We read the article titled “Gender Affirmative Care Clinic: an Overview” with great
interest.[1] The authors effectively emphasized the need for a gender affirmative care team made
up of educated and experienced healthcare professionals and allied professionals who
have the skill, competencies, and compassion to provide inclusive care for the transgender
and gender diverse population (TDG).[2] It is imperative to create a cadre of such professionals who are trained and sensitized
in transgender health, which is being deliberated to be a part of the medical curriculum
by the National Medical Council in India. While such efforts are being made by the
stakeholders and government, we must acknowledge the sparse pool of human resources
and infrastructure to provide high-quality specialized care to the TGD population
in India considering that their population as per Census 2011 is 4,87,803 and is projected
to increase by a factor of 10 in the 2021 Census.[3] It takes time and experience to acquire the expertise of an astute clinician, which
must be drawn from the mainstream medical system.
Similar to the demands of other genders, the TGD community requires access to medical,
surgical, reproductive, emergency, and mental health care throughout their lives,
in addition to gender affirming medical and surgical care. Only if the care is integrated
into a tertiary care system is this conceivable. Therefore, it should be a nested
component of mainstream care with specific sensitivity and empathy to their needs
rather than offering services in a silo. NACO has engaged with the All India Institute
of Medical Sciences, New Delhi, to set up a center of excellence for gender affirmation
care as well as provide linkage to holistic care for all of their health needs (personal
communication to second author). The National Health Authority (NHA) and the Ministry
of Social Justice and Empowerment signed a Memorandum of Understanding (MoU) on August
24, 2022 to provide transgender people with a comprehensive medical package under
Ayushman Bharat-PMJAY to seek treatment in any of the AB PM-JAY empaneled hospitals
nationwide, where specific packages are available.[3] This program can be used right away at the approved centers instead of developing
new channels of service, which could take several years.
Thus, it is vital to integrate the patient care, training, and research related to
this particular segment of the population within designated health facilities in a
sensitive and empathetic manner, involving all the concerned departments.[4] Social separation can be provided to these patients while preventing clinical separation
by designating specific outpatient hours in the evening, we also propose care coordinators
from their own community to serve as liaison officers between the various departments
to facilitate priority and streamlined care and reduce unnecessary hospital visits
and unpleasant interactions.
