A Pakistani trans woman died after medical staff couldn’t decide which ward to put her in. It happens in U.S. hospitals, too.
Alesha, a 23-year-old Pakistani transgender activist, survived multiple gunshots. She even made it to the hospital, albeit in critical condition. But in the end, it wasn’t her shooter that sealed her fate—it was a transphobic medical staff.
Her story is not just tragic proof of anti-transgender discrimination and violence abroad. What happened to her in a Pakistani hospital can and does happen in the United States.
According to the Pakistani newspaper Express Tribune, after Alesha arrived at Lady Reading Hospital in Peshawar, authorities “kept her waiting for over an hour as they couldn’t decide whether to shift her in the male or female ward.” Then, as the LA Times reported, the staff spent “several hours” insisting that she could not go to either ward.
Her fellow activists with the Trans Action Alliance Khyber Pakhtunkhwa (TAA) demanded that Alesha be treated, ultimately succeeding in moving her to a private room. But it was too late. The critically-injured young woman underwent surgical treatment for internal bleeding and died Wednesday morning.
The anti-transgender harassment Alesha and her colleagues allegedly experienced at Lady Reading Hospital can be pieced together from local reports.
Transgender activist Farzana Jan told Dawn that staff followed her around the hospital while she was trying to locate a doctor for Alesha, teasing her instead of assisting her. She added in an interview with Zulfiqar Ali and Shashank Bengali, who were reporting for the LA Times from Pakistan, that men gathered outside the emergency room asked if her breasts were “real or fake.” Another TAA member told Dawn, “The doctors kept asking the injured Alesha if she danced only and how much she charged.”
According to the Express Tribune, a group of anti-transgender extortionists in Khyber Pakhtunkhwa is under investigation for the shooting—a gang that is suspected of being behind a wave of transphobic violence in the province.
The harassment Alesha reportedly received at Lady Reading Hospital is horrific, certainly one of the most extreme examples of mistreatment based on gender identity to occur in a health care setting. But it is also generally consistent with the way that many transgender people have been treated by hospitals and doctor’s offices in the United States.
According to the 2010 National Transgender Discrimination Survey (PDF), 28 percent of transgender respondents said they had been harassed in a medical setting. A small but still unsettling two percent said they experienced physical violence in a doctor’s office. Almost one in five had been denied medical care based on their gender identity, like one transgender man who said that he had been “living with excruciating [ovarian] pain” for years because he couldn’t find a doctor willing to examine it.
Unsurprisingly, this discrimination prompts many transgender people to avoid doctor’s offices, even when they need pressing treatment.
Behind the survey data, there are horror stories waiting to be told. For example, in 2013, a transgender man named Jakob Rumble, then just eighteen years old, went to Fairview Southdale Hospital in Minnesota to be treated for genital pain. What he allegedly experienced was six days of discrimination and abuse.
His time at Fairview Southdale was later detailed in a discrimination lawsuit he filed against the hospital.
Rumble claimed in the suit that he went to the hospital after his genital pain became so severe that he had trouble walking. Like Alesha, he waited “several hours” for treatment after an uncomfortable interaction with the admissions office. After almost five hours, a doctor came to his room and allegedly began asking him invasive questions about his sexual history in “a hostile and aggressive manner.”
Then, he says, the doctor “repeatedly jabbed at [his] genitals with his fingers,” not stopping even after the young men asked him to do so twice. Rumble’s mother intervened, asking the doctor to end the “exam.” The doctor, Rumble claimed, reacted angrily when he asked if the problem had been identified, fuming, “I can’t tell you because your mom made me stop the exam” and leaving the room.
Rumble was admitted to the hospital and stayed for six days, with his mother sleeping in the chair beside him to protect him. According to his lawsuit, the abuse got even worse. Among other incidents, Rumble claimed that one doctor touched his face with the same gloves he used to touch his inflamed genitals and that nurses often examined his genitals without explanation, even when he asked why it was necessary.
In March 2015, a U.S. District Court ruled that Rumble’s lawsuit could proceed as a case of possible sex discrimination. The full report from the National Transgender Discrimination Survey (PDF) contains even more disturbing stories from transgender respondents who faced discrimination at the hospital or in a doctor’s office.
“I have been refused emergency room treatment even when delivered to the hospital by ambulance with numerous broken bones and wounds,” said one. “After an accident on ice, I was left untreated in the ER for two hours when they found my breasts under my bra while I was dressed outwardly as male,” said another.
One respondent said that a visit for a sore throat turned into a forced pelvic exam: “The doctor invited others to look at me while he examined me and talked to them about my genitals.”
It is no surprise that these cases have not turned into costly lawsuits. Transgender people are four times as likely as cisgender people to live in poverty. That rate is even higher for transgender people of color who are, in turn, more likely to face discrimination at the doctor’s office than their white counterparts.
Even if transgender people could afford to sue, legal avenues were not always available to them. Rumble’s case is the first, according to the Washington Blade, to test whether or not a hospital can be sued for anti-transgender discrimination under Section 1557 of the Affordable Care Act.
But even while these stories remain confined to the pages of surveys, with more in the shadows, it is clear that anti-transgender violence in a hospital is not something that could only happen overseas. It happens here, too.
Alesha’s death is not so much an indictment of Pakistan in particular as it is a symptom of a world that, too often, would rather let transgender people die than help them live.