Session 4 - Beyond conference

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[00:00:00] This podcast is brought to you [00:00:02] by the queer of inches and pride and [00:00:08] Thank you my good stuff. [00:00:11] As you forgive me again for a bit of an associate decision. And it's around this history of healthcare in gender diversity, so exists to healthcare and healthcare needs of the gender diverse communities. I'm on the panel with me as Jerry McDonald, [00:00:32] Manny Mitchell. [00:00:40] So, I was hoping the previous session song for avoiding a lot of talking. So just as a way of starting off the session, I'll ask the three panelists just to provide some thoughts. [00:00:55] You're a foreigner, and welcome to the fallen away attire, it seems very weird of us sitting here, like some kind of experts with you that they say so let's reorganize the railroad cycles, Coburn, let's make a smaller circle. [00:01:15] And I do want to make it nice that we're [00:01:17] in a foreign knowing to acknowledge that and to start this session by thinking about the people who are not here with us and the people who are not here with us because they couldn't be for various reasons, but more the people who are not here with us because they've been failed by the health system. And whatever a god so I think let's just take a minute because everybody here I'm going to imagine on this room has stories and people, either directly or indirectly. So let's just take a minute and then we'll start this workshop. [00:02:03] Thank you, Sally, this workshop, as well, I'm sure explain in moments as somewhat organic and unfolding. So I'll hand it back to you. [00:02:20] supposed to start with is a history [00:02:24] in obviously the place of staff is the most condition inquiry into trends. And then six issues was WIM, [00:02:35] which can be [00:02:37] up to [00:02:40] four years ago. [00:02:42] We do not date last year so that the that document identified certain issues, very filthy healthcare, for transport. [00:02:59] There's been some Kelly's Milliken [00:03:02] Yep. So [00:03:07] my name is Amy. I'm a trans woman. I just like to say, first off, the HS inquiry is more about trans issues, and the intersex thing was a sideline. And I think it's probably a lot more work that needs to go into that space as well. So I just wanted to say that. During that process, there was an identification of the lack of the inconsistency of past issues for trans people within New Zealand, and an outcome of that was a project of work, that the administrative health sit up and asked Candy's medical DHB to run them. And luckily enough, I'm here with two other Joey and Manny who are also part of that project. Our role within that project was merely the as a reference group. In a way I like to think of it as a given the opportunity or a conduit to allow the community to voice their opinion on what was happening within the community, it's probably fair to state that the outcome of the HP process could have been better at this, that's one way to suggest it. It was tasked with producing a set of guidelines. for clinicians. That was the way it was set up a very strict a very strict mandate of what what it was going to look at or guidelines of what it was going to look at. It was made very clear to us up front that there was no funding for the outcomes for that simply it was the creation of the guidelines. And then on top of that there was a minister Health Ministry of path towards the intimate that state that there would be a review on the our minds after two years that just June next year now, especially the past two years, but they didn't [00:05:05] publish it until 2012. I was doing research on this. So they could technically say that in 2014. It's due for review, because the date they have on their publication from the Ministry of Health is sometime in 2012. Yeah, [00:05:20] even though Sure. I mean, [00:05:22] the one thing for me that's in the came out of that process, and having the opportunity to talk to a very diverse group of people through some workshops, who ran here in Wellington and also also suddenly ran in Auckland is that, to say the least, it was very patchy health care available. At the end, it really came down to how lucky people were, a lot of that lack came down to where you've lived. And certainly if you lived outside of the main centers, the main centers been Auckland Wellington, and to a degree Christchurch and donate, and then your luck would often be very bad. And you are subject to I'm very poor GPS and the community and, and effectively no support from the DHP for any services whatsoever. And the biggest problem with that is the way RDHP system is set up that is once you're attached to a DHV. By virtue of where you live, it's actually extremely difficult to get a service from another DH. But you can couple that took a lot of trans people not having too much money and the ability to travel to main centers to receive the treatment they want. Something else originally, I'm from Oakland, been down here since 2009. And one thing I should point out, I found it quite hard when I first came to Wellington been a resident