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OK, I think we'll make a start. Those of you here before you gonna have to listen to me again for a bit. I've been asked to facilitate this session. Um, and it's around. It's around health care and gender diversity. So, um, access to to health care and the healthcare needs of the gender diverse communities. Um, on the panel with me is, uh, Jerry McDonald. Um, Marie Mitchell. Um and I [00:00:30] um So I've done a lot of talking in the previous session, so I'm gonna try and avoid doing a lot of talking. So just as a way of, um, starting off the session, I'll ask the other three panellists just to provide some thoughts. So and, um, welcome to to it seems very weird of us sitting here like some kind of expert with you out there in the sea. So let's reorganise [00:01:00] the room. I think C circles cool, but let's make a smaller circle and I I do want to recognise that we're in a, um um to acknowledge that and and to start this session by thinking about the people who are not here with us and the people who are not here with us because they couldn't be for various reasons, but more of the people who are not here with us because they've been failed by the health system [00:01:30] and and whatever regard. So I think Let's just take a minute. Because everybody here I'm gonna imagine in this room has stories and and people, um, either directly or indirectly. So let's just take a minute, and then we'll start this workshop. Yeah. Thank you, Sally. Um, this workshop [00:02:00] as well, I'm sure explain in a moment is is somewhat organic and unfolding, So, um, I'll hand it back to you. Um, I suppose where I where I start with this, there's a bit of history. Um, and obviously, the place I would start is the Human Rights Commission. Inquiry into trains and intersex issues was to be who I am. Um, which [00:02:30] came out 2008. 2008. So five years ago. Um, I went to an update last year, so the the that document identified significant issues and variability in the health care for trans people. Oh, I need you there. Sorry. The child is medical. Yeah. So, I. I can start, I guess. Thanks. [00:03:00] um my name is Amy. Um, I'm a trans woman. I'm and I'd just like to say, first off, the HSC inquiry was more about trans issues, and the intersex thing was a bit of a sideline that I think I added in the end. And I think there's probably a lot more work that needs to go into that that space as well. So I just wanted to say that, And during that process, um, there was an identification of the lack or the inconsistency of health issues [00:03:30] for trans people, um, within New Zealand. And an outcome of that was, um, a project of work that, uh, the Ministry of Health set up and and asked County DH B to run. And and luckily enough, I'm here with two other Joey and who are also part of that project. Our role within that project was merely there as a reference group. Um, and the way I like to think of it is given the opportunity or [00:04:00] a conduit to allow the community to voice their opinion on on what was happening within the, um, community, Um, it's probably fair to state that the outcome of the county Hispanic our DH B process, Um, could have been better. I guess that's one way to to suggest it. It was tasked with producing a set of guidelines. Um, for clinicians, that was, um, the way it was set up. It was a very strict, um, a very strict mandate [00:04:30] of what? It what it was going to look at or guidelines of what it was going to look at. It was made very clear to us up front that there was no funding for the outcomes for that. So simply it was the creation of the guidelines. And then that would be it. Um On top of that, there was the Ministry of Health. Ministry of Health. Towards the end of it did state that there would be a review on the guidelines. After two years, that is due next year. It's actually passed. So it's two years, but they didn't publish [00:05:00] it until 2012. I was doing research on this so they could technically say that in 2014 it's due for review because the date they have on that publication from the Ministry of Health is sometime in 2012, even though it's actually been longer. I mean, the one thing for me that certainly came out of that process and having the opportunity to talk to a very diverse group of people through some workshops who ran here in Wellington and also also some we ran and Auckland is that to [00:05:30] say the least, there was very patchy health care available out there, and it really came down to how lucky people were. A lot of that luck came down to where you lived and certainly if you lived outside of, um, the main centres, the main centres being Auckland, Wellington and to a degree, Christchurch and Dunedin. Then your luck would often be very bad. Um, and you are subject to some very poor GPS in the community and and effectively no support from the DH B for any services whatsoever. [00:06:00] And the biggest problem with that is the way our DH B system is set up. That is, once you're attached to a DH B by the virtue of where you live, it's actually, um, extremely difficult to get a service from another DH B. You couple that with a lot of trans people. Um, not having too much money and the ability to travel to main centres to receive the treatment. They want something else. Originally, I'm from Auckland. Um, been down here since, um, 2008. [00:06:30] And one thing I should point out I. I found it quite odd when I