On December 26, 2018, Portland, Or. activist Jackie Mautner checked her voicemail, expecting a message about scheduling a followup from a recent X-ray on her fractured foot. At the end of the message, after the technician at Kaiser Health thought he had hung up, Mautner heard instead an extended conversation between the technician and his coworker on her status as a trans woman.
This conversation involved denigrating remarks about her appearance as well as sharing details from her recent and upcoming doctor’s visits, including appointments such as her routine physical or her dental cleaning which had no bearing on the X-ray screening and which the technician had no need to look at, much less share with a coworker. Altogether this picking over of the details of her life, subject to the judgement of a transphobic stranger, lasted over four minutes.
“I was hurt,” Mautner said in an interview with Liberation News. “There’s no humanity in that, in how they treated me.” This is the sort of experience trans people have to face in the U.S. medical system. She also shared with Liberation News that although this was an extreme example, this is hardly the first instance of transphobia she’s faced with Kaiser. “It’s even the little things. Every time I go to the doctor, even if they call me by my name, there’s a pause, and they have to confirm it with me – you’re Jackie? That’s not a treatment cis people have to deal with.” This sort of microaggression is part of the reason she often dreads going to the doctor, puts it off or avoids it altogether.
The next day, Mautner and her partner made a call to the Kaiser Permanente support line, asked for a manager and filed a complaint about the incident. “I threatened legal action,” she said, although she doesn’t know if there’s a legal avenue to address this sort of assault, and doesn’t have any reason to have confidence that the legal system would be on her side. “I filed the complaint anyway because I think this sort of issue should be addressed before it becomes bigger. The first principle from a doctor should be ‘do no harm,’ don’t make the problem worse.” Kaiser updated her afterward to let her know the technicians were brought in for a meeting with the Director of Diversity and Inclusion. It’s not clear if they were reprimanded, or if the incident constituted a violation of Jackie’s HIPAA privacy rights. The administrator askedif she had any demands. “I asked for sensitivity training,” she said. “I couldn’t think of anything else to ask that would fix it.” She later heard from a Kaiser employee through Facebook that employees had received an email advising them about the incident.
After talking about this experience on social media, Mautner said the outpouring of support from her community “gave me more motivation to push for changes.” We asked her what those changes would be, for Kaiser. “Well I think sensitivity training is the best starting point for them. But the big issues are systemic, having to do with access. There’s a huge issue with their mental health system for example. You can only schedule two appointments in advance, making long term planning and stability difficult. And you have to take the next available slot. The overall feeling is that they want you out as soon as possible, rather than wanting to support you as a patient.” (Read here about the 2018 Kaiser mental health care workers’ strike in California-Ed)
Liberation asked what she sees as a larger demand, as a trans person and a woman, from the healthcare system. ”Free for all, duh,” she immediately replied. “But I think in general just, treating patients as humans and as members of your own community, rather than as customers. Doctors and patients, which tend to be poor folks, also have very different backgrounds and come at things from very different perspectives, and doctors should consider that.”
The U.S. healthcare system is ranked on many measures as last in the “developed world,” that is among the capitalist states. This is not due to lack of advanced medical technology or a shortage of trained medical professionals. These low rankings are a direct result of the for-profit healthcare system which puts profits ahead of people’s needs. Even a poor country like Cuba that is building socialism has outstripped the United States in many areas of healthcare, most famously maternal and child health, but also in care for transgender people.
In addition to a medical system that is respected the world over, Cuba has esttablished a series of government departments and organizations dedicated to sexual freedom and education, women’s rights, and LGBTQ rights. These include organizations such as the Federation of Cuban Women, the National Work Group on Sexual Education, the Commission for the Attention of Rights Equality for Women, Family, Childhood and Youth. Rather than hoping prejudices would die out and historical inequalities would right themselves on their own, the Cuban people have the support of their own government to carry out proactive campaigns to resolve these issues and to guarantee people’s rights.
In 1989 the National Center for Sexual Education (CENESEX) was founded, with the mission of improving sexual education and fighting for the rights of gender and sexual minorities within Cuba. Bringing together the various state and civil organizations, CENESEX has been responsible for programs to combat HIV/AIDS, creating education programs for contraception and sexual health, and in 2008 pushed for the adoption of a measure to provide trans people with hormone therapy and gender-affirming surgery as part of the free national health plan. It is through the efforts of the Cuban people, free to develop without the pressures of capitalist exploiters, that they have been able to take such a leading role in gender and sexual liberation. If we here in the United States wish to see an end to the everyday oppression experienced by trans women and men the Cuban experience shows that socialism is the path forward.