of West Auckland for majority of my life, just how white Wellington is. And we can probably notice that just by looking around the room here. And certainly when we went back to Auckland, and had one of our who is in Auckland, and South Auckland had the opportunity to speak to a lot of the facilitators, and married woman, trans woman and the community advocates that became very clear to me that there were two main things that would make you lucky and get in healthcare, one of them was being practical. And one of them was that having money because having manager gave you options. And if you lack one of those things, and instantly like both of those things, then your opportunity to get lucky with the house systems that grease straight away. The other thing that has certainly some recent events in Auckland with the open sexual health service or clinic, too short, that's called actually but the open sexual health clinic in Auckland has long provided very good services for the trans community in Auckland. And recently, they had a bit of a snag with the front end. And it reminded me that really a New Zealand, there isn't actually any funding that specifically targeted to trans have. And so lay what is available tends to only be there to assist people through a transition. And then once you've transitioned, or I like to finish transitions called Life is those services that get a little bit more hearing to learn to get I know and Wellington through the services offered by capital coast DHV, there are services there. But again, none of them are targeted, and none of them are funded. So once again, it becomes a bit of a lottery depending on your GP ability of your GP to get you into various programs with the endocrinology clinic, the psychologist, etc. and Wellington, I've been told by one of the psychologists and Wellington, that they don't have any funding for trans people, and they just do it more or less and have [00:08:48] their own goodwill of making [00:08:49] the time available for [00:08:51] for referrals. [00:08:53] And I certainly think that's really the nutshell where our problems actually exist. [00:09:00] That's all done for good. Well, [00:09:03] yeah, I can build off that a little bit. In. So, [00:09:10] Carter, I'm Joey McDonald and I live in Oakland at the moment. [00:09:16] So [00:09:18] about the CMDHB resource. [00:09:21] They were they were two parts of that, that kind of parallel things that were going on at the same time that I think as the official resource was being written by health professionals. And then those of us who were just volunteers to be kind of trans and gender diverse reference group, people would try and get feedback and give kind of our perspective on all Yeah, let's Could you maybe think about how this term real life experience is problematic and include something about safety. And even maybe, think about moving beyond the diagnosis model or thinking about having informed consent, as well as a diagnosis option. So when you're creating pathways of care, which don't exists for trans stuff, in New Zealand, specifically around transition to try and create pathways of care that are flexible, but have consistent, consistent access, because yeah, it was really inconsistent all over the place in different dhvc. We didn't give that feedback, and it didn't really get very far, as you can imagine, in that situation they've run was very, very stretched. So we were just volunteers, they were getting a small amount of money to do it was kind of done with the last minute. So the resource itself, I have never recommend it to anybody, because I think it actually is damaging, it's really, really unhelpful. It's now completely out of date with international best practice, even if you're being conservative and considering that could be been an international based practice. But even on the basis of like the standards of care by the world professional association of Transgender Health, that set those standards of care are now ahead of what this resource is recommending. So it needs to be updated desperately, and hopefully will be I went back and had a look at it recently, because we're doing some lobbying of the Ministry of Health Partners, part of my role at affinity services, which is a mental health NGO, as a rainbow liaison person. So working with a few other people like Manny and like more at the Mental Health Foundation, and jack TI condition. So a few of us getting together trying to write another kind of document, I don't think it'll be a report, but just kind of something to give to the Ministry of Health and be like, hey, this, this thing really needs updating, we still don't have consistent pathways of care that HS a report that was written in 2009, none of those recommendations about health care have been taken up have been moved forward. Yeah, and try and get more conversations happening. On that basis, we so there was that kind of that stream, and then there was a parallel stream of we were getting all this information and feedback from trans communities and gender diverse communities and six communities to a lesser extent. And we created a country unity feedback document, which