first came to Wellington after being a resident of West Auckland for, um, the majority of my life just how white Wellington is, and we can probably notice that just by looking around the room here, Um and certainly when we went back to Auckland and had one of our in Auckland in South Auckland, um had the opportunity to speak to a lot of the Pacific and Maori women, Trans Woman and the community [00:07:00] it became It started to become very clear to me that there were, um, two main things that would make you lucky in getting health care. One of them was being, and one of them was, um, having money because having money gave you options. Um, if you lacked one of those things and it certainly, if you lack both of those things, then your opportunity to get lucky with the health system started to decrease straight away. The other thing that, um has certainly some recent events in Auckland with the Auckland Sexual Health Service [00:07:30] or clinic. I'm not too sure what it's called, actually. But the Auckland Sexual Health Clinic in Auckland has long provided very good services for the, um Trans community in Auckland. And recently they had a bit of a snag with their funding and it it reminded me that really, in New Zealand, there isn't actually any funding that's specifically targeted to trans health. And certainly what is available tends to only be there to assist people through transition. And then once [00:08:00] you've transitioned or I like to think we never, ever finish transition, it's called life As those services start to get a little bit more hairy to, um to get I know in Wellington, um through the services offered by Capital Coast DH B, there are services there, but again, none of them are targeted and none of them are funded. So once again, it becomes, um, a bit of a lottery, depending on your GP the ability of your GP to get you, um, into various [00:08:30] programmes with the endocrinology clinic, the psychologist, et cetera in Wellington, and I've been told by one of the psychologists in Wellington that they don't have any funding for trans people. And they just do it more or less out of their own good will of making their time available for for referrals. And I see, I think that's really the nutshell of where our problems actually exist in in New Zealand, as it's all done through goodwill. Yeah, II, I can build off that a little bit. Um, [00:09:00] in, um, so I'm Joey McDonald, and I live in Auckland at the moment. Um, so about the CM DH B resource. Um, there were there were two parts of that that I kind of parallel things that were going on at the same time that I think is, um the official resource was being written by health professionals, um, and then those of us who were just volunteers to be kind [00:09:30] of trans and gender diverse reference group people would try and give feedback and give kind of our perspective on Oh, yeah, let's. Could you maybe think about how this term real life experience is problematic and include something about safety and even maybe think about moving beyond a diagnosis model or think about having informed consent as well as a diagnosis option. So when you're creating pathways of care which don't exist for trans stuff, um, in New Zealand, specifically around transition, to [00:10:00] try and create pathways of care that are flexible but have consistent, consistent access because, yeah, it was really inconsistent all over the place in different DH BS. We did give that feedback and it didn't really get very far. Um, as you can imagine in that situation, everyone was very, very stretched, so we were just volunteers. They were getting a small amount of money to do. It was kind of whipped up at the last minute. So the the resource itself, I have never recommended to anybody because I think it actually is damaging. It's really, really unhelpful. It's now completely out of date with international best practise, [00:10:30] even if you're being conservative and considering there could be better international best practise. But but even on the basis of like the standards of care by the World Professional Association of Transgender Health that those standards of care are now ahead of what this resource is recommending, um so it needs to be updated desperately and hopefully will be I went back and had a look at it recently because we're doing some lobbying of the Ministry of Health. Um, part part of my role at affinity [00:11:00] Services, which is a mental health NGO, um, as a rainbow liaison person. So working with a few other people like Marie and like Moira at the Mental Health Foundation and Jack at the Mental Health Foundation. So a few of us getting together trying to write another kind of document. I don't think it'll be a report, but just kind of something to give to the Ministry of Health and be like, Hey, this this thing really needs updating. We still don't have consistent pathways of care that HR C report that was written in 2008. None of those recommendations about [00:11:30] health care have been taken up, have been moved forward. Um, yeah, and and try and get more conversations happening on that basis, We So there was that kind of that stream. And then there was a parallel stream of, uh, we were getting all this information and feedback from trans communities and gender diverse communities and intersex communities to a lesser extent. Um, and we created a community feedback document. Um, which was we thought could be, like a companion resource for, um, since