Complaints, resignations and strapped resources are dogging Vancouver’s new gender clinic.
The two-year-old Transgender Health Program (THP) has only three people on staff-director Chan Drepaul, administrator Wynn Buchwitz and community counsellor Lukas Walther.
Walther only works 22 hours a week, and two of those are devoted to the weekly transgender support group. His office is as bare as they come-with a nearly barren bookshelf of transgender books, pamphlets and resources. There’s usually a two-to-three week wait to see him, and it can often take him a month or more to catch up on returning the many phone calls he receives.
“I’m flooded on the front lines,” he says. “This program is showing how under-served we really are.”
With only three people serving the whole province, the THP is struggling to meet the immense need for resources and information about transgender issues. Walther says that the existence of the THP and the demands of its participants show that the trans population requires more funding and assistance.
The THP opened its doors in June 2003 to replace Vancouver Hospital’s Gender Dysphoria Program-also known as the Gender Clinic-after it closed in May 2002. Established in the early 1980s, the Gender Clinic’s mainly clinical approach offered psychiatric and medical care for transgendered people and was the sole gatekeeper for publicly covered transition surgeries.
But budget cuts by the BC Liberals meant the clinic could no longer adequately provide its services, leaving the trans community out in the cold three years ago.
Trans community groups pressured Vancouver Coastal Health (VCH) to create a redesigned health service. After a year of consultation between the trans community and health planners, the THP was born, but with very different services from its predecessor.
The new program focuses on providing resources and peer support to the transgendered community, and aims to educate health care providers throughout the province as well as improve access to care for transgendered people.
But many local trans people say the new clinic is not responsive to the community it’s supposed to be serving.
Within the last year, several members of the THP’s advisory body have resigned in frustration, claiming the program and its advisory committee are not adequately meeting the community’s needs. The advisory body is composed of members of the trans community and representatives from VCH; its role is to identify community concerns, give advice on the program’s direction and generally act as a guide to ensure the program stays on track.
Jamie Lee Hamilton used to sit on the advisory body, but she took issue with the way it operated. She claims that from the beginning, there was no meaningful dialogue within the committee, a lack of transparency and a lack of effective consultation with the trans community.
“This program has not been responsive to the community,” she says. “I don’t think those issues have been resolved.”
Gayle Roberts, a member of the advisory committee who transitioned under the old Gender Clinic, has been involved with the THP since its inception. She explains that while the members of the committee act as a liaison between the THP and the local health authority, when it comes down to it they essentially play an advisory role and don’t have the power to enact immediate change.
She says, however, that VCH has been receptive to complaints and is doing the best it can with limited resources.
“I believe the professionals are doing their very best to meet needs,” she says. “I believe that the organization is growing in a healthy way and responding well to any complaints.”
Part of the turmoil on the advisory committee can be attributed to unrealistic expectations of what the committee can accomplish, says VCH staff and committee member Devon MacFarlane.
“There’s a lot of hopes of what it can do,” he says. “It can’t meet everyone’s hopes.”
But Tami Starlight, a trans activist who was part of the THP’s education working group, agrees with Hamilton that the program is not responsive. The program isn’t doing enough to help the marginalized such as transgendered sex workers, homeless youth and First Nations people, she says.
Starlight left the education board after a year, partially due to personal issues with the previous program director, Joshua Goldberg, but mainly because she felt the advisory committee lacked community consultation-leading to a feeling of disenfranchisement in the community.
She says that a program that doesn’t fully connect with the community and its needs leaves empowerment just out of reach.
“They’re holding the fruit over people’s heads and seeing how far they can jump,” she says.
Hamilton is also concerned about the new clinic’s lack of medical services. With no doctors on staff, she says it’s harder for trans people interested in surgery to find medical care, which could prevent them from taking active steps to transition, such as beginning hormone therapy.
Robena Sirett, a manager with VCH who also sits on the advisory committee, says that a goal of the program is to produce a network of care providers all over province, instead of at just one site.
This month, VCH provided a training intensive for health care providers (both physicians and mental health practitioners) to increase education and knowledge about trans issues, including hormone and surgery assessments.
“We’re trying our best,” Sirett says.
Despite its alleged problems, transgendered people who use services at the THP find it extremely helpful after years of dealing with the frustrations of mainstream health attitudes towards the trans community.
Support group attendee Gail Steyning has been attending meetings since the THP began and feels that the program has been a great source of guidance, relevant information and support.
“I’m just ecstatic with the whole program,” she says. “I found such relief in actually being able to talk to someone who knew what the heck was going on.”
For Kellie Pirie, the support group has provided an immense amount of emotional support and has fostered a sense of community.
“I feel like the Transgender Health Program is this little oasis amidst the larger system,” he says. “Lukas was the first person to call me ‘he’. It’s the little things.”
Support group member Mac Gordon also likes the community support at the THP. “It’s the people who participate that make it work,” he says.
Gordon also says that the THP is a tremendous educational resource for transgendered people because it has valuable information that would be harder for them to find on their own.
“People won’t have to do all the digging,” he says. “I see it as a really needed part of the community.”
Walther says the THP is providing a template for trans communities all over North America because it’s the only transgendered health program embedded within a health system that has people from the trans community working for it.
“What we’re doing is unique,” he says.
For him, the most valuable part of the program is the way it provides support, understanding and a sense of community to its participants.
“The need that it’s really meeting is peer support,” he says.
Walther admits that his job can be frustrating because of the THP’s strapped resources and bureaucracy, but says he stays because he feels the THP is the best place for him to offer help on a daily basis, whether it’s a referral or a friendly ear.
“Every day there’s some sort of miracle,” he says. “Amazing things have happened.”