was we thought could be like a companion resource for since the clinical resource was intended for GPS primarily. So we thought this would be a good thing for us to be able to give at the same time. And that was based on what we thought were the five principles of health care. For our communities, we wanted to base it on access, safety, well being respect and diversity. And we wrote a little thing about that was kind of synthesizing a huge amount of feedback that we were getting from a lot of different people. But that basically, if you had those five values underpinning your provision of healthcare, then you would be doing a lot better than we currently are. So that's a really great little document that I'm rewriting now and updating and hopefully can go out again, and be something that we can give to people and entertain around, knowing that it did come from community consultation, and continues to be really, really relevant. [00:12:58] That's my update on that. [00:13:01] One of the things, and Hello, my name is Manny. And for those of you don't know me, I'm Linda CXBZ. And I also work within the system. I'm a therapist and private practice. And I run a small not for profit organization that does training and education work around intersex issues, I think what will be useful now, as you've heard some reports on some of the initiatives that are going on, if we just quickly go around the group, and provide an opportunity for people to introduce themselves, I think name and preferred gender pronoun if you have one. And then what are the issues that you would like us to talk about, we've got about half an hour left, which I thought this workshop probably could go on, reasonably all afternoon, I'm sure it's an important issue for lots of people. But if you can be brief, and then we'll do our best to address the issues that are afforded. So, Sally, we want to start with you, are you going to work, you know what your role is here? Other than being [00:14:08] more of a transform [00:14:15] here to facilitate workshops or or it wasn't the people and trying to help people avoid [00:14:22] the information that people are looking for. [00:14:25] What would you say is the biggest current health [00:14:30] issue that's not being addressed. [00:14:32] And just [00:14:35] just just in case that's more experienced 20 years ago, have been in psychiatric hospital. And on my exit interview site, I was trained in psychology. And in telling YJ, the same thing and being told, Oh, you don't want to go down that path. So that's 20 years ago, we got these reports. So we're going forward. [00:14:58] We're long white and blue debate. But [00:15:00] let's [00:15:04] roll the journey. And there has been progress despises [00:15:06] Roman in Santa [00:15:11] Barbara, Jesus for pronoun, she [00:15:21] that's really hard questions [00:15:21] just come up with [00:15:23] an answer to what's the most pressing thing. That trans health care [00:15:33] plan mentioned, probably just getting consistent access to services throughout the country, you know, not just in the [00:15:42] big cities, but everywhere. [00:15:47] And so mental health support. UK? [00:15:52] And sorry, just before you start, thank you, and all the organizing group for putting this on, it's obviously important and needed. [00:16:00] Thank you. And I wanted to add on so that you don't have to address if it's kind of the question of what you think is conceptually or politically the biggest issue you could say that or you could say, what you're interested in talking about today or a question that you have right now about any of this stuff could be just what you what you're bringing right now not necessarily what you identify the biggest issue Yeah. [00:16:24] I'm sure I'm I'm Sarah I'm identifies women, women and female financings [00:16:31] sis gender. But I've had a little bit of involvement of the last two or three years with youth over open up the other five strands. And one of the one of the biggest issues has been the lack of respect and the lack of understanding that I've seen from mental health, mainstream mental health people who are supposed to be assisting me not. And I want to try and do some [00:16:56] Thank you, sir. [00:17:06] I just finished. I [00:17:10] used to probably, I mean, why is this been [00:17:14] for the last seven years, which is a big boys myself? [00:17:20] boxes in China, [00:17:25] basically on argue [00:17:28] with me, but also over the years? [00:17:30] Just what, [00:17:33] what what she's gone through [00:17:35] friends, and the fact with the [00:17:38] health issues that it's just [00:17:43] pathetic? [00:17:51] Jim? [00:18:00] Well, one of the words that popped out of the little briefings, health, healthcare, really. So I was really interested in that as well as the as the [00:18:13] as the experience of trans. [00:18:16] I'm thinking I guess that that [00:18:22] strikes me is that it's possible to, to cover health services from a number of directions and find that people just don't know what to do with you. [00:18:33] And I guess that's [00:18:38] that must be really boring. [00:18:40] I mean, I find it worrying as