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When paramedic Danica Rain started to investigate her options for Gender Confirmation Surgery, she was dismayed to find that her choices at home in Canada were limited. So she set out on a worldwide quest to find: “the best possible surgeon who would deliver the best possible results, both in terms of aesthetics and functionality”.

 

Danica Rain - My gender confirmation surgery - GenderGP Podcast

Danica Rain – Paramedic

Danica successfully campaigned for care outside of Canada through the Canadian healthcare system and she now acts as an expert patient and consultant for the Kamal Hospital in Thailand, where she ended up having her ground-breaking surgery.

In this episode of the GenderGP podcast, Danica talks to Dr Helen and Marianne about the importance of getting the right surgeon for you and why the trans community has to be prepared to fight for their right to access better care, rather than being grateful for what they can get.

If you have been affected by any of the topics discussed in our podcast and would like to get in touch please drop us a line at info@GenderGP.com. You can also contact us on social media, where you will find us at @GenderGP on Twitter, Facebook and Instagram.

We are always happy to accept ideas for future shows, so if there is something in particular you would like us to discuss or a specific guest you would love to hear from, let us know.

Your feedback is really important to us so if you could take a minute or two to leave us a review and rating for the podcast on your favourite podcast app, it will help others to discover us.

Links:
Danica’s story was covered on City News Toronto. You can watch it here: https://youtu.be/fOzzVNI9OfY
Find out more about the Kamol Hospital here: https://www.kamolhospital.com/en/

Thank you. We hope you enjoyed our program. Do go ahead and subscribe if you haven’t done so already. If you or anyone else is affected by any of the topics discussed on our podcast and would like to contact us, please drop us a line at doctor@gendergp.co.uk. We’re very happy to accept ideas for future episodes and guests, or if there is something specific you would like us to cover. You can also visit our website, www.gendergp.co.uk. You can follow us on social media @gendergp, and you can sign up to our monthly newsletter. Full details can be found in our show notes on the podcast page. Thanks for listening.

The GenderGP Podcast

Gender Confirmation Surgery with Danica Rain – The GenderGP Podcast S3 E6

Hello, this is Dr Helen Webberley. Welcome to our Gender GP Podcast, where we will be discussing some of the issues affecting the trans and non-binary community in the world today, together with my co-host Marianne Oakes, a trans woman herself, and our head of therapy.

Dr Helen Webberley:I’m really, really excited to welcome Danica with Marianne and I today. Danica, I am going to leave you to introduce yourself and to tell our listeners and watchers who you are and why you have joined us today, and a little bit about you and your kind of campaign, I guess, that is what I would call it. Anyway, over to you.

Danica Rain:Okay, my name is Danica Rain. I am a Canadian citizen, and I am a trans woman. I guess my story first started when I noticed that there needed to be a change within the Canadian system for healthcare for trans-related surgeries. And what I did was I worked with Canadian healthcare so that I could go out of country to have my gender reassignment surgery or gender confirmation surgery. From there, it opened doors within Canada, in my province of Ontario, so that others could follow the same suit and get the well-needed surgeries that they deserve. Afterwards, I guess you could say that I continued volunteering my time for the surgeon where I had the surgery at. Now I am an international liaison who helps patients around the world get trans-related care and surgeries.

Dr Helen Webberley: Brilliant. So how long ago was this?

Danica Rain: I would say about 3 years ago. I had my gender confirmation surgery back in November of 2016. So this would have been probably back in 2015 when I think you could say I started my work or my campaign in regards to changing the legislature so that I could have my surgery funded out of country.

Dr Helen Webberley: And why was it important for you to go out of country?

Danica Rain: It was extremely important for myself, where I have a medical background.Throughout the beginning and throughout my transition, I’ve always been researching trans-related surgeries. Because I only wanted the best surgery for myself. I started noticing a lack of care in Canada, where we only had one clinic out in Montreal, the Brassard Clinic. I did not feel comfortable with the surgery that they were providing for patients. As well as I had talked with many patients who went there who weren’t happy with the results that they got aesthetically, as well as functionality. And that was one thing that weighed heavy on my heart, which was my need to go somewhere else, that Canada can’t provide the surgery that I need.

