South Africa

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

| Refilwe Moloto spoke with plastic and reconstructive surgeon specializing in gender affirming surgery, Dr. Kevin Adams, about the complexities and issues of trans people seeking gender affirming surgery in the country.

The increased media portrayal of transgender and non-normative gender identities has arguably been one of the main catalysts for more people to realize and explore their gender identities.

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

So why is this the case?

Well, first of all, the type of surgery should be distinguished. Although hormone treatment and complementary surgery (breast removal or breast implants) by general and plastic surgeons are more accessible, top-down surgery presents a different set of problems.

Dr Kevin Adams is the only surgeon in the country (and probably on the continent, he believes) who specializes in gender-affirming surgery – specifically related to top-down surgery.

This is a huge systemic problem, as many non-normative gender identities face gender dysphoria without having physical access to desired operations, as Adams can only operate on four people per year.

Doing the math, it may take seventy-five years for Adams just to get through the current waiting list of over 300 people at Groote Schuur Hospital – where he also works.

To be clear, not all trans identities want to have gender-affirming surgery, but the fact that even if they did they would have to wait decades before they could have the surgery is unforgivable.

The number of people trying to access health services and gender-affirming care is growing exponentially. As a result, I have many more patients coming to see me privately… I am the only person in South Africa, probably on the mainland, that I know of who performs genital surgery.

Dr. Kevin Adams, Plastic and Reconstructive Surgeon

This is disheartening to say the least, because although I don’t identify as trans, as a non-binary person I deal with the weight of gender dysphoria every day and currently have no desire to do gender-affirming surgeries.

It’s messed up. The country (re: continent) fails all of them.

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

Listen to the full interview above.

This article first appeared on CapeTalk: How South Africa’s healthcare system is failing our trans community

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

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