A step towards more LGBTQIA + affirmative medical education does not go far enough

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On October 13, the National Medical Commission (NMC), the body responsible for regulating medical education in India, released an advisory regarding the LGBTQIA + community and the necessary changes in the skills of its human-based medical education curriculum. skills (CBME). The opinion, released under pressure from the Madras High Court, notes that there is non-scientific information regarding the queer community and the subject of virginity in medical textbooks – especially in the areas of psychiatry and forensic medicine. While this is a welcome initiative and a step in the right direction, it is not enough.

Medical education in India has focused only on male and female binary, heterosexuality and cis-gender lives, while excluding homosexuality and non-binary and transgender gender issues. This results in exclusion from the LGBTQIA + community. There is also queerphobic content that has often been denounced. Even with the publication of the competency-based medical curriculum in August 2019, the curriculum continues to include a queerphobic agenda.

Such a rampant queer phobia traumatizes LGBTQIA + students in medical schools, many are reluctant to openly share their queer identities, and many face abuse when they do. Similar experiences are also shared by queer faculty members who also face discrimination in the workplace. Such queerphobic teaching rules out the possibility of future healthcare professionals practicing queer-affirmative medicine which, in turn, affects queer patients who are reluctant to come to them. Our ongoing work in the TransCare Covid-19 and TransCare MedEd projects reveals exactly that.

The NMC notification comes against the backdrop of several recent developments. The Transgender People (Protection of Rights) Act 2019 requires governments to take action to “review medical and research programs for physicians to meet their needs. [transgender] specific health problems ”, but no action has been taken since then. In June 2021, in response to a case filed by a gay couple, the Madras High Court established a set of guidelines and ordered the NMC to ban queerphobic practices such as conversion therapy that aims to force change l sexual orientation of a person. In September, Judge N Anand Venkatesh, referring to a report filed by Dr. Trinetra Haldar Gummaraju, a trans doctor, denounced widespread queerphobia in medical education. A week later, on September 7, the Kerala High Court issued an order requesting the removal of discriminatory and inhumane references to LGBTQIA + people from MBBS textbooks.

In its notification, the NMC advised medical schools to teach gender in a way that is not disparaging to the queer community. Authors of medical textbooks have also been urged to edit the books to remove any harmful content relating to virginity and the queer community. Although the advisory title of the NMC mentions the necessary changes in the skills of its CBME curriculum, there is no specification on what these changes are. At the same time, the CBME program itself mentions queerphobic things that need to be taught to students. For example, being transgender, which is a normal variation, is called a disorder. Sodomy, oral sex and lesbianism are all qualified as sexual offenses even though the Supreme Court has read section 377. In addition, the skills which will make a future Indian doctor respectful and empathetic in the treatment of a homosexual patient are fault. Instead, by putting the onus on medical schools and textbook authors, the NMC is simply shirking responsibility while also shedding any responsibility to make the curriculum queer-affirmative. In addition, the advisory committee set up by the NMC has no queer representation.

The NGC should begin by recognizing the flaws in its own CME program and explicitly state the changes required. Specific guidelines on how to make health care queer-affirmative are needed. Otherwise, such guidelines will only create confusion and indifference, as was created a few years ago by a similar notice on the inclusion of disability in the medical curriculum. The directive should also specify changes in several areas and not just forensic medicine and psychiatry. For this there must be a participatory consultation of stakeholders towards the development of a queer-affirmative curriculum. Finally, there needs to be clarity on what the NMC plans to do to tackle gay phobia in the current set of medical professionals. Without these changes, equitable access to care for queer people will remain a distant dream.

This column first appeared in the paper edition on October 25, 2021 under the title “Un pas trop petit”. Shaikh is Associate Professor, Community Medicine, HIMSR, Delhi and Raghuram is Project Coordinator, Sangath, Bhopal


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