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The Current Transcript for August 11, 2016

Host: Connie Walker

STORIES FROM THIS EPISODE

Listen to the full episode

Prologue

[Music: Theme]

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I told them, you know, if we don't do this, people are dying. And so the option is: people die or we do this.

CONNIE WALKER: Dr. Dilan Ellegala’s vision definitely met with some pushback, but he was determined to put life-saving surgery within the reach of rural Africans by putting the surgeon's skills in their hands. Dr. Dilan Ellegala on his unorthodox mission to help by handing over the scalpel. And then…

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Transgender people's experiences are really different. It’s an individual experience. There’s no one like, blanket transgender experience. It’s really about listening to individuals in terms of who they are and accepting new people on their own terms.

CW: Laverne Cox of Orange Is the New Black is just one of many high-profile transgender people helping to bring being trans into the mainstream. But for all the recognition and acceptance we've seen in recent months and years, society at large still has questions about what it's really like to live as a trans person. Well, our panel will have a candid conversation held by comedian and trans woman Lara Rae in half an hour from now. I'm Connie Walker and this is the summer edition of The Current.

How brain surgery with a tree saw led to a rethink of medical aid

Guests: Dr. Dilan Ellegala, Tony Bartelme

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[Music]

VOICE 1: This is Haydom Hospital, located in rural Tanzania. It is the closest hospital for 600,000 people and referral for about 2.5 million. Every year, we treat up to 45,000 patients.

VOICE 2: There's a lot of children born in Haydom with a problem of cerebral water that doesn't drain down, so the head is growing big. And without medical help, those children die of cranial pressure.

CW: In rural Tanzania 800 kilometres from the capital Dar es Salaam, the Haydom Lutheran Hospital is a lifeline. Founded by Norwegian missionaries half a century ago, Haydom Hospital serves an immense need. The doctors working at Haydom make medical treatment possible for countless rural Tanzanians, but many of those doctors come from abroad. And when they go back home, they take their skills with them. One American doctor who worked at Haydom decided that there had to be a better way. So Dr. Dilan Ellegala, a neurosurgeon, set about creating a new model—one that would do something to solve the chronic shortage of doctors, and surgeons especially. Dr. Dilan Ellegala is the founder of Madaktari Africa, a health NGO. He's also the surgeon-in-chief at SonoSpine, a spinal surgery centre, and he joins us from Lynchburg, Virginia. Tony Bartelme is the author of Send Forth The Healing Sun: The Unexpected True Story About Teaching Brain Surgery in the African Bush, which describes Dr. Ellegala's quest. He's with us now from Charleston, South Carolina. Hello to you both.

TONY BARTELME: Good morning.

DOCTOR DILAN ELLEGALA: Good morning.

CW: Dr. Ellegala, I'd like to start with you. What kinds of head and brain injury patients were coming in for treatment when you first went to Haydom Lutheran Hospital?

DOCTOR DILAN ELLEGALA: It's really the entire spectrum of neurosurgical disease. So, everything from childhood hydrocephalus to brain tumours to traumas from head injuries to spinal cord injuries. So, everything that we would see here in the Western world, you see in a country like Tanzania. In addition, you see a lot of childhood and neurosurgical problems in infants.

CW: And what kind of help were they getting in Tanzania?

DOCTOR DILAN ELLEGALA: Really, for neurosurgery, not much there at the time, when I first went 10 years ago in 2006. There were two Tanzanian neurosurgeons in the entire country of 40 million people.

CW: Wow.

DOCTOR DILAN ELLEGALA: And if you look at the US or Canada or Europe, there's a neurosurgeon for every 100,000 patients.

CW: Take us back to your first visit there. What were you doing in Haydom at the time?

DOCTOR DILAN ELLEGALA: You know, I had just finished my training and my fellowship. And quite honestly, I wasn't looking to go do medical work. I was really taking a bit of a break and looking for someplace a little adventurous and wanted to live and do a little bit of work there for a few months.

CW: What did you encounter when you arrived?

DOCTOR DILAN ELLEGALA: It's a large hospital serving over two and a half million people and no neurosurgeons and no doctors. At that time, there were no local medical doctors in that hospital and the hospital had anywhere from 600 to 700 patients at the time, all taken care of by what would be the equivalent of physician assistants or nurse practitioners. And then, visiting physicians and nurses from Europe—mostly Europe, a few from America—who would rotate in and out. There were entire wards filled with children with malnutrition. There were wards with adults with neurosurgical problems. They had just gotten a CT scanner the year before, so they were diagnosing the problems or at least taking pictures of the problems. No one really knew what to do with it and there was no capacity to take care of these patients so they all died.

