Rundale

By Fiadh Tubridy

Transgress the NGS  is a grassroots group fighting for self-determined trans healthcare in Ireland through collective and direct action. The group initially grew out of work within another organisation, Trans Harm Reduction, to identify and share information about GPs that provide healthcare to trans patients. It has since developed as a separate campaign supported by a wider range of trans community groups. Over the past 18 months it has carried out a range of actions including pickets, protests, street theatre performances and sit-ins directed at the institutions responsible for the current state of trans healthcare in Ireland, including the National Gender Service (NGS), HSE and Department of Health.

The context for the development of Transgress the NGS is the dire and worsening state of trans healthcare services in Ireland. There is a waiting list of over 10 years to access the NGS, the only public trans healthcare service, at the end of which prospective patients must undergo invasive and dehumanising psychiatric evaluations. Meanwhile there are no services whatsoever for anyone under 18. As a result, Ireland has been rated as having the worst trans healthcare system in Europe.

Due to this situation most trans people in Ireland either self-medicate, meaning accessing hormone replacement therapy (HRT) without oversight from a medical professional, or use one of the patchwork of often unreliable private trans healthcare services that have sprung up in recent years to exploit the absence of a public option.

Through its early work, Transgress the NGS identified one specific issue whereby GPs are routinely advised by senior officials in the NGS not to provide basic forms of healthcare, including blood tests, to trans patients who are accessing HRT either through private services or by self-medicating – in other words, outside the NGS’ control. Readers can find out more about this issue by reading (and signing) an open letter from the campaign to the Minister of Health. For the past year the campaign’s key focus has been to highlight and overturn this policy as a first step towards a system where trans healthcare can be accessed through primary care providers.

The remainder of the article is based on interviews with four activists – Helen, Bree, Ky and Cristine – who have participated in the campaign in various ways over the past 18 months. Below, they provide their reflections on how the group developed, what they have learnt and what they hope to see in the future.

Rundale: why did you get involved in Transgress the NGS initially?  

Ky: I moved from the US and I was trying to figure out how to access trans healthcare in Ireland. I was finding out about how there are no GPs that would provide care, so I reached out to Trans Harm Reduction (THR) about that. Then obviously THR was starting up a project researching and putting pressure on GPs to provide care and I got involved then. In the US you can just go to a GP to get access to trans healthcare. I was surprised by that not existing here and I wanted to see it exist.

Bree: I was initially motivated by the idea of trying to find out information and being able to identify GPs to recommend to other people. As the campaign has developed, it went in a direction where I felt like I couldn’t contribute to some aspects, like organising protests, but I’ve kept on dealing with people’s emails asking for information about GPs.

Helen: I was involved in organising focused on material issues like housing but I started to see and to think about how these type of issues could be taken up by the far right, so I wanted to get involved in other stuff as well. I was also interested in having more connection with, and getting involved in, the trans community and hanging out with trans people. But I wanted to do something not entirely social. I was interested in things that would make change, not just social activities. From the start, this campaign seemed like something that was very clear and purposeful.

Rundale: what are the issues people are facing with accessing healthcare through GPs and what needs to change?

Ky: There’s a lot of different issues. Initially for trans people going to a GP and asking for care is difficult. Then GPs see it that this is specialised form of care and don’t want to deal with it. They have the impression that they can’t deal with it and won’t do any research. They have fears about insurance even through insurers have directly said that if it’s within their competence then they can do it. There’s a very deep level of ignorance. GPs also don’t have any understanding of what the NGS is and how it works. They’re receiving letters from the NGS and they don’t understand what power the NGS actually has. Lots of people are using private healthcare services and the NGS doesn’t have any power over these.

