Providing Culturally and Clinically Competent Care for 2SLGBTQ Seniors: Inclusion, Diversity and Equity
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Providing Culturally and Clinically Competent Care for 2SLGBTQ Seniors: Inclusion, Diversity and Equity Devan Nambiar, MSc. Acting Program Manger & Education & Training Facilitator E: [email protected] October 22, 2019 2 LT outcomes Group Norms • Give yourself permission to make • Create practical steps to inclusive and safe spaces for SOGI mistakes & have a process to -Deconstruct your address mistakes • Understand 2SLGBTQ+ health disparities ideology, values, • Use “I” statements beliefs systems • Use correct pronouns (he, she, • Competencies in clinical, cultural safety, from religions, cultural humility attitude, morality and they….) implicit biases • Agree to disagree • Become an ally • Create safe space for all to learn -Being comfortable with not knowing • Respect confidentiality and questioning your • Share wisdom & Share airtime discomfort with SOGI 3 SOGI-sexual orientation and gender identity 4 Trans Mentorship Call biweekly -1st & 3rd week on Wednesday 12 noon -1 pm Must register 5 online 6 1 Does Discussions Myths on 2SLGBTQ heterosexuality end at senior • At school, either college and/ or university have you learnt about LGBT2SQ age? clients or in population health? • When did you decide you are heterosexual? How do you know you are 100% heterosexual? • You stop being 2SLGBTQ if you are older, a senior, • Are you familiar with gender neutral pronouns? retired, have an illness • Are there staff who are out at work as LGBT2SQ? • Do you know LGBT2SQ people outside work? • • Have you done an assessment for HRT? SRS/GCS/TRS, puberty blockers? LGBTQ have “excessive” sexual practices • Do you know of resources available for LGBT2SQ clients? • Is there an equity or diversity committee at work? • Wanting/ desiring intimacy (holding hands, hugging, • Does the policy at work include sexual orientation & gender identity? sitting together, cuddling, kissing, etc.) means they • Have you taken AOAR, AOP training? want to have sex • Has your health care provider ever discussed with you about sexual orientation, gender identity or sexual behavior? 7 8 LGBT2S Seniors Introspection (5 mins) • At your table speak to your peers about someone “I can be me. I can talk about anything I want to. And that in important in your life and/or you care about itself relives a lot of mental stress. I mean it’s very good for without gendering the person. your mental stress to be able to be who you are. It is very damaging to be not be able to. • Do not use names, she/he, husband/wife, And if you feel that you are losing yourself to some form of girlfriend/boyfriend, daughter/son dementia, then to me the one thing that I would want to put against that is, the bits of me that are still there, I want to celebrate! I want them there and I want people to see that I • Or describe a client without gendering them am still here. Let’s celebrate it for now. Not a year down the line.” • How was the experience? Re:“Over the Rainbow” Lesbian, Gay, Bisexual and Trans People and Dementia. 2015 9 10 1969- 2019 LGBTQ Global Perspective: Africa, China, Egypt, Greece, Lesbos, Japan, India, Persia, Pakistan China, Qing dynasty, 5th dynasty of Egyptian Alexander the Great & 18th -19th century pharaohs circa 2400 B.C Hepaestion 356-323 BC Pakistan: Shah Abas, 1627 Sappo, 570 BC, Samurai & kabuki Madho Lal & Shah India Persia island of Lesbos actor 1600-1868 Hussain 538-1599 11 12 2 Import of homo/transphobia via European Colonialism & the Penal code: from 1533 buggery law of K. Henry Vlll- drafted in 1834 by Britain, implemented in 1861… “ Two-Spirit, third gender and non-binary genders before any act of carnal intercourse against the order of nature.” colonialism 157 years later: colonial laws criminalize 2SLGBTQ persons 2019- Kenya High Court upholds penal code Uganda • Ancient tradition: neither to criminalize same sex relations anti-gay law in process male nor female Chechnya, 2017 and Egypt-mass arrest of from 2013 • Pre-western colonialism, ongoing gay genocide LGBTQ to now played strongly spiritual role Brunei, 2019- Death penalty, arrest, as advisors, medicine execution and/or torture: Iran, Saudi stoning for adultery women/men, healers, Hijra, Arvani, Arabia, Yemen, Sudan, and gay sex visionary, warriors, advisors Kushra, Somali, Nigeria, Iraq to chiefs, queens, kings Some of the countries in the Caribbean and in Cultural Competency in Practice: Africa and eastern Russia Name one process/ initiative to consider Europe criminalize when providing care to Indigenous LGBTQ+ people clients? In 71 countries it is a criminal offense be LGBTQ (www.ilga.org) 14 History of oppression, criminalization, state sanctioned homophobia & discrimination: Videos • Intersectionality