Advocates welcome new NWT healthcare guidelines on gender

Advocates say new NWT healthcare guidelines for transgender, non-binary, and gender-nonconforming residents are “long overdue.”

The territory’s Department of Health and Social Services announced the guidelines on Thursday. They came into effect on December 21, 2020 and follow similar documents in Alberta, Ontario, and British Columbia.

The NWT now has a code of conduct for safe and inclusive care and referral processes for procedures such as gender-affirming surgeries and hormone therapies.

“Transgender, non-binary, and gender-nonconforming people have the right to respectful, dignified, gender-affirming health care in the NWT,” the document states.

“They are disproportionately affected by poverty, homelessness, unemployment, and health problems such as depression, anxiety, obsessive-compulsive and phobic disorders, substance use disorders, and HIV.

More: Healthcare for Transgender, Non-Binary, and Gender-Nonconforming People

“Healthcare providers are uniquely well-positioned to address these health disparities and increase access to gender-affirming healthcare.”

The NWT guidelines were developed in part by healthcare staff, patient advocates, and the Rainbow Coalition of Yellowknife.

Chelsea Thacker, executive director of the Rainbow Coalition of Yellowknife, helped to edit the document.

They said the document’s publication was “pretty exciting” and would inform transgender, non-binary, and gender-nonconforming people of their right to safe healthcare.  

“It’s going to allow people a lot more dignity, and agency, and access,” they said.

“They can refer to the guide and say, ‘Hey, this is what it says, and this applies to me, so this is what I need from you as a healthcare professional.’”

One of the biggest changes in the guidelines eliminates the need for an individual to receive a gender dysphoria diagnosis from a psychiatrist.

Gender dysphoria is defined in the document as “distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth (and the associated gender role or primary and secondary sex characteristics).”

Previously, only psychiatrists could provide diagnoses for this experience. This often resulted in patients waiting even longer to receive adequate care and support, or needing to leave the North.

Allowing general practitioners to diagnose gender dysphoria can shorten waitlists and let patients continue seeing doctors with whom they feel comfortable, Thacker said, which is key to providing dignified healthcare.

The guidelines acknowledge that Indigenous people face the added barriers of racism and colonialism within the healthcare system.

The document commits to providing “culturally safe healthcare,” which it defines as an Indigenous person feeling “safe and respected, free of racism and discrimination, when accessing health and social services programs and services.”

The document adds: “An important feature of cultural safety is understanding that a legacy of colonialism, including racism in health and social services, influences Indigenous health outcomes and access to care and services.”

‘Just the first step’

Though happy the guidelines are in effect, Thacker qualified their praise by pointing out the document was “long overdue.”

Thacker, who identifies as non-binary, said they’ve had several experiences that left them feeling alienated and dismissed.

“When I asked to get a doctor that was a safe person to work with LGBTQ2S people, I was told that my potential doctor had tattoos and dressed really well and seemed really trendy, so that would be a ‘good fit,’” they said.

“When I asked for a safe doctor for access when I had to get a pap test, the receptionist told me that she’s a woman, so ‘it’s fine.’”

The NWT’s medical record system continues to be problematic, Thacker continued.

For example, there is no “X” marker for gender identification, and the system will only generate a pregnancy chart or a pap test if you have identified as female, which excludes people of other gender identities.  

Thacker described this as “shameful.”

“Our healthcare is different,” they said. “LGBTQ2S healthcare requires different questions to be asked. It requires people to be comfortable using inclusive language, it requires people to create a safe and open space.

“I can’t trust my doctor if I don’t know that they are intending to support and deliver me the best healthcare possible.”

Vulnerability in healthcare

Jacq Brasseur, who was born and raised in Yellowknife, was one of the founders of the Rainbow Coalition in 2011. They identify as non-binary.

Though they now live in Regina, they remember the challenges that came with accessing inclusive healthcare in the North.

“Trying to find a doctor who wouldn’t misgender me or trying to find a mental health practitioner who understood what it meant to be non-binary, all of those things were difficult when I was living in the North,” they said.

Brasseur said lobbying for improved healthcare required a lot of advocacy work and emotional labour.

The fact that the NWT has developed guidelines at all, they added, should be commended.

“I’m really, really stoked,” they said. “Congrats to the Rainbow Coalition for doing all that work.

“From having tried to do some of that work here in Saskatchewan, I’m familiar with how much time it takes, so thank you so much to all the folks who were able to make that possible.”

Thacker said the release of the guidelines is the first step of many toward creating substantial change for LGBTQ2S+ people in the NWT’s healthcare system.

Already, members of the Rainbow Coalition have identified areas of the guidelines that may require revision.

Thacker believes a complete overhaul of the NWT’s medical record system is necessary to make the language more inclusive, alongside mandatory training for healthcare staff on dignified care for transgender, non-binary, and gender-nonconforming people.

“It shouldn’t be an expectation that LGBTQ2S people have to be soft and compliant, and just willing to accept whatever care in order to be seen and to be heard,” they said.

“I think it’s time for the healthcare practitioners to be vulnerable with LGBTQ2S people, even if they don’t have all the answers and don’t know.

“I’m looking for systemic change to match where we are at with social change, and systemic change is often slower, which results in social change reverting back to what it was before. But I think that with a guide like this, we can really push systemic change along faster.

“Not only is it about time, but we’ve got a lot of people motivated to do the job. So why not? All hands on deck.”