Dr Helen Webberley: Danica, so you mentioned two things there, the aesthetics and functionality. Just for the benefit of our listeners, can you expand on what you mean by that, and why it is important?

Danica Rain:Okay, so what I found was that there are some people when they start getting into looking to have their surgery, they’re so excited, and a lot of people don’t have the specificknowledgeof what they’re getting into. Myself, obviously from being a paramedic in the past, and going in and out of hospitals, knowing human anatomy and biology—I wanted it to be as perfect as aesthetically perfect as possible, meaning looking as much as a cisgender woman. When I started seeing some of the surgeries that were coming out of Canada, I was noticing that aesthetically, it wasn’t very pleasing. Without getting too much into it, when you are looking at the construct of the neovagina that was created out of here, I find that when it comes to the labia majora, labia minora, it’s just aesthetically, not as pleasing. Also, the surgery in Canada from what I saw, left a lot of scarring. This was something that I was very petrified about. I did not want to have noticeable scars down there after my surgery. Then when I started researching all over the world, and I started seeing the surgeries that were coming out of Thailand, I was noticing that there weren’t these big, huge, noticeable scars. And it was a lot more aesthetically pleasing. I could tell that they were—how do I say this—creating a better neovagina than what Canada was. Then when it comes to functionality, everyone always worries about sensation. Everyone has this big worry about am I going to be able to climax afterwards? Am I going to be able to have, quote-unquote, a normal sex life? And that was another thing that worried me a lot; that after having my organ changed into a new one, is it going to function properly? Am I going to be able to climax? Am I going to be able to urinate properly? And these were big fears of mine.

Dr Helen Webberley: So Danica, why do you think the results from Thailand were better than the ones in Canada? Is it the technique, or the actual surgeon themselves, or was it to do with training? With the numbers of people, they had done the surgery on? What was the difference?

Danica Rain: Even though all these surgeons around the world go to different conferences and talk to one another, it seems like they–how do I say this—don’t share exactly everything of what they do. That’s why we have different surgeries around the world. Like you have a surgeon who will offer the scrotal graft. There are many doctors who offer the same procedure, but they have a different twist or a different technique to how they do it. What I started noticing in Thailand, there was a doctor called Pricha. Pricha was I guess you could call the founding father for Thai surgeries for gender reassignment surgeries. Doctor Pricha had trained a slew of Thai surgeons. These surgeons are now known as the number one surgeons around the world. To name a few, Dr Kamal, Dr Chetowet, Dr Saran, Dr Sorinn. All these doctors, I guess you could say they were all trained by Pricha.And I believe that the Pricha technique seems to be the better technique because all of these people that I’ve known around the world that have had these surgeries are extremely happy and haven’t had any complications. In regards to myself, I had my surgery back in 2016. I am now 3 years post-op. And I am extremely ecstatic. I love my body. I am extremely happy with the outcome. There have been many Canadians that have followed me afterwards that went to Thailand. They are all as happy as I am. As well as others from around the world. So I just think that they have a better technique than what others are doing around the world right now.

Dr Helen Webberley: That sounds amazing. And how difficult was it for you to get the funding? Was that a big uphill struggle?

Danica Rain: I guess you could say it was a struggle, but I was lucky where I had the medical knowledge as well as I got the help from the Kamal hospital. Meaning, when I spoke to Kamal, and I told him about what I was planning to do, and that I would obviously require a lot of information, because Canada would be certifying an out-of-country hospital, and they would have to make very well sure that there are no types of issues for me to go over there and something happened to me. Which was really good that Kamal provided all the information required. OHIP went through all the information. And obviously, Kamal is under WPath standards. And to be honest, there has never been a death related to Kamal. All of his surgeries have been done very well. So there has never been any bad comeback. It wasn’t easy, but it was kind of easy for OHIP to certify Kamal with knowing that he had the knowledge and he had the training that he has the hospital and that everything was set up for them.

Dr Helen Webberley: Who is Kamal? Is Kamal the doctor or the hospital?

Danica Rain: Kamal is the doctor, he is the primary surgeon. And they named the hospital after him. I would like to say that it is a private hospital, so Kamal owns his hospital.

Marianne Oakes: Can I just interject with an observation here, Danica? Basically, just listening to you there, I think I am hearing that one of the things in Canada that you were struggling with, where surgery is concerned at least, was lack of choice. It was very one dimensional that this operation is just seen as this is what we do. And what you were saying was actually that it is my body, and I want better than what they can offer.

