Updated: Jul 26, 2019
The Catalysts for Change in Transgender Healthcare
A TEDxMSU Talk Presented by Jo R. Codde, PhD
COMPASSION ·DIGNITY ·RESPECT
This past year I awoke early one morning extremely sick with intense abdominal pains. I was vomiting, soaked in a cold sweat, and laying on the kitchen floor. An ambulance was called, and I was off to the hospital. As I was wheeled in on a gurney, I heard a woman say, "Put her in this bay." But then, as I was being wheeled into that curtained bay, I heard someone else call out, "Hey – She's a HE, is this still where you want HIM?"
Within moments I realized the nurse assigned to me wouldn’t touch me. I asked for a warm blanket, but she refused to give me one despite the fact I was extraordinarily cold, shivering, and dripping with a cold sweat. Later, as I continued asking for a blanket, someone in a curtained bay down the line hollered out to the nurse, "Would you please get her a blanket?" Finally, she brought me a blanket. But rather than cover me, or hand it to me, or set it on the bed; she threw it at me! From there my night and the way I was treated in the ER got much, much worse.
As I reflect back on that horrible experience and wondering why it might have occurred; I made a decision. As an academic and now as a transgender woman I set out to find if my experience was unique to me or was this a more significant problem affecting the transgender and gender variant communities. What I found was according to a transgender survey published by the National Center for Transgender Equality, one-third (33%) of those who saw a health care provider in the past year reported having at least one negative experience related to being transgender. Including being refused treatment, verbally harassed, and even physically or sexually assaulted. Moreover, these negative experiences then led to 23% of survey respondents not seeing a doctor when they needed to because of the fear of being mistreated as a transgender or gender variant person. I can identify with this as I am a transgender woman - a 70-year-old transgender woman. And I know I do not deserve to be treated like this. Before I transitioned four years ago, I had never received this kind of care – ever. So why now? Is it because I’m now transgender?
I retired from the Michigan State University (MSU) College of Education in 2014 where my work focused on technology and training in-service teachers. Later my work shifted, and I began working in the Middle East, North Africa, and Pakistan where I continued training teachers, infusing technology, and designing eLearning programs. Now, I'm back at MSU putting my skills in education, professional development, and eLearning to work on new programs for healthcare providers.
Medical education in transgender health care in the United States is lacking. Doctors, nurses, and allied healthcare workers report being underprepared to address their transgender and gender variant patients' needs adequately.
As an academic and a transgender woman, I have a unique opportunity to address the vital healthcare needs of this underserved and vulnerable population of patients. And to do so, I'm beginning right here at Michigan State University with the College of Human Medicine by designing a new eLearning continuing medical education program designed for physicians who need to earn continuing medical education hours for their healthcare licenses.
The program I’m working on will consist of consist of three one-hour online workshops. Each workshop consists of three 20-minute modules covering a range of topics including the medical, mental health, and social issues facing transgender patients. In addition, this program will include video scenarios showing both good and bad patient interactions.
In addition to my work with Michigan State University, I have also been consulting and providing training programs to a number of hospitals in mid-Michigan, medical clinics, private practices, and other medical schools and nursing programs.
When considering this topic, the question we must ask is why do our care providers fail to treat us, the transgender patient, with compassion, dignity, and respect?I believe the reason is that there's a lack of knowledge and, therefore, a resistance to change. They don't know or understand, and maybe would rather not know who we are, what we need, and what the appropriate care model is. We know transphobia exists – and new research is showing transphobia may be the root cause of poor treatment. But I posit that to overcome transphobia we must better educate those who are transphobic and by doing so we can help them better understand the needs of transgender patients.
CISGENDER, TRANSGENDER, and GENDER VARIANT – The term cis-gender refers to someone who identifies as the sex they were born – their sex and gender match. “Cis” is Latin for “same.” Transgender is where their sex and gender do not match – they are opposite and “trans” means “the other.” GENDER VARIANT/FLUID means a person can identify as one gender one day and another a different day. Or identify without a gender or non-binary. Gender varies according to how someone feels about themselves at any particular time.
Next, consider our SEXUAL ORIENTATION. Remember, sex is how we were born, and gender is how we identify. Gender is essentially who we go to bed AS, and sexual orientation is who we go to bed WITH.
Regarding those three key words; compassion, dignity, and respect. Let’s look at how the transgender community defines them. I took a brief survey online in a Reddit transgender forum, and I asked, “what do these words mean to you.”What they told me was this;
Compassion – Compassion isn't something you know or learn – it's something you feel. Healthcare providers can show compassion by understanding who we are, our concerns, and the issues that cause us to stress in medical care settings. Compassion means treating us as they treat everyone, by asking us relevant health questions, and not talking down to us or talking to us in a demeaning or pejorative way.
Dignity – Dignity is related to conduct and asking questions related directly to our care and our immediate medical concern, and not asking questions about our genitals, surgeries, sex lives, or other inappropriate questions that do not relate to the health concern at hand. Such as asking about our genitals and surgeries when we are there for a cold, and not using us as a teachable moment for others, such as a nurse, resident, or tech. Also, as patients we’re in a very vulnerable position – if we feel threatened or we are treated in a way we feel disrespected, we’re unlikely return for further care – even if it’s needed.
Respect – Respect us by not relating every illness or symptom we might have to our gender transition and by using our preferred names and pronouns and asking if unsure. Also, respecting the fact that we know our bodies and we may actually know more about our transgender healthcare than they do.
The question now is what is going to be the catalyst forchange– a change that will improve healthcare for this diverse, vulnerable, and underserved population of patients. The catalyst is me – I am the catalyst – and we, the transgender community, are the catalysts – we demand better care, equal treatment, and providers who know and understand our medical needs.
And now you - the audience - can also be the catalyst for change. By understanding these essential and critical issues – you can educate not only yourself but those around you. And you can help share this information within your social, professional, and academic communities. Sharing is an extraordinary opportunity for every one of us to generate awareness of this critical topic. Moreover, with this awareness and understanding, we can all make a difference in the lives of those who are transgender. This difference may be in your ownlife if you are transgender or if you are considering a transition. Or in the life of a person who may be one of your friends, a colleague, a family member including an aunt, uncle, brother, sister, son, or daughter. Maybe a parent, or even a 70-year-old grandparent as I am!!!
Compassion, Dignity, and Respect– Three words that, along with you and I, will be the catalysts for change. Thank you!