Twenty two-year-old Jomol was assigned the male gender at birth but in 2013 decided to come out as a transsexual woman. Her life has been uncertain ever since. Her family ignored and alienated her.

“It was a kind of solitary confinement,” said Jomol. “I was forced to live with my agonies.”

Jomol felt that she needed to consult a psychiatrist during this difficult time in her life. But she did not have the money for mental health services.

Now, four years later, help is at hand for Jomol and other transgender people like her in Kottayam district in Kerala. On May 23, the Government Medical College Hospital inaugurated the country’s first multi-disciplinary transgender clinic.

The clinic has been set up with the support of the Kottayam District Legal Service Authority and the non-governmental organisation Samridhy, which works with people living with AIDS. The clinic operates on the first Tuesday of every month and has, so far, served more than 50 transgender people in the first two sessions held on June 6 and July 4.

“The number will go up in the coming months,” said Dr Sue Ann Zachariah, assistant professor of medicine and the nodal officer for the clinic. “The primary aim of the clinic is to look after patients from Kottayam district, but we are ready to take care of people from other districts too.”

At the clinic, transgender patients can meet a panel of five expert doctors specialising in general medicine, dermatology, plastic surgery, endocrinology and psychiatry in a single visit.

Panel of doctors from five specialties consultation patients at the multi-disciplinary transgender clinic at the Government Medical College Hospital at Kottayam on July 4. Photo credit: TA Ameerudheen

“We have adopted a unique style of functioning in which all doctors will be available for consultation from 10 am to 2 pm on the first Tuesday of every month,” said Dr Varghese P Punnoose, professor and head at the department of psychiatry. “This multi-disciplinary approach helps the doctors discuss the conditions of the patients and seek opinions from other doctors.”

The clinic temporarily operates from the out-patient section of the hospital plastic surgery department – an appropriate setting given that almost all the transgender patients who have visited the clinic have made enquiries about sex reassignment surgeries.

Equipped for gender reassignment?

Swapna was the first patient to arrive at the clinic on July 4 with complaints of a skin allergy and fever. Within an hour she had consulted five doctors at the clinic. She first consulted the dermatologist and then went to the general medicine expert. The thirty-year-old, who works as a nurse, got her medicines for fever and allergies.

But her most important queries were to other doctors. “The endocrinologist promised start me on the hormone treatment soon,” said Swapna. “I requested the plastic surgeon to carry out the sex reassignment surgery as early as possible.”

Dr Lekshmi Jayakumar, professor of plastic surgery, said that most of patients at the clinic have demanded sex reassignment surgeries. But can a fledgling clinic at a government hospital, which is fully dependent on government funds, meet the large demand for such complicated procedures?

“We have a well-equipped plastic surgery department and I think we can meet the huge demand,” said Jayakumar. “But doctors have to undergo some more training before offering the surgeries.”

Consultation in progress at the multi-disciplinary transgender clinic at the Government Medical College Hospital at Kottayam on July 4. Photo credit: TA Ameerudheen

However, Punnoose sees a greater need for counselling.

“We will offer exhaustive counselling to those who demand surgery,” he said. “It is imperative as we have to find out whether they really need it. Some people might be living with confusion about their gender identity and those issues can be rectified through counselling.”

For many transgender people, like Sanjana who also visited the Kottayam clinic in the first week of July, sex reassignment is a wish that has not been fulfilled due to lack of funds. Now, they hope they can get the surgeries at this clinic where all medical services are free of cost.

“If I had enough money I would have done it in some other hospital,” said Sanjana. “We have been eagerly waiting for the complete transformation for many years. [The doctors] should not leave us in perpetual mental agony.”

Free services

While the transgender community might continue to wait for easier access to gender transformation surgeries, the Kottayam clinic has begun to provide more basic medical services that had been unavailable to transgender people. A survey by Samridhy of 392 transgender people revealed that most of them preferred not to go to general clinics for fear of harassment.

Patients register their names with the multi-disciplinary transgender clinic at the Government Medical College Hospital at Kottayam on July 4. Photo credit: TA Ameerudheen

Kerala unveiled an exclusive transgender policy to ensure well-being of the gender minority in 2015. When the District Legal Services Authority approached the Government Medical College Hospital with a proposal for a transgender clinic, the authorities agreed to help set it up immediately. All services at the clinic – consultation, laboratory tests and medicines – are free of cost. This has made a world of difference to Jomol.

“I just have to travel half-an-hour by bus from my home to reach the hospital,” she said. “I couldn’t meet a psychiatrist four years ago for want of money. The launch of specialised clinic shows things are changing now.”

This reporting project has been made possible partly by funding from New Venture Fund for Communications.