Danica Rain: Exactly, that is completely correct. And that was what pushed me the most. Unfortunately, a lot of people call it the Brassard bandwagon, meaning everyone hops on this train to go to Brassard. And the thing was, I did not feel comfortable with that. The way that I saw it was like you said, this is my body and I deserve the very best. And if I don’t feel comfortable with the surgeon in another province of my country, why should I have to go there for surgery? That’s when I saw the clause within OHIP that said if there is not a practicing surgeon within your province, you could take (unclear 10:00). And I knew that there wasn’t a surgeon in my province of Ontario. That DrBrassard was in the province of Quebec. Therefore, I knew I would be able to take the funding elsewhere. No one had ever done it before because everyone saw the norm of always going to Brassard. And what a lot of people don’t realise, in the end, we are the ones that are stuck with what we receive. I didn’t want to have any complications, I didn’t want to have any issues. I wanted the best of the best. And I also wanted to help others as well.

Dr Helen Webberley: Absolutely. And it sounds from your description of the outcome, that you did, and it was successful for you. Like you say with the aesthetics, how it looks, and the functionality, how it acts, and how it works kind of thing—which is really good. You mentioned the scrotal graft. Would you mind, again, for people who are listening who might not understand those bits?

Danica Rain: I will try to break it down a little bit. So the best way to break it down is—currently, at the Kamal Hospital, they offer 3 types of GCS surgeries, so that is gender confirmation surgeries, or we can just call them bottom surgeries, or vaginoplasty, whichever you are comfortable with. So the first one, it has no cavity, no vaginal cavity. So this would be for the individual who is transitioning, and they are not looking for any type of penetrational sex, and they are not wanting to have to dilate afterwards. So they will have that type of surgery. Then there is another type of surgery, which is the scrotal graft. The scrotal graft would be, basically in short, the easiest way I could say this is that they peel the penis like a banana, where the outsides are creating your labia and the esthetics. And then for the vaginal cavity, it is created with a scrotal graft. They are removing the scrotum, they are thinning it out, and then they are creating a cavity with it. So that would be the scrotal graft. Some people, like myself, went for that surgery. The way that I saw it was that I would be able to have penetrational sex, and I was happy with that surgery. There is a third one, and that is called a colon graft. Withthe colon graft, they remove a section of your colon, and they use that for the vaginal canal, which, in those patients, because it’s a section of the colon, they are able to self-lubricate. There are a lot of patients who prefer that surgery over the other because of the self-lubrication, as well as not having to dilate as much. But in regards to that surgery, there is a what-if, of because it’s a section of your colon, will there be a foul odor later on in life, that they need to clean and rinse a lot? I’ve had patients who had the surgery who are completely happy about it. For myself, I didn’t elect to go for it just because with my own body, I’ve always had issues with my digestive system. Therefore, the idea of removing a section of my colon was just a little too invasive for myself. And I was worried about having stomach problems afterwards. That’s why I went for the graft instead.

Dr Helen Webberley: It’s really interesting. When we look at videos of these surgeries done, it really reminds you that genetically, a male skeleton is exactly the same as the female genetic skeleton. And you can just rearrange things, rearrange skin, rearrange organs, rearrange the tip of the penis to make the clitoris. It’s so fascinating. From a doctor’s point of view, I say wow, that is so clever. How actually similar we are, in terms of that fundamental anatomy, isn’t it?

Danica Rain: Yes, definitely. And we are also moving forward to. There are a lot of other doctors who are trying other techniques right not. The unfortunate aspect is that a lot are experimental. In America as well as in, I believe, Mumbai, India, they are now doing what is called the PPV. It is called the peritoneal pulldown vaginoplasty, where they are using the lining of the peritoneal cavity. It sounds really great, but unfortunately, still in the experimental stages.  And there are a lot of girls who are going out there and trying the surgery out, but what they’re not taking into consideration is this is experimental, there hasn’t been any research done long enough for trans women, and what is going to be your outcome in 5, 10, 15 years from now?