a, as a guideline, I guess, just to be blank wall. [00:18:49] Suddenly, [00:18:54] also sort of struggling as big as what happens to you when you get older, actually, as well. [00:19:00] Clearly, [00:19:04] there's a sort of sense of worthlessness [00:19:08] that can attach to old age. [00:19:12] And it's in particularly in times of economic hardship, I guess, well, [00:19:18] it's repeated. [00:19:21] So I think [00:19:25] there's an awful sense that he could only get worse, I can spot now, [00:19:30] which is very destructive. Oh, [00:19:45] I'm sure it'll get better, actually, because people are doing things. [00:19:53] What I'm thinking is big. [00:20:00] I'm talking with my partner who's, who's younger. [00:20:09] I hope that he's around actually, [00:20:15] just to [00:20:18] if I can't deal with [00:20:34] I use common pronouns. And I guess [00:20:38] I'm curious to learn more about access to genuine [00:20:47] Mr. Bernanke in this gallery, until [00:20:50] we can ask her to use female pronouns as well [00:20:54] is my experience with healthcare is mostly mental health, but I'm really interested is a swimming humanists, and what sort of [00:21:02] stuff I can do to support transhumanism and half of the [00:21:04] big system. I think, [00:21:06] in my mind, that has to be a following initiatives that are happening in support of [00:21:17] our actual [00:21:18] eyes like them are now [00:21:21] I've had some [00:21:25] not great experience Wellington's mental health system. And more recently, a lot of that has to do with being trends. So it's cool to be in a space where you can kind of feel that there have been similar frustrations, I'm just quite enjoying the kind of solidarity there. [00:21:50] Thank you. Hi, my name [00:21:53] is Kelly. I'm for food, female pronouns. And the issue of heels obviously, is a very dear one to all of us. And I just want to echo I think what Amy was saying, particularly about [00:22:09] being Paki hair and being lucky being [00:22:13] and being being having resources have been hugely important because I just call him a little bit low open sexual health service. Organizational health service provider, the counseling, and counseling is one of the most costly and greatest obstacles to people accessing cranz healthcare, because depending on whose protocols you're looking at, generally speaking, three months of counseling as is required, and there are ways of breaking get counseling, quickly by saying, for example, look, I'm going to go off and score all lines illegally. And you can cut down on the amount of counseling that was required. If you are on the view, the live legacy is all mines illegally, that was quite a good take to put trying to minimize the cost because otherwise, people are at least they can go through open sexual hill or some other PHV, which funds a service and hoping their energy, the cost of talk counseling sessions as a huge, huge obstacle mean people. So it was a big financial obstacle which people face almost everywhere. And just as I said, filling in about on sexual health, they found that they had an influx of or greater demand for these services. And apparently, one punishing found that burn time. They was bogged down with transplants. And at that point, those are the little wailing and gnashing of prime hands of the year. And I understand that. And another issue was a psychiatrist who used to assist died last year. And that that's increased the workload, but apparently the training on the shoes, they say that it's only a cup, let's see about one of the big issues and what I'm trying to do at the moment is trying to make healthcare and New Zealand because there are enormous geographical points. And while the CMDHP protocols when they came out my supposed to raise consciousness The reality is, and I think that is absolutely disgusting. I can't use the word out however, the musical justification for many key piece certainly refused the truth. And that means that if you are say living in the east, and they have plenty, you might have traveled as far as part on them to to get trans health care. And if you look to the top and so think as Dr. Jane Morgan and Hilton started offering treatment of the the white canvas sexual health some people were traveling as far as not a walk here or Huntley get treatment. So I mean, aside from the the obstacle of paying for counseling, some people were having to pay, you know, enormous amounts to travel huge distances. So just to sort of rambling a little bit, anybody wants to get on cranz advocates health page on on Facebook, we'd love to try and get as much information as we can and see if we can identify these geographic, always. Because I think that, you know, they need to be identified, the only ones they're identified as it can be possible to at least get on there and perhaps time some of the key piece who needs to be providing health and it just astonishes me that somebody can come in and say, Look, I've got a recognized medical condition, there was a recognized treatment pathway, and then just simply being turned away. I mean, that was obviously experienced that, you know, I was resourceful decided that