All genders are welcomed and represented: #KPLantern in Vancouver, BC (Part 2)

This is part 2 of our visit to Vancouver Coastal Health (@VCHHealthcare) to learn about transgender person health and health care as part of the Lantern project. You can read part 1 here: Visiting the Transgender Person Health Program, Vancouver BC #KPLantern.

Prior to being a physician, Gail Knudson, MD (@Gail_Knudson), was an educator (and still is), she told us. This resulted in what I would call a well developed and rich learning experience with a beautiful epiphany at the end.

The characterization of transgender person health is changing – from mental health to health – the organization of services is changing too

Gail educated us on the ways terminology is changing, which you can review on the WPATH web site.

Terms like “Gender Dysphoria,” and “Gender Identity Disorder,” are likely to morph to “Gender Incongruence.” The additional important change is that they will likely leave the world of the DSM (mental health) and transition themselves to be under health, in the ICD-11.

This is super important because it means that the health of this population will span societal sectors and will need to be “non-divided.” This was the comment of Lorraine Grieves, Manager, Youth Addition, Transgender Health, Prism, Harm Reduction and Peer Programs for Vancouver Coastal Health, who is doing an impressive amount of work in community integration.

There’s the C.A.L.L. Out! (Creating Action, Learning and Leadership) program to build the capacity of youth (ages 15-24). There’s work on supporting safer schools based on research, there’s the creation of networks of parents, and youth and adult support groups.

We also learned of a leading edge practice in the United States (sometimes you have to leave the country to find out these things), which is the engagement of Planned Parenthood in offering hormone therapy and preventive health services.

As I mentioned in the first post, there is greater community involvement than ever in the VCH program, and one of the highlights of its services is the Transgender Health Information Program, which has undergone a significant refresh….

Transgender Health Information Program (THIP)

We spent the rest of our day at Three Bridges Community Health Centre, where THIP, Prism, and a portion of the clinical care model is based. The headline quote from Natasha Wolfe and Beth Clark:

For the first time in a year, the phone is answered by a live person.

And..THIP has a beautiful new web site, which highlights an unmet need in many health systems, for comprehensive health education and wayfinding for this population.

We (health professionals) take for granted that there is readily available health education on almost every topic from all over the internet….except for this one, which is why THIP is so innovative. Go see yourself. And not just telephone and web, a lot more.

We also learned about companion services, including the RACE Line (Rapid Access to Consultative Expertise), which now includes transgender health consultation for practitioners. There’s also a listserv that connects providers locally to support each other.

In speaking with Gwen Haworth and Nikki Zawadski from the PRISM program we learned even more about community engagement and education.

Last Chance by Paul Émile d’Entremont, National Film Board of Canada

We know about the estimated 40-60% suicide attempt rate of people who are transgender. We talked about the “long drawn out suicides” created by a society that erodes people’s choices about how they may exist. Prism, and it people work upstream to open choice for people in Canada and people new to Canada. We learned about the significant challenges of refugees in this culture, that are powerfully portrayed in the film “Last Chance.”

Gwen is a filmmaker and introduced us to this piece:

a woman with a past is a short I made about a trans* , intersex women who has experienced a number of struggles in life, here in the Vancouver area


I am quite taken by the film in the way it shows a society parallel to our own, in the cities we inhabit, with people working to find value and resilience.

Some challenges we learned about are the fact that there are an estimated 100,000 people in British Columbia without a general practitioner. There are also not enough GP’s involved in learning and providing this care. In addition, Canada does not yet have a national pharma care program to cover needed medications (even if they are priced substantially lower than in the United States). Such a program is being proposed now.

Three Bridges Community Health Centre

This is where we spent the rest of our day, learning about the clinical care program, which is primary care based – an adult assessed for hormones may never encounter an endocrinologist. We met with nurses (Iona), community liaison workers (Neil), social workers/counselors (Greg) and doctors, specifically Marria Townsend, MD, a family physician and the Medical Coordinator for the Trans Specialty program here.

The model is all encompassing, and in Gail’s masterful orchestration of the experience, it all came together for us on this day, the “world-class”-ness of the care, here, in this center and the other VCH centers – access to local, distributed, personally sensitive, coordinated care that fosters a sense of belonging.

What is not yet world-class yet is the access to this model outside of this health authority. When we asked people what they would most like to see, it was a local surgery program.

Seeing yourself in the people who care for you

It’s hard to tell the staff from the clients and that’s the mark of a good agency – Nikki Zawadski/Gwen Haworth, Prism, Vancouver Coastal Health

Visualize what it’s like to receive health care, or any services of a sensitive nature from people who have never had your lived experience, and you know what this comment means when it comes to building trust.

This is the time that we learned about Catherine White Holman and the Catherine White Holman Wellness Centre. Catherine White Holman (1954-2009) was a social worker, pioneer, and advocate. She held Neil’s current position – community engagement worker – at Three Bridges. In the words of Marria:

She would walk you around the neighborhood. She could teach you how to sustain yourself. She had a passion for taking action. She impacted people’s sense of belonging – Marria Townsend, MD

In her memory, the Catherine White Holman Wellness Centre has been created:

At the Catherine White Holman Wellness Centre, we aim to provide low-barrier wellness services to transgender and gender non-conforming people in a way that is respectful and celebratory of clients’ identity and self-expression. Our centre is volunteer run, and all of our practitioners are volunteering their time, so that we can offer free services to people who need them, regardless of factors like citizenship, health insurance, or residential address.

The practitioners are all volunteer and are in the LGBTQ community themselves.

Innovation happens in out of the way places

Throughout my ally journey, with everyone I meet, I always ask, “why do you this care?” because I realize that for many of these professionals, their lives/careers could be just as rewarding if not more in other ways if they chose not to do it.

KPLantern Vancouver BC 52942Generations of innovation in medicine. Marria, Gail, Nick

The reality is that innovation doesn’t happen in board rooms or c-suites, it often happens in the places where the mainstream doesn’t want to go. This is certainly the story of how Kaiser Permanente was born, and these are the kind of places we’ve found on the KPLantern journey. They are not perfect, but they are incredible.

There are the Catherine White Holmans, the kinds of leaders whose memories bring tears to the eyes of their followers/descendants. And then there are the people being served, who deserve, and are grateful for the opportunity to be (a) human and (b) choose their own destiny. Of course these people choose to do this work, why wouldn’t they 🙂 .

This post is a little longer than usual. Just a lot to learn and share. The field work portion of KPLantern is now complete, and synthesis begins. Dissemination activities should happen sometime this year – I don’t want to speak on behalf of the Innovation Consultancy (@KPInnovation) on this 🙂 .

In the meantime, thanks to Gail, all of her colleagues, the people and organization of Vancouver Coastal Health for being on the journey with the KPLantern team.

Links mentioned in this post, for reference

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Ted Eytan, MD