Dr Helen Webberley: That actually sounds a little bit scary, doesn’t it, really? The very idea that you are being experimented on, and there haven’t been 2000 cases before you, having had that operation done, as you say, and what other implications are there going to be in the future? It is scary. In some ways, someone has to be the first, to have that kind of technique. Otherwise, we would never have any new techniques, would we? But on the other hand, we do need to make sure that we have got that rigid research behind it.

Danica Rain: Exactly, and that’s why I went for the surgery that I went for because I knew that even though, no matter what, it doesn’t matter who you go to, there is always going to be risks involved with such an invasive surgery. But I went for the surgery that had the least amount of risks—that’s the way that I saw it.

Dr Helen Webberley: Danica, I was looking at some articles about you that have been published on the internet. And I saw a picture of you just before you went in for your surgery, but you had tears in your eyes. I just wondered, what were those tears about? Can you remember?

Danica Rain: Yes, I can remember. It is something that I won’t ever forget. Those tears were just before they were right about to put the anaesthesia on, to put me to sleep. And I remember looking at my friends and Cynthia (unclear 16:15) the reporter, and she saw the tear, and she made a joke and said that’s the money shot, and I looked at her, and she said are you scared? And I said, no Cynthia, I am not scared. These are tears of joy. These are tears of happiness, knowing that as soon as I wake up, I am going to feel complete, and I am going to feel finally normal. Beauce I have been struggling my whole entire life with this. So they were definitely tears of joy.

Dr Helen Webberley: Beautiful. Lovely. Marianne, you do a lot of discussion with women, and men, before they go for their surgery when GenderGP refers a lot of people onto their surgeons. What kind of anxieties or fears are you seeing from the people that you’ve seen?

Marianne Oakes: To answer that, I want to reflect on something that Danica said earlier. My concern is sometimes that they approach it in a very one-dimensional way that they just found a surgeon agreeing to do this, and they’re not really asking the question that, “is this the right surgery for me?” I think part of that being here in the UK. We’ve got a limited choice, similar to Canada. Limited choice of surgeons, the limited choice of procedures. But all of them, universally, are kind of talking the way Danica said there, they’ve waited for so long. And they just can’t wait to get on the operating table. I never hear anybody raise concerns about a negative outcome or that they are going for major surgery. It is just this joy of ,actually, I am not getting the surgery.

Danica Rain: Exactly, I agree with you. One thing I wanted to point out was that a lot of these individuals are not taking into consideration post-operative care. People do not understand this. And I am hoping that one day I will be able to go to the next WPath meeting to bring this issue up. There is no post-operative care for trans individuals anywhere in the world. It is not set up with any governing body through medical whatsoever. What bothers me is all these men and women are going around having these massive invasive surgeries, and then afterwards, they are pretty much sent home and it’s like, that’s the end of it. What people don’t understand is that there is a lot more care that needs to be done after you’ve had this surgery. I’ve noticed in Canada, as well as in America and other places around the world, where people are going for their gender confirmation surgeries, they have their surgery, and not even two days afterwards, these surgeons have these patients up and walking. They are sending them home. I thinkit is just atrocious. Because I remember when I had my surgery, I remember when I came out of the OR, they put me in a room for so many hours where I was being watched. They afterwards they moved me to post-operative care, where I laid in bed for a week. I didn’t walk, I didn’t move. Nurses came and took care of me every single day, and then afterwards, after my first week, then slowly we started getting into removing the packing, removing the catheter, stitches, allowing me to walk and then dealing with dilating afterwards. Which is a very big aspect of this surgery, where you have to dilate afterwards. And what a lot of people don’t take into consideration is, when it comes to dilation, for someone who is doing it for the very first time, it is extremely scary. You don’t know what you’re doing, you are worried about how much pressure to apply, pain.You’re scared you’re going to hurt yourself. And what happened in a lot of these other clinics is they give you a run down, they hand you a dilator, and they tell you to do it yourself. Which I think is completely wrong. This is where you come into so many issues where patients could end up damaging themselves. One thing that I loved about the Kamal Hospital was they have their own dilation section in the hospital. You go, and you have your own cubicle, you go lay down, a nurse comes in, she cleans your wound, she lubricates the dilator and goes through the whole process with you, and she dilates you, so you are not doing it wrong. And she continues to do this for over a week. While she is doing this, she is slowly teaching you.So that afterwards, when it is your turn, you have to prove the nurse that you can do it properly without hurting yourself. I think this is something that a lot of other places should be implementing, but they’re not. I hate that we kind of look like it and it seems like we are in this assembly line, we are just dollars and cents to people. We’re just another number. And they need to start looking at us as human beings.

