New Delhi: According to a 2020 ILGA (International Lesbian, Gay, Bisexual, Trans and Intersex Association) World report, 43 countries still have no protection for LGBTQIA+ communities and 70 countries criminalize same-sex sexual activity, with some imposing the death penalty. According to World Health Organization, health systems constantly punish LGBTQIA+ individuals simply for their identity: banning them from donating blood, not recognizing their partners for social benefits such as insurance and housing. It also states that members of the community face many other forms of discrimination, including misgendering and lack of access to essential health services.
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As we mark Pride Month in the month of June to uplift LGBTQ voices, support their basic rights and celebrate the community, Team Banega Swasth India speaks with a special guest – Dr Sakshi Mamgain, Founder, UTH-United for Transgender Health to understand the need for tackling the challenge of equal healthcare for the community.
Dr Sakshi Mamgain is a practising physician and passionate advocate for queer and trans health who firmly believes that healthcare equity is a human-rights issue. She started UTH-United for Transgender Health, an organisation based out of Dehradun, India with an aim to make healthcare non-discriminatory and accessible for the transgender community while also focusing on the mental well-being and rights of the LGBTQIA+ community.
Here’s what we discussed in the interview:
NDTV: According to National Human Rights Commission, there are an estimated 104 million Indians (or 8% of the total population) who are members of the LGBTQIA+ community, despite this huge number, the access to healthcare remains a challenge for the community in India. Where do you think are the gaps?
Dr Sakshi Mamgain: This huge number representing the LGBTQIA+ community is an understatement and misrepresentation of the community at large. According to a 2022 nationwide survey, which happened in USA, nearly 20 per cent of millennials identified themselves from the LGBTQIA+ community. Things like safety constrains, social or religious factors, homophobia/transphobia and general lack of visible role models in the society, come in the way and serve as a reason for people to be unable to truthfully engage with survey of this sort. So, in my opinion that figure is far from the truth. Talking about the gaps related to access in healthcare, the first red flag is how transgender health is completely ignored. It is also missing from the medical curriculum in India. There is obviously lack of awareness and the stigma is so deeply inrooted that there is discrimination across and somehow all of this finds its way into clinics and hospitals.
NDTV: What are some of the infrastructural gaps in our healthcare system – in terms of facilities and medical professions when it comes to catering to the healthcare needs of the LGBTQIA+ Community? Are there any WHO set parameters in this regard that India needs to match up to?
Dr Sakshi Mamgain: Unfortunately, even, globally there has not been much of progress that has been made. There is a global organisation called W-path (World Professional Association for Transgender Health), which has sets guidelines for the LGBTQIA+ community). When it comes to India, there is a lack of LGBTQIA+ inclusive policies and guidelines. Bringing in some sort of guidelines and clear policies can help bring the community into the mainstream.
It will also help in building a non-discriminatory society with the equal healthcare rights.
NDTV: Given LGBTQIA+ community is diverse and the needs of Transgender may vary from someone who identifies as queer, can you help us understand some of these differences and the nuanced approach that is needed to understand the requirements of this community and sensitise others about it?
Dr Sakshi Mamgain: We at UTH – United for Transgender Health has envisioned a world where patient care is inclusive with mental health and is non-discriminatory. To build a system like this in place we need collaborative efforts from multiple stakeholders. It is high time we bring in systems in place for the LGBTQIA+ community. Till the time, information on transgenders is not included in our education system we will be churning out professionals who are not culturally competent.
NDTV: People from queer communities feel that many a times in our country the community gets wrong diagnostics done as the awareness and understanding of queer people’s healthcare requirement and needs is limited. How true is this?
Dr Sakshi Mamgain: Lack of specific knowledge and education on the topic can result in wrong diagnostics for LGBTQIA+ community. Without proper education on the topic, misconceptions and stereotypes will always come up. And in India, the main issue is of education and awareness.
NDTV: What are the challenges in India when it comes to aftercare post or pre-surgery for transgenders?
