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Delivered by veer on behalf of Principle 17, in front of the A-UMC (the former Vumc).
“The situation we are in nowadays with trans health care is not new. Nor is the fact that the health care system is quite insensitive to demands from the trans community for depathologisation. This depathologisation means that we refuse to be seen as having a disorder or be mentally ill for being trans. Until two years ago however, all medical classifications still judged us to be sort of incapable to judge for ourselves.
Long waiting lists are there for a loooong time already. Four years ago, they were one year. Three years ago - extra spending notwithstanding - they were two years. Five years ago we considered half a year extremely long. That same year Principle 17 issued a report with complaints: 43% of the respondents had serious complaints about how they were addressed, about the management, about the gatekeeping. I guess I don’t have to spell the absurdity of this. The inequality of it. Where else is this accepted without any significant change?
I consider it is a chutzpah to install a quarter master to smooth the process, and not accept any real fundamental change. The quarter master is of course a white cis hetero economist. So, what can we expect anyway?
It is not that there is no improvement. But none of the clinics – apart from the Trans United Clinic and potentially the Nijmegen University Clinic – is willing to work differently. Or to say goodbye to the cis normative gatekeeping model.
In the meantime the depathologisation movement is already more than ten years old. And we won the highest level battle you can think of. We got the International Classification of Diseases (ICD) of the WHO to change their placement and classification of trans people! Alas we did not succeed so far for intersex people. Trans* people and gender identity however, are not a pathology anymore. It is just a sexuality related issue.
The big win in this is that there is no ground anymore to send us past a shrink or a psychologist. There is *nothing* inherently wrong with us! And anyway, who the hell wants to be a healthy, organic whole when you can be a brilliant, injured fragment? The concept of wholeness is suspect. Thanks to society that gives us our position in life, our history, herstory and theirstory, we are who we are.
Our being needs no fixing. Our pain, our trauma needs fixing! Society is the real patient here. The system is the patient and the perpetrator. So, demanding good health care also means changing the world.
Our demands for good quality health care resonate with respect for human rights. Human rights tell us that we have a right to the highest attainable health. Trans health care providers however, usually are utterly unaware of their human rights obligations as providers. Let alone policy makers and health care insurers… Insurance companies that have a stake in maintaining the current model. Gatekeeping also is a business model, as the whole assumed medical trajectory gets billed to the insurance companies at once. So, whether you continue or drop out of the mainstream system, the medical assistance is billed and covered already to the clinic. All these psychologists that have to weigh our transness and our ability to live through the transphobic system… These are jobs – jobs that produce patients.
What we need, what we demand, is autonomy! As everything already should be ours anyway.
We have a human right to decent health care, and not to be bothered with critical, even hostile gatekeeping. Gatekeepers are there to keep you out, a stand-in-the-way between you and your health care. A psychologist who is to decide what you can do with your body… That is ridiculous! That is absurd!
The official appointed experts (not us, who are the real ones) always say that new rules and new practices need to be developed. That is a load of nonsense. Internationally there are clinics that are doing the research. In the USA and in Spain are centers that work with strong informed consent. Also elsewhere in the world people have developed expertise in how to transition. That we are here is the result of cis normativity. Our being is a challenge to the categories that the powers that be are used to think with.
Transgender Europe recently released a report, in which they indicate human rights based trans health care. It is possible. You just need the consciousness that as a doctor you are in the end a highly skilled ‘plumber’. The attitude that the person who requests this care, knows what they want. Again, being trans is a state of being. Not a pathology! It is time to say goodbye to the idea that medicine is all about pathologies.
It is the lack of political will, the current paradigm of medicine and the neoliberal state that got us where we are. And we need to abolish all of them.
What we need is that every professional who wants to, can get education, like hormone technical education on trans. Understands what issues we run into in this fucked up sexist world. And can help us navigate this. We need professionals to understand that gender dysphoria is minority stress and gender stress.
Until we are respected as people with rights we will not rest! If need be, we will occupy the offices of the Health Department and the health insurance companies. Until we break the power relation that fucks up our lives!