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11. Human Affirming Medical Care with Gulnar Feerasta
75 Plays1 year ago
TRIGGER WARNING: This episode discusses topics related to sexual assault, which may be distressing for some listeners.
In January 2024, the Ohio House of Representatives overrode the veto of a bill banning gender-affirming care. The bill “bans gender-affirming healthcare for minors, one of dozens of bills under debate this year that would restrict transgender rights across the U.S.” - Reuters
This week, I’ve invited my friend and colleague, Gulnar Feerasta, to discuss this bill and its impacts on the LGBTQ+ community.
Gulnar Feerasta is a Senior Atlantic Fellow, Yield Giving Awardee, LGBTQ+ health equity and social justice advocate, and the Managing Director of the LGBTQ+ Community Center of Greater Cleveland. She is a dedicated social worker with extensive experience in program development, implementation, and evaluation, grants management, organizational and community engagement, professional training, and education consulting. She is passionate about achieving positive outcomes for individuals and making a meaningful impact on communities.
Gulnar excels in building lasting relationships within organizations and communities to enhance program objectives and deliverables. Her strong communication and collaboration skills enable her to lead and perform liaison activities effectively with key stakeholders, upper management, external support systems, and clients.
Featured in this episode:
- Trans children not being allowed to participate in sports
- “Human based” instead of “gender-based” medical care
- How past trauma can influence medical checkups
- Medical Apartheid
- Hyper marginalization of trans-black women
If you or someone you or someone you know has been a victim of sexual assault, you can find help at the National Sexual Violence Resource Center (NSVRC).
Submit your questions on anything and everything women's health-related and we will answer them in one of our episodes.
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Transcript
Introduction and Context
00:00:00
Speaker
Welcome back everybody to Arvo Manatee. I am here with Gunnar Furusta. She is a social worker with experience in program development, implementation, evaluation, and grants management, organizational and community engagement, professional training and education consulting. Gullnar is passionate about positive individual outcomes and community impact. Gullnar is a senior Atlantic fellow, a yield giving awardee, LGBTQ plus health equity and social justice advocate, and the managing director of the LGBT community center of Greater Cleveland and a friend. You should have started with that.
00:00:41
Speaker
ah but We're so happy to have you here. Welcome, Gunnar. Hi, it's so good to be here. Thanks for having me.
Impact of Ohio Legislation on Transgender Youth
00:00:48
Speaker
Yes, and I'm excited to have you to tell all of our listeners and kind of dive into a conversation with me about LGBTQ health in the community and what people who identify as women are facing in our current day, both in community, in the clinics, in the hospitals, in our legislation. You know, we've got so many different areas to dive into.
00:01:13
Speaker
Maybe we should still just start off by talking about what's happening in the broader scheme with the legislation here in Ohio. Oh my goodness. Everything. I almost have to like pause and take a breath and be like, okay, like what isn't happening? For folks that are not aware or or maybe not in Ohio that are perhaps listening in, Ohio has recently passed a slew of homophobic and transphobic legislation, which is essentially banning access to life-saving care for gender expansive and trans
00:01:50
Speaker
minors. That is one of the pieces of legislation that's passed and you know what is really frightening is that this is the government making decisions for people's children and taking away the rights of parents to make decisions in consultation with medical providers about the types of care and health care that their children can receive.
Debate on Transgender Athletes Ban
00:02:18
Speaker
The other piece of you know legislation that passed around the same time is the ban on transgender athletes in youth sports. That legislation honestly was really mind-boggling because there are already rules and guidelines from the organizations that
00:02:37
Speaker
govern youth, athletics, and sports around the participation of trans youth participating in sports. And in addition to that, I think it's like maybe eight youth out of like so many millions of youth participating in these sports, eight youth. So like all that time and money and resources expended to pass a legislation that is targeting eight youth or five youth or however many youth, but I know it was not more than 10. And what could we have done with those those resources?
Misallocation of Legislative Focus
00:03:15
Speaker
yeah call like says Local Ohioans, right? right people are Having a hard time affording groceries.
