After my earlier article on the crisis in reassignment surgery access in New Zealand, I was surprised at the number of emails from transwomen who related their experience of negotiating the inflexible morass that is the Special High Cost Treatment Pool. I'll relate one woman's experience here. Before that, however, I would like to personally thank trans activist Rachael McGonagil for forwarding me a copy of her own Official Information Act request about the domestic funding crisis that affects access to reassignment surgery in New Zealand, which was invaluable to this current article. Ms. McGonagil filed this Official Information Act request in 2012 and the (condensed) response was the following. The Clark administration inaugurated the current Special High Cost Treatment Pool access criteria for New Zealand reassignment surgery back in 2004. Then, as now, it was the ratio of three transwomen's reassignment surgeries to one transmale. By 2012, the cumulative ratio should have meant that twelve reassignment surgeries for transwomen and three reassignment surgeries for transmen had been carried out. However, the providers put their service on hold while conducting a service review, so the actual cumulative total is ten transwomen and three transmen. The service resumed in 2011, but this was only short-term. Surgeries usually use colon length or inverted penile reconstructive surgeries for transwomen to fashion their new female genitalia. There has been some concern expressed by overseas surgeons and some transwomen about the use of the colonic method related to the incidence of post-operative complications from this method. Furthermore, Ms. McGonagil's request also uncovered an apparent paradox in reassignment surgery funding, which goes as follows. The Special High Cost Treatment Pool is only intended for surgeries that cannot be performed in New Zealand. No funding for overseas medical procedure access will be given in this context if that is not the case. However, the contradiction is this. According to the answer provided at the end of the letter, no reassignment surgery had been performed since March 2011 in the context of that letter. There might have been a slight increase, but the recent retirement of Dr Walker has led to some renewed backlog. I asked Rachel what transwomen did in this situation- her answer was that those who needed reassignment surgery and were able to afford private surgery usually went to Thailand to do so. In other words, that means low-income and many Maori and Pasifika transwomen/faikaleite/fa' afafine/whakawahine cannot afford to do so. While many of the latter choose not to do so for cultural reasons, the option is not there for those that do. As I have said beforehand, this is scandalous. Why can't transwomen and transmen access these essential surgical procedures in New Zealand, or, failing that, why can't New Zealand provide increased funding for transwomen to travel overseas? Why was no priority apparently given to finding a replacement surgeon, given the indication that Dr. Walker would retire soon? Why is this whole sorry saga so indicative of ongoing neglect and obliviousness by the current Health Minister and his government? Recommended: Ref: H201201815: Official Information Act Request: Release Date, 21.06.2012: To: Ms Rachael McGonagil: From: Dr Ashley Bloomfield, Deputy Director General, Sector Capability and Implementation, Ministry of Health. Craig Young - 2nd May 2016