Elyn Bhandari’s ultrasound report stated his prostate was normal in size. For anyone else, it would have been good news. But Elyn is a transgender man, with the uterus and other female reproductive organs he was born with still intact. “I couldn’t believe it,” says the 30-year-old. “They took one look at me and decided I was a cis-man. The registration form had only two options: male and female. I had to pick one and I chose male.” This, he says, led to much confusion. The radiologist was shocked to see the uterus. He wondered out loud how that was possible and then proceeded to give Elyn a report befitting a cis-man. In another instance of callousness, Sudip Gautam, 30, a transgender man, took a friend, also a transgender man, to the hospital. He was having issues with his menstruation cycle. The doctor told him to have a baby. “As if it were that easy. The insinuation was that my friend shouldn’t defy nature,” says Sudip.

The horrors don’t end there. There have been cases of doctors refusing to take transgender men and women as patients. Sometimes, they have been told to wait at the reception while a hospital staff asked the doctors if they were willing to look at such cases. A transgender woman who went to a hospital for leg pain was sent for counseling. She was told ‘these things’ could be fixed.

The discrimination and harassment that the LGBTIQA+ community faces at hospitals in Nepal limit their access to healthcare in multiple ways. There are delays and denials of vital medical care. There’s a risk of wrong diagnosis and treatment. Many choose not to go to the hospital, letting disease fester instead. It’s also not unusual for transgenders who take hormone supplements to do so without consulting a doctor. The hospital staff’s disgust upon finding out their sexual orientation has apparently led to anxiety, depression, and other mental health issues as well. “The attitude of healthcare professionals changes when they find out we don’t fit into the society-sanctioned gender identities,” says Sudip. They ask unnecessary questions. They tease and taunt. A transgender man was questioned on how he developed breasts. Another, who still had breasts, was told to uncover his chest for an X-ray. Being shy and uncomfortable was unnecessary drama, he was told. Bhakti Shah, 36, a transgender man, has had a horrid experience at Tribhuvan University Teaching Hospital. He had to be rushed to the emergency because of pain in his lower abdomen. Despite Shah making his sexual orientation clear—he told them he had a partner who was a woman—they wanted to check if he was pregnant. “I was told my pains were consistent with that of early pregnancy. I wanted to leave but they refused to discharge me,” says Bhakti, claiming he felt so harassed that he ran away. Turns out, Bhakti had an ovarian cyst. To reduce the risk of cancer, the gynecologist he consulted suggested surgery to remove one of the ovaries. Bhakti told the doctor’s team that he wanted to have both his ovaries, as well as the uterus, removed. But his request was denied. What if he later changed his mind about not wanting to have a baby? They couldn’t risk it, she said. “They removed one of my ovaries. A year later, I developed cysts in the other ovary and had to get another surgery,” he says. Besides the financial burden, the inability to exercise his right over his own body took a big mental and emotional toll, says Bhakti. Medical care should be unbiased. Access to health is a basic right, and it’s guaranteed by the constitution of Nepal. But these are empty words for the LBGTIQA+ community. Representatives who spoke to ApEx say they would rather not go to the hospital, for the treatment they get there is often far worse than their illnesses. The discrimination they face discourages them from seeking medical care. At hospitals, transgenders have often been told to stay at the end of the line, with the priority given to cis-men and cis-women. It’s a hostile environment, says Elyn. Sujan Panta, an advocate, says easy access to healthcare is a basic human right. Time and again, people of the LGBTIQA+ community are denied this right because of health professionals’ own biases and also because of a lack of clear laws and policies. “Doctors and hospitals are in a quandary. There is much confusion on what is allowed and what’s not,” says Panta. As far as gender discrimination is concerned, Panta feels a lack of reporting and media advocacy are also responsible. People let it go, as a one-off incident, and that strengthens the discriminatory system. “When a marginalized group faces discrimination of any kind, more so in something as important as healthcare, it should be highlighted,” he says. Simran Shrestha, a transgender woman, says we first need a gender-neutral society for it to translate into good healthcare for all. Despite the constitution guaranteeing equal rights to everyone, Nepal still hasn’t been able to implement it. This, she feels, is because biases run deep. “It’s important to change that, through awareness and education,” she says. Elyn, on the other hand, feels that is the ultimate goal but it’s a long process. The healthcare sector needs immediate reform. For starters, there should be a mechanism to report discrimination that LGBTIQA+ people inevitably face at hospitals. Simran says healthcare professionals should be trained early on, during their internships if not before that, adding there is currently insufficient understanding of LGBTIQA+ needs and issues. “Nepal has made a lot of progress where LGBTIQA+ rights are concerned. There have been many positive changes. But the implementation part is one we must seriously look into,” says Lily Thapa, a member of the National Human Rights Commission (NHRC). “Discrimination is a crime. There are no two ways about it. But what’s also true is that our medical system isn’t sensitized on LGBTIQA+ matters,” she says. The NHRC can work with the LGBTIQA+ community on such sensitization, which is perhaps the only feasible and impactful solution, she adds. “I’m not saying you have to put up with bad behavior until the necessary change happens. There is a mechanism in place whereby you can lodge a complaint with the NHRC and we will look into it immediately,” Thapa says. Unlike most government procedures, it’s actually simple. You can file a complaint online or just email the NHRC with the details. Advocate Panta adds, “It might not feel like a lot. But it’s the start. Not doing anything about the discrimination you face is far worse, especially if it limits your access to a service as vital as healthcare.” BOX Terminologies LGBTIQA+: Lesbian, gay, bisexual, transgender, intersex, queer, asexual, agender, aromantic, and other sexually or gender-diverse identities Transgender man or transman: a man who was assigned female at birth Transgender woman or transwoman: a woman who was assigned male at birth Cis-man or Cis-woman: Cisgender is a term used to describe a person whose gender identity corresponds to their sex assigned at birth