For at least a year María Alejandra Josa, 26 years old and a psychology student, tried to get an appointment with an endocrinologist through her EPS.
She longed to begin reaffirming her identity, but in her native Pasto there was only one specialist for the entire city.
The appointment never came.
Distressed and without much information, she decided to consult with acquaintances and began taking estrogen on her own.
Some time later she settled in Bogotá, and in the midst of check-up exams she learned that self-medication had negative effects on her body.
Luckily, it was a good time to treat them.
That advice and diagnosis was given at the gender clinic, a specialized space to care for people with trans life experiences at the Chapinero Hospital, a public entity in the city.
Three months after opening, the clinic has already treated around 200 patients.
Juana Ferrer also faced obstacles in accessing some health services.
She started her transition a decade ago, but for a year she struggled with delays from her EPS for urgent exam taking.
Only thanks to a guardianship did she manage to make an appointment with the specialist she needed, who referred her to the Chapinero Hospital.
There she met the gender clinic
where, according to what he says, he has continued his medical treatment without problems.
The multiple obstacles that Juana and María Alejandra experienced are a constant for trans identities.
This had been warned by the Pan American Health Organization, which pointed out that in Latin America people with trans life experiences face serious difficulties in accessing medical services.
These obstacles in access, or stigmatization and malpractice, have led many trans people to decide to begin their gender reaffirmation with unsafe or very costly practices.
In 2019, the NGO Colombia Diversa surveyed trans women in Bogotá and found that 96% had resorted to informal mechanisms to transform their bodies.
Between 2013 and 2018, 10 deaths of trans women due to dangerous body transformations were documented.
Andrés Martín, lawyer from Colombia Diversa and who handles several cases related to problems in gender reaffirmation, points out that the barriers exist from the beginning of the process, with situations in which they are judged, they are not treated with their identifying name. or undergo unnecessary surgeries.
“There are quite serious legal and administrative gaps.
“Today there is no guide, route or protocol for the care of trans people in their identity reaffirmation procedures,” he maintains.
“And added to this is the lack of training of medical personnel,” he adds.
Waiting room in the gender clinic of the Chapinero Hospital. NATHALIA ANGARITA
Given these constant complaints, and with the intention of preventing risks, paying off the historical debt and protecting the right to health, the gender clinic was born in a city where at least 4,000 people who identify as trans live, according to the Secretariat. Planning District.
Natalia Baquero, doctor and official at the Ministry of Health, tells EL PAÍS how the initiative came about.
“
The Ministry of Health has designed a public policy of care for the LGBTIQ+ population.
Within the framework of this, since June 2023 we began to work on the idea of doing a pilot test with the Northern Subnet [one of the networks of clinics and health posts in the District] to implement what we call
gender clinic,
focused on guaranteeing the comprehensive right to health and support transgender people who are in the process of transit,” he details.
The pilot, a series of specialized offices on the second floor of the Chapinero Hospital, took its first steps in September 2023, and was officially inaugurated in December.
It started with seven specialties: endocrinology, psychiatry, two plastic surgeons, psychologists, a nursing assistant and a gynecologist.
The Secretariat chose this medical center for the pilot because of the roots that the LGBTIQ+ community has in that town in northeastern Bogotá.
According to Baquero, although the space was promoted by Claudia López's Mayor's Office, there is total agreement with the new mayor, Carlos Fernando Galán, and there are plans to reinforce the clinic.
In parallel, he explains, they have done pedagogy with the Hospital staff, from administrative and medical, with the intention of preventing mistreatment and promoting careful management.
Gynecologist Néstor Giraldo, who formed the program's team of professionals, explains what he has learned in these months.
“It has been an enormous challenge personally and technically, but it is satisfactory because over time you see the patient's loyalty to the program,” he says in conversation with this newspaper.
María Alejandra is an example of this.
She affirms that she has felt well cared for and that she has been assigned all the appointments she requires.
“The treatment is respectful, they already know the precise words to refer to us, they don't get confused.
Many times in other places they ask you how they name you or they look at your ID with suspicion.”
Néstor Giraldo, specialist doctor. NATHALIA ANGARITA
The challenges
For Martín, Colombia Diversa's lawyer, the pilot is a great advance.
“It is an example to follow in Colombia for trans health, as it guarantees the patient adequate care according to their needs and a group of specialists focused on those particular needs, as happens with identity reaffirmation.”
Even so, he points out that the problem is broader, and demands more measures.
“Medical schools must strengthen their differential and gender focus.
“The pathologization of trans identities cannot continue to be perpetuated.”
Baquero agrees.
“The paradigm shift, the change in people's mentality is a challenge.
This is a very conservative society, which has a hard time understanding many things.
That's why we have started training everyone, from the person standing at the door, the one who opens the office or the nursing assistant."
Gynecologist Giraldo assures that his team has been identifying points for improvement.
“Their contributions are usually so that we can optimize the access route.
Let there be as few barriers as possible,” he says.
The Ministry of Health has plans for the gender clinic
.
Baquero explains that this year they hope to approach all the city's insurers, whether public or private, EPS or special regimes, with the intention of expanding their coverage at the Clinic, since so far it is only available to members of Capital Salud and Famisanar.
For her part, Juana believes that the clinic has been an enormous step to protect her and the trans population;
In addition, it means you stop being forgotten.
“Our community should have much more support.
More in the area of health, which is a fundamental right and should not be delayed or violated.
For me it is important to have these spaces where we are treated with dignity,” she says.
She immediately announced with emotion that she had already been given the green light for her facial feminization.
She smiles.
Juana Ferrer, a trans woman, is treated at the gender clinic at the Chapinero Hospital. NATHALIA ANGARITA
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