Quality healthcare is an essential part of thriving, strong communities. However, across the United States, gender-diverse (non-cisgender) Indigenous people often do not have access to the care they need. During Transgender Awareness Week, we are helping to raise the visibility of transgender people and address issues members of the community face.
In 2015, a national survey of over 27,000 transgender adults found that one-half of all Indigenous respondents reported at least one negative experience with a healthcare provider in the past year. Negative experiences ranged from subtle discrimination and insufficient treatment to abusive language and harassment. This poor treatment affected individuals’ desire to access care. Over one-third of Indigenous respondents indicated that they opted not to visit a medical provider in the past year because they feared disrespect or mistreatment.
“We don’t find a doctor very often to who you can say personal things. In fact, often, the response is ‘I am not sure’ when we ask a question. But I want to know if you [as a clinician] can find out more for me, because you probably have better ways to access information than I do. I would like to hear an affirmation like “ok, I will figure it out,” rather than ‘girl I don’t know?!’”
Jeri Brandon, Cherokee Nation
In response, in 2019 a group of dedicated clinicians came together in partnership with the Northwest Portland Area Indian Health Board to grow the capacity of health care providers to provide culturally responsive, gender-affirming care. Over several months the Trans & Gender-Affirming Care ECHO Program took shape.
“We knew we needed to address what we were hearing from our gender-diverse community members who were not accessing potentially life-saving healthcare due to fear of poor treatment and discrimination. At Indian Country ECHO , we believe addressing clinicians’ knowledge, skills, and confidence in treating gender-diverse patients is key. That is why we developed the Trans and Gender-Affirming Care ECHO Program. In this learning community, I/T/U clinicians, administrators, and staff could come together to discover how to create caring and supportive clinical spaces for trans and gender-diverse community members.”
Jessica Leston (Tsimshian), MPH, Clinical Programs Director, NPAIHB
To create opportunities for clinicians to share knowledge, consult with clinical experts, and grow their capacity to deliver high-quality care to gender-diverse patients, the team organized a series of virtual clinics, which ran from March-August 2020. These clinics served as problem-solving sessions, where Indian Country ECHO faculty and participants shared professional insights, discussed case presentations and up-to-date treatment recommendations, and provided each other with community and support.
The organizers found that clinician participants expressed an increase in overall knowledge, skills, and ability to provide quality care to Indigenous gender-diverse patients. Clinicians also expressed increased comfort in advocating for patients’ needs at both the tribal and national levels. Specifically, they said that the program helped demystify gender-affirming care, minimized their fears about treating this population, and provided practical information and feasible solutions that they could apply in their practice.
Program participants reported that they were able to take concrete steps toward creating clinical environments conducive to gender-affirming care, such as staff wearing pronoun pins, ensuring posters and pamphlets in clinic spaces are inclusive, and adapting electronic health records to ensure patients are called their correct names and pronouns.
The Trans and Gender-Affirming Care ECHO Program is now a communal space where providers can share their stories and support each other personally and professionally. These exchanges create more competent clinicians and a strong network of well-trained IHS, tribal, and urban Indian organization staff competent and confident in their skills. Ultimately, this helps clinics provide resilient gender-affirming services in Indian Country, where patients feel safe and respected and, as a therefore, are more likely to access care. Plus, Project ECHO offers a culturally resonant way of doing so through a format that encourages everyone to share their gifts. ECHO values relationships and connection, and offers discussion and guidance on topics most pressing for clinicians practicing in Indian Country.
To learn more about how IHS is working to ensure that all American Indian and Alaska Native individuals and their families receive equal access to health services in the communities where they live, please visit https://www.ihs.gov/lgbt/.
“Indian Country ECHO has created a virtual space to learn from and with peers in Indian Country regarding important clinical topics, like trans and gender-affirming care. I am grateful to partner in this work, and in doing so cultivate safe, equitable, and affirming healthcare spaces for Indigenous people.
Dr. Hannah Wenger, Trans & Gender-Affirming Care ECHO Program Faculty
“Before [participating in this program], I didn’t even ask [patients] how they wanted to be addressed, or what they identified as, so that whole aspect has definitely changed. With this [one] particular kiddo… every time I used [his chosen] name, you could just tell it made him feel so much more comfortable, and he was able to open up a little bit more!”
Trans & Gender-Affirming Care ECHO Program Participant