What if there were doulas for health care? E. Kale Edmiston envisioned a program to help trans people access health care by pairing them with peer advocates. When navigating a system that so often leaves you out, having someone there who understands your needs can go a long way.
The Trans Buddy Program
by E. Kale Edmiston
I’m the kind of person who hangs out in emergency rooms.
Before The Trans Buddy Program launched at Vanderbilt University Medical Center in late 2014, I was attending ER visits with transgender friends, acquaintances, and friends of friends of friends, while also completing my PhD in neuroscience. Building on my training as a doula, I would support transgender people as they accessed health care. This meant many hours spent in ER waiting areas, punctuated by short clinical encounters wherein overworked providers without a background in transgender health tried to communicate with frightened and frustrated patients, most of who had survived abuse from healthcare providers in the past. I would do my best to facilitate communication across the gulf between provider and patient. Then I would cross the street to my day job in the lab and analyze my dissertation data.
It became pretty clear that this wasn’t a sustainable model for getting trans people equitable care. I realized that I needed to find other people to share the workload.
I had previously worked as a full spectrum doula with The Doula Project in New York. What if there were doulas specifically for transgender people?
We adapted The Doula Project model of compassionate care for people regardless of the outcome of their pregnancy, which is itself informed by reproductive justice frameworks created by Women of Color. The Trans Buddy Program owes much of our framework, practice, and philosophy to these groups.
Transgender people form supportive communities to help each other access resources. These communities, built on peer-to-peer support and care, inspire the Trans Buddy Program. The program pairs trained peer advocates with transgender patients to attend health care visits.
The way it works is simple: a trans person calls our phone number and we connect them with an advocate. Our training is over sixteen hours; it includes everything from conflict resolution and compassionate listening skills, to the ins and outs of insurance coverage for transition-related services. Advocates learn how to provide emotional and logistical support over the phone or in-person. A peer advocate might give a referral for a local support group or a gynecologist experienced with providing care for transgender men, remind front desk staff to use the correct name and pronouns, or encourage conversations between provider and patient about the best way to chart gender identity.
Our peer advocates are trained to center the needs of their client. In practice, this means that we discuss the client’s goals for their visit beforehand whenever possible, and do our best to honor their needs and desires. This could mean that an advocate gently corrects and provides educational resources for a provider who misgenders their patient, or it could mean listening as the client processes after the appointment is over. Some clients want an active advocate who will speak up on their behalf, others prefer for their advocate to sit quietly and take notes or distract them with small talk during a stressful procedure.
The Trans Buddy Program model is patient-centered: our goal is to provide support and resources so that transgender people can be empowered to make their own health care choices.
Why does every region need a Trans Buddy Program? Transgender people face enormous barriers to care; we must navigate a cis-centric health care system that was not designed to meet our needs. This means forms that assume cis and binary genders, clinic staff and providers who have received little education regarding transgender health, and staff who might not be informed regarding new trans-inclusive policies for patient rooming. Furthermore, medical abuse and gatekeeping creates a culture of mistrust, fear, and anxiety. Systemic transphobia limits access to resources like housing, employment, and education, disproportionately impacting Black, Latinx, indigenous, poor, rural-dwelling, and disabled transgender people due to racism, classism, and ableism. Thus, it is not surprising that many trans people delay or avoid care. When we do seek health care, we often are expected to educate providers and staff, while also battling insurance companies for coverage and worrying about overt or implicit transphobic discrimination, denial of care, or even violence. Healthcare is an overwhelming ordeal for many transgender people.
My expectations for what our program would look like were thrown out the window as we started to see clients. I thought we would see adult patients for first-time hormone appointments or emergency room visits. Instead, thanks in large part to a provider-initiated partnership with the Vanderbilt University Medical Center adolescent psychiatry unit. The Trans Buddy Program serves a large volume of transgender youth experiencing psychiatric crisis. Our transgender advocates meet clients staying in the in-patient unit; they are often the first transgender adults these young patients meet. We also serve as models for unconditional support and acceptance for clients’ families. Our advocates are proof that it is possible to have a future as a happy transgender adult. These experiences are incredibly powerful and impactful for both client and advocate. Personally, I know nothing I have ever done has been more important, meaningful, and rewarding.
The Trans Buddy Program was founded with the combined effort of cis and trans leaders. Transgender leadership is a crucial component of our model, and The Trans Buddy Program is now led by RJ Robles, a transgender Latinx person who is expert in working with trans youth and who has moved the program forward with determination and vision. Jesse Ehrenfeld, MD, Director of the Program for LGBTI Health, has helped our program access institutional resources and support, which are critical to our program’s growth and longevity. Lauren Mitchell, co-founder of The Doula Project, Kristen Eckstrand, and I developed our volunteer training together in 2014. Lauren also shared her significant insight and experience running a direct care service during our first year. Volunteer Services at Vanderbilt University Medical Center has provided key infrastructure for on-boarding our volunteer advocates. We work with outstanding volunteers, who are a diverse group of cis and trans people committed to serving transgender communities. The Trans Buddy Program wouldn’t be possible without the hard work of all these individuals.
Are you interested in starting a Trans Buddy Program?
We are also always recruiting volunteers; if you are in the middle Tennessee area and are interested in becoming a volunteer, please let us know (all genders, cis and trans, are welcome to apply)!
About E. Kale Edmiston
Kale Edmiston, PhD is the co-founder of The Trans Buddy Program and former co-director of The Program for LGBTI Health at Vanderbilt University Medical Center. He has worked in medical education and transgender healthcare advocacy for nearly fifteen years and has published dozens of papers and book chapters on his two passions: transgender health and psychiatric neuroscience. He is now a postdoctoral fellow in psychiatry at the University of Pittsburgh Medical Center, where he researches social anxiety using neuroscience methods like functional magnetic resonance imaging (fMRI).
When he’s not working, Kale likes to garden, read, watch Star Trek, and hang out with his dogs. He also co-founded a queer DIY punk record label with his girlfriend, Shannon Thompson. Tweet your questions to @EKaleEdmiston.