CW: There was no equipment for neurosurgery.

DOCTOR DILAN ELLEGALA: No, none.

CW: And yet, you decided to treat brain injury patients there anyway. Who was the first person whose skull you sawed open in Haydom?

DOCTOR DILAN ELLEGALA: So the first adult was a man. And if I remember correctly, I think he was in his 40s, who had a head injury, had bleeding over the brain and was pushing on the brain causing pressure, causing one side of the brain to shift over to the other. And here in the US or in Canada, he would have been rushed to an operating room. We would have made a hole in the skull with an electric drill. We would have turned a flap, a window in his skull and relieved the pressure. The operation itself would have taken under an hour.

CW: But you weren't in the West, you were in Tanzania.

DOCTOR DILAN ELLEGALA: That's right.

CW: What did you encounter?

DOCTOR DILAN ELLEGALA: There was no electric drill. There were no ventilators. So the anesthetist, the nurses who did the anesthesia, hand ventilated the patient all through an operation. Afterwards, the family would have to hand ventilate the patient until they woke up. In terms of the neurosurgical instruments, there were no electric drills. There were no cautery devices to stop bleeding that we typically use in neurosurgery. And so—

CW: So what did you use for the surgery?

DOCTOR DILAN ELLEGALA: You know, in the old days in the West, we used wire saws. We would use a hand drill. And there was a hand drill in Haydom that we used and we used wire saws to cut the window in the skull.

CW: Where did you get that saw that first time, that first surgery?

DOCTOR DILAN ELLEGALA: One afternoon, as I was taking a walk, I saw a man outside the village cutting a tree limb with a wire saw and bought that from him and sterilized it and used that as our first case.

CW: So you saw a man cutting a tree with a saw and then you—

DOCTOR DILAN ELLEGALA: A tree limb.

CW: And you thought I need to use that for brain surgery.

DOCTOR DILAN ELLEGALA: [laughs] That's right. Yeah. That's right.

CW: What happened? Was it a successful surgery?

DOCTOR DILAN ELLEGALA: It was a successful surgery. He survived and was able to get back to his village.

CW: Tony, I'd like to bring you in here. Now, this shortage of doctors and surgeons specifically is definitely not unique to Tanzania. How big of a problem is this worldwide?

TONY BARTELME: This is a huge, huge public health issue across the world. Roughly five billion people don't have affordable and safe access to surgeons. So, you know, that translates into about 17 million people a year who are dying because of this shortage.

CW: 17 million people.

TONY BARTELME: Yeah, 17 million. This is more—more people who are suffering and dying than AIDS and malaria and TB combined.

CW: Wow. Haydom Hospital is in large part funded by the Norwegian government and there are plenty of other hospitals and clinics in the developing world that are run along similar lines. Who generally are the doctors at places like these?

TONY BARTELME: You have a small number of locally trained doctors supplemented often by a rotating number of doctors from wealthier countries.

CW: Foreign doctors.

TONY BARTELME: Foreign doctors. Yeah.

CW: And how long do they usually stay when they visit?

TONY BARTELME: Most doctors are very busy, you know, in their own country so they come for a week or two and then often turn that into a vacation. And that's been the model for volunteer, you know, volunteer work over the past two or three decades.

CW: And why aren't there more local doctors in developing countries like Tanzania to staff those facilities instead of relying on the foreign doctors who come in and out?

TONY BARTELME: You know, a part of it is: it requires an enormous amount of investment in education. That investment hasn't happened. And also, you know, I think there's a good argument to be made that the foreign doctors, when they come in, they crowd out the organic development of local, you know, medical education.

CW: How do you mean?

TONY BARTELME: So, you know, if you have lots of foreign doctors coming in, taking care of the medical needs in a particular country, there's kind of a lack of an incentive for a country to build their own health care. So in a lot of countries like Tanzania, a lot of the health care has been in the hands of charities and especially kind of religious organizations. A lot of medical missions are funded by religious organizations and also a lot are funded by universities who want their students and their residents to gain experience in some of these, you know, interesting and difficult settings.

CW: But if they can bring their expertise to someplace like Haydom, for example, I mean why—what are the issues with that, in terms of for the doctors and for the patients on the ground?

