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More Than Restrooms: The Need For LGBTQIA+ Aware Healthcare

August 8, 2018

By Angel Collie

We have all been there: that after lunch meeting that seems to never end. It’s hard to focus when all you can think about is why you insisted on having that second cup of coffee earlier in the day. Finally, you wrap up and go hunting for a nearby restroom. Here you are rushing through the halls of a building you haven’t been in before desperately trying to find one.

You’ve passed a few but none that can accommodate your needs. You ask someone and they make an assumption about you and send you off in the direction of a restroom that simply doesn’t have what you need. So, you have to decide: hold it or risk going into a restroom that will be uncomfortable at the least or downright dangerous at its worst.

The scenario I described isn’t for dramatic effect. If anything, it’s downplayed and it’s something that those who identify as transgender or non-binary  have to think about every single day, often multiple times a day. And, it’s something that cisgender folks, those whose gender identity matches the sex they were assigned at birth, rarely have to think about.

In fact, in many states and towns all across the country, restrooms have become sites of controversy and literal political battlegrounds. Living and working with LGBTQIA+ communities in North Carolina has meant that I’ve found myself talking and writing about bathrooms’ way more than I ever anticipated I would. You might be wondering why and consequently wondering what in the world this has to do with Integrative Medicine.

duke blue devil holding flagAs an educator at Duke working to advocate with, and on the behalf of, individuals with marginalized sexual orientations, gender identities, and gender expressions (SOGIEs), a lot of time is spent creating spaces of welcome and inclusion in the everyday accommodations such as forms, gendered spaces, and restrooms. These are processes and spaces that many take for granted. In fact, cisgender people can move through the world using restrooms, filling out forms, accessing health care and services that are created with their needs and identities in mind. Someone being able to look at you and correctly assume the pronouns you use is one example of a privilege cisgender individuals have that often goes unrecognized on a daily basis.

These advantages and privileges come at a cost for those who don’t enjoy them which brings us back around to what in the world restrooms have to do with integrative medicine. The systemic marginalization, microaggressions, and downright macroaggressions faced by those with marginalized SOGIEs come at a high cost including disproportionate mental, emotional and physical health disparities due to stigma, discrimination and violence. These disproportionate outcomes increase significantly when ones hold other traditional marginalized identities and statistics show that transgender women and transgender people of color face significantly more discrimination, exclusion, and violence.

In a recent report by the National Center for Transgender Equality (link to report: https://transequality.org/sites/default/files/docs/usts/USTS-Executive-Summary-Dec17.pdf), where over 27,000 people were surveyed, it was found that there are systemic barriers in every level of public accommodations from education, to health care, to employment. In every area surveyed, transgender and non-binary individuals face significantly more barriers, negative outcomes, and harmful experiences.

These things add up and negatively the health and wellbeing of transgender and non-binary people over time. In order to provide holistic care for individuals with marginalized SOGIEs one must be aware of the social realities individuals are facing. The upcoming session on providing informed care to LGBTQIA+ individuals, as part of the Duke Integrative Medicine Cultural Competency for Health Professionals program, will serve as an introduction to the LGBTQIA+ community through discussing key terminology, exploring intersecting identities, and providing opportunities for individual reflection. Ideally, the session will provide insights about small but significant ways health care providers can better recognize and navigate systems of privilege and oppression that reinforce and uphold the harmful heterosexism and cissexism that clients with marginalized SOGIEs might face.


Angel Collie is the Assistant Director of the Duke Center for Sexual and Gender Diversity and he serves as an instructor for the Duke Integrative Medicine Cultural Competency for Health Professionals program. If you would like to learn more about the Cultural Competency for Health Professionals program, visit the Duke Integrative Medicine website. Register before September 7, 2018 to receive a 10% early registration discount.

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