00:03:22
Speaker
People are having a hard time affording rent. People are having a hard time paying for gas at the gas pump. Our bridges and roads are integrated, right? And yet we're going to spend that amount of money. And people might say, well, no, it's really not that much money. They didn't pass, you know, money with this legislation, but we're paying our legislators, right? And those are our tax dollars that they're spending their time doing. And that's the time that they're wasting. And then there's all this external money that comes in from special interest groups and super PACs and all the black money that comes in that nobody has any sort of eyes on where this money is coming
Legislation and Personal Autonomy
00:04:05
Speaker
from and how much of it is going to who. But we know that in some cases hundreds of millions of dollars if we think about even you know the attempt to ban abortion, right? And so all of these laws that are being passed that
00:04:19
Speaker
Instead of making people's lives better, I was making people's lives worse. And then when we talk about the right of privacy, I mean, it just blows my mind of the dissonance between like when people were afraid that there might be a vaccine scene mandate during COVID and everybody was like, my body. my strength And I'm like, yeah, my body, my choice, unless you happen to have a uterus or you happen to be LGBTQ plus because then it's not your body or your choice. It's the government or in many cases, judges, right? Legislatures and judges who are not medical professionals.
00:04:58
Speaker
or medical experts make choices for you about your body. So there is just so much that's happening. I think like when you and I, before we jumped on on here, we thought we were also talking about like sort of this intersection of gender affirming care and what we're seeing that opponents have sort of also conflated access to reproductive care, like equating it as being part of this larger issue of trans care and hair on fire and everybody should be afraid, but we're also seeing that. Yeah.
LGBTQ Exclusion and Discrimination
00:05:36
Speaker
And like you said, even if for with the sports situation where it may not be affecting that many people, it's a statement that's being made. And it's a statement that is heard loud and clear as you are not welcome. You are excluded from society. You are not able to participate in even our extracurricular activities in our basic social structure of school. Right? And so hearing those messages loud and clear and seeing them repeated through the media, I can't imagine how that would make a person feel on a day to day basis and then how that translates into every aspect of their lives. Oh my God. Yeah. I have so many thoughts running through my head because I want to say everything and all the things and my brain is working way faster than my mouth can catch up. One thought at a time.
00:06:23
Speaker
Right. So the first thought that I think about is this is state sanctioned medical apartheid. And what is apartheid? Apartheid is state sanctioned systems where you have one set of rules for one group of people, the people that are quote unquote normal, right? Or typical. And traditionally has been cisgender, predominantly white, predominantly heterosexual. And then one set of rules and requirements for another group of people that fall outside of what is considered the social norm and what is socially acceptable. And that's what we have here because there is no other population group that has to jump through so many hoops that faces so many barriers
00:07:14
Speaker
to accessing essential care and life saving care. And I can't believe that people are okay with government sanctioned apartheid. And I think this also then, you know, speaks more broadly to what we're seeing socially and in society and the rhetoric. And I know we're talking healthcare care here, right? But all of that has also a huge influence and impact and implications for the healthcare care system and what does healthcare care look like. When we think about historically, queer people have always been sort of excluded from the healthcare care system. There has been a significant lack of trust and it's not just LGBTQ people, it's also other marginalized communities, including black folk.
00:07:59
Speaker
brown folk indigenous folk right and so then when you compound all of of those marginalized identities intersections the impact becomes more and more compounded and so you know there's things to consider when we think about like toxic minority
Hyper-marginalization of Black Trans Women
00:08:15
Speaker
stress. Recently, I've been reading a lot about weathering. And this is so particular to people of color and especially black people and black women. And I think about the black trans women. Right. So marginalized of the marginalized of the marginalized. Yeah.
00:08:32
Speaker
And, you know, I don't even know if this is a real word. I think of it as like the hyper marginalized, right? If it's not a word, I just made yet call the dictionary people what you're welcome. Yeah. But think about that. And you think about the life expectancy of black trans women. And it's about 30 to 35 years old. So when you think about care and access to care, it's also important for us to be thinking about the social determinants because it's not just about healthcare systems. It's also about all of the other things that impede a person from being able to thrive, from being able to have wellness overall. And so that's one, you know, sort of
00:09:14
Speaker
stream of consciousness that I was having as you were talking. The other thing is also like, and this is sort of related to the social determinants of health, is the economics, right?
