Do government hospitals in Delhi, or anywhere else, have what it takes to perform these crucial surgeries?
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In July 2021, Kerala's first trans woman radio jockey Anannyah Kumari Alex was pushed to take her life, allegedly due to medical negligence during her gender affirmation surgery. Anannyah had publicly voiced her discomfort and dissatisfaction over the surgery performed at a private hospital in Kochi, but received no support.
This is why the Delhi Health Department's circular, directing government hospitals to provide free sex-reassignment surgeries (SRS), is much-needed. But it is also something that needs to be treaded with caution, say medical activists.
The circular mentions that all government hospitals with burn and plastic wards, along with the facility of a surgeon, must begin providing transgender people free sex-reassignment surgeries.
As per the Transgender Persons (Protection of Rights Act) 2019, at least one state government hospital should offer SRS to those who identify as transgender persons. However, this has not been followed by most states, Dr Aqsa Shaikh, a community medicine expert, who also identifies as a trans woman, told The Quint.
Dr Shaikh explained that gender affirmation treatment can come in many forms, and there needs to be clarity on whether the Delhi government means only surgeries. To break it down, a transgender person, who wishes to undergo a gender affirmation surgery, would first:
Consult a mental health professional
See an endocrinologist or gynaecologist who would put them on hormone replacement therapy (HRT)
Laser-induced hair removal
Surgeries like breast augmentation, in cases of transgender women, or mastectomy (removal of breasts), in cases of transgender men
Vaginoplasty or phalloplasty
Dr L Ramakrishnan, public health professional from NGO SAATHII, in Chennai, explained to The Quint that some gender-affirming surgeries can be performed at government hospitals, provided they are gender-sensitised and equipped with the required skills.
For example, he explains, a surgeon may have the skills to perform a mastectomy (removal of breasts) or oophorectomy (removal of ovaries) – but they should not be experimenting with the bodies of patients by performing vaginoplasty when they have no training for it.
Tarun, a medical counselor and man of trans experience, points out that performing a mastectomy on a cis-het body, and on the body of a person who identifies as trans, requires different skillsets. Speaking to The Quint, he said:
A surgery like phalloplasty is very rarely performed in India – as it requires a high level of skill. It is also much more expensive than vaginoplasty.
"Any genital reconstruction must absolutely be performed only by highly trained and skilled professionals. To start with, doctors can start providing all the other healthcare services, and those interested must be trained in these surgeries," Dr Shaikh told The Quint.
Dr Ramakrishnan agrees.
However, if gender-affirming surgeries are going to take place regularly in government hospitals, then the ICMR and National Medical Council (NMC) guidelines, which are followed across the country, need to be in place.
Dr Shaikh added that many doctors who have the skills do not perform gender-affirmation surgeries due to the threat of a legal case – but government guidelines can help overcome this barrier.
None of these guidelines or suggestions can be effective if hospitals lack respect that people from the queer and trans community deserve, say both doctors and activists.
According to Vignesh, hospitals need to consider a separate ward for transgender persons undergoing SRS to ensure their safety.
"There are some government hospitals in Chennai that has a separate ward for transgender persons undergoing SRS. But if this is not possible, one must consider a gender-neutral ward and washrooms. All these things seem small, but they matter," he says.
Dr Shaikh claims that less than 2 percent of trans persons in India have a community card, and the rest do not have access to even basic services due to a lack of identification cards. "Government should address at the earliest the red-tapism."
But most importantly, ensure respect, says Dr Shaikh.
"Don't make transgender persons turn away from healthcare services they deserve and need, because of transphobia."
"Everyone needs to be sensitised, right from the chairperson of the hospital to the ward staff. If this is not done, people will not turn up for better healthcare services, and these will remain policies on paper," Tarun added.
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