the clinical [00:12:00] resource was intended for GPS primarily. So we thought this would be a good thing for us to be able to give at the same time. Um, and that was based on what we thought were the five principles of health Care. Um, for our communities, we wanted to base it on access safety, well being respect and diversity. And we wrote a little thing about that was kind of synthesising a huge amount of feedback that we were getting from a lot of different people. But that basically, if you had those five, values underpinning your provision of health care, then you would be doing a [00:12:30] lot better than we currently are. Um, so that's a really great little document that I'm rewriting now and updating and hopefully can go out again and be something that we can give to people and and agitate around. Um, knowing that it did come from community consultation and, um continues to be really, really relevant. That's that's my update on that. One of the things, um and hello. My name is money. And [00:13:00] for those of you don't know me, I'm an intersex person. I also work within the system. I'm a a therapist in private practise, and I run a small not for profit organisation that does training and education work around intersex issues. And I think what will be useful now is you've heard some reports on some of the initiatives that are going on If we just quickly go around the group and provide an opportunity for people to introduce themselves, I think name and preferred [00:13:30] gender pronoun, if you have one. And then what are the issues that you would like us to talk about? We've got about half an hour left, which I think this workshop probably could go on reasonably all afternoon. I'm sure it's an important issue for lots of people. But if if you can be brief and then we'll do our best to address the issues that are are brought up. So we well, Sally, do you want to start or do you Are you gonna What have you worked out? What your role is here other [00:14:00] than being our Well, uh, my name's Sally Dilla. Um, I'm a trans. Um, but I I'm here to facilitate the workshop. So I'm here to listen to people and trying to help people provide the information that people are looking for. What would you see as the biggest current health issue or issue that's not being addressed just after the tough years? Well, what I was actually thinking about [00:14:30] is my experience 20 years ago of being in the psychiatric ward at Welling Hospital and on my exit interview saying I was Trans and the psychiatrist saying, Oh, that's your business and not interested and then telling my GP the same thing and being told, Oh, you don't want to go down that path. So that's 20 years ago. We've got these reports. So we're going forward. Um, we're a long way from where we need to be, but that's there is. We're on a journey, and there has been progress. I suppose [00:15:00] we're on that. Thanks, Sally. Um, I run on juice for pronoun. Um, I'm a trans woman. Um, it's a really hard question to just come up with an answer to what's the most pressing thing about trans healthcare? Yeah, I imagine. Probably just getting consistent [00:15:30] access to services throughout the country, you know, not just in the big cities, but everywhere. Um and, yeah, some mental health support. OK. And Sarah, just before you start, Thank you and all the organising group for putting this on. It's obviously important and needed. So thank you. And And I wanted to add also that you don't have to address, um, if it's kind of the question [00:16:00] of what you think is conceptually or politically the biggest issue, you could say that. Or you could say what you're interested in talking about today or or a question that you have right now about any of this stuff. It could be just what you're what you're bringing right now and not necessarily what you identify as the biggest issue. Yeah. Thank you. Thank you. I'm my name is Sarah. Um, I identify as a queer, queer woman. Um, female pronoun things, um, she gendered. But I've had a little bit of involvement over the last two or three years [00:16:30] with youth who predominantly identify as Trans. And for one of me, one of the biggest issues has been the lack of respect and the lack of understanding that I've seen from mental health. Mainstream mental health people who are supposed to be assisting and they're not. And I want to try and do something about that in the capacity that I can. Thank you, Sarah. Uh uh. My name is Ken. Um, uh, [00:17:00] I just prefer Kim. I used to probably identify as lesbian, but probably over the last seven years. I just identified myself. I mean, I've had enough of boxes and everything else and trying to put myself on one. Um, basically, I'm I'm here, you know, with Amy. But also over the years, Just what? What? What she's gone through and friends. And [00:17:30] the fact, um, with the health issues, that it's just it's really quite pathetic. Pathetic, pathetic. I'm Jim. And I guess I'm a he, um I can, because I but 11 of the words that popped out of the the little briefings. Health, health care. Really? [00:18:00] So I was I was interested in that as well as the as the, um as the experience of Trans. Um, and the thing I guess that that, um, strikes me is that it's possible to to come up at health services from a number of directions and find that people just don't know what to do with you. And I guess that's, um [00:18:30] but that must be really worrying. Um, I mean, I'd find