Youth LGBTQ Identification Trends
00:09:23
Speaker
So if we're in a state that has state sanctioned medical apartheid, and we also juxtaposition that with the Youth Risk Behavior Survey, and This is a survey that's done by the CDC in all the public schools. And some schools do it every year. Some schools alternated by year based on like middle school, high school, et cetera. Here in Cleveland, we alternate it. And the first time I ever learned about this survey and the data was in 2019, which was the first time they were able to ask a question about identity. And this was the middle school survey. And respondents had the option of identifying as LGB.
00:10:02
Speaker
or something else. And that something else sort of was the bucket for people that are unsure, not sure, and also trans or gender expansive. And it was something like about 17.8% of middle school students in Cuyahoga County identified as either LGB or something else. Fast forward, you know, COVID happens, blah, blah, blah. 2022, the survey was done, And that's the most recent survey that I have at the data to which I have had access to. They did the survey with high school students. And in that case, 25.5% of high school students in Cuyahoga County.
00:10:46
Speaker
identify as LGBTQ plus. wow that's amazing yeah And they asked that question like in in several different ways. And so what I'm presenting is like for all the respondents in all of those cumulative. And first of all, it blew my mind because we've constantly always been told that, oh, like The national data shows that only 3% or 4% at the most identify as part of this community. And I'm like, well, not here in Chicago County, not where I live. And then more recently, I don't know if you saw that the Williams Institute's report that came out earlier this year, Ohio is the state that has the sixth largest LGBTQ plus population.
00:11:28
Speaker
somewhere close between 6.8 to 7% somewhere in there. That's significant. That's 6% of your population. That's 6% of the people that contribute to the economy, right? that contribute through taxes. That was really interesting to me. And so when I see that the state is sanctioning apartheid, we are telling, if we look at Cagal County as a microcosm, a quarter of our future working population, right? Because in four years, I mean, now they're like maximum two years into this, because that was two years ago, that you don't belong here. We don't want you here.
00:12:09
Speaker
And these are young people that are going to be going on to look for jobs, have jobs, go to higher education. So when we think about the brain drain and we think about sure you know talent retention and we think about economic resiliency and growth, we are literally cutting off our nose to spite our face.
Legislation's Impact on Healthcare Workforce
00:12:33
Speaker
Right. And so to me, I'm like, well, how does that make sense? Again, the dissonance is just like flabbergasting in my phone. I know a lot of people who left the state for an hour in the process of leaving after the most recent bill went through.
00:12:49
Speaker
And even though it did not affect them directly, they told me, well, this is just the beginning. you know And it's unfortunately, I think they may be right. Health care system, it's impacting providers. like I know providers that have like, you know what, I'm just closing my practice or I'm not going to see LGBTQ folk anymore. Or there's some that are like, you know what, I'm going to move. If I can't serve people and all people, then I need to go somewhere where I can. that perform the medicine that I've been trained to do, right? And most recently, there was an article, I was talking about how they're seeing this also reflected in students, med students who are applying to med schools, actively making decisions based on whether a state has a abortion ban and whether they have anti LGBTQ plus legislation or a trans care ban. They're like, Oh, that's not where we're going to go to school.
00:13:44
Speaker
And here in Ohio, right, we have right here in Cleveland, three of the best healthcare systems in the country. And we have one of the best medical schools right in the country. And so what does that mean if yeah students are gonna opt out of coming to Cleveland, no matter how good the education is, because everything else isn't. And then residents coming here for training or to work in the hospitals. What does that mean for our healthcare care force? Isn't it Cleveland Clinic that employs over 40,000 people as one of the largest employers in County. And so now we already know we have a medical provider shortage, right with nurses and other things. And now you're just
00:14:27
Speaker
going to continue to reduce it. So what does that mean? 40,000 less people coming to Cleveland to work here to contribute to the city. So then what does that mean outwardly for yeah essential like services that contribute to the health and wellness of the people? Yeah. Right. No, it's a great point. and It's like these things have been going on for a very long time. And I think a lot of current events are bringing them more to light. And I do think there's more visibility that's coming out around things. But for years and years, even lesbian and bisexual women have had decreased rates of coming for preventive care for cancer screening compared to cisgender heterosexual women.
