Trans Healthcare in Indonesia

In this episode, we’ll be talking about something a little more complicated. Trans healthcare in Indonesia. It’s already a tricky subject, but if the health bill passes, there will be a lot more risks of criminalisation and imprisonment, not only for trans people but also for the health care providers and the rest of our allies.

https://open.spotify.com/episode/2AXu1NC9MDUJd713qbrecb?si=82923007e0884338

INTRO

Welcome to New Naratif’s Southeast Asia Dispatches. I’m your host, Bonnibel Rambatan, Editorial Manager for New Naratif. New Naratif is a movement to democratise democracy in Southeast Asia, and this podcast is one of the ways we attempt to do just that.

On May 18th, we released an episode talking about Indonesia’s new Health Bill that is currently being proposed. The Indonesian government has been criticised for their hasty process and lack of access to information for the public. It’s problematic, to say the least, and while some activists are seeing opportunities for reform in this Bill, its potential for harm is nothing to scoff at.

We’ve talked at length about the bill itself, so if you want to learn more about it, please listen to our May 18th episode titled “The Fight for Reproductive Rights in Indonesia”. You can do that after this one, if you’d like.

https://open.spotify.com/episode/36dQQXL5fOHoOfvXbiZR4T?si=a267a20fe1264240

In this episode, we’ll be talking about something a little more complicated. Trans healthcare in Indonesia. It’s already a tricky subject, but if the health bill passes, there will be a lot more risks of criminalisation and imprisonment, not only for trans people but also for the health care providers and the rest of our allies. It’s bleak, although, as always, we do our best to try and keep things hopeful.

SPEAKER INTRODUCTION

My name is Mario Pratama. You can just call me Tama. I’m from Indonesia. I’m working with Transmen indonesia as Program Director.

That is Mario Prajna Pratama. Tama is a feminist LGBTQIA rights advocate from Indonesia, known for pioneering Indonesian trans masculine movement and for his persistence in mainstreaming trans and gender identity issues among LGBTQIA communities, feminists, and various social movements. He has been working with grassroots trans and queer communities since 2008, specialising in knowledge building, advocacy, and programme management.

Hi everyone, I’m Riska. Now I’m working at Crisis Response Mechanism Consortium and I’m also at SGRC Indonesia that focusing on the sexuality, research based on youth people.

That is Riska Carolina. Riska is currently the Crisis Response Staff at Crisis Response Mechanism (CRM) Consortium. She is the coordinator of sixteen community paralegals in nine provinces in Indonesia for handling LGBTQIA-related crises. Another advocacy that she is currently focusing on is to abolish the SOGIE Change Effort, which has been targeting more of the LGBTQIA community in Indonesia.

So here goes. Our episode on trans healthcare in Indonesia.

INTERVIEW

LGBTQIA+ & Indonesia’s Health Bill

Based on your understanding and what you’ve seen so far, why do you think we have to really care about this health bill?

Riska Carolina

From my own perspective,

This bill is very heteronormative, especially for reproductive health, is only limited to the man and woman in a binary way and is not flexible to the interpretations.

Considering the regulation in Indonesia excludes transgender people and a nonconforming person, it will be huge gap to get the sexual and reproductive health, for instance, or the mental health aspect on this bill.

Because if we’re talking about the health bill, so we will talking about the whole four aspect of the health that will be neglected by those policy maker.

Community Awareness

Yeah. So it’s quite clear then that since as you mentioned, the bill is very heteronormative, it’s very binary normative, but in that sense also there’s a lot of risk for queer people, for non binary people, for trans people as well.

But I want to move on to Mas Tama here. How much do you think has the community of the LGBTQIA community in Indonesia, how much have they understood about this bill, if at all?

Mario Prajna Pratama

Actually, I can say that we don’t know about this bill. It’s only like small number of us who are probably active in the organisation or activism who recently just heard about this bill.

So the community, they have not heard about this at all because it was even shocking for me and my organisation to hear that the House of Representative came up with this bill. So we had no idea at all.

