Breaking Down Healthcare Barriers for Transgender British Columbians
by Zak Matieschyn, BSN, MN, RN, NP(Family)
I am always amazed, and a bit shocked, when I think about how much the world has changed in the 20 years since I began my nursing career as a student at the University of Victoria. We were still in the early days of the Internet back then, and had no idea that two decades later we would all be carrying mini computers and smartphones around everywhere we went. We were plugged into our discmans in the pre-iPod era and were still recording TV shows on big black VHS tapes. Healthcare was a completely different world – HAART therapy had still not been unleashed on the AIDS epidemic, smoking was still prevalent in nearly half of the population, the Botox era hadn’t started and no one had even considered that there could be a vaccine like HPV for teens that could prevent cancer later in life.
In the midst of all of these changes, complicated social debates that had previously seemed irreconcilable were firmly decided and put to rest: gay marriage, access to abortion, medical assistance in dying and the legalization of marijuana. Much was done to reduce stigma for those living with HIV and mental health issues. Healthcare and society have undergone significant positive change.
One of the most important changes for B.C. occurred in July, when the province amended its human rights code to ban discrimination on the basis of gender identity and expression.
I can’t profess to understand the emotional, psychological or physical challenges faced by those whose gender expression varies from what they are assigned at birth. But as a health practitioner and a human being, I recognize the systemic barriers that transgendered individuals feel when seeking health services in a system that forces you to tick ‘female’ or ‘male’ on most paperwork. And while transgender health services will hopefully become an aspect of health as routine as managing a thyroid condition, it is still considered a specialized area, with many healthcare practitioners feeling inadequate and uninformed when it comes to providing transgender health services.
Earlier this year, the sole healthcare practitioner who had been offering specialized care for transgendered people in my region needed to close his doors to any new referrals. This would effectively leave people needing to travel to larger centres in our province for their appointments (at least a four hour drive). Not only do people have the right to caring, non-judgemental health services, they should also be able to access them close to home wherever possible. In light of this, I was happy to complete some further studies and step in to fill this gap. I can truly say that this is some of most fulfilling work that I do – to help support and facilitate someone’s process towards their true gender expression.
I believe that most of us have the best interest of all patients at heart, and I know I still have a lot to learn about how to support and provide care for those who identify as transgender. I also know that it is part of my responsibility to understand, to learn and to continue to grow so that the divisions and barriers that these individuals currently face when seeking health care, are permanently eradicated. The truth is that our society, and by extension, our healthcare system, is still very entrenched in two gender, what-you-were-born-with-is who-you-are understanding. Just last week Saskatchewan announced that it would cover up to 100% of gender reassignment surgery – an important and groundbreaking move that will give hope to thousands of people. And yet the public reaction to this announcement has been overwhelmingly laced with homophobia, anger, distrust and scorn. This is not the response that we, as a society, need to be giving to a group of individuals that already face significant challenges.
As a profession, nursing could be better at preparing nurses to support transgender individuals. It goes further than just helping to ensure specialized transgendered care exists regionally where people need it. We all need to work towards a healthcare system that is barrier and judgement free. Great progress has been made over the past decades towards reducing discrimination on the basis of race and sexuality (although the work is certainly not yet complete). General acceptance of a broader comprehension of gender identity and expression is really still in its first steps.
I urge all nurses to consider what actions you might need to take to change the healthcare experience of the transgender patients you meet. For individuals, Trans Care BC has some modules they offer to targeted social service and healthcare workers who specifically work with trans people. For organizations such as ARNBC, there are programs like the VPD Safeplace program, of which we are a proud member. Safeplace allows anyone from the LGBTQ community who feels unsafe to seek out our office where staff will ensure they can talk to someone, rest and call police if necessary.
By our actions, by our willingness to learn, by our assuredness that every single person has the right to express themselves in the way they see fit – we can model leadership for the healthcare community. More importantly, we can demonstrate our belief that every single Canadian deserves competent, supportive and accessible health care.
ABOUT ZAK MATIESCHYN
Zak’s interest in health and healing began at the early age of nine years old when he would carry a small first aid kit while playing with friends. Since then, his passion for healthcare and health policy has been unwavering. He was particularly inspired by concepts of family, community and societal health, as well as the social determinants of health during his undergraduate (BSN UVic, 2000), graduate work (MN UVic, 2008), and clinical experience in urban, rural and remote B.C. communities.
Zak has served on numerous boards and committees, including the BC Nurse Practitioner Association Executive and was the first Nurse Practitioner in B.C. to be invited to sit on a Division of Family Practice Board (Kootenay Boundary, 2010 – 2014). Through this work he has gained valuable experience in member engagement, optimizing board governance, and relationship building among diverse stakeholders. In his clinical practice, Zak has worked med/surg, emergency, intensive care, vascular access and outpost nursing. After obtaining his NP education in 2008, he began a practice in a West Kootenay family clinic, providing primary healthcare to the general public with a focus on marginalized populations. Zak is President of the Association of Registered Nurses of BC.