it worrying as a as a gay man, I guess, Um, just to be a blank wall, um, of understanding. Uh, and and it also sort of strongly as being as what happens to you when you get older, actually, as well. Clearly, um, there's a sort of sense of worthlessness [00:19:00] that can attach to old age. Um, and it's in, particularly in times of economic hardship. I guess as well. It's repeated. Um, so I think there's an awful sense that it could only get worse if it's bad. Now, Um, which, um, is very destructive. I would think [00:19:30] so at the moment. Are you hopeful or hopeless? I'm sure it'll get better, actually, because people are doing things. Um, but I would think it's, um certainly, um, talking with my partner who's who's younger at day. And um [00:20:00] um, I hope that he's around, actually, Um, and just to if I can't deal with, um that he's there. OK, um, I'm a I use feminine pronouns. And I guess, [00:20:30] um, I'd be curious to learn more about access to general health care. Hi, I. I use, um I use female pronouns. And this is Valerie, Um, until we can ask her. We use female pronouns as well. Uh, I guess my experience with health care is mostly to do with mental health, but I'm really interested as a woman and a feminist. Um, what sort of stuff I can do to support trans and help with my and I think [00:21:00] in my way there has to be a following initiatives that are happening and support it. So, Yeah, I'm just here to listen and learn it. Really? I'm Rachel. I use them pronouns. Um, I've had some mm, not great experience. Wellington's mental health system. And more recently, a lot of that has to do with being trans. So it's [00:21:30] cool to be in a space where you can kind of feel that there have been some frustrations, so I'm just quite enjoying the kind of solidarity there. Thank you. Hi. My name is Kelly. I prefer, uh, female pronouns, and, uh, the the issue of, um, health, obviously, is a very dear one to to to all of us. Um and I just want to echo. I think what Amy was [00:22:00] saying, particularly about, um uh uh being and being lucky, uh, being, uh, being being, uh, having resources and being hugely important because I just fill in a little bit with Auckland Sexual Health Service. Um, Auckland Sexual Health Service provided counselling and counselling is one of the most costly, uh, and and greatest obstacles to people accessing trans healthcare. Because depending [00:22:30] on whose protocols you're looking at, generally speaking with three months of counselling is required. Now, there are ways of breaking your counsellor more quickly by saying, for example, Look, I'm going to go off and score hormones illegally, and you can cut down on the amount of counselling that is required. Um, if you are on the view that I lack these hormones illegally and that is quite a good tactic for trying to minimise the cost because otherwise people [00:23:00] are, unless they can go through Auckland sexual health or some other DH P, which funds a service. And I think there are any, uh, the cost of, uh, to counselling sessions is a huge, huge obstacle for many people. So we've got this big financial obstacle, which people face almost everywhere. And just as I said, filling in about Auckland sexual health, they found that that had an influx of, um, or greater demand for their services. And apparently one clinician found that [00:23:30] her entire, um, they was booked out with, uh, transplants. And at that point, there was a little bit of whaling and Nash and throwing their hands in the air. But I understand that another issue was a, uh, a psychiatrist who used to assist died last year, and, uh, that's increased the workload. But apparently they're training up more clinicians. They say that it's only a hiccup, Uh, let's see. But one of the big issues and and what I'm trying to do at the moment is trying to map [00:24:00] healthcare in New Zealand because there are enormous geographical voids. And while the C, MD P protocols, when they came out like a helps to raise consciousness, the reality is, uh and I think that it's absolutely disgusting. I can't even sort of work out how there is an ethical justification for it. Many GPS still be refused to treat, and that means that if you are, say, living in the Eastern Bay of plenty. Uh, you [00:24:30] might have to travel as far as, um, to, uh to get trans health care. And, uh, if you lived in, uh, until, um, I think it was Dr Jane Morgan in Hamilton started offering treatment at the, um, the Waikato Sexual Health Pike. Um, some people were travelling as far as, um, or Huntley to get treatment. So I mean, aside from the the obstacle of paying for counselling, some people [00:25:00] were having to pay. Um, you know, an enormous amount just to travel huge distances. So just sort of doing a little pitch here. If anybody wants to get onto trans advocates Health page on, um, on Facebook, we'd love to try and get as much information as we can and see if we can identify these geographic voids because I think that, you know they need to be identified and only once they're identified is it going to be possible to actually sort of you get in there and perhaps [00:25:30] target some of the GPS who need to be providing health. And it just astonishes me that if somebody can come in and say, Look, I've got a recognised medical, there is a recognised treatment pathway, and it just simply being turned away. I mean, that is, um I've experienced it. Um, you know, I, I was resourceful. I