Ancient Indian culture is rich with stories of transgender and gender non-conforming communities belonging to higher echelons of society. In addition to that, their history implies their extensive knowledge of fine arts, politics, and literature. 

However, colonization by the white Europeans brought restrictions and shame to the Indian transgender community. Laws were enforced to criminalize their performances and lifestyle, freedom to practice their profession, and right to own any property which forced them to live in specific areas that further marginalized these communities - effects of which are prominent even today. 

The attempt to eliminate the hijra community forced its members to resort to professions like begging and sex work to sustain themselves and their families. Although these forms of discrimination and structural violence are paralyzing in themselves, access to quality healthcare is another major issue faced by gender minority communities. This issue is further exacerbated by the lack of adequate resources and training of health care professionals in caring for people with various gender identities and sexual orientations subjects. 

To combat these knowledge gaps, Swasti Health Catalyst is attempting to set up an accessible platform with a variety of resources.

We at Swasti, conducted a wide search across Google, Google Scholar, Youtube and snowballed into several national and International University platforms to look for accessible resources on “gender sensitivity” or “gender competency training” in the context of health services. The search for material, specifically for healthcare professionals, yielded several paid training that involves multiple steps which are generally not feasible for busy professionals. The resources that were free of cost were severely lacking in scope and provided a very generic description of gender and sexual orientation. We noticed that customization of such training for a healthcare setting was severely lacking. Additionally, most of the affordable or free resources were relevant to white-dominant countries such as the USA and Western Europe. This was again a major drawback since India has a highly diverse LGBTQIA+ population; with different community names, identities, languages, lifestyle, health needs, and professions. The prevalent cultural disconnect rendered several resources unserviceable for Indian medical professionals. Even well-known and respected international organizations failed to address this gap in healthcare delivery. 

WHO’s gender-sensitive training document (2006) talks about how women’s health topics, especially sexual and reproductive services, are severely neglected but, there are hardly any specific mentions of female sex workers and their increased need for high-quality reproductive health services. Evidently, gender-oriented reports on health and healthcare infrastructure focus on women’s health while completely ignoring the needs of the LGBTQIA+ community. While this is a very pressing agenda, the neglect for training medical professionals on the health needs of the trans community is glaring, detrimental to the community and professionals in the long run.

In an attempt to include gender as an important lens to have in the medical curriculum, CEHAT (Centre for Enquiry into Health and Allied Themes) along with the State Government of Maharashtra and MUHS (Maharashtra University of Health Sciences) brought out guides on “Integrating Gender in Medical Curriculum” for various subjects in the MBBS course. This initiative was an attempt to bring out the role of gender in medicine not only from a clinical disease/illness point of view but also as a social construct of how gender plays a role in inequities in health and well-being. This helped medical professionals in approaching patients holistically and understanding the barriers and stigmas that inhibit among different communities and their health behaviors and decisions. The promising results of the impact of this study lead us to believe that such upstream measures are one of the best ways to make our healthcare infrastructure inclusive.

Since most resources on LGBTQIA+ patients’ needs and expectations are not easily available or paid, this deters medical professionals from accessing this training- barring the fact that this information should be made available to them free of cost and during their medical training itself in the first place.

The MITHR 2.0 program was conceived as a project to form a bridge between the supply and demand of healthcare for marginalized women communities. We wanted to connect individuals from such communities, without access to primary healthcare, to primary care providers and institutions that were sensitive to their needs. This unique position brought insights from both sides: community members and healthcare providers.

Healthcare providers showed interest in learning more about these communities, surprising as to how complex these communities are, and concern on how even their basic needs are not being met by the system. Instead, STI services are being provided through other parallel and vertical health programs that are not always integrated into the primary healthcare system. But these issues were never brought up in their medical training which left them unprepared to understand and treat these individuals. Through this program, Swasti and PCMH Restore Health worked with training providers who participated in our program for LGBTQ+ sensitization.

But why stop there? 

Moving forth, we wanted to share these knowledge resources with others doing similar work and with those who show interest in supporting such endeavors. Therefore, we developed a comprehensive database of 

(1) Already available (free) and culturally relevant resources and 

(2) Swasti and PCMH Restore Health created videos of relevant learnings and community voices from our MITHR 2.0 program in the form of a resource bank. 

This platform can be accessed by any and everyone and has a wealth of material; technical and non-technical; community voices, their needs and expectations, the barriers they face in accessing healthcare services and potential areas of improvement; medical curriculum; and studies that demonstrate the benefits of educating medical professionals on gender and sexual orientation. This knowledge bank includes videos, articles, clinical guidelines and research papers, and much more. It sheds light on experiences of the trans community within the current healthcare system, their expectations, and needs. It provides insights into the use of respectful and inclusive language, dispelling myths and superstitions, breaking down gender norms, and aiding smooth accession of health services.

Primary Healthcare Database

What’s different about this resource bank is the blend of both existing, known material and the creation of resources through collaborations with CBOs and CSOs within Bangalore. We partnered with Swathi Mahila Sangha and Samara Organization, both community-based organizations, in Bengaluru to develop videos of the interviews with community members. These videos highlight the necessities of this population and the challenges that they faced while accessing healthcare services. It was a collaborative process, where we ensured to hear, understand, and amplify the community’s needs through a video platform. 

The community’s input and needs assessment provide a broader view of what is required by our medical staff today to truly address the top requirements of marginalized communities. The majority of the existing resources focus on sexual and reproductive care; with STI material and needs taking the center stage . While reproductive health services are needed, we see time and time again that those tend to overshadow basic primary healthcare needs of this community.

Voice from the community : Health needs of transgender people by Ranjitha https://www.youtube.com/watch?v=AYm1xsekz-U 

These resources give us a deeper understanding of what our training materials (or lack therefore) are missing and how these rifts can be mended. Additionally, we have also incorporated the experiences and concerns of providers who were a part of our MITHR 2.0 program, giving a holistic view of this issue. 

This database is freely available and can be used and replicated by others to fit into specific cultural and ethnic contexts. Our custom training course, which is certified by the Academy of Family Physicians (AFPI) of India and SafeAccess is also available for any and all medical professionals and caregivers. 

By means of this knowledge bank of training resources, Swasti aims to raise awareness on the importance of gender sensitivity training for medical professionals and provide resources for the same.