TONY BARTELME: So a few patients will benefit from that experience. And we shouldn't lose sight of that, you know. However, there have been a lot of studies that have taken a look at the efficacy of medical missions, short term medical missions as they're called, and they found that a lot of these medical missions, you know, aren't as efficient or safe as other models, such as—Mercy Ships is one—and there are some other organizations that have kind of more permanent models of teaching and treating.

CW: Teaching local doctors?

TONY BARTELME: Yeah, yeah.

CW: So what happened to the local doctors who they do train? Do they end up staying in the country?

TONY BARTELME: Well, brain drain is a huge issue internationally. It’s understandable if you gain the skills and you suddenly become very marketable anywhere in the world. You know, we're seeing a lot of doctors from sub-Saharan Africa and elsewhere in Africa, move to Canada, United States and Europe. It's a huge problem.

CW: Dr. Dilan Ellegala, there was something that you noticed every morning at the medical meetings in the Haydom Hospital that brought home kind of the unequal positions of local and foreign health care workers. What was that?

DOCTOR DILAN ELLEGALA: It's the real life example of what Tony just was mentioning, which is every morning in this hospital, all the physicians gather around in the radiology room and go over all the films that have been done overnight and the prior day. And in this room, every morning I walked in, all of the Western and foreign doctors would be sitting at the front of the room. All the Tanzanians would stand in the back. Imaging—would be x-rays, CAT scans—would be shown. The foreign doctors would discuss the problem, the patient, would discuss the imaging, make a plan and after that meeting was over, they would go out into the wards and take care of those patients. The Tanzanian medical staff was still standing at the back of the room and slowly falling out at the end. And you could see how disenfranchised they were from the care of their own people in their own hospital. What Tony was talking about, governments being put in the background when foreign charities or countries or doctors come in to provide the health care, happens on a very local granular level where you see that in the health care workers locally. That then becomes a psychology that is perpetuated within the healthcare workers in that hospital and you see that then in the villages around that hospital as well. I think we're unaware of this happening and that's part of why it happens. It's really an insidious issue actually.

CW: Hmm. Well, Dr. Ellegala, you set out to help try to change this situation initially with help of one Tanzanian hospital staffer named Emmanuel Mayegga. Who is he?

DOCTOR DILAN ELLEGALA: He's a wonderful man. So he's actually a year older than I am, he's—at that time was 37. He grew up in Haydom, in the village. He went to school. He became what's called assistant medical officer, which is—the closest equivalent we have would be a physician assistant. But from my first day in Haydom when I met him, you can tell a surgeon by the way they walk, by the way they talk, by the way they move. And he had confidence, he clearly was hungry and he was capable. And so, after observing what was happening in the hospital, in these radiology meetings, seeing the patients who were, frankly who were dying, because nobody could help them or I could help them or one of the foreign doctors could help them but when we were gone, they would be back to baseline. I sat and thought about it in my room day after day and thought we've got to do this differently. When I leave, if I don't do something different, my being here has really been for very little good.

CW: So what was the difference that you wanted to make?

DOCTOR DILAN ELLEGALA: To leave behind something more lasting.

CW: So what was your goal for Emmanuel?

DOCTOR DILAN ELLEGALA: My goal was that he would be trained to do basic neurosurgery by the time I left. And towards the end of my stay, I realized that yes, this is great to have one person doing this, but what we really need is more. So my goal for him, my goal was to see if he could start training others.

CW: Wow. So this is someone who had a job in the hospital, like a physician's assistant. Had he ever done surgery before?

DOCTOR DILAN ELLEGALA: Yes. So the physician, these system medical officers, these physician assistants actually take care of all the patients. So they do all the general surgery. C-sections.

CW: What about neurosurgery? Had he ever done that?

DOCTOR DILAN ELLEGALA: No. No. Never done neurosurgery.

CW: Did he have a medical degree?

DOCTOR DILAN ELLEGALA: Not a medical degree.

CW: So what made you think he could do it?

DOCTOR DILAN ELLEGALA: My background is academic neurosurgery. I was a professor of neurosurgery. I taught students, residents here in the US, to become neurosurgeons. And after a while, you are able to identify promising individuals who have whatever it is, the drive, the intelligence, the technical skills, the eye-hand control, whatever. I haven't fully defined exactly what those are but he had that. He had it and I could easily see that.

CW: How long did it take before Emmanuel Mayegga was doing surgeries on his own?

DOCTOR DILAN ELLEGALA: About two and a half, three months.

CW: Wow. How long had you trained to become a neurosurgeon?