decided that I would target a soft counsellor target a soft. Um um, Doctor, [00:26:00] uh, but when it sort of turned out that my regular GP I had to disclose to him, uh, when he did a chest examination when I was sick, and I said to him, Before you start, let me just give you true confessions. And I said, I'm sorry I didn't come to you to start with, but I wanted to make sure I was only going to places where I knew I was going to get a good, good reception. And I didn't know about you. So forgive me, but, uh, now, you know, And now that we're here, perhaps you could assist me, and it was He [00:26:30] was just horrified. Well, no, he wasn't horrified. He treated me for my illness, but he did not want to, uh, include trans health care, uh, for me. And he was my primary health care giver. Emphasis on was I'm Marie, and I am female pronouns, and I'm here to listen so I appreciate you a female gender neutral pronoun. [00:27:00] Um, but I don't know what the main thing is. There's a lot of stuff. Um, Big one for me was the process around that document a few years back, you know? And it doesn't surprise me that the, you know, probably gonna push out the review further. And they said they were taking ages to publish the things, but, um yeah, I. I found that process to be extremely frustrating [00:27:30] in that, um, but I made a submission on yet I noticed about 40 issues with the document. People take a few. They changed three others in the end. And, you know, there wasn't any kind of response or anything like that. Of course, as to why not change anything else. So just the fact that on so many levels you don't get to listen to, I think Thank you. [00:28:00] I'm I'm during Christmas. Um, I was born female, but my gender has always been really fluid throughout my life. I've never really, um, identified as strictly male or female. Um, I'm here because I've recently, um, completed a PhD which looks at the medical management and support of intersexuality in New Zealand. Um, I guess that I'm here because I only found out about this conference at the very last minute. [00:28:30] But I saw various topics such as healthcare, and I thought, Oh, that looks very interesting. Um, I guess my interests are support for people with intersex conditions in New Zealand and, of course, throughout the world. And throughout my research, there was one something. Um, I remember I interviewed Priscilla, who's now a past education coordinator at Rainbow Youth [00:29:00] and as well as my thesis, as well as gender diversity and gender issues. When I interviewed Priscilla, she talked about she talked about financial diversity, and I thought to myself, That is really something. Um, particularly a medical and nursing education. I feel that that would be a very, very important topic to talk about, um that people there isn't just diversity [00:29:30] of genders. There's also diversity, um, sexual organs and genitalia as well. Thank you. Hi. My name is Jess. I'm hoping my pronouns usually do, Um, I'm here mainly to listen and gather whatever I can from the conversations and people's experiences. I suppose also as a teacher, I'm very interested in how I can get um, access and information. Um, for youth, the win. And, um so [00:30:00] that community consultation document, if you could let us know at some stage how to access things like that, that would be really, really helpful and great. Thank you. Uh, hi. I'm David. I use, uh, male pronouns, and I think like you, obviously, I'm just here to listen to learn. Thanks, Dad. Hello. My name is Grant. I identify as a male. I am a mental health professional. Um, and I'm here to learn. Hi, I'm Nicola. I use [00:30:30] she hair and the hair look. So if we were to summarise as a as a theme here, I think what we're hearing from people, um is we haven't heard any fabulous stories of, um, people encountering wonderful things as a generalisation. And I think the important thing to think about is in our current medical training in New Zealand, doctors get two [00:31:00] hours in which they cover gay and lesbian, and there is nothing about trans health. And there is nothing about intersex health. And there's nothing about gender non conforming. So the stories that I'm hearing back are really not surprising. And I think this is the nexus of the issue is that we have a very poorly informed, um community right across the board. I think what is changing is that there are is [00:31:30] a growing awareness and people wanting information. So I think we do have a doorway of willingness. But there's a huge knowledge gap, and the other thing on the other side is that the the need is growing and it's growing right across. Um, and it was, you know, someone raised the issue of ageing and we we could go around and identify the the subgroups and there are many and I don't think that we are doing this well in any area at all. [00:32:00] We don't have lots of time. In fact, we have a quarter of an hour left. So I think what would be useful is is for the, um, initiatives that are on the table to think about those of you who would like to be involved, the one that I can report on. I was with AAA group of people who went to the associate Minister of Health. Some of you will be aware that this government has a new initiative [00:32:30] around reducing suicidality in new Zealand, and it's quite a large initiative. There's $80 million being assigned to this, and the document that came out at the beginning of the year mentions