Raina Roy and Abhiraj Bag - Kolkata’s trans community has been locked out of healthcare and livelihood

Originally published by Scroll on July 28, 2020.

Raina is a founder of Samabhabona (Baishamya Durikaran Samiti), a trans-led organisation in Kolkata working with trans rights since 2013. Abhiraj is a trans rights activist based in Kolkata.

Over six months into the outbreak of Covid-19 in India, it has become clear that the pandemic does not affect everybody equally. It has amplified the sufferings of the already-marginalised trans community. We spoke to 10 trans persons and trans rights activists in Kolkata over the course of the past few months to better understand our situation as a community.

Several members of our community have lost their livelihoods due to the lockdown and remain unemployed for over three months now. Those engaged in sex work and begging have no respite in sight for the foreseeable future. As a community, we are more likely to be unemployed as traditional employment opportunities are inaccessible to us. Our health concerns are also diverse, as we grapple with gender dysphoria alongside other psychosocial issues. Covid-19 has exacerbated these inequalities and effectively locked us out of livelihood as well as healthcare.

An alienating system

When it comes to accessing institutional healthcare, visiting hospitals can be a daunting ordeal for trans men and trans women, as we frequently encounter discrimination and stigmatisation from healthcare providers.

Even in emergency cases such as accidents, medical attention is delayed due to confusion whether the patient should be admitted to the male or female ward. Finding compassionate healthcare providers is difficult, especially in government hospitals. Most often, they are not sensitised to trans-health issues.

Such experiences have alienated us from the healthcare system and left several members of the trans community reluctant to seek medical help.

Access to general healthcare has further worsened with Covid-19, as many are unable to seek emergency medical assistance. With no sustainable source of income and deteriorating health condition, elderly trans persons are hit with a double whammy. Despite their failing health, there is presently no provision for routine health check-up which they can avail. The reluctance to consult a healthcare service provider has increased due to the added risk of infection.

SRS services are city-centric

Many in the community had scheduled their sex reassignment surgery or SRS and started taking the necessary hormonal medication. However, because of Covid-19, they have now had to postpone their surgery indefinitely. This uncertainty further aggravated distress together with issues of hormonal imbalance. Due to loss of income, many are resorting to alternative cheap hormonal medication and without proper medical supervision, its consequence could be harmful.

Those who have undergone SRS or are currently on hormone replacement therapy often experience side effects such as rise in blood pressure and blood sugar levels, urinary tract infection, and other immunity-compromising problems. To treat these side-effects, a patient may need to consult an endocrinologist, gynaecologist or urologist. However, such specialists are only available at district hospitals. At the sub-district level, we may be able to consult a gynaecologist at best. An endocrinologist or urologist would be available only if we travelled to the district hospitals or medical college hospitals.

A lockdown spanning over three months, restrictions on travel and closure of public transport have made the city-centric, SRS-related healthcare systems inaccessible to the transgender persons in smaller towns and villages. Pre-Covid-19, a few NGOs and community-based organisations provided sexual health services. However, they were unable to continue their services during the lockdown. This has adversely impacted the trans community’s access to sexual health services.

So far, two trans women have been tested positive for Covid-19 in Kolkata. Thanks to the intervention from activists and other allies, they were quarantined in the female ward when they tested positive. Both were asymptomatic and are presently self-isolating at home. Within the trans community, there is inadequate awareness about Covid-19 testing protocols and procedures. The saving grace has been the dedicated provisioning of ten beds at the MR Bangur Hospital, specifically reserved for transgender persons.

Community care

The most hard-hitting impact of Covid-19 is undoubtedly on the mental health of our community. Often faced with social stigma and physical abuse, we take refuge in the comfort of each other’s support. In the absence of familial ties, community support is vital for our well-being. However, Covid-19 and the consequent lockdown measures, has distanced us from our only source of support and solace – community interaction and meet-ups.

Although digitally mediated communication has somewhat helped in coping, it is not as effective or cathartic as an in-person conversation. This has increased the susceptibility of substance abuse in the community. Parallelly, there has been a considerable rise in domestic violence cases too. Even under normal circumstances, we are more likely to encounter intimate partner violence, but are skeptical to seek redressal as the law-enforcing institutions – both judiciary and the police – are biased against us.

At hospitals, the constant misgendering that we face at the hands of healthcare professionals can be traumatising. Aparna Banerjee, a trans-person in Kolkata, said that this trauma has only worsened during Covid-19, when frontline healthcare workers are not sensitised about trans health. To escape this trauma, some trans women have resorted to unscientific castration, leading to urinary tract infection and kidney-related problems. Gender dysphoria also puts the trans community at a higher risk of anxiety, depression, self-harm and suicidal tendencies.

The political milieu

Such strains on our mental and physical health come at a time when we are already distressed by the thought of being disenfranchised. The latest National Register of Citizens list in Assam had excluded many trans persons, as they couldn’t establish family ties, for being disowned by their families. And if they were included, their gender was incorrectly stated.

With the 2019 Transgender Person Act coming into force, a District Magistrate is given the authority to recognise a person as trans. This defies the right to self-identify, as upheld in the 2014 NALSA judgement. The current provision also necessitates providing proof of surgery and has no consideration for gender incongruence. The burden of providing proof of surgery is unnerving, especially for someone who has just transitioned.

As such, the cumulative impact of the 2019 Transgender Person Act and the Citizenship Amendment Act-National Register of Citizen mandate could lead to a significant part of the community being disenfranchised. In resisting this coercive pronouncement, we staged a protest in Kolkata earlier this year.

What can be done

The health and well-being of the trans community has suffered decades of institutional neglect and the Covid-19 pandemic has intensified this suffering. Remedial policy measures have been long due and cannot be delayed any further. Shelter homes have been one of our long-standing demands, to ensure safety and care for the transgender community, particularly the elderly. It is important that such shelter homes are democratic spaces, and not religious centres, that are welcoming of trans persons from different walks of life.

Secondly, healthcare systems, both public and private, need to be more trans-friendly – doctors, nurses and other staff in hospitals and healthcare centres need to be sensitised and trained to identify and understand the healthcare needs of transmen and transwomen. Recruitment of more transgender people as health workers would go a long way in treating transgender patients more humanely, with support and care.

Measures to contain the spread of the pandemic should include increased testing of transgender persons, and tracking the testing and infection rates among trans persons. Relief measures aimed at addressing the economic crisis need to acknowledge the loss of livelihood in the trans community and provide adequate financial support and compensation. Finally, it is important that governments, both at the centre- and state-level, pay heed to our demands and include representatives from the trans community while formulating policies that impact our lives in significant ways.