The Kerala government’s decision to introduce free sex-reassignment surgeries in government hospitals may open a new lifeline to transgenders who feel they are trapped in bodies that are not compatible with their feelings.

No such facility for such surgeries exists, either in government or private sector, in the state at present, says VN Jithendran, director in the social justice department of government of Kerala.

Transgenders blame this on the state still being very conservative in its approach towards gender minorities. “There are only men and women in Kerala. The society doesn’t recognise the existence of transgenders at all,” says 29-year-old Faizal, who fled to Bengaluru in the face of harassment and humiliation in his village near Chavakkad in Thrissur district.

Chilla Anil, executive director of Chilla, a non-governmental organisation in Thiruvananthapuram, points out that at present transgenders are forced to go to Chennai or Bengaluru for such surgeries. This is neither practical nor affordable because these surgeries are a long-drawn and costly process.

Anil said that a male to female surgery costs around Rs 2 lakh to Rs 5 lakh, while female to male surgery costs between Rs 4 lakh to Rs 8 lakh in private hospitals. This is not affordable for majority of the transgenders since they neither have regular income nor the support of their families.

Even those who have the money find it difficult to go for surgery outside the state as the process involves counselling for six months to two years, continuous hormone therapy for at least one year under the direct supervision of a physician and long post-surgery observation.

With this background, Anil said the decision to introduce the facility in government hospitals in the state will be a big boon to the transgenders. A survey conducted among the transgenders in the state last year found that nearly 81% of the estimated 25,000 transgenders wished to change their gender identity.

The survey found that as many as 76% of the transgenders were reluctant to reveal their actual gender identity because of the fear that they won’t be accepted if their gender identity were revealed. Majority of the transgenders who wish to change their identity reported lack of support for the surgery from any quarters.

Anil said that the transgenders in the state have been demanding free surgery facility in government hospitals for a long time now. The demand was raised at the International Conference on Gender Equality held at Kovalam in the state capital of Thiruvananthapuram in November.

Road blocks ahead

But Anil was sceptical about the government decision since it has come from the social justice ministry headed by Dr MK Muneer. The health ministry that has to implement the decision has maintained a mysterious silence on the issue, said Anil.

“We had made several representations to Health Minister VS Sivakumar for providing the facility at least in government medical colleges, but the minister remained deaf to our pleas," Anil said. "We don’t know whether Muneer has made the announcement after taking his colleague into confidence.”

Jithendran added that the department was pursuing the matter with the health ministry. “We will be soon sending a concrete proposal in this regard to the ministry for implementation, Jithendran said. “I hope the facility will be in place at least in medical colleges during the next financial year.”

However, Jithendran admitted that the process was not easy since Kerala does not have trained physicians to conduct sex reassignment surgeries, which require a multi-disciplinary team of urologists, endocrinologists, sexologists and psychologists.

“We have the specialists, but we need to hone their skills to perform the surgery. We hope the proposal will become a reality before the middle of the coming financial year. The government is committed to bring the gender minorities to the mainstream,” he added.

The new initiative is part of the steps being taken by the government to implement the transgender policy announced in November last year. The policy, the first of its kind in India, is aimed at improving the life and living conditions of the transgender community.

Gender Taxis

Another major step under the policy is a “Gender Taxi” for the transgenders. The taxi service to be owned and operated by the transgenders is aimed at ending the societal stigma towards them. The programme conceived by the state-run Gender Park on the lines of the successful “She Taxi” is proposed to be rolled out later this month.

While the “She-Taxi”, launched in November 2013, is run exclusively by women for female passengers, the “G Taxi” has been envisaged as an “equality taxi” in which all travellers, irrespective of their gender, can avail of the service.

PTM Sunish, chief executive officer of Gender Park, said the “G Taxi” was also intended to ensure interaction between transgenders and members of the other two genders. This, he said, will help in changing the mindset of the people towards the sexual minorities.

Ten transgenders have come forward to operate “G Taxis”. They are now undergoing training. The government is trying to help them procure the cars. This may not be easy since the banks will insist on collateral security, which most transgenders may not able to provide as they do not have family support.

Transgenders have welcomed the initiative saying that it will not only help them in earning a living but also in gaining access to mainstream society. “I am confident that this will be a successful venture,” said Navas, a transgender involved with the “G Taxi”. "Running a taxi is more than a means of living. It gives visibility to the transgenders and that will in turn help them in joining the mainstream."