our community in one sentence in the entire document and we're not identified. And I'm saying we I'm using an inclusive queer umbrella. We're not identified as a risk group and it's very clear all around the world, um, and and [00:33:00] a wide variety of research that the queer community, probably in most places, sits only next to indigenous communities as being high risk and, um, very exposed to suicidality, of course, as are most marginal communities. So the there was a briefing paper written and it was it was essentially Auckland centric, but there were other people involved. [00:33:30] I have to report that the minister was neutral in his, um, hearing, but that it's actually looking like it's moving in a very positive direction. They he has been out and consulted with the ministry and you can talk about that, but it's looking like there is going to be a new statement coming out, um, whereby our community will be identified as a risk community, so that's a positive, um in terms of, [00:34:00] um, an activist strategy that we can do things to achieve. I think the problem is that the deficit is so huge. And then those of us working in this area are are very small in comparison to the need in terms of, um, trying to find uniformity across New Zealand. It is one of the problems with our current DH B model is that each DH B has its own priorities and its own [00:34:30] way of doing things. So we do not have a uniformity and delivery of service in any area, and and our community is very poorly served in this regard. Um, I'm just gonna say one thing because one person mentioned lover surgery, Um, and the access to that The New Zealand, oddly enough, is probably one of the one processes that does technically exist in New Zealand. And not everyone's aware of this. Um, [00:35:00] you can apply or get on to a waiting list for a lower surgery or genital surgery here in New Zealand. However, um, it's a very opaque process, and no one's really 100% sure how this is working the special high cost treatment stuff. Yeah. Um, it happened, it was set up, I think, in 2003 that they would do three surgeries every two years and two male to female one [00:35:30] F, two M. And it was covered by, um, the special high cost treatment or funding pool. Yeah, one of those two. And it's an interesting thing, because that poll only exists to provide surgery overseas where surgeries don't exist in New Zealand. So there has been, um I believe around about 12 or 13 people in the past 10 years who have managed to go through that process so they're still not hitting, even hitting their numbers there. A few of those people have been, um, FM, people who have been sent overseas to the [00:36:00] Belgium or Netherlands, one of the two. And we've heard, um, some feedback from that, um, there have been the balance of those have been, uh, male to female surgeries carried out by a surgeon in Christchurch. However, in the last 24 months, there's been lots of conflicting rumours about that surgeon continuing to, um provide that service. It is an area that needs to be talked about a lot more and brought up with the Ministry of Health. Especially since if that service is [00:36:30] going to disappear from Christchurch and it certainly doesn't seem to be easy to access. Um, Then what is happening to this funding so effectively? 100 and $20,000 is in that budget, um, to be assigned every two years. The last time I talked to someone about this within the Ministry of Health, which was a couple of years ago, the answer was Is that money that's not being spent is being set aside? Um, so in theory, who knows how much money is there? But, um I mean, that's [00:37:00] a reasonable pressure point to talk to the Ministry of Health because they have that service. And, um, it doesn't seem to be getting access. That's part of relates to an issue that I've been thinking about in trying to create any kind of change around this, Whether you're talking to the Ministry of Health or trying to like, I've gone on and talk to nurses, undergraduate and postgraduate nurses at Auckland uni trying to do any kind of education. I get stuck because I'm like, should we be aiming? Should I be aiming for like a bare minimum and saying, OK, can I can I talk about de pathologize and [00:37:30] talk about using the informed consent model so that there's a wider diversity of, um, gender expression is OK for everybody, whether you're trans or sis or somewhere in between or intersex or whatever that, um, but we we haven't even got the really, really basic stuff covered. So like and mental health support seems like it comes up all the time that people would really just like some kind of access to, um, a low cost counsellor or a low cost, [00:38:00] um, psychotherapist or just someone who they could get that kind of support from. And, um, sometimes it's made a requirement, as you've said Kelly, that that people have to fulfil a certain amount of hours of counselling. Um, and that's not international best practise now, either. But it still happens all the time, framed up as something that a criteria that we have to meet, not something that's a support system that's available for us because we have to go and find someone usually in private practise, who's probably really expensive. [00:38:30] Um, so I get really frustrated because I don't know how to encourage DH BS to create consistent pathways of care for us, but also to make them really flexible. So not to be policing people's gender