When Dr Noor Riffat Ara joined Dhamrai upazila hospital two years ago, she noticed too many issues, from medical staff crisis to mobile phone theft, a rural hospital could possibly have. But the first thing she took into her hands was quite different.
The hospital in-charge convened her colleagues to a meeting, sought their opinions and dedicated "room 110" of the one-storey hospital for treatment of transgender people on Sunday every week.
Besides, the emergency department of the hospital would prioritise the disadvantaged group in treatment.
The simple but bold initiative that unlocked health access to third gender people met with enormous appreciation by the marginalised group, broke the gender-related stereotype, and minimised the community relationship gap between the group and general people.
"We are now welcomed at the hospital like the VIPs. But things were completely different even two years ago," Tanisha Biswas, who works as a beautician, told The Business Standard.
Before the joining of Dr Noor, physicians would get scared if any transgender patient popped up. Other people would laugh at them and refuse to stand in the same medical queue.
"Therefore, most of us would not visit any doctor and opt for drug stores for over-the-counter medicines," Tanisha recalled.
According to unofficial estimation, there are 1.10 lakh transgender people in Bangladesh who are mostly deprived of basic rights such as mainstream education, health and employment.
People belonging to the discriminated minority live on handout, sex work and often extortion, leading to people get frightened when they meet a transgender individual – who goes by "a Hijra".
There are 35 hijras in Dhamrai, which is around one-hour drive from the capital.
Anonnya Banik, a transgender social worker who now comes to the hospital, said all the medical staff of the health facility are very friendly and doctors also listen to them cordially.
"We are really grateful to them. We thank the physicians for not driving us away like others."
The doctor without a leaner childhood
The inception of room 110 dedicated to transgender patients incorporates the mind-set of Dr Noor towards the marginalised people. Her colleagues differentiate the physician for her compassion for disadvantaged groups, someone who would compromise her comforts for the people and live rather in a rural Dhamrai even if there are options to get transferred to capital Dhaka.
The physician completed her academic career from a Sylhet medical college in 2010, and then joined the public service. She, however, was not yet happy with what she was doing as a doctor.
"I was looking for an option to serve poor people who are not able to visit a doctor even once for years. I felt I needed more than an MBBS degree," said the doctor.
Subsequently, she got enrolled to the National Institute of Preventive and Social Medicine (Nipsom) for a master of public health degree, which she says provided her with a comprehensive picture of access to healthcare.
According to Dr Noor, she could open "room 110" thanks to the medical knowledge she obtained in Sylhet plus humanitarian values at Nipsom.
"Our hospitals have dedicated corners for communicable diseases, specially-abled people and breastfeeding. I thought why there should not be a special room for the transgender people. If the doctors deny them primary treatments, where would they go?"
"During my childhood, my father used to say Mili [Dr Noor's family nickname] is different from others as her choices are not leaner – just black or white. That memory still inspires me," smiled the doctor.
They need 'room no 110' at every hospital
Transgender people usually come to Dhamrai hospital with common colds, coughs, fevers, skin allergies, general and seasonal health problems, according to doctors.
At least seven transgender individuals told The Business Standard that they do not visit a doctor for treatment since they are usually denied treatment by both public and private hospitals. Rather, they go to drugstores seeking the widely known medicines.
"If I have an anal pain, I would go to pharmacies and ask for painkillers concealing the actual case," said one of the third gender people.
Another transgender individual said when they get sick, they seek help from their "Mashi" [aunt] – an elderly transgender person who is responsible to look after a group and gets a major share of the handout. The Mashi then would arrange an appointment with a quack.
"I do not visit doctors as they get scared of us," Beluni Begum, 38, a transgender person of Dhaka's Korail slum, told TBS. As she was told about the dedicated room for the group, Beluni said there should be such a facility at every hospital.
What about tertiary treatment?
Even though Dhamrai hospital provides transgender people with primary treatments, the doctors said they cannot refer critical patients to advanced healthcare facilities owing to their unwillingness and a lack of dedicated treatment corner there.
With a prior appointment over the phone, Anonnya Banik said she went to a private hospital [name withheld] for thyroid treatment in 2013.
"Before seeing the specialist, some common check-ups by the specialist's assistant revealed my hijra identity that led to a tumult of shouting by the waiting patients and medical staff. Surrounded by them, I neither could cry nor retaliate. The incident left me in a trauma for months," Anonnya recalled.
"As humans, we just want your recognition. We are not seeking your favour, or free treatment."
Dr Noor said not only upazila hospitals but also all the medical college hospitals and key health facilities should have arrangements for transgender people.
"They are getting treatment for minor health issues here. But we cannot refer the road accident injured or surgery cases to advanced facilities. This should end," she noted.
The concept transgender denotes or relates to a person whose sense of personal identity and gender does not correspond with their birth sex. Many of them now in Bangladesh undergo surgeries to change their sexual identities assigned at birth.
But the surgeries are not performed officially.
According to Anonnya, the entire medical arrangements are something forbidden – performed only by unknown doctors at lesser-known clinics at around Tk3 lakh. She said the "unscientific and improper surgeries" are prompting several health risks.
Referring to a case who had the surgery at a clinic in Dhaka's Moghbazar, Anonnya said the patient developed infection after the surgery. As the infections worsened, they had to admit the transgender individual to the hospital again.
Dhamrai upazila hospital Gynae Consultant Dr Neher Banu said Bangabandhu Sheikh Mujib Medical University, or Dhaka Medical College Hospital has adequate facilities to perform such surgeries.
"If the operations are regularly performed at the government facilities, their mental woes and diseases will reduce significantly," she noted.
'Keep us safe to protect others'
At Dhamrai, seven people, including some transgender individuals, were recently diagnosed with human immunodeficiency virus (HIV) AIDS that causes concern to Anonnya Banik.
Anonnya, who maintains one kind of liaison among the local transgender group, said since many of them are sex workers, they could end up infecting others if not detected early.
"You should keep us safe if you want to protect others from AIDS," said Anonnya. Apart from the life-threating chronic illness, rights groups have been advocating for bringing transgender people under Covid inoculation campaign.
The government recently brought Chattogram transgender people under the immunisation programme by introducing the "third gender" category on vaccine sign-up web portal.
Dr Noor, however, got the transgender people in the upazila inoculated earlier this year by showing them "women".
Mohuya Leya Falia, programme coordinator at Manusher Jonno Foundation, said all citizens regardless of their gender identities have equal rights to health.
"The government needs to ensure the rights. There should be special orientation programmes for health service providers since many of them are not gender sensitive to transgender people. The programmes should include diseases that the people develop more often and how to deal with the patients sensitively," she noted.
"Shustha Jibon", a non-governmental organisation (NGO) has been working on medical assistances to transgender communities in Dhaka under a project of Manusher Jonno Foundation. The NGO organised a coordination meeting with government officials and stakeholders at Dhamrai upazila hospital, where Dr Noor said separate wards will be designated for transgender people.
Authorities promise support
Samanta Lal Sen, coordinator of Sheikh Hasina National Institute of Burn and Plastic Surgery, said he was not aware that such surgeries were being performed in private clinics.
"If someone wants to have the operation here at the burn institute, I certainly will provide help," he told TBS.
While replying to a query whether the health directorate has any plan to introduce a transgender-dedicated corner at each hospital, health directorate Director General Professor Dr ABM Khurshid Alam said, "Hospitals are responsible to ensure proper care of all, not just the transgender people. If a hospital can arrange a special measure for the group proactively, we will lend a hand to it."