our target was soft counseling target or soft, done, Doctor, but women sort of turned out that my regular GPIX do disclose that when he did the cheeks the examination when I was sick. And I said before you stabbed me just a little bit the True Confessions. That's it. I'm sorry, I didn't come to you to stay with but I wanted to make sure I was only going places where I knew I was going to get a good, good section. And I don't know about you, so forgive me. But now you know, and now that we here helps you could assist me and it was he was just horrified. Well, he wasn't hard, it treated me like Uber's but he did not want to include cranz health care for me and he was my primary health care giver. Emphasis on was [00:26:52] I'm married and I have pronounce [00:26:55] a appeaser listens I appreciate. [00:27:09] Main thing is there's a lot of stuff. [00:27:13] big one for me was the process around that document a few years back Yeah. And surprise me the [00:27:23] propaganda pushing out their views. I see something like taking ages to publish two things. But [00:27:31] I found that process to be [00:27:35] really frustrating that medicine [00:27:43] knows about all the issues of the web will take a few it seems three years in the end. And you know, they will support a lot of courses. change anything else. So just the fact that me little jacket and listen to [00:28:07] Andre Christmas, [00:28:09] I was all the passion for female [00:28:11] but my dream has always been very [00:28:12] fluid. throughout the life [00:28:15] I've never really identified a strictly male female. [00:28:22] I'm here because I recently completed a PhD, which looks at the middle management and support of intersexuality in New Zealand. I guess that I'm here because I only found out about this conference at the very last minute. But I saw various topics such as health care, and I thought that was very interesting. I guess, my interest support for people with under six conditions of New Zealand and of course around the world. And throughout my research, there was one something [00:28:57] RMMI interviews. [00:29:01] Priscilla penna caps is now a past Education Coordinator at rainbow youth. [00:29:06] And as well as my thesis as well as gender diversity and gender issues. When I interviewed Priscilla, she talked about [00:29:17] she talked about [00:29:20] financial diversity. And I thought to myself that is really something particularly a medical and nursing education. I feel that that will be a very very important topic to talk about that people the isn't just diversity agenda is also diversity, sexual organs, and genitalium as well. [00:29:47] Hi, my name is Jace. [00:29:50] usually do. [00:29:51] I'm here mainly to listen and get whatever I can from conversations and people's experiences. I suppose also, as a teacher, I'm very interested in [00:30:00] RXC some information for us, the whiner [00:30:05] and so that community consultation documents, if you could then [00:30:10] it's not some stage how to existence. [00:30:16] I'm done with our use. [00:30:19] In the future. [00:30:24] Good 30 minutes grant [00:30:26] identifies male, I am a professional. [00:30:34] Hi, I'm Nicola I use. [00:30:43] So if we would have summarizes is a thing. I think what we're hearing from people is, we haven't heard any fabulous stories of people encountering wonderful sense as a generalization. And I think the important thing to think about is an current medical training and easier, doctors get two hours in which they cover gay and lesbian. And there is nothing about trans health, and there is nothing about industry excels. And there's nothing about gender non conforming. So the stories that I'm hearing back, I really not surprising. And I think this is the nexus of the issue is that we have a very poorly informed community right across the board. I think what is changing is that there is a growing awareness, some people wanting information. So I think we do have a doorway, of willingness, but there's a huge knowledge gap. And the other thing on the other side is that the the need is growing, and it's growing right across. [00:31:53] It was, [00:31:54] you know, someone raised the issue of aging, and we could go around and identify the subgroups. And they're a meaning. And I don't think that we are doing this well, in any area at all. We don't have lots of time, in fact, we have quarter of an hour late. So I think what would be useful as initiatives that are on the table to think about those of you who would like to be involved, the one that I can report on I was with a group of people who went to the Associate Minister of Health, some of you will be aware that this government has a new initiative around reducing suicidality and New Zealand and that's quite a large initiative, this $80 million being assigned to this and the document that came out at the beginning of the mentions our community and one sentence and the entire document. And we're not identified, and I'm saying way I'm using an inclusive queer umbrella, not identified as a risk group. And it's very clear all around the world, and a wide variety of research that the queer community, probably