Inside RML's OPD For Trans Persons: Are Dedicated Health Centres Really Helping?

Can dedicated OPDs for transpersons help tackle discrimination and improve access to healthcare?

Transgender healthcare in India (Image for representational purpose only.)

(Photo: PTI)

Trying to locate the dedicated Out Patient Department (OPD) for transgender persons in Delhi's Ram Manohar Lohia Hospital – reportedly the first of it's kind in the country – can be tricky. There are no placards or signboards pointing to it.

Almost three months after the OPD was inaugurated with a lot of fanfare on 17 September, FIT found an empty waiting area and a non-descript 'OPD room' with two young residents from the medicine department on duty, when we visited the hospital.

When asked if they had received formal training in transgender healthcare before they were posted here, the doctors (who didn't want to be named), said that they only underwent a one-day sensitisation workshop.

"Other than that, it's what we were taught in our curriculum," one of them said.

The OPD services at RML Hosptial, hailed as a major step towards tackling discrimination and stigma faced by trans people in hospitals, are meant to be available to transpersons every Friday, from 2 pm to 4 pm, have a dedicated registration counter panel, and a panel of 10 – 12 doctors from across departments.

However, has the dedicated space been able to effectively close the gap it intends to?

FIT has also reached out to authorities at RML. The copy will be updated based on their response.

Inside the RML OPD for Trans Persons: How it Operates

According to news reports, at least 20 people showed up to the OPD for consultation on the first day of its opening. On this day, however, there were no waiting patients.

Contrary to the empty waiting area and lack of patients in the OPD, the two doctors posted there at the time say the OPD has gotten a 'good response' since it opened two months ago. "We get 10 to 15 patients in a day usually," one of them says.

Apart from medicine, they explain, doctors from different departments –psychiatry, dermatology, urology, burns, endocrinology and paediatrics –are posted in the OPD every week on rotation.

"Some people come with gender dysphoria, we diagnose and counsel them. They also come with Sexually Transmitted Infections (STIs), or for HIV testing, and some skin issues linked to STIs. etc," a doctor said, on the issues that they encounter.

"We do the initial consultation and then refer them to the concerned departments. We also have a psychiatrist and gynaecologist who sit here separately too," he added.

However, for instance, there is a possibility that a transgender patient visits the OPD with an issue linked to endocrinology, but a dermatologist is posted to the ward. This would mean that the patients would still have to visit the different departments after the OPD to get treated for the specific issues they have.

FIT waited outside till 4 pm to speak to a potential patient but no one showed up. The doctors perhaps preempted this, because by 3:17 pm they locked the room and left.

Why the Dedicated Centres? Are They Helping?

RML isn't the only one; an ambitious 'Centre of Excellence' for transgender healthcare is also set to open at the All India Institute of Medical Science (AIIMS), New Delhi, soon.

Sassoon Hospital in Pune and GT Hospital in Mumbai, too, inaugurated dedicated wards for transgender people earlier this year.

These initiatives popping up in major government hospitals this year are not coincidental. They are essentially driven by the promise of better healthcare for trans persons, according to the Transgender Persons (Protection of Rights) Act, 2019.

In fact, according to the Act, at least one government hospital in each state should be equipped enough to deal with the specific healthcare needs of trans persons – still a distant dream on the ground.

• Discrimination, stigma, and access

Trans persons are often denied healthcare access due to discrimination, stigma, and even ignorance. Hostility, and judgment also keep many trans persons from seeking out medical aid.

"Existing OPDs can be a bit difficult for trans people to access, not necessarily because the doctors are insensitive, but it could so happen that other staff and other patients in the OPD may have prejudice and stigma against them," says Anjali Siroya, a trans woman and activist who works with Humsafar India, an NGO that works towards uplifting the LGBTQ+ community.

There’s also the issue of documentation. For instance, Siroya says, if a trans person needs to be admitted, they (hospital staff) don’t know whether they should be admitted to the male or female ward. "This basic understanding is not there."

• Have specific healthcare needs

Historically, transgender individuals have been excluded from the realm of healthcare services. "The healthcare system has neglected the overall health of transpeople, with a narrow focus on preventing HIV and STDs," says Siroya.

"Transgender persons have reguar healthcare requirements, but also needs beyond them, like getting a gender dysphoria certificate, gender affirmative treatment and related complications, etc."

Anjali Siroya

"Surgeons also often don't customise their surgical intervention to the body needs of a transgender person," Dr Anmol Rawat, a Public Health Expert, and a transman, tells FIT.

"I got my top surgery from a doctor in Delhi, and it was pathetic," he adds. "These mess-ups happen when doctors are not trained in these intricacies."

This begs the question, does the current medical curriculum adequately educate doctors on transgender healthcare? Are they equipped to handle the specific needs of patients in these special OPDs?

As well-meaning as these exclusive spaces in these hospitals are, are they really helping make access to healthcare easier for transgender persons?

"I am not against having an exclusive OPD because that serves the purpose that the healthcare delivery system should be equipped to cater to the needs of trans individuals," Anjali Siroya tells FIT.

"A large part of trans communities in India are not only socially, but also economically marginalised. So having exclusive space for them in government hospitals with a staff that is sensitised to their needs can make it easier for them to access these services too."

Anjali Siroya

"But," she adds, "In the long run, I wouldn't really encourage this idea."

What Can Help Then?

Issues of stigma, discrimination, and access apply to transpersons even when they try to access non-trans person-specific healthcare. For instance, even if there is a dedicated OPD, they would still need to access the services of other departments.

"If one has skin issue or STI, they would have to go to a dermatologist. If one has a fever, they would have to go to a medical specialist. If one needs a gender dysphoria certificate, they would need to go to a psychiatrist. So all OPDs will need to be equipped to take trans clients and patients. "

Anjali Siroya

This, Siroya says, is an issue that would need to be addressed at its root. "The current MBBS curriculum doesn't cover enough of trans healthcare, and sexual identities, the correct terminologies, the health issues they face, and how to make the patient feel safe and welcome. This is the problem, and this is the gap."

This is where programmes like AIIMS' Centre for Excellence could potentially pave the way.

"This is a space for providing gender affirmative care, including surgeries, sexual healthcare and so forth," says Dr Manish Singhal, Head of the Department of Burns and Plastic Surgery Department, who is also the head of the Centre for Excellence.

“Doctors, nurses, and the frontline staff who will be involved in the new Centre for Excellence, have received sensitisation training," he adds.

"However, there is also another capacity building component to this where doctors are to be trained by doctors with clinical experience in dealing with and customising care to the specific health needs of transgender people," says Dr Anmol Rawat, Vice President, National Network of Transgender Persons, and is involved in shaping the programme anchored at AIIMS.

"Our ultimate goal is to create a cadre of doctors who will be well trained to give this kind of holistic treatment in other parts of the country too, as well as to leverage people with lived experience, to created allied healthcare professionals from the community itself," says Dr Rawat.

He adds, "This initiative is still in the pipeline. But it involves multiple stakeholders from the community from various countries, including the International Institute Of Health Management Research (IHMR), NACO, World Professional Association for Transgender Health (WPATH), NNTP, and more."

"So, the short term and long term visions are laid out, but right now they are focusing on making the short term vision happen. And the best part is that a huge push for change is coming from within the community itself."

Dr Anmol Rawat