More than just an apple a day

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At 333 Sherbourne st, just south of Carlton and across from Allan Gardens, sits a squat, largely windowless building. Since 2003 the Sherbourne Health Centre (SHC) has operated out of this unassuming location, offering up an astounding array of health and wellness programming, including a slew of services dedicated to queer and trans folks.

Directly to the north, a shiny new glass structure has recently emerged from behind the curtain of scaffolding that has marked the site for more than a year. Formerly the Central Hospital, construction has been underway since 2005 to transform the structure into SHC’s snazzy new digs.

Once the move is completed in mid-March, the second floor of the new building will become a mini Mecca of queer and trans healthcare.

“We’re all gonna be on the same floor, all of the LGBTT [lesbian, gay, bisexual, transgendered, transsexual] services will be on the second floor,” says the LGBTT program’s health promoter Michele Clarke. “I should say all of the LGBTT-specific services, because I think that’s one of the great things we’ve achieved here at Sherbourne is that… everybody has LGBTT clients.” Part of that has to do with the overwhelming response the centre has received since it first opened its doors.

“I think we have the best of both worlds now,” says Clarke, “because when we opened the demand for services was greater than what our staff here [in the LGBTT program] could provide so… all of the service providers have developed clinical expertise in LGBTT health issues. You can come here and if you want the gay-specific health program you can have it and if that doesn’t matter to you, you can see anyone here and know that they’re gonna be knowledgeable and serve you in a way that’s appropriate.”

Queer and trans health aren’t the only areas of focus at SHC. The centre also provides targeted services to homeless and underhoused people as well as newcomers to Canada. While statistics from SHC’s 2006 annual report suggest that roughly a third of the patients who access the centre’s services are doing so through the LGBTT Program, determining the number of queer and trans people who use the facilities is a little more complicated.

“In this area of town a lot of people who are queer and trans want to be identified as part of the general population,” says Sydney Tam, one of three physicians on the LGBTT program. “It’s just nice to have an option of something that’s more exclusive.”

The LGBTT program director Anna Travers, who has been with SHC since before its programs were up and running, says the second floor of the new building will be “a queer space within a queer space.”

So if the whole centre’s so damn queer-friendly, why have the queer and trans-specific programming at all?

“People say, ‘Well, why do you need a gay doctor?’ or, ‘Why do you need a lesbian health program?'” says Clarke. “There are many of us who live our lives in particular ways where that doesn’t matter anymore. Because our social circle or our family support or whatever exists in a particular way so that we don’t necessarily feel that we need queer professionals in our lives to serve us.

“But we forget that many, many people don’t live like that, you know, and don’t feel safe still. And they… want to feel like they’re coming to somewhere that’s queer-specific and just for them.”

Says Travers: “I think it’s nice and that it’s kind of important sometimes to have a very visible symbol and a place people can recognize as a focal point. A hub, if you like.”

Like all of Sherbourne’s programs, the queer and trans team includes a range of health professionals working collaboratively. The team currently includes three doctors, a nurse, a health promoter and two counsellors; there are plans to add a second nurse or nurse practitioner, a psychiatrist and a social worker.

In addition to the plethora of programs and events run out of the centre (see sidebar for details) the LGBTT team offers primary healthcare to approximately 2,500 patients a year.

“Clients could, if they chose to, have everything under one roof — physician, nurse, counsellor — and all these people would be working collaboratively,” says SHC counsellor Carole Baker, explaining that the various team members consult with each other and refer clients to each other where appropriate.

“Our definition of primary healthcare is broader than what you’d generally see in a doctor’s office,” says director of communications Denny Young. “It’s prevention, it’s long-term strategies for mental and physical health, as well as just flu shots and that kind of thing.”

When it comes to accessing core healthcare, having a queer-focussed physician can make a huge difference to the quality of healthcare a patient receives.

“I get calls like, ‘I want to switch over to you because my doc elsewhere said lesbians don’t need pap smears,'” says Tam, “or, ‘I’m really fed up with my doctor because they called my sexuality a lifestyle.'”