expression in order to access any kind of transition related health care. And, um, not to be just using that same DS M diagnosis model for everybody and yeah, but sometimes they don't even know where to start because, like if people would at least [00:39:00] say Yes, I will work with you. That's a step forward from what we've got going on in a lot of cases, rather than me getting really worried about the quality of how that's going to go or the options are we going to limit people's options. I don't want to create pathways that then become really rigid, and everybody has to adhere to the same criteria to get on this pathway. And then that's and you've got to do this. This, this and this and then that's the process, and there's no flexibility. Whereas now we've got to just talking about informed consent, and I know that [00:39:30] you're you know, you're a expert on this and anybody who wants to do a bit of deep and around might want to have a look at the, uh, the health services protocols for trans care. And of course, in what you do is you can turn up a practise nurse will take your blood, make sure that there are no adverse health conditions such as high cholesterol level or whatever, and might prescribe, uh, that day and it's all done on an informed consent basis. And the [00:40:00] inconsistencies here. I mean, you might go to a doctor who will make you go through the hurdles or if you've got resources and and can get to a bit of digging around, there are doctors. And so I think there are places that we we can find. But again, some of it seems to be almost the best kids secret out. And I think that, you know, as I said, with this Trans Advocates health page, we're just trying to get as much information as possible and maybe, you know, form a decent database. And, you know, certainly if you can dig around and talk [00:40:30] to people, you might be able to find doctors who are much more willing to go down that, um more like a informed consent Vancouver model rather than the um, uh, real life experience or three months of counselling and expecting people to turn up. You know, um, dressed appropriately dressed as masculine or as femininely as possible simply to try and do the civil job on the the gatekeeper. [00:41:00] You know, I, um it it it there, there seemed to be, you know, I have some high level principles about, you know, socialising medicine and the sense of, like the doctors are running a monopoly, basically. And doctors in the book. Really? Um, um but the whole service being quite a way of transferring wealth from, um, people on low wages to people on very high wages without really any particular say [00:41:30] they were shown they're a monopoly. Um, it's widely discussed in some aspects of economics. Um, does it philtre down to, um, people's health care political? Um, the guy next door to me is going to Thailand. Um, it's not a I mean, there's a whole emerging world of going abroad to have operations and all sorts of things. Um, but we don't talk about [00:42:00] it. Um um and I'm not sure how how you introduce the discussion into a a AAA country in which follows also about the tradition of having decent services provided by itself. Um, at home, um, you know, with a sort of cultural philosophy or that controls the, um, immigration into the country [00:42:30] from healthcare expert healthcare trained professionals as well. Um, so I mean, it's just the different levels that the that the sort of experience you're talking about and the popular nature of it. And then there's the There's some some of the economic welfare policy realities which are to do with transferring money to a wealthy class of people. Is there a place for the discussion? We [00:43:00] suddenly sort of say, Well, I'm gonna go go abroad. You know, I think we've got two levels. We've got individual people attempting to access the care that they need right now. And then We absolutely do have a AAA broader debate about, um, our health care system in general in this country and who has access to it and how effective it is and that there has been massive changes going [00:43:30] on, and most of us are unaware of what those drivers are. And the fact that the the individual GP as as a disappearing species, um, that it's mostly medical practises now, And that's come about through changes requiring, you know, 24 hour emergency services and and other levers that have informed that. And so, yes, I think [00:44:00] absolutely. There's the two different places, and And we need to be having conversations in both. OK, and we haven't added very much. And Geraldine, thank you. And the access to intersex care. We have this, um, barbaric and cruel system that goes on in this country with babies. But once you are an adult, um, or you have a suspicion that you might be an intersex person getting access to any kind of support [00:44:30] and service in this country is almost at zero. And one big issue. I'm very interested is informed consent. This isn't in relation to the topic of genital diversity. When I interviewed Priscilla at Rainbow Youth, Um, this is in terms of, um when I think about a small baby, um, a case of a scenario of a baby that's form of ambiguous. Gee, [00:45:00] um, this little baby can't talk. They can't consent to surgery and hormonal procedures. And the issue that my thesis deals with is that, um and I've spoken to a interested nurse about it. She knows specialist doctors who pressure parents to perform surgery on intersex Children