How South Africa's healthcare system is failing our trans community

Refilwe Moloto spoke to plastic and reconstructive surgeon specialising in gender affirmative surgery, Dr Kevin Adams, about the complexities and issues of trans people seeking gender-affirming surgery in the country.

The increased media representation of transgender and non-normative gender identities has arguably been one of the leading catalysts to more and more people realising and exploring their gender identities.

This has led to an increase in demand for gender-affirming surgeries, resulting in long waiting lists. Through the public health system, for example, one can wait up to 25 years for top surgery. Other barriers include geographic accessibility, with gender-affirming care mostly only being available in major urban centres of provinces such as Gauteng, the Western Cape, KwaZulu-Natal.

So why is this the case?

Well, firstly the type of surgeries need to be distinguished. Though hormonal treatment and top-up (breast removal or breast implants) surgery from general and plastic surgeons is more accessible, top-down surgery presents a different set of issues.

Dr Kevin Adams is the country's only surgeon (and probably the continent's, he reckons) who specialises in gender-affirming surgery - particularly related to top-down surgery.

This is a huge systemic issue as many non-normative gender identities face gender dysphoria without physically having access to go through the desired operations due to Adams only being able to operate on four individuals a year.

Doing the math, that may take Adams seventy-five years just to get through the current 300+ waiting list at Groote Schuur Hospital -where he also works.

To be clear, not every trans-identity wants to have gender-affirming surgery, but the fact that even if they wanted to, they would have to wait decades before they could get operated on is unforgivable.

The number of persons trying to access health services and access to gender affirming care is increasing exponentially. As a result of that, I have far more patients coming to see me privately... I'm the only person in South Africa, probably on the continent, that I know of, that does the genital surgery.

Dr Kevin Adams, Plastic and reconstructive surgeon

This is disheartening to say the least because despite not identifying as trans, as a non-binary person, I face the brunt of gender dysphoria every day and I currently have no desire to do any gender-affirming-related surgeries.

It's messed up. The country (re: continent) is failing every single one of them.

Remember: stop being nosy. A trans person has no obligation to disclose their genitalia to anyone and you're an asshole for asking in the first place.

Listen to the full interview above.

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