EXPERIENCING HEALTH SECTOR AS A TRANS NON-BINARY PERSON
In today’s episode, we have with us Krishanu who will talk about their experience of navigating the healthcare sector as a trans non-binary person from a medical as well as a social lens.
Krishanu is a study of sociology and they work on the intersection of sex workers and SRHR. They also work in adolescent health in Delhi state. They Identify as queer and a trans rights activist.
RKF: Hi Krishanu, so happy that you could join us today. We are extremely grateful to have you here. Before we get into it, let me introduce Krishanu. They are Krishanu, a study of sociology and they work on the intersection of sex workers and SRHR. They also work in adolescent health in Delhi state. They Identify as queer and a trans rights activist. Before we get into the thick of it, is there anything about yourself that you want to share with us your life and your interests?
Krishanu: Hello Rishma! So nice to be invited and I am glad that I get to be a part of it. Really grateful to the organization and also you for having this conversation. About me,I am currently living in Delhi so I like to go to Lodhi Garden and other public places in Delhi that are open. Especially in winters I love to soak in the sun and eat oranges and read something. I am also a dog parent and that is also a huge part of me and I think that’s it for now.
RKF: That’s lovely, thank you for sharing. So, let’s get into the issues in hand. Do you think people in the community avoid visiting medical health units or medical professionals because of their identity? And if yes, then why?
Krishanu: Before going into that, I would like to talk about what healthcare means. Right now I am not just going to focus on healthcare in terms of gender affirmative services but like the entirety of healthcare in terms of physical health care, mental healthcare and any other kind of services one might seek from the medical fraternity at large. so there are a lot issues that the community has to face when getting into a medical enterprise or Medical fraternity but mainly you know a lot of things that we already know about, that we face a lot of issues in terms of power, gender affirmative services, like homo-replacement therapy or surgery or just anything else that you know you need to interact with the system of the medicine that is there in the country then that difficult to access generally because of the lack of information and transphobia that overrides everything. But apart from that I feel that there is a sense of general hesitance that is there while attending to a general medical health service. For me, I identify as a trans non-binary person and anytime I have to go and interact with the medical spaces, I try to masc myself up, in the sense that I try to present masc and fit into the categorisation of a masc as a person so that I can just avoid a lot of things that I have to go through which range from the moment you enter the medical facility. It is not only the doctor who is going to be a problem for me but also the patients sitting next to me, like they will look at me and talk about themselves which is very discouraging. Then, how do I access these spaces given the attitude other people have? Also the staff, like the nurses and administrative staff, will ask your name and then say that “acha aap ladki hai?” “nahi, aap ladka likh dijiye”. Also, these questions are asked to you point blank, like what do I answer? What do I identify as? That becomes an issue. Apart from that, when you interact with the doctor they will try to assume things about you, things like you are sexually active. There is also this stigma that people treat queer people like they are not humans from the medical lens, they put an expert lens and they suddenly become the expert of my life, my medical condition and needs. Often times, they prescribe an HIV test but nothing about me or my history was there to indicate that I need a HIV test, they will not even suggest it, they will directly prescribe it and then a lot of other issues come up which I will talk about later but yes there is a lot of general hesitance because there is no information whatsoever about gender sensitivity in terms of what is trans, gender non-conforming, what is these socio-economic communities like hijra-kinnar community. Oftentimes they are also like “arre ye toh hijra hai” when you go there and sometimes you don’t identify like that so you have to explain to them. Again, any space I access I have to make sure that it is safe for me and having to do that continuously is definitely discouraging and at the end of the day you will try to avoid this and not go there.
RKF: Yes, absolutely. I understand where you are coming from and the lack of sensitivity in almost all sections of society regarding gender, sexuality is atrocious to say the least. I also relate to what you are saying, it is too bad, truly. We know that nothing exists in isolation, everything is related to something or the other. How does social setting affect the medical field? What do you think society reflects when it comes to medical health and accessing healthcare facilities?