a most places sets only next to indigenous communities is being high risk, and very exposed to suicidality. Of course, there's a nice marginal communities. So there was a briefing paper written, and it was, it was essentially Auckland centric, but there were other people involved. I have to report that the minister was neutral and his hearing, but that it's actually looking like it's moving in a very positive direction. They, he has been out and consulted with the ministry, and you can talk about that. But it's looking like there is going to be a new statement coming out. We have about our community will be identified as a risk community. So that's a positive in terms of an activist strategy that we can do things to achieve. I think the problem is that the deficit is so huge. And then those of us working on this area, a very small and comparison to the need, in terms of trying to find uniformity across New Zealand. It is one of the problems with our current DHB model is that each DHB has its own priorities and its own way of doing things. So we do not have a uniformity and delivery of service in any area. And our community is very poorly served in this regard. [00:34:49] I just going to say one thing because one person mentioned love is surgery. And BX is to bet the New Zealand, oddly enough, is probably the point of the one processes that does typically it's just the New Zealand and not everyone's aware of this. You can apply or get on to a waiting list for lower surgery, surgery or genital surgery here in New Zealand. However, it's a very opaque process, and no one's really hundred percent sure how this is working [00:35:24] this special high cost treatment. Yeah, [00:35:25] stuff. Yeah. And it happened. It was set up I think in 2003, that they would do three surgeries every two years to mount a female one, if to him and it was covered by the special high cost treatment, funding polio one of those two. And it's an interesting thing because that point and it says to provide surgery overseas with surgery standard system, you Zealand said it has been I believe around about 12 or 13 people in the past 10 years, we've managed to go through that process. So there's still not even hitting the numbers there. Few days people have been it when people have been sent overseas to shut down gym or Netherlands one of the church, we've heard some feedback from that. They have been the balance of those had been out of female surgeries carried out by searching and Christchurch. However, in the last 24 months, there's been lots of conflicting rumors about that surgeon continuing to provide that service. It is an area that needs to be talked about a lot more and bought out with the Ministry of Health, especially since of that service is going to disappear from Christchurch. And it certainly doesn't seem to be easy to access. And then what is happening to this funding. So effectively $120,000 is in that budget to be signed every two years. The last time I talked to someone about this within the Ministry of Health, which was a couple of years ago, the answer was is that money that's not being spent as been set aside. So in theory, who knows how much money is there, but I mean, that's a reasonable pressure point to talk to the ministry accounts because they have that service. And that doesn't seem to be getting Max's [00:37:13] that's part of relates to that an issue that I've been thinking about in trying to create any kind of change around this with you talking to the Ministry of Health or trying to like I've gone and talk to nurses, undergraduate postgraduate nurses that will plan uni, trying to do any kind of education, I get stuck, because I'm like, should we be I mean, should I be aiming for like a bare minimum? and saying, Okay, can I can I talk about deep apologizing and talk about using the informed consent model, so that there's a wider diversity of gender expression is ok for everybody, whether you're trans or says, or somewhere in between, or into steaks [00:37:47] or whatever, that. [00:37:51] But we haven't even got the really basic stuff covered. So like, and mental health support seems like it comes up all the time that [00:37:59] people would really just like [00:38:01] some kind of access to a low cost counselor or a low cost, psychotherapist, or just someone who they could get that kind of support from. And sometimes it's made a requirement, as you've said, Kelly, that that people have to fulfill a certain amount of hours of counseling. And that's not international best practice now, either. But it still happens all the time, framed up as something that a criteria that we have to meet not something that a support system that's available for us, because we have to go and find someone, usually in private practice, who's probably really expensive. So I get really frustrated, because I don't know how to encourage dhvc, to create consistent pathways of care for us, but also to make them really flexible. So not to be policing people's gender expression in order to access any kind of transition related health care and not to be just using that same DSM diagnosis model for your everybody. And