Demand for doctors with knowledge of trans issues is even higher, says Travers.

“We’ve had a very big response from the trans community because I think that was a big, big gap and we knew that going in,” says Travers, adding that Sherbourne currently serves more than 400 trans clients.

“As we start exploring care for trans people… we find there’s different ways of doing different things,” says Tam. “We’ve been working to develop a standard of care based on real-world practice, [on what’s] the best way to offer medical treatment to the trans population.”

Tam explains that, in addition to developing protocols around the medical aspects of transitioning from one gender to another, SHC has also worked to find ways to be more sensitive when administering cross-gender exams, such as performing a prostate exam on a trans woman.

“It’s getting your mind wrapped around doing something to someone or for someone that is generally specific to the opposite gender and being sensitive to their needs around that,” says Tam.

“A lot of it is acceptance. We need to accept our patients however they identify or present. Part of it is validation, validating them for who they are without judgment.”

It was the high demand that led to the decision to limit new patients in the primary healthcare program to the 416 area code.

“We were overwhelmed,” says counsellor Rupert Raj. “We had so many trans clients from other provinces, we realized we didn’t have the resources to give care to so many people.”

“We did, about two years ago, really have to take a look at where people were coming from and really make it be Toronto only and not beyond,” says Travers. “That was to do with the large numbers and also to do with the fact that if somebody was coming from Thunder Bay — and we literally had people offering to come from Thunder Bay for that service — then we were not functioning in the way that we wanted to, which was as people’s primary healthcare, meaning the place they came to for little stuff as well as a big things. If they only came once a year for gender-related services then we weren’t seeing the whole process.”

The problem is, there aren’t a lot of options when it comes to referring those patients. As a result, Sherbourne has become involved in two projects that could ultimately change the state of trans healthcare across the country, if not around the world.

The first is the Trans Pulse Project. Launched in autumn of 2005, the project recently received a $300,000 grant from the Canadian Institution Of Health Research, to study the health issues and access issues of trans people throughout Ontario.

“We’re hoping to shift now into doing research and trying to put together good evidence for the needs… of trans people, so that we can be of service in trying to promote better policies and greater access,” says Travers.

The second is the would-be Rainbow Resource Centre. “The idea is it’s more of a behind-the-scenes resource for people throughout Ontario so that they can find materials they might need or assistance in finding local resources…. We’re waiting to see if the ministry is going to choose to go ahead with it.”

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The impact that Sherbourne’s programs and staff have on the quality of healthcare for queer and trans people in Ontario goes far beyond the services provided at the centre. Much of that involves advocacy and training with other healthcare professionals.

“It’s trying to get people to understand sexual orientation and gender identity are determinants of health even if they are not classified as such by Health Canada and other organizations that list such things,” says Clarke. “But they are, right, because we have different health outcomes and different health factors because we’re queer and because we’re trans.

“A lot of our health disparities exist not because we’re queer but because being queer or being trans is a stigmatized, marginalized identity to have in the world. So really, if I could get rid of homophobia, that would improve the health of my communities, but I can’t do that. So it’s a bit of a paradox because you’re working from an individual level when it’s really a systemic issue.”

Clarke isn’t the only one whose work stretches beyond the centre.

“We get calls to do training workshops all the time but we can barely keep up with the requests,” says Raj. “It would be great if we got this resource centre ’cause it would take some pressure off of us.”

“I do get calls from physicians and nurse practitioners,” says Tam, “from across the province and across the country. We want to act as a resource for those in primary healthcare so they can treat their patients within their own communities.”

“There are not many places in North America that do the kind of work we do,” says physician Keith Loukes, who used to have a sex advice show on PrideVision. “We get calls from LA to North Bay. We’re actually sitting out on the world stage which is great.”

“Everyone on staff, they’re stretched for time but they’ll sit on panels or go out and do trainings and things like that, which they don’t have to do,” says Clarke. “But everyone so strongly believes in the health promotion aspect of our work — the education and the research — that that’s just as important as the clinical services that we provide today to the people who walk through the door; that the scope of our work is way beyond just these four walls.”