Marianne Oakes: That is very interesting because this is just my own experience. I mean, I’ve not had surgery, but my experience of being in transgender care is that sometimes it’s just “Be thankful you get anything.” Actually, we’re not treated as humans. We’re almost treated sometimes as an inconvenience or just a meal ticket for certain medical practitioners. I don’t know if I am being harsh there. It’s just a feeling I get.

Danica Rain: I totally agree with you. And I say that to a lot of patients that speak to me. Unfortunately, this is a multi-million dollar business. The clinics out there.

Marianne Oakes: The other thing that you said, Danica, and it was really refreshing, I don’t know what it’s like in the circle that you mix in, but the idea of functionality. It’s almost if you ask for how functional my vagina is going to be, someone is going to frown at you and judge you. Are you serious about this? It’s almost like they invalidate you and your need for surgery if you are concerned about sex afterwards. And actually, I think it’s probably a large percentage of your decision making. Certainly, on the technique and the procedure that you are going to go through.

Danica Rain: Definitely.

Dr Helen Webberley: It’s shocking, isn’t it? From being a doctor, hearing trans people say to me that they have to be grateful for any counselling you might get, be grateful for any hormone medication you might get, and don’t make too much fuss if you don’t get a strong enough dose. Be lucky that you’ve got what you’ve got. And now I am hearing the same kind of thing. The production line, the money wallet of surgery. People not being looked after afterwards. I mean, goodness gracious me, this is 2019. We shouldn’t be talking like this, should we? It’s really, really sad. As you were describing the post-operative care that you got, I was imagining people in the UK where we are at the moment—people going for mastectomy, for treatment of cancer, for example, or having part of their bowel removed for colon cancer, or something like that. You know, they would be assigned a specialist nurse, they would be there at the end of the phone to look after any problem once they got home, et cetera. With transgender people, at GenderGP again, we have so many people inquiring, saying, “I’ve had surgery. This is leaking, this is broken, I can’t do this, this is hurting me. Do you know where I can go for help?” And it’s just awful, how little care there is after surgery.

Danica Rain: It’s so hard for these individuals because the problem is, afterwards when they go to either their GP or their gynaecologists, a lot of GPs and gynaecologists out there aren’t versed on post-operative transgender care. They don’t know what to do. Even attending physicians at emergency rooms, where I could even just give you a short story really quickly, where last year myself, I suffer from a skin condition called psoriasis. It’s kind of like eczema. I get blotchy red skin. And it flares up when I go through stressful situations. And unfortunately, I had a really bad flare-up last year, and I ended up having some psoriasis skin in my vaginal area. So this hurts extremely, and I went into the emergency room at our local hospital. I had a doctor actually argue with me saying that I was cis-gendered and that I had a yeast infection. I explained to him that I was trans and that I highly doubted that I had a yeast infection, and he actually argued with me until the nurse said, you may not know her, but I have seen her on TV, and she is transgender. Still then, he did not want to change his diagnosis. It was still that I had a yeast infection, and they prescribed me Canesten to go home with, which obviously did not help me, and I ended up having to go to a dermatologist for help afterwards. But, just like that, it was a shock to me where I am having a doctor argue with me on whether I am trans or not.

Dr Helen Webberley: I think I’m not defending doctors, but I’ve met a lot of doctors who don’t like being wrong, do they, Danica? And they think that certainly, patients shouldn’t know more than the doctor, but clearly in this case you did. I’m interested actually, do you know whether the hospital and DrKamal receives funded operations from other countries like the UK, like the European Union, USA—have they had successful funding in their states?