00:15:08
Speaker
So I don't know. I mean, I feel like this has been a long standing issue for the LGBT community. I don't know if you have any comments on how even decades ago, how that could impact someone who had a terrible experience and then just never comes back ah like 20 or 30 years. yeah
Personal Healthcare Trauma Stories
00:15:23
Speaker
Yeah, right and so I think like part there's two sides to that. There's the work that we have done as people who are invested in and really deeply passionate about health equity and health care and access to care that have you know worked with providers and worked with communities to start building that bridge of trust.
00:15:43
Speaker
to get folks finally to come in the door, right, to get essential health care services like our Thrive with Pride event. This is our fourth year here at the center. It's our annual health and wellness day and it's continued to grow. But at the core of it was the desire to create a culture of health and wellness for our community And to do it in a place in community where people feel safe walking in the door and they know that they're going to be treated by providers who are inclusive and safe and affirming. So we've done all that work and now there's these laws that are passing.
00:16:16
Speaker
that are literally like undermining all that work that was done just to get people access to care. And now that they're finally accessing care, the state is saying, nope, you don't get to access care. Right. And so there's that piece. And then there's the very real piece also of like the historical trauma communities of color. for queer communities. And then, you know, again, the overlapping intersection of all of those marginalized identities. And this makes it so hard. You know, I hear from youth that come to our programs and they're talking about feeling that the world thinks that they should die. That why do people want to kill us? Right? Why do people hate us? And I hear the same thing from our
00:17:00
Speaker
elder generation, you know, the generation that has lived through the AIDS epidemic, and the way that that was weaponized to dehumanize people who were HIV positive and to dehumanize the LGBTQ plus community, the entire spectrum in between for them, it's retraumatizing and reminding them of all they lost all the people that we lost in our community during those times. And then, you know, you think about, I can't speak for other people's stories, but like for folks like me, for many years, I stopped going to the doctor because and I think this was back in 2015.
00:17:39
Speaker
or something like that. I had a really horrible experience with a pack. So I walk into the doctor's office and, you know, just some nice, you know, white lady. And before she gets started, it was my first time with this provider because the provider I had been going to had moved. And so I just close to her and I say, Hey, like, you know, I have PTSD. I have a lot of trauma. I'm a survivor of sexual assault. And so I need you to like, just be really gentle and, and just talk me through this and let how much courage to even say that and to for a brand new person that you're meeting the first time. So difficult to say that. and Yeah, i I was shaking and I was sweating and I was just so tense. But I was like, I gotta of let her know. And
00:18:29
Speaker
as I was like, so before you even like come anywhere near me with the speculum, please just tell me that, you know, you're getting ready to insert the speculum. And she was like, Oh yeah, yeah, sure. Sure. You know, thanks for letting me know. And then she's like doing her thing. I'm in the stirrups. Like, you know, she's all up close and personal and she's like, okay, so, you know, we're gonna, we're gonna start. And she just like shoved that speculum in me or at least it felt like, you know, cause like, She didn't even tell me like, okay, so you're gonna feel my hand on your leg. You're gonna feel this cold, whatever, right? It was just like, okay, so I hope you're hope you're ready. Bam. And I checked out. I completely disassociated. And thank goodness my best friend was in there with me and I was holding his hand. And he told me that I just started screaming and crying. And I must have scared the bejesus out of that doctor because like, like oh my God, what's going on? and then like
00:19:29
Speaker
I couldn't hear her cause I had checked out, but I stopped going to the doctor after that. And I didn't go and I didn't go and I didn't go. Um, the only doctor I went to was my neurologist because I had to go once a year to get access to like my medication. Yeah. Right. had a mirant Yeah. Um, and I'm somebody who has a lot of comorbidities and I remember I had just started at the center and I went to the neurologist and you know, we're making small talk, whatever. Oh, so where are you working? You're still working in the same place. I'm like, no, I'm working at the LGBT center. And I don't know how the conversation just sort of like got off track where she's like, Oh, that's really great that you're helping those people. And I'm like, Oh, those people, like, what do you mean by that? But like,
00:20:16
Speaker
