SRS surgeries in Kerala are monopolised by four private hospitals, said Maya Krishnan, an advocate at Kerala High Court.
In months preceding her death, Alex had been discussing the possibilities of taking legal action against the Renai Medicity hospital with Krishnan.
“All the while that we were discussing the option, Anannyah was also contemplating undergoing a corrective surgery at the same hospital”, said Krishnan. “That is the problem with the monopoly. Trans people have no alternatives.”
Gender affirmative healthcare was not available in the government healthcare system in the state, according to a study conducted by Queerala, a LGBTIQ organisation in 2019. Two years hence, things remain unchanged.
The Transgender Persons (Protection of Right) Act, 2019 mandates public healthcare provisions, including sex reassignment surgery and hormonal therapy, for transgender persons. The Act also recommends for the publication of a health manual for SRS, in accordance with the guidelines issued by World Professional Association for Transgender Health (WPATH).
Psychiatrist Dr Jithin T Joseph believes that the WPATH guidelines, if followed properly, could address major concerns regarding the SRS in the country.
“A set of specialists, including psychiatrist, endocrinologist, plastic surgeon, gastroenterologist, gynaecologist and urologist are involved in the surgery. The WPATH guidelines are issued based on scientific studies, expert opinions and challenges faced by transgender persons”, he told Behanbox.
Though medical practitioners in India are not legally bound to follow the WPATH guidelines, the Transgender Persons (Protection of Right) Act recommends formulating guidelines in tune with the WPATH in India, said Dr. Joseph.
Private hospitals, in a hurry to cash in on the financial support offered by the government, flouted many of the norms, said Krishnan.
“Around five persons underwent SRS surgery during the time I was admitted at the hospital. I realised that they were cashing in on our desperate urge for a better life”, Govindan told Behanbox. While a consultation with a psychologist was arranged ahead of the surgery according to the norms, it was a routine exercise.
“The psychologist would just ask whether we are ready for the surgery but never talked of its implications in detail”, said Govindan. “In Anannyah’s case, I realised that she was neither given necessary hormone therapy nor the psychological support,” she said.
The first SRS surgery within the government healthcare system was conducted in 2017 at the Government Medical college hospital, Thiruvananthapuram. Sagar, a trans man, filed a complaint with the former Health Minister KK Shailaja and the State Human Rights Commission, about his botched surgery and the mental and physical trauma that he underwent.
“They took my body for their experiment. The doctor I consulted in Mumbai told me that the surgery at the Thiruvananthapuram MCH was not done according to protocol. This in turn led to several complications. The strong antibiotics they gave me for the infection caused further serious health issues,” Sagar said in an interview with Firstpost.
Thereafter, SRS procedures were conducted entirely in the private sector.
After Alex’s allegations and her death, Kerala’s social justice minister R Bindu informed the Kerala Assembly that a protocol would be introduced regarding sex reassignment surgeries.
“Government plans to address the issues, including medical complications of SRS, as a matter of immediate concern. The transgender justice board has decided to constitute an expert panel to study the possibility of introducing gender affirmative healthcare in the government sector and to issue norms according to WPATH guidelines”, she informed the assembly.
M Anjana, director of the Directorate of Social Justice, speaking to Behanbox, said that the government had taken steps to offer gender affirmative health care in government hospitals. “The expert panel will also check on the progress of the proposal to set up gender affirmative health care in government hospitals. The recommendations of transgender members of the transgender justice board too are being considered for follow up activities,” she said.
The minister has also ordered the directorate of the social justice department to submit report on providing health insurance to transgender persons and inclusion in the priority list of Life Mission, Kerala government’s housing scheme for the homeless.