Danica Rain:It all depends on the funding. So from what I know so far obviously, Kamal has had funding from Canada. They also deal with some other insurance companies when it comes to the Americans because I know the Americans—it all depends on where you work and what type of insurance and how your insurance covers it. I’ve had American patients where they go in they pay for their surgery they get a receipt they give that receipt to their insurance company and then their insurance company pays them back.I believe there are others that are on like, I believe it’s Medicare. And there’s that sort of coverage.When it comes to Australians, they’re starting to be a really big push in Australia for Australians going overseas for surgery as well. Because again, just like Canada, just like the UK, Australia does not have enough surgeons. From what I know, I believe they only have two. So I know that they’re inundated with patients and a lot of these patients are now going to Thailand as well.One thing that I was able to work out for the Australian patients was,okay, let’s make sure I say this correctly, it’s called a superannuation.Therefore Australians while they’re working, they pay into what’s called a super, a superannuation. I guess this is kind of like your retirement pension for later on. Well, I guess they have a clause where if someone is trans, they can dip into their superannuation for surgery.Therefore a lot of these trans individuals now that have superannuations are dipping into their supers to take this money to be able to go overseas and to have their surgeries because they—from what I know, it’s not covered under their health care.

Dr Helen Webberley: And do you know any in the UK and Europe European Union, have you heard of people from here accessing it?

Danica Rain: No, I haven’t. I’ve had patients from the UK that have went to Kamal, but these have all been patients that have, I guess you could say, paid out of pocket.I haven’t heard anything about any type of funding from the UK to pay for people’s surgeries.

Dr Helen Webberley: But certainly in the UK, as well within the European Union, I’m not sure,but I know in the UK, people are entitled to go abroad for treatment if they’re not able to get that treatment in the right time from the NHS. I know that they extend that to Europe, so you can go to Europe for treatment, but I wonder a bit like you whether anyone’s ever pushed those boundaries as you did back in 2016, and actually pushed, you know, that case forward.And I think you know it’s a very interesting concept because we don’t have enough surgeons we’ve got a huge number of people on the waiting list. And as Marianne and you were saying, you know by the time you get to the top of the waiting list, you know the though of you kind of arguing about what technique you might want—I’m shaking my head stunned sitting here thinking that would be absurdthat one would even think to do that

Danica Rain: I was going to say it’s one of the most difficult decisions anybody could make in their life because from trying to pick the proper surgeon, trying to pick which surgery will fit you best, it’s extremely scary.And I think that’s why I do what I do today, because I know how hard it was for me, and I have some medical degrees. I could just imagine somebody who is just starting and has no clue. The fears and what they go through, it’s unbelievable.

Marianne Oakes: I suppose what’s going through my mind is that a lot of patients, certainly in the UK that you know, it’s like an assault course of validation, how you know are you genuinely trans, and they go to all the great lengths to make sure that you will not make a mistake, and that you know who you are. But actually, when it comes to the actual care, it’s just really not that good. If you put the same effort into giving good care as you do, making sure it’s right for you, I  just feel it would all be a lot better.

Danica Rain: Definitely, definitely.Because if the care was better especially with post-operative care—the whole goal to all of this is so that these individuals can lead positive, productive lives afterwards and not be a strain or a drain on the health care system. We want people to be able to go, have their surgeries, feel comfortable about themselves, and then move on with their lives and be productive, and not deal with so many issues afterwards of either having a botched surgery and having to go for plenty of revisions to try to fix yourself or being oppressed afterwards because you didn’t receive what you thought you would getor having complications.

Marianne Oakes: And then we start looking at regret and pain plus to the regret means that we were never trans in the first place, when actually we just regret that we took the wrong surgery.

Danica Rain: And that’s why I really push to KamalHospital because I love the amount of care that they give towards their patients.They give you more than enough time for healing, and it’s also the post-operative care that they provide afterwards. I mean, these patients, like myself, when I flew back to Canada if I had any type of issue or any type of question or problem I can reach out to the hospital and they will get back to me promptly and try to figure out what’s going on. And I even brought it up to Dr Kamal, where I was like, “What happens if later on, I have an issue? What happens if later on, I have to come back for another surgery or a revision?Is it covered?” And that was one thing that weighed a lot on my heart where he was like,“Of course it’s covered.” He said you don’t pay for any of it other than the anesthesiologist. That’s it. And unfortunately, because of my skin condition, I did have to go back for a couple of revisions, and you have to realise this, for every revision around the world the minimum price tag is ten thousand dollars.I went back four times, so that would have been forty thousand dollars Canadian that I would have had to dish out to try to fix. As I said, this psoriasis skin problem that I had down there, and it was all covered. I didn’t have to worry about any of it, which was something that meant a really big deal to me.

