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By Cameron Sullivan
The term gender health can elicit reactions of confusion, embarrassment or fear in even the most compassionate people. But Santa Clara Valley Medical Center’s (SCVMC) leaders knew that opening the county’s first-ever comprehensive Gender Health Center this year was essential to ensuring “Better Health for All”.
The new healthcare service, located in one of Santa Clara Valley Medical Center’s 10 ambulatory care centers, offers specialized primary care and whole-person health care that considers the complex social barriers to the health of individuals who identify as transgender, non-binary and gender-diverse.
Aricka Arana, MSW (medical social worker), is excited about the specialized services offered by the center. “Patients say they have gone to appointments at other centers for routine things like blood work and been told, ‘We can’t treat you because we don’t specialize in trans care,’ or they’ve been asked, ‘How do you make a penis?’ by medical professionals providing care to patients,” said Arana.
Meanwhile, she and her team members sometimes hear, “Why do they need a special clinic?” To that, Arana replies, “It would be ideal if people who identify as transgender, nonbinary or gender-diverse could feel comfortable and safe going to any medical clinic and receive gender-affirming care.” Unfortunately, that scenario has not been the reality in Santa Clara County — until now.
“On the simplest level, we created a ‘medical home’ that provides high-quality health care as an essential human right,” said Dr. Jackie Newton, who has an MPH (Master of Public Health) degree and is the co-founder of SCVMC’s Gender Health Center.
Originally formed within Santa Clara Valley Medical Center’s “Valley Homeless Healthcare Program (VHHP) in 2016, the positive outcomes of that gender clinic more than justified opening the dedicated Gender Health Center at Valley Health Center Downtown.
The new center operates in addition to the original gender health clinic that continues to serve VHHP patients. Two primary care physicians, an obstetrician-gynecologist, a psychologist, a psychiatrist, a medical social worker, two nurses and front-line staff members at the new Gender Health Center support SCVMC’s mission to provide high-quality, compassionate, and accessible health care for all.
“The walk-in clinic model is tailored to those experiencing homelessness, as opposed to the appointment system at the Gender Health Center,” said Newton. The vision is that patients who stabilize at the Homeless Healthcare Program’s clinic can “graduate” to the Gender Health Clinic through the cross-program referral process at all of the other ambulatory care sites, regardless of gender identity.
“Our No. 1 service is that we connect with people,” said Newton. “We form relationships. Many people tell me we are their second family.” National data show that 1 in 2 people who identify as transgender, nonbinary or gender-diverse have been rejected by at least one family member because of their gender identity. But among Dr. Newton’s patients experiencing homelessness, data reflect a number closer to 95 percent. “Often, our patients are estranged from family and friends,” she said. “We serve as a place they can go for a human connection.”
The gender health component is just one piece of SCVMC’s whole-person care program. “Just as you can’t treat somebody’s diabetes without ensuring they have food security and housing, which requires income, which requires physical and mental health, we have to think beyond the walls of the Gender Health Center to provide holistic treatment across a person’s life span,” said Newton.
SCVMC’s approach combats the structural violence issues of transphobia, homophobia, racism and sexism. And, because rejection and discrimination typically are internalized at home, in schools and later in workplaces, Newton’s patients tend to have high comorbidities of mental illness, substance use disorder, HIV/STDs, and unstable access to health care.
As a result, a majority experience homelessness or unstable housing. In partnership with community organizations, SCVMC’s Gender Health Center addresses these issues with individualized holistic care.
A series of affirming events begins right when someone enters the center. Each patient is welcomed and compassionately evaluated by social workers and licensed vocational nurses. Psychologists such as Irene Guerra, Ph.D., are among the professionals patients may encounter. Guerra works primarily with the people experiencing homelessness in VHHP’s Gender Clinic.
“We smile and say, ‘Hello, what’s your name and your gender pronouns?’ ” said Guerra. That information is then shared with the entire team to build a respectful atmosphere. “We’ve even normalized this so that across every clinic, these patient questions are standard,” said Guerra. It’s a make-no-assumptions approach that goes hand-in-hand with Trans 101-type training to help all medical staff members avoid inadvertent prejudicial language.
Patient services at the Gender Health Center range from standard treatment for primary care and acute care conditions to the psychological, psychiatric and biological elements of gender transition. For patients requesting medical assistance with transition, medical social workers, psychologists and psychiatrists engage with and counsel them, using shared decision-making and an informed-consent model to guide treatment.
“You don’t have to have extensive training from onset to work with the population we serve in the gender clinic,” said Guerra. “Our job is to have cultural humility and to treat everyone with dignity and respect.” Keeping trust and an inclusivity at its core, SCVMC’s Gender Health Center reflects the greater mission of the entire Health and Hospital System.
“I foresee that what we’re doing at the Gender Health Center will serve as a model for every aspect of care at SCVMC, across the different subspecialties and the system as a whole,” said Newton. By honoring people’s basic human rights and respecting each individual, Santa Clara Valley Medical Center empowers communities through optimal whole-person public health care.