August is my birth month and along with it comes my family’s annual reminder for health insurance premiums. Like many Indians, I also took health insurance pretty late in life. This year I decided to upgrade my insurance plan after seeing the havoc that Covid wreaked on India’s healthcare system. Healthcare in India is so expensive that all your savings can disappear in one moment in case of an emergency. When I upgraded my plan, the insurance company set up the regulatory call to explain its details. This part is almost always a heartbreak for transgender persons as most (if not all) health insurance policies do not cover gender-affirming surgery costs. I was listening to the company’s representative, and throughout the half-hour call, my thoughts kept going back to Anannyah Kumari Alex.
As the first mainstream transgender radio jockey in the Indian circuit, and the first from the community to contest assembly elections in Kerala, Anannyah was one of the community’s brightest and more outspoken voices. As a Trans Rights activist, she fought for the community like a fearless warrior. Tragically, on 20th July 2021, Annanyah was found dead in her apartment. A roaring trans voice was silenced. This news sent shock waves throughout the country. Especially, the transgender community was left heartbroken and concerned about their future. Healthcare for transgender persons are in the worst possible state, and no government of Independent India has ever had paid heed to this issue.
For context, Anannyah was only 28 and had her gender-affirming surgery performed in 2020 at the Kochi-based Renai Medicity hospital. Like many trans individuals, she must have dreamt of a better life after struggling for years with fighting gender dysphoria. But, things turned ugly after the surgery. According to news reports, she could not stand for a prolonged period after the surgery for more than a year.
Anannyah alleged medical negligence on the part of the doctors of Renai Medicity who had performed the surgery. According to her, the surgery was not a success, as she shared that the “private part look[ed] like a piece of meat; it had no resemblance to a vagina”. She wanted to undergo a surgery to correct the disfiguration, but the hospital denied her treatment and allegedly asked for a huge sum of money for the corrective procedure. Anannyah suffered from various post-surgical issues for one year, and the hospital did not help her. According to her last interview, she claimed that the surgical errors had led to health complications. According to the initial police probe, the case looks like a suicide. But, is it?
The life of transgender persons starts with the dysphoria and the struggle of living in an alien physical body. Then, most trans people opt for gender-affirming surgery to align their physical and mental experience of gender. Gender-affirming Surgery is life-saving for most of us. Most of our lives is spent on preparing, planning and dreaming about the life we want. And then comes unfortunate news like that of Anannyah’s, and all our hopes die silently. She opts for the surgery with the hope of living a better life, but the most important act of her life caused her death. The medical negligence, in this case, has not only ruined a precious life but also caused fear in many transgender person’s hearts—especially those who are preparing for their surgery.
Saral, a young Trans-woman from Chandigarh who had already started her hormone therapy and was planning for the surgery, says: “This unfortunate incident is going to add on to the hesitation that folks/parents have for their transgender children. It is adding to my hesitation as well for having my surgeries done in India. These are major surgeries and do have consequences.” Gender-affirming surgery is one of the most complicated medical procedures. A slight mistake or negligence on the part of the doctors can ruin the entire life of a person. There are not many specialist doctors or hospitals in India, and surgery abroad can cost a fortune.
Aru, a Trans-person from Mumbai who is yet to start their medical journey, says: “These sort of lapses become a major reason for why people have to travel abroad and don’t trust the [Indian] medical system here for their transition. That, in turn, becomes a major challenge because of obvious reasons [such as] resources for migration, travel costs, medical expenditure abroad, which then severely impact mental health.”
Moreover, people now are most afraid to go for their surgery. Namita, a young trans-person from Ahmedabad, says, “I have to rethink my surgery because, one, it is too costly and what happened with Anannyah just broke my heart. But, surgery or not, I am a woman, and I want the surgery to get rid of my dysphoria, but now I have to think about it…may be I will delay my process.”
Healthcare in India is in a mess, and when it comes to health care for transgender persons, it is horrible, especially if we talk about Gender-affirming Surgery. The surgery is complex, it is very costly, and no health insurance policy covers the cost stating that it is cosmetic surgery. A trans-person prepares themselves for life, and after numerous sessions with the psychologist, they start hormone therapy. Then, at least a year later, they go for surgery. So in a sense, the gender-affirming surgery is not a one-day affair; the entire journey takes a lifetime. It is a lifeline to stay alive. Gender dysphoria makes one hate their body so much that it becomes so distressful and depressive and some trans-people choose death over life; that’s when they go for the surgery. For Anannyah also it was supposed to be a life-saving surgery. Alas! It could have saved her life. The negligence, in this case, is blatant, and with the way the hospital and doctors behaved after her surgery, it can be said it is not a suicide but a systemic murder resulting from insensitivity. The trauma of the incident is far-reaching and beyond words. The entire community is in shock, fearing the future. The mental health of everyone has taken a hit and the impact is too devastating.
Anannyah is not alone; there are many such cases in India where trans-gender people could not get the body they want even after spending their entire life’s savings. Unfortunately, most of those stories never come out in the open. There is no government regulation in this area, and that is a giant loophole. There are no specific and designated hospitals to conduct these complex surgeries. Even therapists and endocrinologists are under no obligation to ensure their patient’s safety. Most trans-gender persons are left to fend for themselves, and these hospitals take advantage of this situation, knowing fully well that they might be safe even in the case of a major lapse on their part.
Moreover, due to social ostracization, the economic condition of most transgender persons is not stable enough to afford expensive specialty hospitals, and I have already discussed the hiccup with health insurance coverage in this matter. This leads to a grey area wherein negligence and improper after-surgery care costs many a trans-life in India. One such precious life lost to suicide was that of Anannyah’s.
This unfortunate incident has opened up the debate on Transgender health care, at least within the LGBTQIA+ community. Silence on this issue will mean going back to square one and another life lost in vain. As a community and a country, we should not turn a blind eye to the matter anymore. It is time that the government started regulating and designating proper and sufficient hospitals for gender-affirming surgery. Also, the government should fix a cap on the cost of surgery so as to make it more affordable to more people. Finally, and the most important one, the Insurance Regulatory and Development Authority should allow and ask insurance companies to cover the cost of gender-affirming surgery in their health insurance plans.