Lack of expertise and government oversight endangers transgender people’s gender affirmation

28 October 2021
Nandana Suresh suffered severe pain and other medical issue following a botched gender affirmation surgery. For many trans people, the lack of expertise in hospitals and the lack of government oversight makes gender affirmation surgery a dangerous necessity.
Mrudula Bhavani
Nandana Suresh suffered severe pain and other medical issue following a botched gender affirmation surgery. For many trans people, the lack of expertise in hospitals and the lack of government oversight makes gender affirmation surgery a dangerous necessity.
Mrudula Bhavani

Nandana Suresh was numb when she heard about the suspected suicide of the transgender activist Ananya Kumari Alex, reportedly following a failed gender-affirmation surgery. Suresh told us she immediately thought back about her own botched gender-affirmation surgery, and how many others like her would have had to suffer the pain and other post-surgery complications that had plagued her for the past 20 months.

In 2019, Suresh underwent the surgery at Saravana hospital in Tamil Nadu’s Madurai city. For the next year, she struggled to urinate. We met Suresh at her partner’s residence in Mararikkulam village, in Kerala’s Alappuzha district, on the afternoon of 22 September. She had already changed her clothes twice that day due to bleeding, as she had to insert a catheter tube for urination a day before. “I had barley boiled in water to make urination smooth but still the quantity of urine was tiny,” Suresh said.

Suresh’s experience is common for transgender people in Kerala who underwent gender affirmation surgery in the state. While the state claims to help fund such surgeries, the transgender people are only reimbursed after the surgery, barely reducing the struggle for a community that has been economically marginalised. Trans-rights activist told us that the state does not offer such surgeries in government facilities and medical staff at government hospitals can be hostile to the needs of the community. The lack of guidelines or clear protocol has also meant that private hospitals can conduct such surgeries without the transgender person being prepared for the procedure or giving informed consent. This has led to several transgender people suffering severe medical complications following the surgery. Trans-rights activists argue that the issue is exacerbated by the Transgender Persons Act, 2019, because it makes surgeries a necessity to access welfare schemes meant for them, forcing many reluctant transgender people to undergo unsafe surgeries.

Following Ananya’s death, there was an outpouring of accounts by transgender people about their own uncomfortable and often debilitating experiences with gender-affirmation surgeries in private hospitals in Kerala. The accounts spoke of surgeries often conducted without following established medical protocols for such procedure, and by doctors who lacked the requisite expertise. Suresh too wanted to share her account, because she reasoned, “If enough of us speak up, maybe something like this will never happen in the future.”

“My longing for the surgery is 21 years old,” Suresh told us. Growing up in a Malavedar tribal colony in Kollam district’s Punalur village, she could identify her gender identity, during her school days itself. She went to school wearing girls’ clothes and told the school’s authorities that she can only dress in this manner demanding that they accept her the way she was. After her secondary education, she left home, doing odd jobs in Karnataka, Tamil Nadu and Maharashtra, to collect money for her surgery.

Ashfaque EJ is an independent journalist.

Mrudula Bhavani is a freelance journalist based in Kerala.

Keywords: transgender Kerala queer rights gender violence Indias transgender community
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