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It is a sleety mid-December afternoon in Winnipeg and I am guessing we will not have a great turn out. To my surprise, when I walk into the basement training room at Klinic, it is full, and I quickly find a seat at the back. Every chair has a little piece of paper on it; I know that this must be for one of the key tools of our trade, the magical question box.
I am sitting in on a Q & A session for our Trans Health Program. We began doing these sessions this year to address people’s questions about the program in the most efficient way, reducing the time it takes and increasing our time for new appointments. They are one of the many brilliant initiatives of our new team of Nurse Coordinator Gail and Peer Worker Elliott, who are leading our first ever Saturday session today.
Group information and Saturday sessions are some of the ways that we are working towards meeting our strategic goal of being more accessible to the people that need our services. This is a conversation we are having a lot right now, as we move into the last year of our plan and start preparing for our re-location next spring. One of the reasons I am excited to sit in on the group today, is I know that our Trans Health team have been leaders in this work, and used to have one of the longest wait times at Klinic. With a focus on teamwork and providing care differently, the team has dramatically reduced these barriers over the last year.
The Q and A sessions are an opportunity to answer the most common questions we get about the program. Trans health care and gender reassignment, have one of the most complicated pathways in the Manitoba health system. We have been working hard with our partners in health to try to simplify this pathway, but we have a long way to go. At Klinic, our focus is doing our part to make the journey a little easier.
In this session, Gail and Elliott talk about our role and emphasize that we are here to help people get started, but also to connect them to other system resources. Trans Health is a specialized program at Klinic; one of the reasons we are such an active teaching facility, is that we want and need primary care practitioners to be partners in trans care now and in the future. The session includes tips for talking to primary care providers about starting or supporting hormones, as well as accessing new hormone injection groups, which are aimed at increasing capacity and empowering clients in their own care.
Elliott and Gail take the time to discuss the roles of everyone in their care team, a core component of team-based care. Each client has a specific team assigned to their care and everyone has a role to play. This is related to my last post about micro-teams and our movement towards formalizing our micro-team model at Klinic. Though our Trans Health team has largely operated this way since the beginning, there are key differences, including team members and complexity.
One example is that the Trans Health team includes a psychologist, whose main purpose is to assess clients for surgical readiness before referring to the Montreal based gender re-assignment clinic. In Manitoba, both an approved psychologist (of which there are only Klinic’s and one private in the Province), and an approved health provider (which includes our full Trans medical team and a few other providers in the Province), must jointly make a recommendation for surgery to Manitoba Health before they can be referred to Montreal. Chest augmentation or masculinization can be done locally with approval from two approved providers.
This information and the pathways and timelines are a significant part of the presentation, it is also available on our website.
They also talk about laser and electrolysis access, an ongoing issue, as currently a Doctor is required for electrolysis coverage and there are no doctors providing this service in Manitoba. It is our hope in the future, that there may be an increased ability to use non-medical providers for non-medical procedures, and a widening of the approved providers available. Not only would this provide better and more efficient care, it likely would be at a reduced overall cost to the medical system.
After the initial information session, we take a quick break for people to submit their questions and stretch before the Q and A. I notice how many people have come with a support person, often their parent or close family member. I think about the anxiety that both these clients and their loved ones must experience in trying to access good care, in a society that still has a long way to go to treat people who are transgender with the compassion and dignity that all of us deserve and should expect. Many of the questions that come up after break are about statistics, services, fears and myths in areas such as hormones, fertility, and of course, surgery. Here are some examples:
- How many trans people are there in Manitoba? We do not know, but Ontario estimates 1 in every 200 Ontarians is transgender. We have over 700 people in our clinic, with 200 new intakes this last year.
- What about people outside of Winnipeg? We support one clinic in Brandon, in partnership with Prairie Mountain Health, we can do appointments by telehealth in other areas of the Province, in addition, our founding physician, Dr. Ian Whetter, who now works with Northern Medical Connections, is working to support and grow capacity in the North.
- What if you are under 16? People under 16 are currently referred to the youth clinic GDAAY whom we work closely in partnership with
- Where can we access mental health type support? Elliott does provide support, as do our social workers, and our psychologist can assist with assessment. Anyone, including family members, can access Klinic’s Drop In Counselling program.
- What if I never look and feel (gender)? I find this question emotional. It really strikes to the core of what it is to feel yourself in your body, and the pain in the experience when you live with unalignment. Elliott eloquently talks about how it’s all inside, only you can say who you are, and that “we have a lot of work to do as a society to unpack what makes a person a female or a man”. Elliott also talks about the importance of creating your own community.
- How long will it take?
- Usually about 2 months to get first appt
- 4 months for chest consult and 3-5 more for surgery
- Bottom surgery is about a year wait
- 4 months to see a psychologist, however, someone has to spend a full year on hormones prior to consult
I know that I often talk about the important role that both Klinic and SERC (Sexuality Education Resource Centre MB) play in answering questions that can sometimes be difficult to ask. Participating in this session reminds me of this, and how grateful I am that something I get to do in my everyday life includes opening up the conversations that we need to have, even when they are hard. It is hard for a society to admit when it has done wrong, but that is the only real path to making it right. If you are unsure if that is the case, let me leave you with a few important numbers:
- 20% of homeless youth identify as 2SLGBTQ+
- 70% of trans youth have experienced gender discrimination
- 36% of trans youth report being threatened in school
- 69% of trans youth have reported seriously considering suicide
- 70% of trans youth report experiencing sexual harassment
Every year November 20th marks a national day of remembrance for transgender people who have died by violence. In 2019, the US is reporting 22 deaths.
If you are experiencing a crisis contact Klinic for support:
Manitoba Suicide Prevention & Support Line (24/7)
Toll free: 1-877-435-7170
Klinic Crisis Line (24/7)
Phone: (204) 786-8686
Toll free: 1-888-322-3019
Sexual Assault Crisis Line (24/7)
Phone: (204) 786-8631
Toll free: 1-888-292-7565
more info on Sexual Assault services
Trafficking Hotline (24/7)
Toll Free: 1-844-333-2211