Anti-transsexual discrimination in Kenyan medical services

We have an insidious form of cancer in Kenyan society. I would like us to examine an incident that took place a month ago and encompassed human rights violations against a pre-op male-to-female transsexual person in Kenya. I will call her Barricade. Barricade was set to have her sex-reassignment surgery in Kenya’s largest referral hospital on 17 March but the director of the hospital came to know about it from the minister of medical services. He went ahead and cancelled the operation on 16 March, requesting that Barricade tell her parents to send a 'no objection letter' to him stating that they would not sue the hospital if the doctors provided their daughter with medical services. The director also said that he had not been consulted when all these were going on. With the director having cruelly blocked Barricade's right to healthcare (safe in the knowledge that he can get away with violating the human rights of 'a transsexual prostitute' while threatening doctors if they assist her), I would like to put some of the falsehoods he has spewed forth under the knife.

First, the nonsense that Barricade should have her parents sending a 'no objection letter' to the director indicating that they would not sue the hospital for respecting Barricade’s human right to access healthcare is absurd and thoughtless. Barricade is 25 years old, a fact that seems not to register in the director’s thick and small skull. Additionally, forcing her to get a no objection letter from her parents means she is obligated to reveal her medical history to her parents. This goes against her right to privacy, but then the director seems to be in need of a number of classes to educate him on human rights.

Well, Barricade talked to her parents – who reside some thousands of miles away from Kenya – and her mother pointed out that the request for a no objection letter is not valid and she should not be forced to intrude into anyone’s medical history. Well, she is right and may our loving God bless her immensely for that, but then she is bitter that the director is forcing 'un-Christian and un-African stuff' on her. Transsexualism is anathema to her and she feels she should not be subjected to such issues, especially when it’s not necessary since she believes Barricade can make responsible decisions in her life and not just in matters of gender-identity disorder. She dismissed the whole no objection letter, affair claiming she needs time to think about it.

The director’s actions aren’t any different from those of people who kill fellow humans in the name of Allah or due to allegations of witchcraft. The impact and ruthlessness of 'transphobia' is alike to that of defiling a two-year-old. A sane and civil human will not demand for a no objection letter from the parents of a depressed adult in need of treatment. A sane and civil human being will not demand for a no objection letter from a woman in labour before assisting her deliver her baby. An insane and barbaric human will however request for a no objection letter from a TB patient before treatment is offered, and an insane and barbaric human will request for a no objection letter before treating a transsexual person. Period.

On top of his glaring transphobia, it’s evident he has bought into the assumption that sex-reassignment surgery is not part of medical regimen in the treatment of gender-identity disorder. How can an educated Kenyan swallow such a fallacy, hook, line and sinker? I won’t answer that one but I hope the excuse is not ignorance of gender-identity disorder. We cannot go around justifying hateful action with a stupid line such as, 'Oh, I don’t know anything about transsexualism. We live in a complicated world.'

Shame on all you who use this line to justify your hatred for minorities. How many of you know the pathogenesis of cholera, pneumonia, meningitis, gonorrhoea and chlamydia? Do you go around beating and hating people with cholera and chlamydia? If the director knows the pathogenesis of all the diseases that people get to be treated for at Kenyatta National Hospital how by chance does he not know the aetiology or a single fact about transsexualism? Your guess is as good as mine and any civil human being needs to question and challenge this kind of irrationality and hatred.

You don’t have to be a transsexual person to understand the injustices transsexual people get subjected to. I don’t have to be a woman desperate for abortion services to know the pain of feeling helpless and desperate. You don’t have to be HIV-positive to know that stigma kills. I don’t need to have kidney failure to realise appropriate resources need to be invested in procuring and repairing our dialysis machines and making them accessible in all corners of Kenya. Yes, there is money for all these but it’s used by our politicians and political leaders and their fan clubs to travel to the USA for Obama’s inauguration – and maybe even for the christening of Obama’s dog Bo. It’s also used to buy them Mercedes Kompressors and pay for the stupid retreats they are so fond of going to following cat fights with tribal kings from other 'enemy tribes'.

This spiteful director also seems to be out of touch with what happens in his office. Barricade presented a letter recommending her for surgery and hormone therapy from the team of psychiatrists who evaluated her. She presented it to the secretary and after Barricade followed up her case, she was directed to a team of doctors who did an evaluation on her for several months. The doctors followed an accepted protocol – and additionally give it a chance to change Barricade’s short fuse – in handling her case, yet the director felt he wasn’t consulted.

Did he want to be the one who made the first cut or the one to anaesthetise her? This is pure malice. I will let you readers in on a 'top secret' in the trans-community. I refer it to as a top secret since very few healthcare providers seem to be aware of it – not just the walking cabbages in the streets. Sorry for the digression. Gender-identity disorder – commonly known as transsexualism – is a psychological disorder with a diagnostic criteria in the Diagnostic and Statistical Manual – 4th edition (DSM-IV), the manual all psychiatrists use to treat psychological disorders. The International Classification of Diseases also stipulates a diagnostic criteria almost identical to that in the DSM-IV. On top of these, there are the standards of care (SOC) laid down back in 1979 by psychiatrists led by Dr Harry Benjamin, which have undergone a number of amendments to accommodate advances in healthcare delivery to transsexual people and reports on the successes of gender-reassignment therapy.

Why, with all these structures, would anyone claim that transsexual people should not access medical care in Kenya? Does the director want to lay down the law that no transsexual person will ever be treated in Kenya, and in particular at Kenyatta National Hospital? Anecdotal reports indicate success rates of up to 97 per cent among male-to-female reassignments. But then the director is ignorant of these facts and therefore should not be made to face the music. No. That’s not the way this should be handled. Humans, let's put an end to these atrocities. We are all aware of what happens when we let similar hateful actions happen without the masses saying 'no'. It happened between 1939 to 1945. During this era six million humans lost their lives (and not in combat) just because a crackpot somewhere hated their origin and what they had supposedly done to Jesus some centuries ago. Surprisingly, a president somewhere in the North claims this is a myth. How far from logic and reality can any human be to make such a claim? Or was he desperate for attention? Let’s do the right thing. It’s starts with you, Barricade and me. We can do away with religious beliefs, culture and any irrational source of common impetus to torture humans.

* Audrey Mbugua is a member of Transgender Education and Advocacy, a Kenyan organisation formed to address social injustices committed against the country's transgender community.
* Please send comments to [email protected] or comment online at http://www.pambazuka.org/.