DOCTOR DILAN ELLEGALA: [chuckles] After medical school, eight years of residency and another year of fellowship.

CW: Wow. So you taught him the skills that you felt he needed to do the surgery after you left. What happened when you left?

DOCTOR DILAN ELLEGALA: He kept doing surgery on his own. He started to teach the first Tanzanian MD at that hospital to do neurosurgery as well. We kept objective data of what his outcomes were. When I went back for the second time a year later, he came up to me. As I walked into the hospital, he came up with a big smile on his face, gave me a hug, took me into his office to show me a CAT scan, before and after surgery of a patient just like I had done when I first got to Haydom, of somebody who had had a head injury, bleeding around the brain and he had done the craniotomy, removed the window bone, taken out the blood. He brought the patient in, who was stone cold normal. You could barely tell he had an incision in his scalp and it was one of the proudest moments I've ever had and you could see the pride in his face too.

CW: He saved his life.

DOCTOR DILAN ELLEGALA: He saved his life alone without any foreign doctor to help him.

CW: So you did a study about how well Mayegga’s patients were doing. What did you find?

DOCTOR DILAN ELLEGALA: We actually compared his data to what was happening in the nearest large neurosurgical centre which is in Nairobi, Kenya. And the neurosurgeons there reviewed the data with me and they agreed that it was comparable to what they were doing there.

CW: What kind of pushback did this “train first” model, as it came to be called, get from other surgeons initially?

DOCTOR DILAN ELLEGALA: Initially, there was a lot of controversy around it. My mentors here in the US actually called me and said Dilan, what are you doing?

CW: How did you answer them?

DOCTOR DILAN ELLEGALA: [laughs] Well, I told them, you know, if we don't do this, people are dying. And so the option is: people die or we do this.

CW: What about other surgeons in Africa, specifically? Did they have a different reaction?

DOCTOR DILAN ELLEGALA: The surgeons in Kenya initially had the same reaction of: this is terrible. You can't train non-MDs to do neurosurgery. In fact—

CW: Have those reactions changed now?

DOCTOR DILAN ELLEGALA: It is. So, I actually invited the head of neurosurgery in Kenya to come to Haydom and the neurosurgeon in Dar es Salaam, Tanzania and the neurosurgeon Moody Qureshi in Kenya, came to Haydom and actually saw Mayegga operating. They operated with him. They looked at the outcomes data that we had. And at the end of their stay at Haydom, they said this has been a paradigm shift for us.

CW: Tony Bartelme, how much traction is this “train first” idea getting now?

TONY BARTELME: Well, I think you're starting to see some pretty well-organized groups creating these sort of “teach first” types of programs. So, I think, you know, we're heading—we're starting to head in the right direction now.

CW: Dr. Ellegala, you have obviously specific goals for helping to improve the number of local doctors in Tanzania. But what is the key message that the medical community should take from your experience there?

DOCTOR DILAN ELLEGALA: The very core of what we're doing or what's happening: by teaching people to be independent, we're changing the way they think about what's possible. And it's opening up a world of possibilities that never existed before because of the mental constraints that we, all of us, have. And so if you ask what is it that this is really doing, that's what this is really doing. And if you look at the three people we trained initially in Haydom, one became the first local Tanzanian medical director of the hospital. The second ran for parliament and the third, Mayegga, is now looking at becoming an ENT physician, surgeon. And I think it's really getting rid of the boundaries that we impose on ourselves mentally about what we believe is possible.

CW: Well, it's fascinating. Thank you both for joining me this morning. I appreciate it.

TONY BARTELME: Oh, it's my pleasure.

DOCTOR DILAN ELLEGALA: You’re welcome. Thank you.

CW: Dr. Dilan Ellegala is a neurosurgeon and founder of Madaktari Africa, an NGO that promotes the “teach first” model of medical aid in Tanzania. He joined us from Lynchburg, Virginia. And Tony Bartelme is the author of Send Forth the Healing Sun: The Unexpected True Story About Teaching Brain Surgery in the African Bush. He was in Charleston, South Carolina. I'm Connie Walker and you're listening to the summer edition of The Current.

ENCORE: Transgender Canadians discuss acceptance in 2016

Guests: Lara Rae, Meryn Cadell, Alex Abramovich, Ella

CW: Hello, I'm Connie Walker and you're listening to the summer edition of The Current.

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So for the people out there wondering what this is all about, whether it's about courage or controversy or publicity. Well, I'll tell you what it's all about. It's about what happens from here. It's not just about one person. It's about all of us accepting one another. We're all different. That's not a bad thing.