Krishanu: I would like to contextualise my personal experience and also I would like to give you sort of an understanding from the end of doctors and medical fraternity and where they come from and the queer patients and people in large. Queer people are not one monolith community where there is like one identity. So when I go inside, even if I present as fem, it will make them very uncomfortable because my gender confuses them and they get really anxious still they will not deny me any kind of treatment, I will be able to navigate my way through it because I talk in “English” and that becomes one of the very major markers to who gets access and who doesn’t and then there comes people from the community who don’t talk in English or who don’t come from this caste and class background and then the way medical institutions treat them is completely inhuman, it is very very heart wrenching to look at the kind of treatment people from marginalized communities get and then add queerness, transness, gender conforming identities to it. Even when I go inside a medical fraternity, I see that even if people are doing the things they need to do, I can see that gaze towards me which is not something which is normal. They are looking at me, trying to identify who I am. I sometimes feel like hiding myself just to avoid the anxiety around me because everybody around me just gets anxious by looking at me and I feel responsible for it and then also the gaze stays with you, the feeling of not being welcomed or settled and that is me, a savarna middle class person’s body can get such treatment and gaze then what about bodies of other marginalized communities, people who are pushed to the margins, they are completely dehumanized. Their bodies are not like human bodies, they are not only told what to do, they are not asked what they want, they are experts and they will tell you and that happens everywhere in medical spaces. Now, going into what medical professionals think. What I understand so far is that what happens is that sciences, or STEM fields pose themselves as natural sciences and to say natural is to say that they are pure and more free of biases and when people are trained in such kind of atmosphere, how medicine is taught in India, people who do these courses think that they are the most scientific, rational, they can’t have any biases so any prejudices will not affect us. They are not ready to even listen to anything we have to tell them because they think that medicine is scientific, how can I not be scientific? That is also where they are coming from, they are very much refusing to understand that they are complex people and they come from backgrounds where they can carry prejudices.
RKF: Yeah, absolutely. That makes so much sense. Inadvertently or advertently, we are also witnessed to behaviour like this where we haven’t been able to speak up but in and around us people have dehumanized other people just because they don’t present as heteronormative and that’s not okay with them, that is insanely insensitive and that should be from everybody’s point of view and that isn’t and that is where they problem is. So, from the time you started identifying as queer has your approach to healthcare changed in anyway, at all?
Krishanu: I think I was coming from a space of complete lack of information because this is not a part of our socialization, instead stigma is. You know I was carrying a lot of stigma and later internalized transphobia also. It is very difficult to accept that I was a trans person and then I decided to identify with a label for it. For a relatively longer period, I knew I was a trans person but I didn’t label because of how much internalized transphobia existed within me. Obviously it was a struggle to navigate but after that also I don’t know if it has changed so much in the sense that I felt intimidated by the entire medicine aspect of things and I think I still do feel very intimidated personally and I feel that I am not sure about a lot of things and I have a lack of information because well where do I access this information if I don’t devote myself into it, if I don’t do an active looking into the matter? In my personal life I have taken a backseat where I try not to interact with the medicine and medical atmosphere as much as I can and where I have to I try to use strategies of masking myself as a cishet person or trying to pass as a cishet person but that doesn’t happen. Anywhere I go, people are always confused about me, no matter I try to present masc or fem they are always questions raised and laughter, giggles in the background. My relationship hasn’t really changed, there is definitely much more information but that information is not getting embodied in the sense that I feel confident about it. I know a lot of things about the procedure but it is not coming with the confidence that I can trust the medical spaces to go there personally for myself. I think that is my experience.
RKF: I have a friend who identifies as trans, he was talking to me about it that how internalized transphobia was probably the biggest hurdle that he had to cross in order to identifying himself as a trans person but even when that is over the rest of the world is waiting with insensitivity to receive him. That was his perspective and it doesn’t sit very well with all of us and it shouldn’t in the society. So, what do you think is the need of the hour because we see discrimination like this everywhere around us in the 21st century, what do you think is the responsibility of the society at large? How can this be rectified and what is the demand for change and what can be done?