Bree: Generally people don’t know where to go to access healthcare and by default they’ll go to their GP and all the GP is willing to do is recommend they go to the NGS. A lot of GPs are afraid to go near this type of healthcare even though it’s actually not different at all. In lots of cases GPs want nothing to do with trans healthcare and aren’t willing to do blood tests in cases where people are self-medicating. Or, in some cases, they say they’ll do blood tests but won’t interpret the results. I initially looked at the TENI [Transgender Equality Network of Ireland] website and they had a very limited amount of information about GPs. It wasn’t clear how they would deal with people who are self-medicating. So, obviously, people contact us about this all the time.

Helen: Currently the conversation about trans healthcare is so detached from reality. Everything to do with trans healthcare is seen in the context of the culture war. Our demands and focus are about a radical overhaul in trans healthcare, but also one of the key goals is to have a space for trans people where we feel powerful and have agency and are organised. A lot of people don’t have any sense of what it means to be in an organised group or don’t have basic organising skills. It’s about us as a community – to feel powerful and to be thriving and to feel like we matter.

Rundale: What have you learnt through your involvement with this campaign?

Ky: The negatives things are to do with the system that Transgress was trying to change. It was my first experience of direct action and it was evident very quickly that it would be a slower, more gradual process than just going and shouting outside a building once or twice. It was a wake-up call that it would be very hard. But it was helpful to learn from all the people that were there and a good experience from the perspective of community building. There need to be lots of different prongs to the approach, different moving parts and different organisations pushing forward. And all these different pieces are important. There needs to be an ecosystem of different groups that are community-centred and build upon the voices of people in the community.

Helen: From an organising perspective, what I’ve learnt is that the impact on the group itself and people being empowered is just as important as the outcome. Although that’s maybe affected by the fact that I’m not currently trying to access healthcare. So while I do have a stake, the dynamics are a bit different. I also really feel the repressive state apparatus at play. We’ve made it clear that we have a democratic mandate, and we have the numbers but officials have no interest in meeting with us. They see us as aberrations to be managed. It’s an incredibly regressive perspective.

Bree: I’ve learnt how many people are going through challenges trying to access basic forms of healthcare. And being involved has really shown the practical benefits of organising and what can be achieved. Doing outreach and systematically collecting information has been really powerful.  

Rundale: Are there any particular achievements that you’re most proud of?

Cristine: There were really great moments of connecting with people and little wins along the way, like hearing people say “I’m so glad someone is doing something about this.” And then also the great turnout at the protest at the NGS last year.

Ky: Just generally, how quickly we were able to build a solid base of support. There was an obvious vacuum and there were so many people who were itching to do something. How quickly we were able to get so many people together was really exciting and provide that space for people to advocate for their healthcare.

Helen: The turnout to events and actions, getting people to meetings, when people take on new tasks and things they haven’t done before. It’s also been a very enjoyable and joyful form of organising. We’ve been quite flexible with it and the campaign has changed and developed loads in ways that have been intentional and had a purpose.  

Rundale: What do you hope to see happening in the future?

Bree: I’m looking forward working with GPs more directly. There is a move to start training GPs which shows we don’t need to feel too constrained by the system as it exists at the moment. It would also just be exciting if people could get prescriptions directly, through informed consent. That would be great.

Helen: I would like to have a formal response to our campaign and our demands from the Department of Health. I would love to force that out of them. We have shown that we have a popular mandate already, but I want us to grow and have more members so they can’t ignore us anymore. We will have to be quite creative to get that to happen.

Ky: I think we are making great strides in building partnerships across the grassroots groups and NGOs – among clinicians, researchers, and advocates – and from the local to the international level. So I see it becoming a more powerful movement that is taken more seriously by the government and professional bodies. Having met with countless activists, academics and healthcare providers, I’ve seen how much people want to learn and take action – they just need a conduit for it. I also imagine our advocacy getting more and more forward-thinking, rather than dwelling on the broken centralised clinic we have now. Building the system we want outside of those walls.

Transgress the NGS will be organising more actions to make our voices heard in the near future. You can get information on upcoming events and actions by adding your contact details when you sign the open letter to the Minister here.