yeah, but sometimes they don't even know where to start. Because like, if people would at least say, Yes, I will work with you, that's a step forward from what we've got going on. And a lot of cases, rather than me getting really worried about the quality of how that's going to go, or the options are we going to limit people's options, I don't want to create pathways that then become really rigid, and everybody has to adhere to the same criteria to get on this pathway. And then that's when you've got to do this, this, this and this, and then that's the process. And there's no flexibility, whereas now we've got totally inconsistent, [00:39:34] talking about [00:39:35] concedes now that you know, your expert on this, and anybody who wants to build a team around might want a lot of the the BNQ concrete services protocols for rapid trains care, of course, in Vancouver, what you do is you turn up a practice news will take your blood, make sure that there are no adverse health conditions center with high cholesterol, legal or whatever, and might prescribe [00:40:01] for one day, [00:40:03] and it's all done on a consistent basis. And the inconsistency is here, I mean, you might go to a doctor who will make you go through the hurdles. Or if you got resources, and then can get to the ground, there are doctors. And so I think there are places that we can find, but again, some of it seems to be almost the best kept secret out and other that you know, as I see, because trains, advocates, health patriots trying to get as much information as possible and maybe form a decent database. And, you know, certainly you can look around and talk to people, you might be able to find doctors who are much more willing to go down that more like the st Vancouver model rather than the American the real life experience with three months of counseling and expecting people to turn up, you know, Grace, the primary Christians, masculine or feminine May as possible simply to try and do the same are on the hit the gatekeeper. It [00:41:11] seems to me and I have sort of high level critical rules about you know, socializing medicine, the sense of like the doctors like winning a monopoly, basically, doctors in the village rated each [00:41:25] city has failed to lead by transferring wealth from [00:41:30] people on low wages to keep on very high wages without really any particular side, they will show their monopoly. It's widely discussed in some aspects of economics. Does it filter down to [00:41:48] people's health care political idea, [00:41:52] the guy next door, please go to Thailand. [00:41:58] Hold me world and going abroad, operations, tips things. But we don't talk about it. [00:42:08] And [00:42:11] I'm not sure how, how you introduce the discussion into [00:42:18] country, which has also have a tradition of having decent services provided by itself. And that's how, you know, with the sort of cultural philosophy, all the controls the integration into the country from healthcare expert, healthcare, trained professionals as well. So I mean, just the different levels, that sort of experience she talked about, and the popular nature of it. And then there's the the some some of the economic welfare policy realities, which is the newest transferring money to a wealthy class of people. [00:43:00] sort of place but [00:43:04] the discussion should be somebody, sort of the first out cycle, I'm going to go down the road, you know, [00:43:13] we've got to lens with individual people attempting to access the key that they need right now. And then we absolutely do have a broader debate about health care system and GMO in this country and who has access to it and how effective it is. And there has been massive changes going on. And Mike's for this around aware of what those drivers are, and the fact that the the individual JP as a disappearing species, that it's mostly medical practices now. And that's come about through changes requiring in the 24 Hour Emergency Services and other labels that have informed that. So yes, I think absolutely this the two different places, and we need to be having conversations and books. And we haven't added very much in Jordan, thank you. Access to enter six care, we have this barbaric and cruel system that goes on in this country with babies. But once you are an adult, boy, you have a suspicion that you might be an under 6% getting access to any kind of support and service in this country as all my steps zero. [00:44:41] And also one big issue I'm very interested is informed consent, in relation to the topic of generational diversity. [00:44:51] At rainbow youth. [00:44:54] This is a chance of when I think about the small baby. The case of [00:45:01] baby that's what I'm thinking was [00:45:04] dinner Samia. [00:45:06] This little baby can't talk they had considerable surgery and chemo procedures. And the issue that my thesis deals with is that and I've spoken to a registered nurse she knows specialist doctors who pressure purposely performance injury on intersex children because they say blah, blah, blah, they don't want the surgery to be bullied at school and john suffer from issues etc, etc. [00:45:34] But