CW: What a difference a few years makes. Thanks in part to high-profile people, such as Laverne Cox, Janet Mock and Caitlyn Jenner, transgender people are more visible in today's world than they've ever been before. But as Caitlyn Jenner suggested there at the ESPY Awards, there is still plenty of confusion and ignorance: people wondering what it really means to be trans. So in January, we convened a panel of transgender people to talk about their experiences, misconceptions they'd like to see corrected and the questions they wish people would just stop asking. Lara Rae hosted the panel. She is a stand-up comic, a comedy writer and the artistic director of the Winnipeg Comedy Festival. She's also a trans woman who came out last summer. Lara Rae was joined by three guests. Meryn Cadell is a writer, educator and friend of Lara’s. Alex Abramovich is a post-doctoral research fellow at the Centre for Addiction and Mental Health and the third guest works in the fashion industry in Toronto. She asked to keep her name private so we called her Ella. Here's their conversation.

LARA RAE: I want to talk to you about how things have changed and so let's start by putting it out there. What are the things that people say or do most frequently that offend you? Meryn?

MERYN CADELL: I must say generally I find a fairly easy time but I would say it's mostly questions about the body, the kinds of questions that no one would ever dream of asking anyone else. And Laverne Cox actually, and Janet Mock have handled this very well in an interview, I think with Katie Couric. No one would dream of saying so what are your politics on, you know, wildlife preservation and so, and your vaginal lips, are they large or not like—you know that kind of thing?

LARA RAE: Of course not. No, it’s disgraceful.

MERYN CADELL: In fact, the moment you say that you're transgender, if you're talking about that, they'll say very succinctly, like so do you have one? Are you going to get one? It's all about the having or the getting.

LARA RAE: Yeah. I remember, you know, when I was still male and came out as gay and I had a transgender male partner and we were in the hospital. And my partner was quite sick and the surgical resident says so you're a couple. How does that work? And then started asking a whole bunch of inappropriate questions. What about you, Alex?

ALEX ABRAMOVICH: Yeah, I have to definitely agree with Meryn. It's just the questions about the body that I get quite frequently. Bumping into an old colleague, you know, in the hospital that I work at, walking down the hall, haven't seen the colleague in a few years, the first question is, first statement is oh wow, you look great. So have you had the surgery? And it's like first of all, what surgery?

[crosstalk]

LARA RAE: Yeah, there are many.

ALEX ABRAMOVICH: There are many different types of surgeries that trans people can have.

LARA RAE: We know that from Caitlyn Jenner.

ALEX ABRAMOVICH: Absolutely.

LARA RAE: [chuckles] You can never stop.

ALEX ABRAMOVICH: But I know what they're asking when they ask you have you had the surgery?

LARA RAE: Yes, of course. They’re asking about you know, in the case of female, and male to female, some bottom surgery. What is your genital configuration?

ALEX ABRAMOVICH: Absolutely. And so they think that it's okay to ask these questions about the body and then as well as, I've had an extremely difficult time navigating the health care system as a trans person. And so, with doctors, you know, it's like the minute they find out that I'm trans, they automatically start using female pronouns for me, even though I present as male and I don't go by male pronouns.

LARA RAE: I know. I'm kind of shocked at the health—I heard the duty nurse say I don't believe in the whole transgender thing. I don't believe in it.

MERYN CADELL: Oh, I’ve heard that one too.

LARA RAE: It’s like, oh, I don’t believe in cancer. How about you, Ella?

ELLA: I think I have to say definitely, you know, asking questions about the body, so saying oh my gosh, like is that real? Is your face real? Is your nose real? Is your cheeks real? I'm like yes, they're all real. I haven’t had surgery on my face. A lot of questions definitely about, well, dating for example, like oh my gosh, does that make me gay? Am I going to get some crazy disease? Like you know, like there's always this like, weird perception that, you know, we are so different and we're so weird and it's scary to— especially with dating, I think like as like a post-op trans woman, dating is definitely something that is challenging and really difficult. But I think every day, definitely people are always shocked like oh my god, really? And they'll try to find something wrong, either it’s your voice or—

[crosstalk]

LARA RAE: Oh yeah, they’re looking for clues, right?

ELLA: Something that’s manly or feminine or something that’s definitely prominent that makes you trans. It's like why? Just look at me and that’s it.

LARA RAE: They try to find the old person in you—

ELLA: Exactly.

