In 2021, Kerala and Madras high courts said that the medical curriculum of India is queer-phobic and perpetuates stigma against gender and sexual minorities
In our society, transgender people face violence at the slightest provocation. Not many show up to help them cope with the after-effects. And then there are systemic barriers trans people face when they try to access legal and medical help.
For instance, take the case of Tista Das, a well-known transgender rights activist, actor and writer. Tista, who identifies as female, resides in the outskirts of Kolkata with her husband Dipan, a trans man. In 2019, they tied the knot in a traditional Bengali ceremony grabbing headlines.
During one afternoon in December, hearing a commotion, Tista came out of her two-storey house in Agarpara. Suman Das, who rents space from Tista’s family to run a shop, was abusing her elderly mother. When Tista intervened, Das used slurs like “chakka” and “hijra”, gave rape threats, and then physically attacked her. When her partner Dipan tried to intervene, he too was beaten.
Following the events, lodging an FIR against the culprit seemed the logical way forward. But that too was fraught with difficulties. The police were unwilling to lodge it, alleges Tista. Instead, they lodged a general diary. “Despite my request for a lady police officers’ presence to record my statement, none was made available,” she says.
As per the NALSA judgment, the Supreme Court has said that a trans woman will be treated as a woman, says Kaushik Gupta, advocate, Calcutta High Court. “Her statement ought to have been done by a lady police officer, just like in the case of a cisgender woman,” he added, “Unfortunately, in our country, even a cisgender woman does not get this facility very easily. There are many police stations where there are no female constables or officers.”
The police finally registered an FIR after the intervention of civil society and arrested the accused.
By early evening, Tista started experiencing pain in her abdomen from the assault. She went to the nearby medical college and hospital. She was sent to the gynaecology department, but once she disclosed she was a trans person, she was allegedly denied treatment and ostracised by the doctors on duty.
The medical system remains a huge barrier towards trans identifying people.
“I told them clearly that I have undergone sex reassignment surgery but still they asked questions like if I was pregnant and when I had my last period,” says Tista. For an hour the doctors in the gynecology department allegedly refused to treat her pain. Finally, on the intervention of a senior doctor, they acquiesced.
“They forced me to strip down and examined my reconstructed body parts in front of male doctors,” says Tista. She was given pain medication and discharged.
“When we talk about the training of the doctors at the graduate and postgraduate level, gender incongruent is the technical term used for trans persons. It is either not taught at all or is taught in a very derogatory manner calling it a pathology or a mental illness,” says Dr Aqsa Shaikh, trans woman and associate professor of community medicine, Hamdard Institute of Medical Sciences and Research.
“When it comes to an average doctor’s training in the undergraduate level, there isn’t anything in the curriculum that teaches them how to interact with a transgender patient, what to expect, how to ask for permission, how to use the pronouns, preferred names, preferred gender, etc,” she adds.
“They have not been taught how to respectfully examine a trans person. So we find doctors refusing to treat trans patients at all because they don’t feel confident,” Dr Shaikh says, pointing out that the training that exists does not tell them to discriminate against anyone based on their gender.
In 2021, Kerala and Madras high courts had said that the medical curriculum of India is queer-phobic and perpetuates stigma against gender and sexual minorities. Both the courts had advised the removal of such content from the curriculum.
When it comes to the post-graduate curriculum like psychiatry, endocrinology, surgery, etc, for a very long time transness was considered a disorder, says Dr Shaikh. That has been done away with now. “When you think like that, you want to cure the patient. This leads them to ask a lot of unnecessary and personal questions that are not related to the disease the patient is affected with. That is how it all leads to a very bad experience for a transgender patient.”
Dr Shaikh acknowledges that a lot of systemic changes are needed in the medical curriculum not only to weed out the queer-phobic and transphobic content but also add the skills the doctors would need to take a medical history from the trans persons, to examine them, to provide health services and so on.
Standard operating guidelines have been given by the World Professional Association for Transgender Health, a global body dedicated to transgender health, on how medicos should be providing services to transgender patients. These guidelines are available publicly.
For example, when providing services to trans persons, their preferred names, preferred gender, and preferred pronouns should be used. “We also go by the organ checklist. So there may be a transgender woman who has a prostrate or a trans man who has a uterus. So those kinds of understandings are important. But right now in the medico-legal framework or when it comes to guidelines by the Indian Medical Association or any other association or bodies, there is nothing,” says Shaikh.
Dr Subhrojyoti Bhowmick, clinical director, Peerless Hospital in Kolkata which runs a clinic exclusively for trans persons says that the sensitisation should start from the guards at the gates and go all the way up the chain. “Because trans health is not taught elaborately in our medical education, we conduct sensitisation training for both medical and non-medical staff,” he says.
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