Krishanu: Thank you for posing that question. I think we can tackle this through three major components from my own personal experiences and experiences of working around trans healthcare in the current context. First and foremost for me is agency, that is coming from the idea that being trans is my identity and I’ve this whole right of that identification and that is not up for debate and nobody else gets to tell me otherwise. But our legislation comes in between and the recent Trans Act which is extremely dehumanizing and draconian which takes that away from us in a manner. I think that needs to be fixed, legislatively and also principally in medical institutions not just for trans people but simply understanding that people walking into a medical institution doesn’t give away their rights to bodily autonomy just because you are an expert on medicine doesn’t mean that you are an expert on my body,my experiences and my choices definitely. So agency should be handed over to people who are coming in as patients and require their service and then decision making can happen in a shared way where all information can be shared with the patients and decision making can happen from their end. There is no right or wrong in terms that you should have to do this or that from an expert medical opinion because that is also the state of our MTP right now where medical termination of pregnancy, if you get to abort fetus or not, the medical board will decide after the stipulated time period of 24 weeks and even before that, after 20 weeks you need a second doctor’s opinion on that. All of this agency is placed in the hands of medicine which doesn’t make sense to me because already these people think that they know the most pure science in the society and when you give them this kind of pedestalization where they get to decide about other people’s bodies, I don’t think that should happen. In context of mental health also, it happens a lot that this person is mentally unstable, we will make medical decisions for them. Moving on from there to my second point which is privacy. I think privacy is completely not there in this system in India except for some exceptions that people must have encountered in the private facility, that is again a very big distinction to be made in the medical health setting in India, private and public are completely two different ball games all together, they don’t come to a congruence anywhere. Private is running in their own manner where you can throw money and get services out of most politeness, people even have experiences of gender affirming behaviour, like people ask what are your pronouns when queer and trans people enter except that this space is very exclusive and not going to be accessed by people of the community who don’t come from certain privileges. So, whose healthcare is this then and whose affirmation is this then? Then we go to the public and we understand that privacy is not there whatsoever. This also makes me wonder about the queer and trans youth who are under 18 and who have to go and get services from medical providers with their family and parents. In that sense there should be enough privacy between patient and doctor that the patient can come out to the doctor and say this is how I identity or share their sexual activity freely without having to fear that this person will tell their parents and then they will be outed or some personal information will be shared with the family. Lastly and very importantly, lack of information which can be tackled in multiple ways because there is so much stigma with queer people entering any medical facility, one thing that is stamped on us is HIV, carriers of HIV, that is how they see us. A lot of people have even experienced, like people don’t sit next to me and are denied injection because they think they carry this dirty disease called HIV. There is so much stigmatizing happening, information is the only way that this can be tackled, also gender sensitive information, also sex ed. There is no sex ed for queer people. Like today if I wanted to talk about my sexual needs and if I wanted medical opinion on it, where do I go? How do I google? Even if I google that doctors near me how do I know that this doctor is not going to give me a traumatic time that I will come more stigamzied and even more scared of sex than I was before? These are the three things, agency, privacy and information I feel that steps should be and can be taken for a queer, trans affirmative medical practice because it is very much social as it is scientific.
RKF: That makes a lot of sense. Agency, transparency, privacy and information for the public, that’s the way to go, you say. That resonates really well. Thank you so much for sharing all of this with us, it is really enlightening and to get your perspective on it is also really nice. It was great talking to you and I really hope that with this podcast and the work that Rangeen Khidki Foundation is doing, we can destigmatize this area a little bit. We invite more people to talk about it and be open about this. So, thanks a lot for making time for us.
Krishanu: Thank you so much Rishma and thank you to the RKF for doing this as well. I really really hope that there is more conversation about it and people get to know that your average experience is not universal, there is so much more happening at the end of the world that you don’t know about and there is so much more that needs to change. So, yeah thank you so much for this.
RKF: Absolutely, thanks a lot!
This article has been transcribed by Shatarupa Paul, Junior Research Manager at Rangeen Khidki Foundation