. You may choose facial surgery, top surgery, bottom surgery or a combination of these operations. If you are a transgender woman (assigned male at birth or AMAB), other surgeries may include Adam’s apple reduction, placement of breast implants (breast augmentation), removal of the penis and scrotum (penectomy and orchiectomy), construction of a vagina and labia (feminising genitoplasty).

If you are a transgender man (assigned female at birth or AFAB), you may have surgeries that involve breast reduction or mastectomy, removal of the ovaries and uterus (oophorectomy and hysterectomy), construction of a penis and scrotum (metoidioplasty, phalloplasty and scrotoplasty).

Psychological rehabilitation
According to psychiatrist Dr C J John, trans persons have an intense desire towards SRS. “In reality, they should be emotionally prepared for the surgery, its outcomes and fully aware of all the complications and agonies attached with the procedure. They will have to face many levels of psycho-social issues after the surgery. Though all hospitals follow the regular procedures of ensuring that the person is in need of surgery and counselling them of the impacts, they forget that they also require psycho-social support and mental health support at all levels,” he said.

Cost of SRS in Kerala
The cost of SRS depends on the number of surgeries and the types of surgeries that a person chooses. Officials of Sahayathrika in Thrissur, an organisation catering to lesbian/bisexual women and transgender persons of Kerala origin, said they are mainly working for transmen and 90 per cent of them go only for top surgery. “The cost of top surgery in Kerala can go up to Rs 1 lakh. They avoid other surgeries since they involve more complications that might continue for a life term. In the case of transwomen, the surgeries are more complicated and the cost can go up to Rs 2 lakh to Rs 3 lakh,” said one of the officials.

Why are government hospitals not offering SRS?
Not many government hospitals in Kerala are offering SRS, said Sruthi, an official of Sahayathrika. “At present, only Government Medical College, Kottayam, is conducting such surgeries. Only one or two people have undergone surgeries there. Many transmen had completed surgeries at the hospital where Ananya underwent surgery. However, none of them developed complications. That may be because their surgery was comparatively simpler,” she added. In Government Medical College, Thiruvananthapuram, an SRS was performed in 2017, the first such surgery in a government hospital. Currently, five private hospitals are performing SRS in the state.

Social justice department’s proposal
Though a transgender policy was launched in 2014, a standard operating procedure (SOP) pertaining to the rights and issues of the trans people were not formed. In 2019, the social justice department submitted a proposal to the government to fix guidelines for many issues concerning the transgender community, including SRS. It suggested a fully-developed unit in Thiruvananthapuram and Kalamassery medical college hospitals to perform SRS. However, that proposal is not yet considered, according to sources in the department. Kerala is now following the guidelines of the Medical Council of India. At present, the department has formulated a scheme which provides financial assistance to transgender persons for undergoing SRS, according to the department website. The maximum amount is `2 lakh. To apply for the amount, the applicants must possess transgender identity cards, address proof, medical report regarding the SRS from a hospital and declaration from the doctor concerned. The applicant must be aged at least 18.

Reply from the hospital
Authorities of Renai Medicity, refuted the allegations related to medical negligence in the case of Ananya. The statement by its medical director absolved the team led by Dr Arjun Asokan, who performed the surgery, and Dr Madhu, from the Renai Centre for Comprehensive Transgender Health, of negligence. “Though Ananya developed intestinal obstruction,  a common complication of the surgery, it was addressed by a procedure. She was satisfied with the treatment at the time of discharge. It was after 6 to 7 months of the surgery that she complained about surgically implanted body parts and some urinary issues,” said the statement. It said another surgical procedure was recommended to resolve the issues and she was convinced of going through the follow-up treatment.

Is it possible for a transperson to shift to another gender easily with the help of sex reassignment surgery? How expensive is it and how does the person find money for the same? Are they welcome after the surgery? TNIE looks into some primary questions being faced by the trans community in Kerala

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