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Monday 10 April 2017


Trans and intersex healthcare: urgent attention needed

Posted in: Health & HIV, Features
By Jacqui Stanford - 1st April 2015

Parliament’s Health Select Committee has heard that the lack of healthcare services for trans and intersex people is a priority public health issue where urgent intervention is needed.

“Currently in Aotearoa we are at a point of greatest need,” Auckland counsellor and advocate Tom Hamilton told the gathered MPs.

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“Trans and intersex people and their whanau are approaching health professionals, paediatric, adolescent and adult, mental health and suicide prevention care services included, and are surprised to find a variety of standards or approaches to their care being used nationally.

"Each DHB represents different levels of expertise, resulting in frustration for the community, which leads to further delay in treatment, possible mental health deterioration and extra costs being met by the individuals … or individuals actually educating the health professionals to improve their experience of care.”

Hamilton’s submission follows a petition urging the government to take action “to address the inadequate supply of publicly funded gender reassignment health services, including counselling, endocrinology and surgical services, in New Zealand”.

He told the committee trans and intersex people are quite simply not cared for effectively with the current standards of care and treatment pathways in New Zealand.

“As well as the barriers to professionals assisting trans and intersex people, there are also personal access issues for other health issues outside of gender identity … trans and intersex people are fearful of stigma and discrimination, or culturally inappropriate practice.”

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Tom Hamilton
Hamilton says trans and intersex people do not trust the public health system to meet their general healthcare needs, for both general health and specific trans and intersex decisions.

“The long term effects of this perceived stigma and discrimination is that their wellbeing is affected and health issues are ignored for too long for effective care to benefit them, and benefit the health system.”

Hamilton said it’s a public health priority which requires urgent attention.

He pointed to the Youth 12 study which found high rates of depression and self-harm among trans and gender questioning young people, and a lack of access to health care. A Scottish study was raised, which found suicidal thoughts and attempts reduced drastically after transition – however that some trans people found it increased during transition – showing the importance of support through the process.

Hamilton reiterated that New Zealand has still not implemented the recommendations of the Human Rights Commission’s transgender inquiry.

He is calling for a number of things to happen:

· Audits and assessments of what is currently available.
· Committing to cost effective medical care, with mental health and suicide prevention services included.
· Increasing trans and intersex people’s access to healthcare, nationally, using models which recognise informed consent, are non-linear, and include Maori and Pasifika perspectives, and meet international standards – we should also update NZ standards.
· Training for all healthcare practitioners, and ongoing professional development.
· Research.

MPs from National, New Zealand First, National, Labour and the Greens sat on this morning’s committee and were supportive and engaged.

Committee Chair Simon O’Connor thanked Hamilton for his presentation, courage and passion, promising to look into the issues and reach out to the Ministry of Health for more advice and information. He acknowledged they had only discussed the “tip of the iceberg”.

Labour MP Louisa Wall pointed out that there have been 68 applications for funded gender reassignment surgery over the past seven years, and just nine surgeries have been carried out.

“The evidence is clear we’ve had 87 per cent unmet need from our community, who have actually gone through to apply for the gender reassignment surgery.”

Hamilton said that from his experience working with the community, there is a ten year wait, and another delay now due to the only surgeon doing MtF surgery in New Zealand retiring. “And there was some concern in the community, to my knowledge, that that surgeon wasn’t meeting the needs of the clients, they weren’t comfortable with the procedure.”

He said some people were happy with that service, but others who were able have saved up and gone overseas instead. He added there is no surgeon in New Zealand who would be able to do bottom reassignment surgery for FtM trans people. “Our people are going to other parts of the world to have those surgeries completed. Some of the concern would be that when they return if there are complications, that could be difficult to deal with.”

Hamilton pointed out not all trans people also require or want surgery, but there is definitely not enough access. He added that there is disparity in the quality of care across the country, with some rural providers getting educated and offering tremendous care.

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Kevin Hague
Green MP Kevin Hague, who helped facilitate todays’ hearing, said he expects any audit will show the quality of care is “woefully inadequate”. He said a picture was emerging that we are not meeting some international standards, have not implemented Human Rights Commission recommendations and Counties Manukau DHB protocols that were developed have not been implemented either.

Hague said advice would be sought from the Ministry of Health on the issues raised today.

Tom Hamilton is the former Executive Director of Rainbow Youth who is now a counsellor and gender and sexuality educator, and a Trustee of the Intersex Trust of Aotearoa NZ.

He was supported by fellow counsellor and intersex advocate Mani Mitchell at this morning’s hearing. They made it clear they were not speaking on behalf of any group, but were two voices from a wide and diverse community, with a list of identities which is “endless and must be treasured”.

Hamilton acknowledged that he was himself a dominant identity from within a marginalised community. “I am not a representative who has been marginalised as much as many of those beside me in my work. I cannot represent their voice, but I can acknowledge the human rights they are not having met in regards to their healthcare today.”

He asked to be heard, and not “tokenised or tick-boxed”. “And to those in the community I live in, please accept my humble role here today. I hope you will stand alongside me as we do this mahi together.”

Hamilton also acknowledged the work of trans and intersex community members and their allies.

 

Jacqui Stanford - 1st April 2015

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