Dealing with heartbreak

At the start of the year, I sat on a panel alongside some colleagues to talk about the submissions that were, at the time, being invited on the possibility of restrictions on trans kids' right to access healthcare. One of the other panelists talked about the care our communities need right now, and pointed out that while we talk a lot about managing and supporting recovery from burnout, we aren't talking about what a lot of us are actually experiencing: heartbreak.

It's been a year for heartbreak. We still don't know what the Minister of Health will decide when it comes to puberty blockers. In the meantime, we've seen pathways to access this care fall over as people pre-emptively comply with possible future restrictions that would, no doubt about it, be based on sex-based discrimination without good cause.

We've also seen the Minister of Health intervene to prevent the publication of PATHA's updated national gender affirming healthcare guidelines - guidelines that were commissioned by Te Whatu Ora, approved by Te Whatu Ora's National Clinical Governance Group, and approved by Te Whatu Ora's Executive Leadership team. They've been written with care and expertise from a huge number of people, and reviewed by even more experts, both nationally and internationally.

It's a beautiful document. I wish I could show it to you. We've got beautiful new artwork from River Jayden, illustrating Elizabeth Kerekere's Te Whare Takatāpui, the new takatāpui health framework that many rainbow health projects are using. We've got new illustrations from Sam Orchard, representing the rich diversity within our communities. The guideline is accented throughout with paua shell, acknowledging the 2018 guidelines that came before.

It's written with generosity. It's robust, detailed, and holistic - the 2018 guidelines are 56 pages, and these updated ones come in at 182 pages. They include essential updates to the 2018 guidelines, but also include really significant and important new content, with specific sections for Māori and Pasifika trans people, refugees and new migrants, older trans people, and important sections on non-medical affirmation and building inclusive clinical practice. In fact, the guidance on prescribing puberty blockers only makes up 6 of the 182 pages in this document.

One hundred and seventy-six pages withheld because six pertain to a decision that politicians will make about a vulnerable minority's right to access healthcare. Not clinicians - politicians. Politicians who are now acting to actively make care for trans people less safe in Aotearoa by forcing the non-publication of critical updated clinical guidance.

It's nonsensical. I'm heartbroken.

I've watched so many people put massive amounts of time, energy, and expertise into this work. To get so close to publication to have it forcibly withheld by someone with no stake - no clinical involvement with trans people, no clinical background, isn't trans or supporting a trans person, and has no good reason to withhold this work - it's heartbreaking.

It's been a year for heartbreak. I think one of the cures is reframing, looking for the silver lining, looking for the positive or productive spin - not to downplay the harm and the hurt, but as a way to be able to move forward.

Over 500 medical bodies, health and community organisations, healthcare services, and individual practitioners have signed an open letter calling for the guidelines to be released. Signatories include the Paediatric Society of NZ, the College of Clinical Psychologists, the Royal NZ College of General Practitioners, the Psychological Society and Endocrine Society. There's broad clinical consensus that releasing these guidelines is the right thing to do. Te Paati Māori and and the Green Party have both called for their publication.

So while I don't hold hope that the Minister will have a sudden change of heart, I hold some hope that the pressure of the majority of our country's medical bodies calling for their publication will prove too much for them to continue to withhold them. I hold more hope for the future - this letter represents the broad consensus within professional fields and society more broadly that protecting the wellbeing of our trans whānau is more important than using us as a political football.

But it's been a year for heartbreak, and this week is no exception. Alex's story has weighed on me heavily this week - the story of a trans teenager, without whānau support, tragically losing his life only for our publicly-funded broadcaster to persistently misgender him in his death.

I was trying to think of when the last time a trans person was so callously posthumously misgendered in Aotearoa like this. I thought back to Charlotte Loh, who passed away in 2015, a little over ten years ago. Her gender was acknowledged at her funeral, but reporting initially didn't gender her how she would have liked to have been remembered. Some of us marched up Queen Street. Others held their own vigil in Albert Park. We come together, in these moments, because heartbreak is not something you should bear alone.

So, perhaps, it's been ten years since this last happened - except this case feels more callous. The way anti-transgender lobbyists have pounced on this story, "shopped" it around looking for the outlet that would run with their framing and have the most impact, and the way around the world anti-transgender activists have crowed over it. This is politicisation of a trans death - as Angel, who knew Alex and brought his own words to light has shared:

The original article seems so suggest that 'because social services focused so much on Alex's gender identity, they neglected his eating disorder'. It is deeply ironic then, that all of the conversation now seems to be around Alex's gender identity, and people are neglecting to raise awareness about the eating disorder that killed him.

I think it's been longer than ten years since the loss of a community member has been framed so disingenuously, with political intent, by a major media outlet. I've described RNZ's article as perhaps the most unethical piece of reporting about our community in Aotearoa for over a decade, and I don't think I'm exaggerating. I'm shocked it has remained online, with no comment or statement or clarification, considering their reporter was immediately provided with access to over 6000 messages from Alex himself, sharing his side of the story.

It's been a year for heartbreak. I'm trying to not let it weigh on me too much - remembering that this is a long fight, and the moments where it feels like we've lost are just that - small moments, in the scheme of things.

But I think it's okay to sit with heartbreak, sometimes. This week, of all weeks, when we remember those we have lost, when we come together with those around us to share kai, watch the dawning skies, and remember those we miss - I think it's the week to sit with it.

Manawatia a Matariki mā Puanga, e hoa mā.