LARA RAE: —as soon as they find out. You can see that look. It plays into kind of a stereotype that has passed. That's the idea that we are defined as a particular gender, by our gender, or that legally or medically, we don't become that person until we have this surgery. But we are now in a place thankfully, where our gender is something that we own and declare ourselves. This is, I think one of the reasons politically—

ELLA: I completely agree with that. I mean, a lot of people would say wow, you're a woman now. It's like no, before my surgery I was definitely a woman. For me, like my journey, is not complete I would say. It’s just starting in some ways and complete in some ways.

LARA RAE: Now Alex Abramovich, you had a different experience, maybe than these two, but very similar to me where you kind of came out twice, right? Once as a queer person and then later as a trans person. I did that three years ago. I came out as gay male and then as a trans woman. How were those experiences different for you?

ALEX ABRAMOVICH: Yeah. So, I came out as a lesbian in my early 20s and during that time, I didn't think that it would be possible for me to even come out as trans. It wasn't something that really occurred to me. I don't think I had enough knowledge so what felt right to me was to come out as a lesbian. I had an extremely challenging coming out experience during those years and you know, as a result, it did lead me to the work that I do today, which focuses on LGBTQ youth homelessness. I came out as trans during the second year of my PhD when I turned 30 and that was challenging in a whole different way, right? So coming out as a lesbian had its challenges, coming out as trans was a whole other—lots of other challenges that came along with that. And for me, what was most challenging was that I was working in a professional—in a hospital environment.

LARA RAE: Where you would think, you know—

ALEX ABRAMOVICH: Where you would think it would be a professional environment. I was working in a downtown busy Toronto hospital and I was working, I was completing my PhD at the University of Toronto. And so the transphobia that I dealt with was very much sort of institutional in the workplace.

MERYN CADELL: In the 90s, and because I had a certain amount of notoriety and people tended—there was at the time, the Queer Nation idea of pushing people who were “closeted” to come out. I faced a lot of, you know, you should come out already. I was lambasted at The Advocate, a whole page of The Advocate about what a liar I was. I remember being so hurt about it because I was doing all that I could to say this is who I am, I didn't know yet the gender piece. So I was with men as I am now, mostly with men. And yeah, there was no other way to consider it. And I faced a lot of—I was kind of one thing, an odd sort of satisfaction when I came out as trans and transitioned, it was sort of like see, I told you I was queer. You know what I mean? It became something I could more identify, more describe correctly, finally.

LARA RAE: Yes. No, it's very true. How about you, Ella?

ELLA: I think it's different in a sense like when people again, when women, I think there's different reactions. So there's been positive and negative for sure. With women I think, you know, with friends, it's either oh my gosh, like thank you so much for telling me after so many years. I mean I've lived a life for seven, eight years when I'm just a normal girl let's say, whatever that means. And people had no idea. And when I did finally decide to, you know, come out and tell people that, you know, like I'm actually a trans woman. I'm just not a regular girl who just walks around and is in fashion. I'm actually different and I'm proud to be different now.

LARA RAE: Mhm. Well, that's wonderful. I mean, you know, and I have to say this is the radio. I mean, you know, I'm very early in the stage. I mean, you know, I think it would be fair to say. I mean, first of all, you're extremely beautiful but I mean, you know, nobody would think that you were transgender.

ELLA: Thank you. I appreciate that. It just took a lot of confidence, a lot of work, a lot of effort to get here. And that's—we were talking about the whole LGBT community earlier. I definitely did receive some backlash there too. I've had a lot of people, you know, kind of say like oh, you're just beautiful, like it must be so easy for you. No, it wasn’t.

LARA RAE: No.

ELLA: I’ve gone through the same thing, same challenges. I've worked hard to get where I am. I put myself through university. I was homeless before. I worked really hard to get where I am and it takes time, it takes effort. And it's also the people, you know, around you that could either build you or put you down. So yeah. It’s been a wild ride, let’s say.

LARA RAE: Absolutely. And the support is so important. You were saying, you know, as part of your studies, that suicide rates drop by about 93 per cent when people have a good support network.

ALEX ABRAMOVICH: Absolutely. So we know that the rates, Trans PULSE Study, which is an Ontario study that looked at trans people, the health of trans people in Ontario, found extremely high rates of suicide amongst transgender people in Ontario. But that the rates of suicide decreased by 93 per cent with strong family support. So we know that that is critical—

LARA RAE: The person themselves doesn't want to necessarily end their life. They just don't want to live the life that they’re put forward.

