Mongolia Brief July 31, 2014 Part III
Mongolia’s medical community open to providing care for transgender individuals
August 1 (UB
Post) By Margaux Maxwell and Mathilde Michaud
Mongolian
transgender individuals say they are afraid to call on local health care
providers for the medical procedures vital to their mental and physical health.
Despite popular
perception, the majority of the Mongolian medical community says they are
willing to administer transition-related care. Many private hospitals possess
the facilities to live up to their claim, but training and education are still
needed before transgender individuals undergoing female-to-male (FTM) or
male-to-female (MTF) transitions can get the help they may seek. Ingrained fear
stemming from a history of social persecution and a general sense of distrust
in the underdeveloped Mongolian healthcare system is provoking this abstention.
The discussion
surrounding transgender issues is young in Mongolia, even among the LGBT
community. Transgender individuals have a fear of exposing themselves in a
society where their reality does not yet seem to be understood.
“In today’s
everyday life, I cannot dress as a woman and board a bus,” said Sarnai, a
transgender woman who no longer wears clothing she feels expresses her gender
after facing social pressures.
The psychological distress that accompanies social stigma can also lead to mental health issues for transgender individuals.
The psychological distress that accompanies social stigma can also lead to mental health issues for transgender individuals.
Mental health
According to
the Institute of Medicine (IOM), transgender individuals are more susceptible
to developing mental health problems, such as anxiety and depression, and are
more likely to experience difficulties in relationships with peers and family
members. However, it should be noted that these symptoms are socially induced
and are not intrinsic to transgender identity.
Anaraa
Nyamdorj, executive director of Mongolia’s LGBT Centre, commented on the
matter, “There are many more cases of mental health issues, such as alcoholism
and depression, all these things appear to be quite acute for LGBT people,
starting from adolescence.”
The National
Center of Mental Health in Mongolia (NCMH) has provided mental health services
to LGBT individuals in the past, where LGBT patients can be treated for
depression by the facility’s sexologist.
However, the low staff to patient ratio makes treatment difficult. For example, at the time of publishing this article, the NCMH sexologist was on a leave of several months, meaning that transgender people were left without access to mental health care.
However, the low staff to patient ratio makes treatment difficult. For example, at the time of publishing this article, the NCMH sexologist was on a leave of several months, meaning that transgender people were left without access to mental health care.
Additionally,
patients at NCMH are evaluated according to the International Statistical
Classification of Diseases and Related Health Problems, 10th Revision (ICD-10),
where “transsexualism” and “dual-role transvestism” are listed under “gender
identity disorders,” implying that these states of being are diseases.
This is not a
uniquely Mongolian problem, as the IDC-10 is published by the United Nations
World Health Organization and used internationally.
“We are not
trying to correct LGBT people in any way, we are merely trying to treat them
for depression and anxiety that come from what they experience. To us, they are
just people like anyone else who need help,” said MD S.Munkhtuya ,
addictologist and specialist at the National Center of Mental Health,
illustrating that judgment is not the issue but lies in a flawed international
medical diagnostics code.
Hormone
replacement therapy (HRT)
Although some
facilities such as the Mongolian Menopause and Andropause Society and Songdo
Hospital possess the equipment to provide HRT services in Mongolia, none
currently offer treatment for transgender individuals.
Hormone
replacement therapy (HRT) is central to the transition process, as sex hormones
regulate the development of sex characteristics. It is often the only medical
procedure undergone by a transsexual individual. Changing fat distribution, muscle
mass, and hair growth can be part of this process.
Entering an HRT
program can involve many risks, such as heart disease and breast cancer.
Therefore, close medical monitoring is suggested by specialized institutions.
“As long as you
are taking hormones (possibly for the rest of your life), you need to have
regular physical exams and lab tests to monitor your overall health. The first
year after starting hormones, the prescribing doctor/nurse will want to see you
at least every three to four months; after that, you will have appointments at
least every six months,” explains the Canadian Center for Addiction and Mental
Health’s Hormone: a guide for MTFs.
“Personally, I
sought help from a hormone doctor. And the doctor was not welcoming, he/she
even advised me to become a man again!” exclaimed Mugi, a transgender woman
living in Mongolia.
The LGBT Centre in Mongolia has created a program dedicated to trans issues to help them live a healthy life, mentally and socially. The centre gathers information from health professional groups such as the World Professional Association for Transgender Health (WPATH), allowing those pursuing HRT without the support of a doctor monitoring their hormonal levels to know approximately what their status should be in regards to their transition stage. But not everybody reacts the same way to hormones, as the dosage and type of hormones used should be determined by the levels of hormones already present in one’s body, impossible to regulate unless a patient seeks counsel from an endocrinologist.
The LGBT Centre in Mongolia has created a program dedicated to trans issues to help them live a healthy life, mentally and socially. The centre gathers information from health professional groups such as the World Professional Association for Transgender Health (WPATH), allowing those pursuing HRT without the support of a doctor monitoring their hormonal levels to know approximately what their status should be in regards to their transition stage. But not everybody reacts the same way to hormones, as the dosage and type of hormones used should be determined by the levels of hormones already present in one’s body, impossible to regulate unless a patient seeks counsel from an endocrinologist.
The Mongolian
transgender community encounters another obstacle in its attempt to access
HRTs: high prices. Mugi explains that hormone products are extremely expensive
and few in the community are wealthy enough to access them.
“We seek
financial help but nobody except our family and friends will help us,” she
says.