Dr Sakshi Mamgain: Like all the surgeries, post-surgery care is of utmost importance. In India, there is a scarcity of doctors who specialised in expertises in transgender related healthcare. And those that exists are only accessible to patients that can afford them.
Generally, there is lack of standardised guidelines, protocols for treatment of transgenders. All the gaps lead to inconsistencies in care and hinder provision for adequate support for the community.
NDTV: What is Hormone Replacement Therapy (HRT) and how easily it is available in India?
Dr Sakshi Mamgain: HRT or Hormone Replacement Therapy is just a medical treatment which is done via use of hormones. This treatment brings changes in people’s desired secondary sexual characteristics. HRT is usually used by trans individuals as a part of their general care. HRT typically involves use of medications with hormones such as estrogen and testosterone, which can help an individual align their physical appearance with their gender identity. In India, getting through the HRT treatment has a lot of obstacles. For HRT treatment in India, first one is required to get a certificate from a psychologist and then one is required to go through endocrinologist to finally access the service. Because of the obstacles, the traditional Hijra community has to resort to over-the-counter medications, which if not checked can have fatal medical complications. So, ultimately, it all boils down to a system in place.
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NDTV: Is puberty blockers still a dream for many people of LGBTQIA+ Community?
Dr Sakshi Mamgain: I would say yes, it is pretty much same as HRT. The process is long, there are issues of affordability, medical expenses covered by insurance, and an ongoing debate on ethics, information surrounding the use of puberty blockers for trans youth. Extensive research doesn’t exists till date, but it is said that it is safe when done under observance.
NDTV: Why are treatments for LGBTQIA+ community so painful and expensive? What can be done?
Dr Sakshi Mamgain: It is not that treatments for transgender people are very painful and expensive. The fact is that our staff is grossly understaffed. Mostly it is the fact that we don’t have enough trained healthcare experts. The need of the hour is to sensitise everyone who is providing healthcare for transgenders only then the issue of treatment related to LGBTQIA+ will be resolved.
NDTV: When it comes to Mental Health, what are the challenges for LGBTQIA+ Community?
Dr Sakshi Mamgain: When it comes to mental health, the community faces a lot of stress due to societal stigma, discrimination. Statistically, transgenders have higher cases of depression, anxiety disorders, suicidal ideation. The same factors also lead to higher incidences of substance abuse. We need to understand that this subject is delicate. We need mental health experts to deal with the crisis. The goal should be to help the person and not project your beliefs on them. We need to understand that their lives are not our lives.
NDTV: Health being the basic right, what are the five things India needs to prioritise to tackle the challenge of equal healthcare for LGBTQIA+ Community?
Dr Sakshi Mamgain: Education is the first priority. We need to be talking, we need to be making noise, we need to be sensitising future generations and make people aware about the specific needs and care that this community needs. At this point of time, we are not prepared. For most of the consequences of inadequate healthcare is that we lack training, it is a systematic failure and we just cannot put the blame only on doctors and society. Our regulatory body needs to make policies and bring in a required system in place. I am myself from the community, I identify myself as both queer and non-binary person and I understand both sides – medical and the community. My suggestion to the community will be that patients need to place a little more faith in their doctors. I understand we are lacking and we have a long way to go, but we are trying to work towards a better system and society. So, a little bit of patience, and a lot of consolidated efforts can help us bring in the positive change.
NDTV – Dettol have been working towards a clean and healthy India since 2014 via the Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – theLGBTQ population,indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the currentCOVID-19 pandemic, the need for WASH (Water,SanitationandHygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fightmalnutrition, mental wellbeing, self care, science and health,adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, which is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues likeair pollution,waste management,plastic ban,manual scavengingand sanitation workers andmenstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India wheretoiletsare used andopen defecation free (ODF)status achieved as part of the Swachh Bharat Abhiyan launched byPrime Minister Narendra Modiin 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.
