So, a little while ago I got a call (on my personal phone, which is a relatively new distinction) from a contact working in trans health. I picked up cheerfully, expecting a work kōrero or some navigation or some problem solving, but instead got:
Kia ora, Jen. I’m ringing today to organise a First Specialist Assessment for you for the Gender Affirming (Genital) Surgery service.
Some background - until relatively recently, the waiting list for this surgery was astronomical: at one point, it was about 70 years. Sometimes I tell people that, and I have to repeat, and then I have to say “seven-zero” because it’s so absolutely beyond the scope of normal comprehension for medical care.
This situation arose for a number of reasons: we had one surgeon providing this care, and then he retired. We sent people overseas, but at a rate of four people every two years, a rate established in 2003 that was quickly outpaced by demand.
It was one of the first pieces of community advocacy I engaged in, relatively soon after I first came out, and I think the first piece of press I ever did. I was relentless on the Official Information Act requests to the Ministry of Health, asking about funding, and the numbers of people actually sent off for surgery, and why it wasn’t given higher priority. At one point, the Ombudsman released a withheld email from a Taranaki doctor that was absolutely brutal:
Why in Gods name put a patient on a 40 year waiting list? Isn’t 40 years outrageous enough for the Government to admit failure – they want the list to grow? I suppose they do, that makes it much more an intractable problem and puts it into the “too hard” category. I think it is just inflicting cruel, cynical, hopelessness on the patient –generate a false sense that something is being done – “I’m on the waiting list at least”
I eventually had a wild moment at the very first trans health symposium at the University of Waikato in 2019, where I ended up sitting next to the person from the Ministry of Health who answered all my OIA requests - thankfully, they were delightful and shared how useful those requests were in advocating for change from the inside.
The good news is, things are improving quickly. In that Herald piece linked above, 23-year old me says “at this rate, I wouldn’t get surgery until I’m 73”. I’m 28 now - that alone is pretty astonishing.
In 2019, the government announced a funding boost, effectively turning that 4-people-per-2-year limit into a bottom line. The number of people on the list jumped 160%, we contracted a surgeon to perform these procedures in Aotearoa, and things started to move. Te Whatu Ora now publishes regular updates about the service, referrals, and waitlists - if you do the math on these numbers the situation looks worse than it is!
They’ve also established a great wrap-around service, who my colleague who called me now works for. As I’m writing this, reflecting on where things were in 2016 and looking at Te Whatu Ora’s updates page now, it’s almost unrecognisable. We were operating in a total information vacuum and relationships between the Ministry and the community were sparse and tense at best.
There’s still room for improvement, for sure - our whole health system is under immense pressure, and that affects this service the same way it affects many others. The wait list is still long. Many of us are concerned about how this service will (or, rather, won’t) be prioritised under a change of government. Nothing is certain.
But, this week on Thursday, I have a 7am flight to Te Whanganui-a-Tara for my first specialist appointment. It’s not something I’ve ever had to seriously think about - it’s always been in the far distance.
I’ve got a lot to say about the BMI requirement - I love my body, I love my relationship with my body, I love my self image and self worth and self love, I love my relationship with food and with cooking and with eating. I consider myself healthy. I’ve had to really seriously think and reflect on those things, on my values, on how I might be able to meet this arbitrary number in a way that aligns with my values and maintains all those things I love about myself.
I’m sharing about this process - about the wait times, about the assessment, about the BMI requirement (and my dreams of one day soon replacing all BMI requirements in our health system with individualised assessments), about what comes next. I know of one other person in my personal life whose name has been called and found themselves in a similar situation (thanks to you, for prompting these thoughts in me then and now - I think I’d be feeling much more jarred by this step if we hadn’t talked about this before) and I know many people, trans, non-binary, and otherwise are going to be curious about this journey.
And it’s out of self-interest, too! WORD Christchurch this past weekend left me feeling inspired, engaged, wanting to get back into creating beyond my photography. I want to write, I want to make more videos (I made that one video about photography a year ago and haven’t done anything since).
So, I’m walking. I’m exploring our backyard, exploring Waitaha and Te Poho-o-Tamatea and Te Pataka o Rakaihautū. I’m taking my camera with me, and engaging with my photography. I’m enjoying my body, the company, the views. I’m finding and creating joy, finding ways to make this arbitrary number a celebration of this journey I’ve been on and am still on and will always continue to be on.
So - come for a walk with me, in person or online. I’ll keep sharing. Let me know where you’ve enjoyed walking? Share your recs! Share your photos! Let’s go on this hīkoi together.