Affirmation Blog 02 - Larger - Rhea Rollmann
So long as I’m blogging about my experience with gender affirmation surgery, it would be remiss of me not to comment on the problem of financial barriers facing trans folk who seek medical interventions like surgery.
But wait, you might say – don’t we have a public health care system in Canada? Shouldn’t medical interventions that have been deemed medically necessary and life-saving (by an array of global health organizations) be accessible to residents of Canada without cost?
Yes, they should. And if you talk to a politician, they’ll probably say that they are. But the reality is they’re not.
I chronicled the ways our health care system fails trans patients in an in-depth investigation for The Independent a few months ago, which you can read here:
Suffice it to say that while some trans-affirming surgeries are covered by MCP on the books, the reality is a mish-mash of exclusionary fine print and co-pay measures that render major surgeries out of reach for so many people in this province.
In my own case, I thought I would fare okay as I transitioned. I had a job with a health plan, and I even had savings in the bank.
But as my transition proceeded, I watched my savings dwindle and my credit debts grow. Hair removal for trans feminine patients (laser hair removal, electrolysis) is not covered in this province at all (this has been achieved, or is being challenged, in other jurisdictions). Top surgery (breast augmentation) is listed as one of the medically necessary affirmation surgeries covered by MCP, but the fine print of who is eligible contains the most restrictive criteria in the country – so restrictive that literally no one in this province has ever qualified. It would be comical if it wasn’t so sad.
Meanwhile, most complex surgeries for trans patients cannot even be performed in Newfoundland and Labrador (mastectomies for trans masculine people, genital surgeries for all genders). So although they’re covered by MCP, we have to figure out how to get to a clinic outside the province in order to access the surgery. NL has a program called the Medical Transportation Assistance Program (MTAP) which is supposed to cover this, but it’s a severely inadequate cost-share program (and if you’re a client on income support, you fall under a different set of equally inadequate programs). MTAP requires you to cover all your costs up front, and then cross your fingers and hope you might get some of those expenses re-imbursed. For me to go to Montreal for a vaginoplasty requires me to cover airfare costs for both myself and a medical escort, as well as accommodation costs for the escort (which is recommended by the medical teams – you’re pretty immobile following the surgery).
The expenses I faced after I got the call offering me a surgery date, ran into the thousands of dollars. And they keep growing – a few weeks before my surgery the clinic sent me a list of items to purchase, including some medical items I have to bring with me. This cost me another few hundred dollars I wasn’t expecting.
My workplace was very supportive and provided me the time off for surgery and recovery (we’re unionized, and have a gender transition leave in our collective agreement – one of many great reasons to unionize!). But how was I supposed to cover all these extra costs? I had already maxed out my credit (both credit cards and line of credit) covering top surgery and hair removal. Now here was the opportunity I’d been on the wait-list for for years – but accompanied by a bill that I had no way to pay.
I was literally in a state of despair over what to do. I tried marshaling my financial resources and doing creative budgeting, all to no avail. Meanwhile, the surgery date grew closer and the expenses just kept rising.
I had long considered doing a fundraiser, but kept hesitating. There’s a real stigma in our society about asking other people for help. I had really been infected with that whole neoliberal mentality which tells you that if you’re incapable of being self-sufficient, it’s a personal failing.
But as the date grew closer, I eventually resigned myself to the fact it was the only way I’d be able to make this happen. To quote the wise and wonderful Brit Byrnes, who was a tremendous support to me through this process and encouraged me to go ahead with the fundraiser: “It’s okay that you’re scared but remember it’s only because neoliberalism has taught you it’s wrong to need community support.” It’s true. It’s hard to express just how frightening and scary it is to admit to the world – your community and your peers – that you need their help and support. Even after I had the initial fundraiser post made up, it took me an additional three days of talking to other trans folk who had gone through this, until I felt reassured enough to give it a try.
The response was overwhelming (but still ongoing – you can check it out at this link: https://gofund.me/1f1f7d3c ). I literally cried every time I logged in, and saw more people donating and sharing it. Former co-workers. Friends I hadn’t seen since elementary school. Distant colleagues I had never even met face-to-face. Friends and relatives of friends, who I didn’t even know.
It’s hard to know what to say in response to such overwhelming kindness and generosity. Some people made tremendously generous donations, but even the smallest donations elicited just as many tears – tears of joy, of relief, of astonishment at the kindness of people I sometimes didn’t even know.
At the same time, I must admit, my joy was mixed with a note of sadness. I knew how many other trans folk were out there trying to raise funds for these surgeries as well. I personally know several here in St. John’s. Not everyone has had the good fortune I have – I know that I’m blessed with having a wide social and professional network, some of whom have quite well-paying jobs. It’s ironic in a way – I’ve often lamented at how long it took me to come out, and wished that I’d transitioned earlier, as a teenager or in my twenties. But waiting this long enabled me to build up the network that has made funding my surgery even possible. Not so for many of the other folks – often much younger, frequently jobless or students – who are also trying to access surgery.
Every time I received a donation, I also thought of those people who were struggling to raise the funds. Our provincial public health care system – which requires residents to fundraise for their own medically necessary surgeries – is completely inadequate. And it’s a problem faced by other patients in our health care system too, not just trans patients. This is no way to run a public health care system. And so many people fall between the cracks as a result.
Our government knows this. In the story I cited above, I filed Access to Information requests to obtain government briefing notes, in which health care officials bluntly warned that the more financial barriers were removed, the more people would come forward in the province seeking to access surgery.
As they should! You don’t run a health care system by not funding medically necessary treatments, out of fear that people might access them. A truly public health care system would provide these services, with up-front coverage, and no fine print to try and exclude as many people as possible. As those same government briefing notes grimly observed, the costs to the health care system of not providing trans-affirming health coverage – costs counted in the form of sick days, mental health issues, and suicide attempts – is even greater. Yes, the government used precisely that sort of cost-benefit analysis. I would add that even worse is the cost in human anguish and suffering, the inability of so many people to achieve their full potential and thrive to the degree they could.
I don’t even know how to thank all those who have made my own surgery possible – beyond committing to continue to fight for a more accessible public health care system for everyone. It’s a fight we all need to be part of.
Rhea plans to blog her continuing journey here on the Engen Books site, so stay tuned for updates. Keep an eye open for Rhea's Queer History of St. John's in 2022, and preorder Acceptance, featuring a story by Rhea, here from Engen Books.