Ontario recently announced an expansion of access to transition-related surgeries, a move the government and healthcare providers hope is a step towards solving a bottleneck of need.
Health Minister Eric Hoskins made the announcement in a statement on June 22, 2017, saying the province will partner with Women’s College Hospital and Sherbourne Health Centre’s Rainbow Health Ontario to increase access to chest surgery and other in-province resources in 2018.
Cheryl Woodman, chief strategy officer at Women’s College Hospital, says it’s a step in the right direction.
“It was a very ambitious announcement, but we’re happy that the government is really seriously considering this as a priority,” she says. “The idea is to create access in a publicly-funded hospital so that there’s more capacity across the province and hopefully eventually across the country.”
Last year, the ministry expanded access to referrals for transition-related surgeries, making it possible for qualified health professionals to provide referrals in surgical services, resulting in skyrocketing demand.
“What we knew was going to happen was that there might be another bottleneck,” Woodman says. “We started to clean up that bottleneck in terms of [referral] wait times but what we didn’t put in place was access to actual surgical services.”
Rita OLink, community relations representative at TG Innerselves — a transgender support organization based out of Sudbury — agrees the announcement has been a long time coming.
“I am very glad they’re finally moving on this, because for decades there was zero,” she says. “With the population of Ontario, it’s ludicrous that they’re not done here.”
Barriers will still remain, she notes, especially for residents in Northern Ontario communities. Even when travel costs are covered, the patient must pay up front.
“For Northern Ontario, travel is a huge issue, you’ve got very small communities separated by huge distances.”
According to statistics from the Trans PULSE project, 51 percent of trans people make $15,000 per year or less.
“If we’re putting up a barrier there, that only those who are well enough off can do it, we’ve set up a class system,” Olink says. “That’s not my Ontario.”
OLink plans to push for further accessibility throughout the province. She suggests that the Northern Ontario School of Medicine create bases out of its two teaching hospitals in Sudbury and Thunder Bay. The majority of surgeries could be done in Toronto out of Women’s College Hospital, but once a year, she says surgeries could be performed in Sudbury and Thunder Bay on residents from their catchment areas.
“That’ll ease travel problems and make it much more accessible, because a trans person in Ontario should have the same right to access to services as a person from southern Ontario,” she says. “As long as you leave these hidden barriers in place, it’s not solved.”
She stresses the surgeries performed by Women’s College Hospital are a strong starting point, “but we dare not stop there,” she says.
Increasing demand for surgeries
According to data provided to Xtra by the Ministry of Health, the demand for transition-related surgeries has been steadily increasing over the last five years. Since March 1, 2016, surgery approvals increased by seven times since the previous year (in the 2015–2016 fiscal year, there were 195, and in the 2016-2017 span, that number jumped to 1365).
In an email to Xtra, a Ministry of Health spokesperson wrote that Women’s College Hospital is currently in the process of recruiting surgeons to perform external genital surgery, and has received funding in the last two years to support a transition program.
Woodman says the college will do everything it can to reach its goal of increasing surgeries by 2018.
“But I’m trying to be really realistic and make sure that the public understands realistically that this is a very challenging thing to try to do.”
The main challenge, she says, is recruiting surgeons who are able to perform the surgeries. They are also looking for surgeons — mainly plastic surgeons and urologists — who are interested in being trained and mentored, a process that can take time.
OLink expects the added accessibility will only make a small impact on the heavy demand, at least initially, since because Ontario won’t see a facility like the one in Montreal that is dedicated to surgeries.
“These things get started slowly. It’s not going to be 30 surgeries a week,” she says. “Is it going to make an effect on the waitlist? Is it going to make a major effect? No.”
While increased access to surgery is beneficial, Woodman stresses that it’s only one part of the larger issue of addressing the health care needs of the trans community.
“Not everyone who is trans or non-binary or gender nonconforming is interested in having surgery. This is just one facet of the entire health access and health system that we need to make sure is accessible for trans folk,” she says. “From social determinants to health, to primary care, to these sub-specialized areas of health . . . it’s been an underserved community and in some cases, a poorly served community, so we’re just starting now to fix it and build it.”
Currently, Sherbourne Health has a short-term care facility for people who have had a transition-related surgery. Another partner of Women’s College Hospital, the Centre for Addiction and Mental Health (CAMH), provides care for trans people who have complex mental health issues.
“My feeling is that we have to have all of our health care providers trained, and we like to use the term ‘cultural humility,’” Woodman says, “that they have this understanding, so whether it’s an endocrinologist or a dermatologist, that if this is relevant, they know how to appropriately treat people with the highest quality care and the greatest respect.”
Woodman says another area that needs addressing is ensuring that Ontario Health Insurance Plan fee codes and service codes are up to date and appropriate.
Ontario will become the second jurisdiction in Canada to provide access to genital surgery, which means trans people will no longer have to travel outside the province to get the procedure.
“Patients may require follow-up care following surgery so the closer to home that patients can receive surgery, the better it is for patients,” a ministry spokesperson told Xtra.