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'We can't keep sending trans people abroad for major surgery with no aftercare when they get home'

The Irish healthcare system is failing transgender people and forcing them to go abroad for treatment, Noah Halpin has said.

Noah and Fionn in Poland
Noah and Fionn in Poland
Image: Noah Halpin

THE IRISH HEALTHCARE system is failing transgender people and forcing them to go abroad for treatment, an activist has said.

Noah Halpin, the new Community Aid Officer with Transgender Equality Network Ireland (Teni), has called for the current model of care to be updated as a matter of urgency.

Halpin said there are no public surgery options for transgender people in Ireland, meaning they have to travel abroad for treatment – including during the Covid-19 pandemic.

Halpin recently went to Poland with his friend Fionn Collins, who was undergoing top surgery – a procedure to remove breast tissue.

“We had to travel abroad, like most trans people in Ireland, because unfortunately there are no public surgery options for transgender people in the country,” Halpin explained.

A doctor who previously carried out surgery as part of the public system in Ireland retired last year and has not been replaced. Halpin said there is a private option, but this costs around €12,000 and has a long waiting list.

Top surgery in Warsaw has a waiting list of up to two years but costs around €4,000.

“[Surgery in Ireland] is very inaccessible. So that means that nearly all trans people will have to go abroad for surgery. It’s very expensive to try to go private here,” Halpin said.

“It would be less than half the cost to go abroad, and that would include accommodation, flights for two people, food and drink for two people the whole time, and taxis to and from the hospital.”

Halpin said Poland, aside from cost, is “currently the most desirable option” for many people as the surgeon in question, Dr Lembas, is “considered widely by the trans masculine community as one of one of the best top surgeons in Europe”.

Halpin said Ireland “can’t keep sending people abroad for major invasive surgeries with little to no aftercare when we get home”.

“Does that sound familiar?,” he asks.

“We can’t keep asking people to go through that. Especially during the pandemic, when people have been waiting years already for the surgery, they’re not going to cancel.”

image_6483441 Fionn Collins Source: Noah Halpin

Collins said flying to Warsaw was stressful as there was no social-distancing on the flight and mask-wearing was not enforced.

“It’s stressful flying for surgery in normal times, but Covid has made things much more difficult because you have the added fear of having a Covid-positive test prior to surgery and then everything would be cancelled even though you’ve prepaid and you’re already in the country.

“So it was very nerve-racking in terms of ensuring that the two of us stayed Covid-negative.”

Luckily, both men tested negative for the virus ahead of the surgery.

‘I was terrified’

Collins initially had top surgery in London in September 2019, but it did not work as planned so he needed to have corrective surgery to revise it.

The surgery in Poland was booked around 18 months ago – before the pandemic. He said travelling abroad for surgery takes a big mental, as well as financial, toll.

Going abroad for medical reasons is deemed essential travel – but he says trans people shouldn’t have to travel in the first place.

“I would have preferred to have it at home, but that wasn’t an option,” Collins said.

image_6483441 (3) Fionn post-surgery Source: Noah Halpin

Halpin could not wait in the hospital with Collins while the surgery was happening due to Covid-19 restrictions.

“I was absolutely terrified,” Collins recalls of being alone just before the surgery.

“Obviously there are precautions because of Covid, I completely understand that, but would have been nicer (to have someone with me). It also would have been nicer to have had it done at home.

“I didn’t ask for any of this to happen, I didn’t ask to travel in pain.

Of course I’d like for it to be done at home but unfortunately the Irish healthcare system makes us go abroad, even during the pandemic, which I think is absolutely disgusting and unacceptable.

Despite the stress of going abroad, Collins views himself as “one of the lucky ones”. He said he has taken out a number of loans to pay for healthcare and is currently about €15,000 in debt, but saw no other option.

“I’m grateful that I could take those loans – a lot of trans people in Ireland can’t and they are stuck in the system (on a waiting list) or some people aren’t even in the system. So I’m very fortunate in that regard.”

While in Warsaw, Halpin also underwent a procedure. It was unplanned, but the surgeon fit him in at the last minute.

“I was just going over there to look after Fionn, I wasn’t expecting to have a procedure done,” Halpin said.

He underwent his own top surgery in Warsaw in October 2019, but has had some issues since then and found out that a surgical clip, a small piece of metal, is in his chest.

image_6483441 (2) Noah before undergoing his procedure Source: Fionn Collins

image_6487327 Noah post-procedure Source: Fionn Collins

Halpin underwent a procedure under local anesthetic on the day the two men were due to fly back to Ireland. One issue was corrected but the clip could not be retrieved. He could not undergo full surgery because he was flying a few hours later.

“I was frightened but luckily it all went fine,” he said.

“It was the only option I had, otherwise I would have to spend an awful lot of money coming back to Poland, and we don’t know how long Covid is going to last. Unfortunately he couldn’t find the clip, it was in too deep and he couldn’t go any further under local anesthetic, but he did fix that bit at the side.”