ALEX ABRAMOVICH: Absolutely and that support is just so critical and something back to what Meryn was saying, was that in terms of the lesbian community not accepting trans men, right? I know that when I came out, I lost a lot of my lesbian friends because it was like you’re joining—

LARA RAE: Yeah, yeah, yeah.

ALEX ABRAMOVICH: You’re just too pretty. You’ll never pass as a man.

ELLA: Join the dark side.

LARA RAE: You know the one that I got, it’s almost humorous because you know, as a male, Meryn, you know me. I asserted myself.

MERYN CADELL: Yes.

LARA RAE: There’s a word that begins with “A” for you know, how I behaved sometimes, with my white male privilege. But you know, I’d be standing at Shoppers Drug Mart for instance, and I’m in the line— and this would never happen when I was standing kind of manspreading, you know, waiting to go up—that a man will just walk in front of me like I’m not there and I’ll say I was there first. And I realize he literally didn’t see me.

MERYN CADELL: Mhm. Welcome to invisibility.

LARA RAE: Yeah, yeah, yeah. And I want to be invisible in some ways in the sense of just looking like a normal woman. But that invisibility of just not mattering, you know, is something that you know and you learn very quickly.

MERYN CADELL: Can I just say one thing, Lara?

LARA RAE: Yes.

MERYN CADELL: I was just thinking back to something that Ella said. I don’t know, it would be interesting to hear other people’s opinion on it. When you talked to Ella about how beautiful she is, which she is, and also thinking back to the discussion about surgery, trans people amongst themselves, once they know each other, may talk about their surgeries and the angst around doing them and the complications and that sort of thing.

LARA RAE: Yes. Yes.

MERYN CADELL: And the same I think is true of how trans people’s friends will talk about passing—which is a word I loathe—but that idea of how one is doing, how one is looking. But the reason I raise it is because I think it's true, correct me if you feel otherwise, that generally speaking, it's not something that—if we're talking sort of about what people say that bothers other people, it's kind of not cool for someone who isn't a dear friend and possibly only a friend who’s trans to say oh, you're looking great. You would really pass but your hair's too long. You should take her earrings or whatever, that kind of advice is completely unsolicited.

ELLA: I completely agree with that. It's like, you know, maybe not that pink hair today. It’s not fair to the person because you know what, sometimes, you know, when you're just transitioning, I mean, even me. Like when I first started when I was, I think like 14 or something, and when I fully transitioned, I didn't look the part. I looked probably crazy. But it's not really fair for someone to say like oh, like you should do this. I mean, there's different ways of giving advice but to be like yeah, maybe you don't fit right and let's try to be the cookie cutter woman. I don't think it's fair. Everybody is different in how they present themselves, how they want to be their own trans.

LARA RAE: Mhm. Now, with all the wonderful things that are going on, you know, Transparent, the show and you know, Orange Is the New Black and Caitlyn Jenner and so on. You know, I say all the time, we’re all the rage. There was this collector's magazine that I saw, you know, with all these transgender people on it. I couldn't believe this world would exist when I was young so we must celebrate that. But because we're now so public and then we’re becoming—and you know I'm a comic so I'm very hyper aware of this—we become, you know, the butt sometimes or just the reference point for jokes. And here's one very recently and this is Ricky Gervais. So let's take a listen.

SOUNDCLIP

As I say, I'm going to be nice tonight. I've changed. Not as much as Bruce Jenner obviously. Now Caitlyn Jenner of course. What a year she’s had. She became a role model for trans people everywhere, showing great bravery in breaking down barriers and destroying stereotypes. She didn't do a lot for women drivers. But you can’t have everything, can you?

LARA RAE: So there you go and there's two things to observe. One is that he made the joke and two that the joke worked quite well, right? So it was accepted right, by the dominant culture. So I mean, we deal with this all the time, and so did you guys have anything to say?

ALEX ABRAMOVICH: I guess my first reaction is just that I think that there are certain, you know, thoughts and comments that should be left in your mind and you don't need to share. Like just like what we're talking about today, certain questions, and I think that it's time that people just come to understand, you know, what is appropriate to ask and what is inappropriate to ask. And I think it's good to, you know, sort of think before you ask a trans person or make a comment: would I say this to a cisgender person?

ELLA: Exactly.

LARA RAE: Meryn?

MERYN CADELL: Yeah, I have—I mean, Ricky Gervais certainly is an equal opportunity.