And then to say, like you know I think like you know more and more of these kids that are identifying as you know a part of the, for she couldn't even say the acronym. yeah right She's messing up, like, the LGBTQ+. And then she's like, you know, I just think it's because of trauma. Like, I've been reading all this research that says that LGBTQ plus people are more likely to have experienced sexual assault and sexual violence than others. And so, of course, it makes sense that they wouldn't want to have anything to do with the opposite sex. Oh, my gosh. and Like, what does this have to do with my migraines? I didn't actually ask your opinion. on
00:20:54
Speaker
yeah and you know this is somebody who had just come out to myself right a couple months before that somebody who is really trying to figure out it was not something that had ever been on my radar for myself of like that this is who i am and one day in the middle of a conversation it just popped out of the mouth you know and i was like wait a second what just happened it really fucked me up excuse the language but like yeah I was already struggling with this around like trying to just figure out my identity and just
Identity, Trauma, and Mental Health
00:21:24
Speaker
who I am. and
00:21:25
Speaker
having all these questions. And that sent me on this spiral of like, am I queer because I am a survivor of childhood sexual ah assault? Is that why I'm queer? Like, you know, and it just it just so messed me up. It's so unfair to you because this is someone who's not a psychiatrist or a psychologist. This is just Your neurologist is taking care of migraines. She wasn't even the neurologist. She was the physician, nurse, nurse practitioner, whatever it is. Okay. Like the point being that not an expert in that area. Right. And what about like client patient boundaries, like doctor patient boundaries? and i' like Yeah. And on the flip side of that, I'm also so grateful that I landed where I landed and I'm working where I'm working because we have a pride clinic here. Right. It is the only.
Towards Human-Affirming and Trauma-Informed Care
00:22:17
Speaker
pride clinic location, like a Metro that is actually out in the community and not in a medical facility. It took me months to get the confidence and like, you know, build myself up to even go and see a provider. But it was also because I've been out of care for so many years. There was something wrong. And I'm glad I went because my thyroid was completely jacked up. my A1c, you know, I was pretty much on the border of pre-diabetic and diabetic. So you needed healthcare, like you needed medical care. care. And if I had been able to stay in care and continue with preventive care, it wouldn't have gone up to that point. yeah But I also see like how life-saving affirming care can be. And I don't think about gender affirming care as, you know, gender. I think about it as we have to
00:23:06
Speaker
get out of that binary and think about it as human-affirming care, because we're all human. Like, just like I have a penis and a prostate and I go to a doctor, I would expect the doctor after I hit a certain age to talk to me about getting a PSA draw to monitor for, you know, a common- About the organs, not about gender. And if I'm a woman, I want to be able to go to a doctor who's going to understand and think about like, you know, Pap smears, but also cervical cancer and menopause and be able to give me the right type of care. So why should that be denied to any other person that walks into the doctor's office? Because you're focused on the human. Sometimes I think about, I'm like, should we just reword it to say it's human affirming care? Yeah. Right. And gender shouldn't have anything to do with it.
00:23:56
Speaker
Well, it's sad that we even would have to name it, right? It should just be what is care. You know, I'm thinking the same thing about the Pride Clinic. I love that there's a Pride Clinic that is at the LGBT community center, but at the same time, all of our clinics should be so affirming. Because not everybody can get to the center. But I think it's super upsetting, and I'm sure a lot of people listening will just will feel this as well. And what can we do better about it? You know, I feel like everybody needs to learn trauma informed care, everyone needs to be made aware of the community issues that we're living in our social issues that we're living in. Also be conscientious of how you're speaking about them to people, like regardless of what role you may have.
00:24:41
Speaker
you never know what people are going through. And we just yeah don't know what battles people have. And to make sort of offhand comments about your opinion that you may not have actually any sort of accurate information about could keep someone from getting care for years. Yeah, hopefully, like I've been able to humanize the issue and remind people that we can't afford to sit and be like, Oh, this doesn't affect me. So why should I be bothered? Or why should I care? Because the implications of that are so much bigger, right? All our care is sort of interconnected and right now it might be trans people's care that is being denied, but we have seen how that has also impacted care for women and reproductive care. And from there, it doesn't take long for it to start being targeted towards more and more and more people.
00:25:28
Speaker
And even if you don't like queer people or don't believe that they're normal or whatever, I hope that you have enough humanity in you to recognize the humanity in another fellow being. Ultimately, you know, that's what matters is that they're human beings. Exactly. Thank you so much. And thank you for your time. It went way faster than I thought it was. ah no