More Transparency Needed in Navigating the Medical Labyrinth

March 5, 2014 in inQueery

file000908892912Our nurse looked like Amanda Palmer. Considering how long conservatism (read: homophobia) has been entrenched in the medical establishment, and remembering my own experience being mocked in hospitals for having an alternative hairstyle and piercings, it was refreshing for me to see a number of friendly, knowledgeable hospital staff sporting rainbow sneakers, piercings and tattoos. A paramedic in the hallway confided to us tongue-in-cheek that the whole hospital is run by queers.

Similarly, on the surface, the Bay Area is one of the most welcoming and progressive places for LGBTQI people. There’s no shortage of health care facilities and programs, and finding a queer-friendly doctor is as simple as running a Google or a Yelp search. There are services for niche populations too, from sex workers to MSM to people living with HIV and others with unique needs.

East Bay Pride and Gaylesta are examples of sites with long lists of hotlines and resources to connect patients with doctors. The University of California – San Francisco website has a resource page devoted to information about LGBT health issues. The UCSF Medical Department is the only U.S. health clinic that has earned a perfect score on the national LGBT Healthcare Equality Index by Human Rights Watch for six consecutive years. And last year, San Francisco became the first city to provide gender reassignment surgery to uninsured transgender residents through its Healthy San Francisco program.

Accessing these services is another matter.

Oakland resident A H recently enrolled in Healthy SF, and has yet to see a doctor. At a recent appointment, he arrived early in the morning and waited for four hours, only to be told that they would not be able to see him that day. He had come for a blood panel, and had been fasting since the night before. While not a life-or-death situation, the experience exemplifies that of many other patients – long waits, missed appointments and frustration. In addition, A H will need to soon find a different healthcare provider because Healthy SF may not be eligible under the Affordable Care Act.

This is not an issue related to discrimination for being queer or transgender; instead, it’s a symptom of a sick system.

January’s East Bay Express article highlights how underpaid and overworked hospital staff in Alameda are struggling to meet demands, and how ultimately it is the patients who suffer for it. Those most in need of help – the low-income, the uninsured, and people affected by medical emergencies, chronic conditions or mental illness – are often the least equipped to navigate a bureaucratic system of legal documents, insurance coverage, phone lines and opaque jargon. The time spent searching for services, waiting in waiting rooms, and holding on phone lines is time taken out of work hours. Some abandon the search altogether.

Frankie, who is presently homeless in Alameda County and seeking care for undiagnosed allergies, says they first sought help from the Alameda Alliance for Health. After being on hold for more than 25 minutes at a time, Frankie says, they would eventually hang up because the line is not toll-free and every minute cost them money. Only when Frankie went through a friend’s mother, who formerly worked in insurance and knew the right language to use and the right people to reach, did they manage to arrange an appointment.

In interacting with doctors, Frankie says they were still given few options until they clarified that they are not white but Latina. Frankie says, “Making that distinction is what helped me get through, and that’s not right. It shouldn’t matter what race you are.” The doctor prescribed Frankie an intramuscular medication that lasts several weeks so Frankie wouldn’t need to worry about frequent visits and multiple injections, but the medication came with side effects. At the appointment, Frankie says, they didn’t think to ask about contraindications and how the drug might interact with their other existing health conditions.

“I took it because I was desperate,” says Frankie, “Only after I went and did some research, I realized that someone with the conditions I have shouldn’t take this drug. But when you’re in that situation, you’ll take the quick fix.”

Frankie would like to see LGBTQI patients get connected with LGBTQI health care advocates, who can assist and advocate for people like them.

“There’s a disconnect between queers in the Bay Area,” says Frankie. “The biggest connection is between sex and fun, not research and support – and those are critical.”

Frankie envisions a site where people can list their skills and others can pay or trade for services.

“It would create employment and it would be cheaper for the low-income queers who need assistance in getting the services they’re entitled to,” says Frankie. “It’s much more expensive not to receive care, and to end up in an emergency room due to some untreated, but treatable, condition.”

In 2012, the U.S. Department of Health and Human Services published a list of recommendations to improve the health of people in the LGBT community. It included an increase in outreach to make people aware of available opportunities and programs, expansion of health profession training programs, and the inclusion of a LGBT cultural competency curricula because, according to HHS, “the lack of culturally competent providers is a significant barrier to quality health care for many LGBT people, particularly those who identify as transgender.”

A program called the Highland Health Advocates, initiated in autumn of 2013, intends to close the gap between services offered and services accessed. Highland Hospital, Children’s Hospital Oakland and the East Bay Community Law Center will collaborate to train clinic staff to refer appropriate patients to the program, to recruit and train undergraduate, MSW, MPH, and law students to help patients access services, to provide free access to legal services, and to organize a database that includes help for not only health care, but housing, utilities and food security in recognition of the fact that for some individuals, addressing their health needs takes a backseat to more pressing concerns, like eviction and hunger.

“We plan to train a group of committed undergraduates to staff a “help desk” at Highland Hospital in Oakland… where the volunteers will walk these clients through the process of accessing a multitude of resources,” state the Highland Health Advocates. Ultimately, they hope to give patients a better experience, reduce the number of people resorting to using emergency rooms as their primary care and improve the health of low-income patients overall.

Bryce Wolfe is a Guest contributor at InQueery and a volunteer at the Pacific Center.


Bibliography

  • “Hotlines; Information & Referral; Counseling & Mental Health; and Community Centers Resources.” EastBayPride.com. Contra Costa County Mental Health Project, n.d. Web.
  • “Resources.” Gaylesta. The LGBT Psychotherapy Association, n.d. Web.
  • “UCSF LGBT Resources: FAQs.” LGBT.UCSF.edu. LGBT Resource Center, n.d. Web.
  • Rush-Monroe, Karin. “UCSF Medical Center Earns Perfect Score For Health Care Equality.” UCSF.edu. University California San Francisco, 11 July 2013. Web.
  • Levin, Sam. “Nurses Say Kaiser Oakland Is Shortchanging Patients.” EastBayExpress.com. East Bay Express, 15 Jan. 2014. Web.
  • “U.S. Department of Health and Human Services Recommended Actions to Improve the Health and Well-Being of Lesbian, Gay, Bisexual, and Transgender Communities.” HHS.gov. U.S. Department of Health and Human Services, Jan. 2012. Web.
  • Alter, Harrison, MD. “Highland Health Advocates.” LevittCenter.org. Andrew Levitt Center for Social Emergency Medicine, n.d. Web.