Marianne Oakes:Just while you’ve been talking there, it’s just been going through my mind though that a lot of this I feel starts right at the beginning, that we were funneled into a flawed system that has an attitude to all trans people. And the one thing I say is that nobody’s looking at better models of care. And it’s interesting, we talk about the KamalHospital, and I’m wondering whether anybody from the UK or Canada is actually going out there and saying,do you know this is fantastic? This is what we all transgender health care should be offering. And my frustration is that I think we have a flawed model in the UK from the very start. And actually, there’s a refusal to accept that it’s flawed at the start. Therefore the outcomes are going to be flawed if we’re not careful, and that informs the attitude of the services all the way through. Does that make sense?

Danica Rain: Yes, that does make sense. Definitely.And that’s what I’m hoping that maybe eventually in the future would be something that WPath would be looking into because obviously, the WPath is the governing body around the whole entire world. Therefore I think that WPath perhaps should be implementing some type of protocols regarding post-operative care.

Marianne Oakes: I’m sorry to sound slightly shocked that in 2019 that we say that WPath should be doing that.My assumption is, as a layperson, is that they’d be all over this.

Danica Rain: That’s exactly what I thought. And then when I started talking to a girlfriend in Australia, she was explaining the lack in Australia. I explain the lack from Canada, and then we started seeing our friends in other countries, and we were like,“You know it’s kind of silly that WPath this big entity and everyone’s following whatWPath says. But then, in the end, there are so many problems, and it doesn’t seem like anything is really outing.” So hopefully they will listen eventually and as I said I’m hoping that the next conference, I would like to go to the next WPath conference and actually speak up about what’s going on because there should be some type of standard. There should be some type of standard for all of these hospitals to follow.

Dr Helen Webberley: You know, what you’re saying is absolutely right. What we need is we need some good evidence and case law to guide us. We need to create those guidelines and protocols, and then we need to adhere to them. And you know there need to be ramifications if we don’t adhere to them.It’s simple it is in every other branch of medicine. This is not rocket science is that. It’s absolutely fascinating, Danica. I know from what I’ve seen, the work that you do supporting women in making choices for themselves is amazing. It would be so great if some of our people that come to GenderGP we could direct them to you to have a chat about the options because it isn’t just one size fits all as you say.And you know that confirmation surgery, we see what difference it makes to people, and we see how people wait so long for that anticipation to finally become their true selves. And as you say, don’t just jump into the first operating bed that you come across it. We need to really make sure this is the right thing, don’t we? Exactly.

Danica Rain: A patient needs to take their time to do their research because, in the end, they’re the one that’s making this big step.They’re the one that’s making this big decision, and they’re the one that’s signing that informed consent paper afterwards.And there are so many different things that they have to take into consideration. There are those that, like myself, that I get a little say the privileged or the lucky ones where our countries pay for the surgery. So that’s great for me. But there are so many other individuals out there where they’re paying for this out of pocket. So then it’s hard where they’re wondering well you know if I pay twenty-five thousand dollars to have the surgery done in America, am I getting a better surgery if I’m paying twenty-five thousand dollars. Well, know what. You can go and see Kamal in Thailand and you pay ten thousand dollars.So there’s a lot of things you have to take into consideration from the surgeon, the technique that you choose, the aftercare. What are your desired results? Because everyone’s different, we’re all individuals, right?

Dr Helen Webberley: Absolutely. And I think you know what Marianne was saying earlier was, you know, we have to stand up for our rights. And trans women are just as important as any other women. Trans health is just as important as any other health.And I’m really pleased that over the last few years people are beginning to hold up that flag and say I deserve better than this. I matter. I count. And you’ve got to help me in the same way that you would help anybody else. I think, Danica, just listening to you, it’s inspirational. You know being brave enough to share your story, which is obviously a very private story, you just help so many people. And I’m sure that the people listening here today will be inspired to fight for what they want, to look at what the options are that are available to them, and make sure that they’re getting what’s right for them.So thank you so much for coming on. Thank you for sharing your story. And thank you for all the work that you do helping people, you know, in your own time just advising people. Thank you so much.

Danica Rain: Thank you. It was my pleasure. It is my pleasure.

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