Although the law on civil registration provides opportunities for transgender individuals undergoing HRT to change their gender marker on official documents, the law does not mention access to HRT within the health care system. Mongolian transgender individuals are forced to buy hormones themselves, making it more difficult to control the variability of the type of hormones they use, another factor endangering their health.
Although the law on civil registration provides opportunities for transgender individuals undergoing HRT to change their gender marker on official documents, the law does not mention access to HRT within the health care system. Mongolian transgender individuals are forced to buy hormones themselves, making it more difficult to control the variability of the type of hormones they use, another factor endangering their health.
Sex
reassignment surgeries (SRS)
Mongolian
doctors are far from reaching the international standard for training and
education on transgender health care, as illustrated when many did not know the
definition of “transgender” when asked by the UB Post.
Many health
care centers, such as SongDo Hospital and Achtan Elite Hospital, told the UB
Post that they have the facilities to provide medical assistance to transgender
individuals, but merely have not been approached.
“Although we
have never been approached, we would be happy to help any member of the
community who comes to us,” said Sarangerel Luvsanvandan, the director of SOS
Medica Mongolia Ulaanbataar International Clinic.
Even though the
clinic can not perform any of the transition surgeries themselves, their first
choice of referral would be Bumrungrad Clinic in Bangkok, where many
transgender individuals go for sex reassignment surgery and hormone replacement
therapy.
The clinics
refer their trauma and emergency patients to hospitals in Mongolia such as the
National Trauma & Orthopaedic Research Center of Mongolia, but told the UB
Post that they would not recommend a Mongolian facility for transition-relation
surgeries.
The Mongolian
transgender community does not seem ready to trust its healthcare system, a
feeling seemingly shared by the general public.
A Mongolian
citizen, Bold, expressed his fear, “I would not get surgery in Mongolia, I do
not trust the system for many reasons. For one, doctors drink vodka before
performing surgery because it is seen as a brave act,” a claim for which we
have not been able to find official confirmation.
“Misdiagnosis
happens frequently, Mongolians feel that they should get checked multiple times
from many different doctors. For example, a doctor will tell you that you have
cancer when in fact you do not,” Bold added.
Transition
related-surgeries vary from uterus removal to genital reconstruction. Most of
them are pretty invasive surgeries with high risks of complication and
postoperative bleeding, necessitating close monitoring and highly trained
staff. Furthermore, they require a large array of specialists often
collaborating on a single procedure. These surgeries can help transgender
individuals feel more at ease in the presence of sex partners or in venues such
as physicians’ offices, swimming pools, or health clubs. In some settings, it
might even reduce risk of harm in the event of arrest or search by police or
other authorities. Thus, they represent a really important step both in closely
matching gender identity and ensuring their personal safety.
The first
Mongolian LGBT Dialogue took the issue up in March 2014, where questions about
the day-to-day health challenges of transgender individuals were discussed with
Mongolia’s state and LGBT representatives.
Mongolia and China to finalize mid-term trade and economic development plan
August 1 (UB
Post) Deputy Director of the Asia Department of the Chinese Foreign Ministry
and head of task group of the Chinese-Mongolian intergovernmental commission,
Sung Yaomin, arrived in Ulaanbaatar to discuss the development of the mid-term
economic partnership plan for Mongolia and China.
Deputy Minister
of Mongolia D.Terbishdagva welcomed Sung and the Chinese representatives
accompanying him. The Deputy Minister expressed gratitude for the active role the
Deputy Director played in the development of the partnership plan, and pledged
to finalize it during the official visit of Chinese President Xi Jinping. The
Deputy Prime Minister noted that this document will help expand the economic
partnership between the two countries.
Also co-chair
of the Mongolia-China intergovernmental commission, Deputy Minister
D.Terbishdagva expressed his thanks for the many years of contributions to
developing bilateral trade between the two countries and for Sung’s broadscale
knowledge of Mongolia.
Sung Yaomin
expressed China’s interest in cooperating in Mongolia`s mining and
infrastructure sectors by providing access to reputable Chinese companies, and
pledged support and cooperation in projects of strategic interest, including
the Tavan Tolgoi and Oyu Tolgoi projects.
Trade volume
between Mongolia and China reached 5.96 billion USD last year.
Prime Minister’s advisor arrested on embezzlment charges
August 1 (UB
Post) Independent Authority Against Corruption (IAAC) officials arrested the
Prime Minister’s advisor, L.Gansukh, in Tuv Province on Tuesday, on suspicion
of embezzling 3.6 billion MNT from a local project budget.
“He worked in
charge of the government’s ‘Coal’ program to supply reasonably priced coal to
citizens last year, and the Mongolian National Audit Office’s preliminary study
found that he might have embezzled a total of 3.6 billion MNT from the
program’s budget,” explained Chief of the Investigation Department of IAAC
E.Amarbat.
He was arrested
along with three other suspects and is currently being questioned at a
detention facility in the province.
In relation to
the case, Prime Minister N.Altankhuyag issued an official statement defending
the program’s officials.
“The ‘Coal’
program benefitted thousands of residents in ger areas with lower than average
income. A ton of coal is now available at 80,000 MNT, which used to cost
200,000 MNT, thanks to this program, which was managed by E.Amarbat,” the Prime
Minister said.
“I will
strictly fight against these illegal efforts to defame the government’s
projects and prevent the continuation of the ‘Coal’ program, which resulted in
the arrest and detention of people who worked hard in order to bring cheaper
coal to the public.”
Link to
article
Comments
Post a Comment