Trans Health Care in Santiago de Chile

By Gabriel González, CASA Chile Fall 2019 (Brown University ‘20)

I'm unsure if I'll ever be able to fully explain the emotions I felt when a transmasculine patient came in with their family and began hormone treatment, especially in another country where LGBTQ+ lives are also often unspoken of, invalidated, and met with violence. It fills me with hope and reassurance knowing that there are other health care professionals providing quality service to an extremely underserved and stigmatized population in a resource limited setting. It is also personally reaffirming seeing trans patients come in the office and receive health care – trans related or not – that they want and need. It’s amazing knowing that patients who don't have support can start the program and leave with a network of health care professionals who, even though they might not totally understand and comprehend their life experiences, care for their well-being and fulfillment. This experience reaffirms again my goal to become a physician who not only does understand on some level what these patients experience but also empowers them to continue living as their authentic selves.

Living this took place while I was abroad in Santiago de Chile at the Gender Identity Program (Programa de Identidad de Género) aimed at non-cisgender and doubting patients offered through Hospital Dr. Sótero del Río (Complejo Assistencial Dr. Sótero del Río). I got to know Laura Toledo, social worker, from the Rainbow Office (Oficina Arcoíris) who helps coordinate the program and the welcome of patients. She explained to me the purpose and mission of the program, which is to create a network of health care for trans patients in Santiago. This program is solely operated by the hospital, meaning that there are no state resources that support the program. Although the Ministry of Health has circulated two memos/informs about how to attend to and treat transgender patients – in 2011 and 2012 respectively – the Ministry does not have mechanisms to assure their fulfillment. 

Despite this, Laura explained that there exists a team of health care professionals composed of endocrinologists, a gynecologist-obstetrician, surgeons, a social worker, a speech therapist, psychiatrist, and psychologist who give health care to trans patients through the program. The path of care for these 415 or so patients consists of meeting with Laura at the office to learn what care can look like through the program and then they’re added to the electronic health care system. The patient receives an appointment with the psychologist to evaluate their mental health and need for a psychiatrist, appointments with the gynecologist-obstetrician and/or endocrinologist follow to then plan for hormone treatment. I was fortunate enough to be able to shadow Dr. Javiera Barros, gynecologist-obstetrician, and learn about this intimate process with patients.

It was interesting being in this clinical setting, and in Santiago at large, as someone who identifies as transfemme and doesn’t always have a ‘traditionally masculine’ gender expression: I sometimes wear highlighter and other makeup, have my nails painted, wear necklaces, and other things traditionally considered ‘for women’ while in public. I especially did this whenever I went to the gender identity program because I knew it was a space where LGBTQ+ visibility is key – I knew there would be stares and the constant feeling of something happening to me, but knowing that my presence could be reassuring for trans patients as well as having the solidarity from CASA (mil gracias a Pilo y Amanda), the cohort, my host mom Pia, my new Chilean queer and trans friends, and the health staff (mil gracias a Dra. Mónica Nivelo por haberme puesto en contacto con el programa) made me feel all the more powerful and confident in what I wanted to accomplish.