"Wing It": Difficult to navigate across Canada, uneven trans-healthcare coverage

Donna Battaglia knew she was born with the wrong body from an early age, but knows she is true. It wasn't until she got older that she learned the words to explain it.

"The anxiety of having to take a shower — I have to know that I always have the wrong part and can't do anything about it."

A few years later She was able to explain what she needed and began a social and legal transition.

Complete coverage: Inside the pride

But live in disagreement with her body I made a huge sacrifice the year I came.

"It came to the point where I basically drank myself and died trying to escape from my previous self."

She finally said, "In the process. I was able to connect with a medical provider who supported "rolling". She started using hormone blockers, was prescribed hormone therapy, and began researching surgical procedures. However, navigating the healthcare system was a challenge.

"I had some doctors who categorically refused to deal with me as a woman," says Battaglia, now 66, who lives in Calgary. "It wasn't overly dramatic. I was probably 98 percent amazing."

Read more: Canada More than 100,000 people are transgender, and the 2021 census states

, enough to meet the needs of diverse transgender, intersex and gender communities. I'm not a practitioner.

"I'm in several groups and I'm listening. People are always asking." Please give us some recommendations, where are we? Tell me if you can go. When we went to them, this person was like this. They didn't want to see us and they didn't want to talk to them. They wanted to get involved. No. "

'Gender professionals do not have to be psychiatrists.

Professionals want to see more trained and licensed healthcare providers (nurse practitioners, general practitioners, social workers) to provide gender-affirming care I am. This reduces latency, increases access, and eliminates barriers.

"Currently, instead of being on the surgical waiting list to confirm gender, a letter from a psychiatrist, from a psychologist, before being on the waiting list for surgical evaluation. There is a system that needs to receive letters. Care, "said Riley Nielson-Baker, organizer of Gender-Affirming Care Nova Scotia.

"It's reminiscent of the times when transgender people were treated as mentally ill."

Nielson-Baker has 11 years of chest surgery, according to state requirements. I know people who had to wait. They say the Nova Scotia psychiatrist's waiting list is over 14 months old.

"You don't have to have a mental health and stability check for surgery. If someone needs to get rid of the appendix and you need to check your mental health once, not to mention twice.

Dr. Michael Marshall is an Edmonton-based psychiatrist specializing in transgender health. is.

He states that in most states and territories psychiatrists need to "verify transgender", which isWorld Professional Association for Transgender Health Professionals (WPATH). ) It is not really a requirement for standard treatment of.

"Gender specialists are trained people. Therefore, the psychiatrist's requirement is that there are additional hurdles that are unnecessary."

He points out that gender diversity has been removed from the International Classification of Diseases (ICD) as a psychiatric diagnosis.

"It's no longer a mental illness. The transgender condition is shattered by the ICD, so in fact the government should listen. The system needs to be modified to reflect it.

He emphasizes that transcare should be addressed as a holistic health. And others agree.

"Some of the conversational issues about trans-healthcare are talking about transitions only. We need to talk about holistic and general healthcare," says Nielson-Baker. .. "Transitional care is only half the story.

" We can migrate everything we want, but respond appropriately to us and our general medical needs. If there is no medical service available, the medical system is still not functioning. ”

They say that transgender people living in the countryside of Nova Scotia receive respectful and comprehensive medical care. He says he often has to drive for more than two hours.

Nielson-Baker praises his doctor, but her waiting list has been on for years. Said it was long.

"For me, it's the world for me that there are people who do it for everyone, not just who cares about who they are and how they identify themselves.

"When I enter the office (of my doctor), there is a poster on her wall that says," Men also get daddy. " Get sexual health care.

“Gold Standard” for sex reassignment surgery Yukon

Health is under the jurisdiction of the state, so the procedures, treatments, and medications covered vary. The requirements for receiving these interventions vary depending on where you live, as well as the waiting times of psychiatrists and other health care providers.

"The only state or territory that is close to doing something right in Canada is the Yukon Territory," says Nielson-Baker. "They deserve so much praise for the work they have done ... they are now leaders in the country."

Read more: Gender-verifying care access is "overly burdensome," Trans Nova Scotia

Marshall, WPATH educator, said Yukon's latest I helped write the policy.

At the request of the territory, he and his team also provided free comprehensive health training for Yukon practitioners who wanted it.

"In North America, there is about 2-3 hours of education on 2SLGBTQ + overall health throughout the medical school, and given all the different presentations within the community, 2-3 hours will be in the future. Stay away from the training of healthcare providers.

"What Yukon did was to recognize it and provide free training to all providers after the fact."

Yukon Also, people seeking access to care that has removed many barriers to transgender and gender diversity.

"The individual standing in front of the provider literally traveled for miles and was there. What Yukon wanted wasn't, and he took care of any practitioner he went to. It was possible to do. "

This area is also a trans-community, supporter, such as electrolysis, facial feminization surgery, body contours, tracheal shaving, voice work, etc. Expanded the scope of procedures that healthcare providers have stated are important.