LARA RAE: Absolutely.

MERYN CADELL: And it's hilarious, isn't it? They brought him back after a few years and said because we love his generous, fun loving spirit—because they literally said never again, he will never host the show again, so that's funny. Yeah, I guess. I mean, it's just already, I think, Caitlyn—those two words “Caitlyn Jenner” have already become—I think in the comedians’ world—it’s already passed. That’s already sailed.

LARA RAE: Absolutely. It’s old news. And you know, I have to say compared to years ago, and I mean, I always began as a comic and obviously I have to have some latitude as a comic. You know, and he’s a shock comic, so he's doing what he's supposed to do as a job, right? But I mean it is important to kind of realize that, you know, you can't spend your whole day worrying about what jokes people are making and so on. But there’s certainly less transphobic than they used to be. I mean, even Ellen made a terrible joke a few years ago, you know, on one of those award shows, that was about Liza Minnelli looking like a transgender woman. You know, kind of basically saying she looked like a man, right? And so, you know, we're definitely moving forward. You know, and then I always begin with the idea. I mean, do we honestly think that Ricky Gervais as a human being, is a transphobic, homophobic person? I don't know. I don't think so.

ELLA: I think we do have to be careful with the jokes. I think as time progresses, I mean we can obviously, you know, I think, do those kind of things more often, especially in media. But I think because trans, the way it's portrayed in media, it tends to be really bad. Like the word tranny is used a lot. Yeah. It makes me shiver.

LARA RAE: Oh no, it’s gross. But often, you know, when you know what the media does, it's simplified too. And this is why where we can come in, I think, to share our stories and stuff and help educate people in kind of a gentle way. Now, we started this conversation asking you about things that, you know, that are offensive and so on. I hate being misgendered for example. Just don’t say anything, you know? But I'd like to know some of the positive things people have said to you since you transitioned. I’ll start, which is that people have e-mailed me and said you know, when you did this big thing, I realized there was something in my life that I wanted to do that wasn't quite as big—change my job or leave my husband or whatever it might be—and it gave me the courage to say, you know, maybe at 52, I can do something. You know, there's a next chapter for me. You know, they used to say there's no second acts in American lives but I think that you know, I think there are and this is definitely a second act for me. What about you, Meryn?

MERYN CADELL: Something that was said early on to me, my mother's friend. You know, my mother obviously went through some difficulties. All parents do, I think, even just trying to re-imagine someone that they've known literally since they were born. But a friend of my mother’s said you make a wonderful man, Meryn, which is a lovely comment. And then my sister, quite a while later, when she said, you know—this was a couple of years later—I mean, she said I was thinking about you and I realized Meryn has always been a middle-aged gay man. So it was perfect.

LARA RAE: [laughs] Alex?

ALEX ABRAMOVICH: So I've worked with young queer and trans people for a long time now, who are experiencing homelessness. And so, actually during one of the interviews, a young trans woman said to me you're trans, aren't you? Well, what do you do when people stare at you on the subway? And you know, she was really struggling. And I had never come out as trans until that moment where I thought okay, well, here's an opportunity for me to maybe be the role model that I never had growing up, that I never had when I was in academia. And so that prompted me to come out as trans and so I think the greatest thing has been to be able to be a mentor and just a role model for younger people.

LARA RAE: And Ella?

ELLA: I didn't have trans support or really anybody to look up to when I was young. I kind of, I guess, did it on my own. And for me, like I really want to now I think, as I'm getting older, really be a support system, be a role model and be a voice to people who don't have one or who can’t have one.

LARA RAE: That's great. And you know, I learned something so I hope the listeners did too. And good luck and love to you all.

MANY VOICES: Thank you. Thank you very much. Thank you so much.

CW: Meryn Cadell is a writer and educator. Alex Abramovich is a post-doctoral research fellow at the Centre for Addiction and Mental Health and the guest we identified as Ella works in the fashion industry in Toronto. We have kept her real name private. They all spoke with The Current’s guest host Lara Rae in January. Well, a year has passed since Lara Rae came out as a trans woman. We checked in to see how she was doing. She says the last eight months have been the most challenging time of her life and she is now fearful of leaving Canada to travel. But she also shared some happy news. Lara says she was recently accepted on the waitlist for gender confirmation surgery which leaves her “electric with excitement.”

[Music: Ending theme]

CW: That’s today’s edition of The Current. I'm Connie Walker. Thanks for listening to the summer edition of The Current.

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August 11, 2016 full episode transcript

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