because they say blah, blah, blah, and they don't have the surgery. We're trying to be bullied at school and, um, suffer from issues, et cetera, et cetera. But of course, how do we know that? [00:45:30] And, um, this is the thing, um when and Brazil raised that the topic the issue of genital diversity Um, I feel that if there was more education about that in the medical and nursing system, I believe that would really assist, um, not just people with intersex conditions, but the wider population who may not have a classified intersex condition. Because, of course, um, as Priscilla, [00:46:00] genitals come in all shapes and sizes. And I know from myself from, um, spending a lot of time reading medical textbooks as part of my research that boy genitals do come in all different shapes and sizes. So I think where I'd like to go with that and thank you is, um, the New Zealand Society, you know, is is very divided at the moment. And I think the clear example, though somewhat horrifying, [00:46:30] is the article that appeared on The Sunday Star Times. They speaking very brave article by our family, talking about their seven year old and then watching the initially horrifying media reaction and overreaction, and some of the stuff that was written was absolutely putrid. And we could talk about that and then seeing trans youth around New Zealand, um, find their voice and speak to that and and some of the, you know, really wonderful things that have come out of it. [00:47:00] But what it highlights to me is that there is a a segment of the New Zealand population, and it's larger than what I'd realised, you know, saying things like people that support trans Children are abusing them, you know? So there's a very strong narrative in a part of New Zealand society who absolutely does not want us to have access to care and who thinks that anything that is different is repulsive and horrible [00:47:30] and should be stopped so it sits within a context. And I think New Zealand has become a much more polarised society and and when you saw the response last weekend in the paper, it highlights that because it's often underground. But, um, and and Grant and the response to Grant standing, wanting to be the new leader of the Labour Party. I. I was surprised that some of the vitriol that came out and some of the segments of the Labour [00:48:00] Party that surprised me, but maybe it shouldn't have. So we've got a We've got a huge amount of work to do and that does not so that sits there. And yet all of us in this room are are seeking and needing day to day health care. And very rarely do we get respectful, well informed health care at the level that we should be able to take absolutely for granted. One other thing, which, um also a bunch [00:48:30] of rains. Um, I guess it has to do with perhaps mental health issues, but, um, gender assignment, um, is an issue that my the deals with. And I remember talking to the surgeon who I won't name, but, um, we got on the subject of gender assignment and gender stereotypes and things like that. And he said to me that he heard about Children who may not have been intersex, but, [00:49:00] um, they were brought up in a gender neutral way through your stereotypes. and he said, Oh, those Children When they became teenagers, they turned out to be really screwed up. And I thought to myself, Now, why were they screwed up? Mhm. And what support were they given and and were they indeed screwed up? And it was Was it the projections of of a person, you know, I would. I would love some of these people to come to a space like this and actually [00:49:30] come face to face with the fabulous diversity that's here, because I think, um, these people have got no idea. Literally, I've got no idea and they don't see us as beautiful people. They see us as pathology and they, but they didn't know they didn't they wouldn't have a clue. So what we've done today, we've scratched around, skidded around something that's complex and incredibly important, and we've run out of time. I'm happy to, [00:50:00] um, give my email address to anyone who wants me to send out that little the community Little thing about the five principles and informed consent stuff. I can send that to whoever wants it. Once it's redrafted, it'll probably take me another like few weeks to finish it up But then it's Yeah, I can give you my email address. Or maybe I'll get the organisers to send out my email address. I don't know something, but that that'll be a tangible thing. There's other tangible things that are happening, but that's something I can offer. OK, I think that about wraps it up. And I suppose just [00:50:30] as a summing up the the the health care for trans and gender diversity of six people is a very complex issue. And I'm just thinking here. So you all this, the psychological services we need or don't need. There's access to the medical system, the endocrinology and getting the the health you need there. There's access to surgery or lack of access to surgery. That's getting good care in the mental health system for non trans issues. There's getting [00:51:00] good health care in the medical system for medical issues and being treated with respect. And there's the in issues we've had now to discuss a whole range of stuff and, as said, we just scratch the surface. I mean, it's a complex, it it's a complex here, so thank you all very much for coming along and participating.
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