"The individuals we value have made it clear that these interventions are necessary and life-saving health care, and Yukon believed them," Marshall said. Said.

Access to Gender Surgery

Montreal'sPrivate Clinichas long been the only facility for genital surgery to identify a specific gender. .. Over the past few years, at Ontario and British Columbia Public Hospitals, at the Women's College Hospital in Toronto, and Sex Reassignment Surgery Program B. C. Started offering them through.

Read more: Canadian provinces, territories

B. C. Health insurance coverage by gender begins to provide procedures to British Columbia British Columbia Transcare Medical Director Maria Townsend said in 2019 for Yukon residents and their patients, their loved ones, and healthcare providers. He states that it was a very positive change.

"Think of someone who lives in Terrace, British Columbia and is undergoing vaginal plasty in Montreal. A week later, they fly, cross Canada, and Vancouver. You have to fly to and switch planes to fly again to their home community. I can't personally imagine having to do it a week after surgery. "

According to Townsend, being able to undergo surgery locally means improving pre-care and post-care, counseling, and a closer support network.

"We know that access to care makes a difference. It improves people's health, their mental health, their quality of life, their well-being, it. There is a lot of evidence to show that

"We meet the needs of the people, reduce the waiting time for care, and allow people to receive care in the public system as close to their homes as possible. In order to do so, we need to work on building medical services. ”

It took time for Battalia to determine what steps she needed and could take. She submitted an application to Clinic de Chirurgie in Montreal. However, after waiting for a long time, I decided to investigate another solution near my home.

Due to other health problems, she was working with a Calgary surgeon to remove her bladder.

"The surgeon who was doing it was familiar with the whole process and worked for those who came back from Montreal. It's just like I mentioned it in a promise. I didn't know where I wanted to go and I didn't plan. I just got rid of what I didn't need. That's all I want to do. He said: "It's easy. It's an extra 20 minutes.

"I removed my bladder and at the same time had a" bottom surgery ".

Battalia wants her Admitted that "it was a wing", the process was streamlined, there were fewer hoops to jump, and it was available in all states and territories.

"It makes much more sense to do it locally. There are these great hospitals here, many staff are fully understood and knowledgeable, and what they do. I know what you are doing. I don't know why it isn't used. "

Expanded coverage

WPATH is a mental health service visit (evaluation, diagnosis, referral, treatment). For), laser hair removal or hair grafting, facial reconstruction / contouring, voice therapy, voice correction surgery are recommended. Target treatments in addition to hormone therapy, chest and genital surgery. All of these are recognized by the organization as "medically necessary".

"For some people, having genital surgery is not the most important thing. The most important thing is to walk around your day, see who you are and be safe. Is what you can do, "said Townsend.

"The feminization of the face, the shaving of the trachea, the voice therapy, all of this is really, really important," she emphasized. "It affects their daily lives — whether they have employment, whether they are harassed, whether they are attacked. It's actually huge.

" As a society , We should care about it. "

Read more: Appeared as a transgender in Alberta:'It's hard at first Was ... I was always very cautious'

"The policy of the Yukon Territory is the first in North America, and it is impossible for other states and territories to stand by and act."

Battalia's voice surgery is a breakthrough for her It says that it will be something like that. She is on the phone at work all day and always has a misgender. However, voice surgery is not covered by Alberta Health and the waiting time for voice therapy will be longer.

"I can't afford to operate on her own voice, which isn't feasible," says Battalia.

"Unless you join a company that has a healthcare plan to cover it, or you have a lot of spare money, it's just an exorbitant cost."

Read more: Find Your Voice: The Glenrose program helps transgender diverse people speak as they please.

Proponents are also promoting a more comprehensive and integrated education for future and current healthcare professionals.

"It needs to be incorporated into health science education — all medical students, all nursing students, everyone studying physiotherapy — everyone to serve this population. You need to be exposed to the kind of education you are trying to support, "says Townsend.

Read more: Inside the pride: Two-spirit indigenous girls encourage others to be themselves

In the case of Battalia, it was a transition — social, legal, medical — roller coaster. She waited for years on the list, submitted the paperwork and resubmitted. She endured her practitioner who misunderstood and did not understand her, and worked with her medical professionals to customize her own surgical plan. She was waiting for referrals, approvals and treatment.

Now she's approaching 70 years and hopes she won't wait any longer.

"I feel completely natural and perfect.

" I'm old in my heart until nothing bothers me I didn't know how hard I was with my body. It was like day and night and the switch was turned on.

"I don't feel anything but myself," she says. increase. "Well, what it should have been from the beginning."

Resources are available if you or someone you know is at stake and needs help. In case of an emergency, call 911 for immediate help.

For the directory of support services in your area, see Canadian Association Please visit.

Details on how to help people in crisis Government of Canada website