of course how do we know that [00:45:36] and this is the thing when the solar rays that are chocolate, the issue of emotional diversity. I feel that if there was more education about that and the medical nursing system, I believe that would really assist not just speed with a disease conditions like the wider population, you may hothead classified under six conditions, because of course, son, as Priscilla reigns, Gina souls come in all shapes and sizes. And I learned from assault from spending a lot of time reading medical textbooks as part of my research, that point jewels do come in all different shapes and sizes. [00:46:24] So thank where I'd like to go with it. And thank you is the New Zealand society new is very divided at the moment. And I think [00:46:32] the [00:46:34] clear example, though somewhat horrifying is the article that appeared on the Sunday Times last weekend very great article by a family talking about their seven year old and then watching the initially horrifying media reaction and overreaction and some of the stuff that was written was absolutely putrid. And we could talk about that, and then seeing trends around music and find the voice and speak to that, and some of the, you know, really wonderful things that have come out of it. But what it highlights to me is that there is a segment of the New Zealand population, and that's larger than what I had realized, you know, saying things like people that support trends, children are refusing, you know, that say there's a very strong narrative in a part of New Zealand society, who absolutely does not want us to have access to care. And who thinks that anything that is different, is repulsive and horrible and should be stopped. So it sits within a context. And I think New Zealand has become a much more polarized society. And when you saw the response last weekend in the paper at highlights that because it's often underground better. And and grant and the response to grant standing, wanting to be the new leader of the Labour Party, I was surprised that some of the vitriol that came out, and some of the segments of the Labour Party that surprised me that maybe it shouldn't have. So we've got we've got a huge amount of work to do, and that does not. So that sits there and yet all of us in this room, seeking and needing day to day health care, and very rarely do we get respectful, well informed healthcare, the label that we should be able to take excellently for granted. [00:48:35] Also watching rains, [00:48:39] it says to do with perhaps mental health issues, some jingdong refinements, as an issue that my thesis deals with an argument will change [00:48:50] your mind right now. But [00:48:53] we've got all the subject of January assignments and gender stereotypes and things like that. And he said to me that he heard about children who may not have been under six, but they were here with a big, gender neutral way for your stereotypes. And he said all those children when they became teenagers, [00:49:13] they [00:49:14] turned out to be really screwed up. And I thought to myself, you know, who are they screwed up? [00:49:22] And will support when they give up? [00:49:26] And anyway, they end date screwed up. And it was was it the predictions of a nice and, you know, I would I would love some of these people to come to a space like this and actually come face to face with the fabulous diversity that's here. Because I think these people have got no idea literally, I've got an idea. And they don't see us as beautiful people. They see us as pathology. [00:49:50] And they've met us but they didn't know, they know that. They didn't even they wouldn't have a clue [00:49:56] what we've done today, we've scratched around good at around something that's complex and incredibly important. And my friend, [00:50:05] I'm happy to give my email address to anyone who wants me to send out that little the community little thing about the five principles and informed consent stuff, I can send it to whoever wants it. Once it's redrafted, it'll probably take me another like few weeks to finish it up. But then it's Yeah, I can give you my email address. Or maybe I'll get the organizers to send out my email address that or something. But that will be a tangible thing. There's other tangible things that are happening with that something I can offer. [00:50:35] As far as just as a summary. [00:50:39] The healthcare for transgender business people, it's a very complex industry. And I'm just thinking here slinky all these psychologists in this this Natal darkening, has access to the medical system, the new chronology, and getting [00:50:55] healthier in India [00:50:57] has access to surgery, lack of exercise, [00:51:01] there's getting good cheer, the mental health system for long transitions is getting good healthcare and the medical system for medical issues are treated with respect. And this six issues we've had had to discuss a whole range of stuff. And as Manny said, we've just scratched the surface [00:51:21] complex, [00:51:24] complex here. So thank you very much for coming on and participate

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