Aftercare problems

The flight back to Dublin was difficult – both men were in pain and still recovering.

“We’d both taken painkillers so our minds were a bit fuzzy. It was really quite difficult even getting onto the plane with our bags and things like that, considering both of us were not at full strength and were very sore, that that was hard,” Halpin said.

Again, he said social-distancing was not enforced and the man next to him refused to wear a mask until a air hostess intervened.

Both men tested negative for Covid-19 the day before they flew home, and were isolating together as a precaution when they got back to Ireland.

A couple of days later, Collins was feeling unwell and fluid (seroma) had started to build up on his chest. He went to an emergency department but was initially told he could not receive aftercare for a surgery he had abroad.

Both Collins and Halpin then tested positive for Covid-19. They were sent home but Collins had the seroma drained the following day.

“I’m happy and thankful that the seroma was drained because the pain was excruciating,” he told us.

Collins noted that it’s already difficult enough for people to have to go abroad for surgery without being denied aftercare upon their return.

He said there is essentially no aftercare for trans people in Ireland unless they “kick up a fuss”, but it shouldn’t be this way.

“Ireland needs to look at changing the model of care, investing in surgery options for people in Ireland, and training GPs so that they’re aware of the aftercare they need to give,” Collin said.

IMG_1164 Noah Halpin Source: Noah Halpin

Halpin this week started his new role as Community Aid Officer with Teni. He said one of his main focus areas will be pushing to change the model of healthcare for trans people in Ireland.

“There is so much that needs to be done with trans healthcare in Ireland, it’s probably the number one issue that we need to tackle for trans people in the country. The model of care in Ireland needs to be changed – we don’t abide by international best practice standards of care,” Halpin said.

“We run off a psychiatric model of care here, it’s a model where people are forced to prove themselves as opposed to being believed.”

Halpin said changing the model of care would also help reduce waiting lists.

“Everybody’s being bottlenecked into seeing a psychiatrist at the National Gender Service, the waiting list is currently over three years,” he said.

Halpin said GPs need to receive extra training in trans healthcare, and public surgery options also need to be made available.

He said mental health services for members of the trans community also need to be improved. Self-harm and suicide rates are much higher in the trans community than in the general population.

Research from Teni and others has shown that timely access to healthcare and support has a positive impact to people’s mental health and overall wellbeing.

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“If you look at mental health statistics on self-harm and suicidal ideation before medical treatment and after – there’s a big difference.

“If anybody tries to argue that [trans healthcare] isn’t essential or is not life-saving treatment, the statistics there prove otherwise,” Halpin said.

Adolescent services

In February, TheJournal.ie revealed that the Gender Identity adolescent service that was situated in Crumlin children’s hospital is no longer receiving further referrals.

Teni was last month informed that CHI at Crumlin was no longer receiving referrals from either the Child and Adolescent Mental Health Service (CAMHS), or the Gender Identity Development Service UK (GIDS UK/Tavistock clinic in London).

A long-awaited report on transgender healthcare published in December made a number of recommendations including that psychological support for those under the age of 18 should be provided and delivered by the Irish health service, rather than in the UK as was previously the case.

Halpin was part of the steering committee that compiled the report and told us “it’s a piece of work that I’m not just going to drop”.

There are many young trans people in Ireland that need and deserve adequate healthcare, and for them to be told, and for their families to be told, that there is nothing there for them is devastating and can have a massive impact on their lives going forward.

“For transgender people, timely intervention is key to successful transition and mental health,” he said.

Teni is calling on the HSE to develop and implement a Multi-Disciplinary Team (MDT) to support the provision of care for young trans people in Ireland.

Patients receiving treatment in Crumlin previously received psychological services via the Tavistock clinic in London, which was funded by the TAS.

However, Tavistock’s contract with the HSE recently ended and is not being renewed.

A spokesperson for Children’s Health Ireland said: “CHI will continue to engage with the HSE, Treatment Abroad Scheme and Tavistock relating to any new referrals under the UK High Court ruling recommendations and following any court appeal determination.

“Currently the HSE are working on the establishment of this team service in Ireland to include the recruitment of a Consultant Psychiatrist with a special interest in Gender Identity as part of the model of care.

“CHI at Crumlin have advertised for a replacement Consultant Paediatric Endocrinologist who will be part of the Team and interviews are occurring in early March 2021.”

Healthcare services for trans adults are based in St Columcille’s Hospital (SCH) in Loughlinstown in Co Dublin.

The HSE had not replied to a request for comment at the time of publication but a spokesperson previously told TheJournal.ie that most of the recommendations in the steering committee’s report were in progress, and that it was considering updating the current model of care.

Information and support services can be accessed on Teni’s website.

About the author:

Órla Ryan

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