https://www.youtube.com/watch?v=O1islM0ytkE 2-Spirit Indigenous • Trans And Native: Meet The Indigenous Doctor Giving Them Hope. Dr. Makokis created a unique approach to Nov 28, 2017 transgender care, combining Indigenous and Western teachings. In Canada for 40 yrs: “Homosexuality was grounds for surveillance and interrogation • https://www.youtube.com/watch?v=MSnvtj0G3cA by the RCMP under the directive of the newly-established Security Panel. Over the • Seniors; The Fruit Machine: Canada's Cold War gay purge course of four decades, thousands of men and women had their privacy invaded, their • https://www.youtube.com/watch?v=CRvjgevw2Sw careers ruined, and their lives destroyed because of a “scientific” machine and a • Gen Silent >50,000 men to 100,00 men disgraceful mandate.” • https://www.youtube.com/watch?v=fV3O8qz6Y5g HIV/AIDS Activism via AIDS Action Now= catastrophic drug program = Trillium Drug Program 15 16 Timeline of Oppression on LGBT2S seniors Why Pride? Current age 70 years Born 1948 Age 21 years Decriminalization of homosexuality • “When you hear of Gay Pride, remember, it was not born out of a (1969) need to celebrate being gay. It evolved out of our need as human beings to break free of oppression and to exist without being Age 25 years Removal of homosexuality from DSM criminalized, pathologized or persecuted. (1973) Age 28 to 50 years Territories/provinces prohibited Depending on a number of factors, particularly religion, freeing discrimination on basis of sexual ourselves from gay shame and coming to self-love and acceptance, orientation (1977-98) can not only be an agonising journey, it can take years. Tragically some don't make it. Age 55 years Marriage recognized (2003) Instead of wondering why there isn't a straight pride be grateful you have never needed one. Celebrate with us.” Age 66 years Gender Identity and gender expression added to Ont. H.Rights (2014) • Anthony Venn-Brown Age 69 Federal protection on gender identity and expression (2017) Recognized in senior environments – Invisible Coming Out : Fernando & Lito Pride –Sense 8 17 https://www.youtube.com/watch?v=0JtLzzR5h3Y & Gen Sillent 18 3 Ontario Human Rights Commission Human Rights for LGBT2SQ people in Canada . 1969 Consensual sex between same sex adults removed from Criminal Code of Canada . 1973 Homosexuality no longer classified as a mental Illness . 1974 Gays and lesbians permitted as immigrants to Canada . 1977-98 Territories/provinces prohibited discrimination on basis of sexual orientation (Ontario in 1986) . 2003 Ontario legalized same sex marriage . 2005 Canada opens doors to LGBT marriage and immigration . 2012 Ontario recognizes gender identity, gender expression in its human rights 2006 legislation (13 June 2012) . 2017-Bill-C16 Canadian Human Rights Act to include gender identity and expression 19 20 Every Resident - Bill of Rights for people who Access to Washrooms live in Ontario long-term care homes (2015) “Trans people should have access to washrooms, change rooms and other gender specific services and facilities based on their lived gender identity.…Organizations should design or change their rules, practices and facilities to avoid negative effects on trans people and be more inclusive for everyone….The duty to accommodate the needs of trans people is a shared responsibility.” Ontario Human Rights Commission Policy on Gender Identity and Expression, 2014 Duty to accommodate: OHRC’s policy section 13.4 (p.38) 13.4.1- access based on lived gender identity) 21 22 Impact of isms in health care systems Homophobia – Sexism-Transphobia – Misogyny- Transmisogyny • Heterosexism: The unrecognized and assumed privilege that people have if they are heterosexual. Examples: holding hands, or kissing in public without fear; talking about their partners, etc. • “Because many 2SLGBTI Q+ people have learned to live with • Homo/bi/transphobia: An extreme and irrational the stresses of being different over a long period of time, aversion to homosexuality, bisexuality and trans gender they may not be aware of the toll that this experience of people. It can also mean hatred of LGBTQ people, sexual chronic low-level stress creates…... But slowly both the client behavior, gender identity, gender expression and /or and the provider may discover – together – that the residual culture. effect of this stress is a big part of a presenting problem • Cissexism: the belief and treatment of transgender such as depression.” people as inferior to cissexual (non-trans) people. 23 Re: Working therapeutically with LGBTI clients: a practice wisdom resource (2014)24 4 Outcome of acute & chronic stresses due to SOGI Minority Stress Of this experience of “acute and chronic, low-level stress – from external and . The chronic psychological strain resulting from stigma and internalised events and process – contributes