I write this, two days after Alesha, an activist from Peshawar, Pakistan died after being shot 6 times. In an alternate universe, in an alternate history, Alesha may not have died, coming back stronger from her ordeal to take on the world and changing it. But perhaps, in this alternate history, Alesha would never have been shot?

You see, Alesha was a trans woman. And so, purely by dint of existing, she was under risk. As an activist who worked to ensure equal rights for her trans sisters and brothers, she added to that risk. What this world hates most is someone who is supposed to be meek and cowardly and afraid, but is not.

Although she was rushed to a hospital when she was attacked, Alesha couldn’t get the life-saving surgery/treatment that she needed, because a group of doctors were more worried about a stupid, inane administration issue: as a trans woman, should they put Alesha in a woman’s ward, or the men’s?

While these group of white-coated products of the medical education system argued back and forth, Alesha suffered. After much debate, her surgery was performed outside a toilet. By which time it was too late, and another trans woman died an all-too-premature death.

Sadly this is not a rare instance of the medical system failing trans people. At every turn, every encounter, transgender people, and other gender and sexual minorities often have to fight for treatment and services that the larger society takes for granted.

Unnecessary and extraordinary pathologisation, gatekeeping, a reliance on outdated medical texts and flawed understanding of human biology, and very high costs of essential medical care, are some ways in which trans persons are denied their right to self-determine their lives and their identities.

In 2010, the US based advocacy organisation Lambda Legal conducted a nation-wide survey of LGBT individuals and those living with HIV. The survey found that more than 50% of LGB individuals, and more than 70% of transgender individuals, and 63% of those living with HIV, faced discrimination when seeking medical care.

Given that a considerable number of transgender persons – especially trans women (in this context, trans women include Hijras, kothis, aravanis, jogammas and other indigenous non-binary identities) are also HIV positive, the denial of medical care to these individuals is potentially fatal.

By discrimination, Lambda report lists the following: being refused needed care; health care professionals refusing to touch them or using excessive precautions; health care professionals using harsh or abusive language; being blamed for their health status; or health care professionals being physically rough or abusive.

Unfortunately, such a survey has not been undertaken in India, and so we do not know what percentages of trans women, trans men, and other gender nonconforming people are discriminated against. But going by personal experiences, and hearing horror stories from my trans brothers and sisters, the numbers could be significantly higher in India.

Before a trans person begins hormonal transition, they will have to undergo a psychiatric evaluation. And here, we come across the first gatekeeper. Trans men I know have had psychiatrists tell them that they cannot transition without experiencing the joys of motherhood. Trans women have been asked if they feel the lack of a mother-figure and hence the transition. It is not uncommon, after months of counselling and therapy, which often comes at prohibitive costs for trans women who come from dalit and oppressed castes, and poor/working class homes, to be denied the all-important certificate that would enable them to begin hormone replacement therapy.

Either through ignorance, negligence, or wilful manipulation – mental health professionals are determined to discourage and limit the persons choices. Psychiatrists and psychologists rely on medical text that have been outdated for at least 15 years, and believe “transgenderism” is a disorder of mental development.

Passing this gate brings a trans person in contact with endocrinologists and physicians. I know of endocrinologists with extreme prejudice who believe that trans women are a sin on the face of earth, who think that we are playing god in seeking to change our “god-given” bodies, who believe that trans women are no more than “sissy men”, and while they will prescribe the hormones we demand, they personally think that it is a crime. When, after much trouble, a trans person meets that rare endocrinologist who does not judge, she or he will often prescribe dosages that are unsuitable to the person.

This is combined with the fact that most dosages are prescribed for white Americans – and may be largely insufficient for the Indian population.

A trans woman, after a sympathetic psychiatrist who can give a non-judgemental, unbiased evalution, and a knowledgeable endocrinologist who prescribes suitable, effective hormones, then encounters the huge pharma industry.

Hormones are prohibitively expensive.

And often kept so because the pharma industry knows that trans people will pay a ransom just to feel a tiny bit of personal happiness. The only reason that the testosterone blockers I buy are comparatively cheap is because it was designed and produced as a pill for middle-aged men with hypertension.

Trans women often have to resort to crude backroom surgeries, quacks and cheats, touts, delicensed medical professionals to get at least some of the physical transition they seek. In 2016, despite laws – both state and national – this is still the case because costs and prejudice, social apathy, all combine to seriously limit and hinder the lives of gender minorities.

The disability rights discourses talk of reasonable accommodation required for persons with disabilities to live lives fully, as part of mainstream society. Trans persons too need reasonable accommodation – and that is simply for medical care industry to treat us as human beings. As people with the same hopes and aspirations as the rest of the world. Till then, there will be more Aleshas dying everyday.

Featured Image Credit: Alesha had been critically injured after she was shot six times on Sunday night| DunyaNews.tv

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