To answer your question about why it’s important to understand about this bill, because basically it affects our lives, as simple as that. Especially with me and other trans community, because I’m a trans man working with trans men community in almost our daily life, we are asking about our rights to help, about discrimination that we got in all aspects of health.

And then when I read the bill, I feel like oh shit, this is going to put even more effect to us in a negative way. So it is affecting our life. So therefore, we need to care about this. We need to pay attention on this bill.

Yeah. Kak Riska, do you have anything to add?

Riska Carolina

This bill says something about the normative values. It means that, well, queer people basically against the normative value that uphold in value of Indonesia. The queer people are there in the culture in Indonesia.

The problem is that some people say that the normative value of Indonesia, it will be not considered the people, especially for this bill. It will become more barrier will be intake for the transgender people. That’s what I want to say, especially in my expertise. This will be lots of for the healthcare system because it’s so binary, it’s only for women and men that did not include the transgender people that have the probably different aspect of health in this matter.

So it will have huge gap for the transgender people and the non conforming individual.

Current Trans Healthcare

Yeah, definitely. I think we talked about this in the last episode when we talked about the health bill also that since looking at the law, looking at healthcare, especially under normative lenses, under lenses of like when we talk about values or anything instead of actually saving lives is very detrimental.

But let’s roll back a little bit and just give the listeners a better idea of what is the current situation since the health bill is under discussions and stuff like that.

What is the current discussion of healthcare, particularly for the queer community, the trans community especially maybe Mas Tama would you like to take this?

Mario Prajna Pratama

Trans people are so far away from accessing health care. So it’s not only about transition, transitional care, transitional related health care, but in general.

Like, for example, many trans people do not access health care services on daily basis because we need to show our ID card.

And then it means, like, we have to be out to explain that we are trans. And then we get discriminative attitudes and services. People laugh at us, they call our name in front of other patients, things like that.

So many trans people do not want to go to access the healthc are even though they are in need. For example they get like panic attack or even they got problem with the heart and cholesterol. So it’s just big no, that’s the first situation.

The second one is also many trans people but trans men, trans women or even like all the non binary folks cannot even afford to go to access the health care services. Why? Because many of us lives under poverty, we cannot afford to put some money to access the health care and we do not have the access to health insurance as well. So that’s the second current barrier.

And then also when we talk about health care related to transition not so many health care providers want to provide that. Many health care providers do not even understand about trans issues, what are trans, what are the needs and then so that when it comes to transition also even if the doctors have the capacity to do that they are afraid to be criminalised or they are afraid to be rejected by other professional health providers.

So it’s like we have to access the health care related to transition under the table. So it’s like we are hiding, we pay a lot to get the access that we need because it’s so limited. So then some hospital or clinics then raise the prices because they know it’s not available, the health care is not available, the services are not available so they raise the price.

So we have to pay way more compared to folks who lives in other country who have the open access to transition related care.

Health Care Opportunities

Yeah, this is extremely relatable for me as well because every time I try to access health care services I always try boy moding, I always try to just appear as a man and then people just get confused and all of these hassles that I’d really rather not work with.

And also another side effect of transitioning that I did not expect would have is that I’m becoming a lot more knowledgeable about my own body, about my own health, about my own endocrine, yeah, my endocrine system and stuff like that.

There’s a joke among some of my trans friends which is like every trans people are basically forced to become their own endocrinologist to understand about hormones and stuff like that. But yeah, obviously that’s not ideal, right? It’s not bad obviously to learn more about your body.

But it shouldn’t be like that. It should be the responsibility of health care providers, of the government, of the doctors and everything else.

How do you think the health bill affects this? I mean, the current situation is already bad, right? But with the health bill, there’s a risk that it’s become worse.

But there’s also, I think, if you think there might be opportunities for us to push for better health care services, health care providers, what do you think?

Mario Prajna Pratama

I don’t think the bill opens up more opportunities for us, trans folks or queer people in general, because, for example, in this current bill, they already put the non-discriminatory value in the bill. But they do not mention specifically, like, for example, nondiscrimination based on sexual orientation and gender identity. So that’s the first one.

So we are already not included in that sense. Also, when they mention about vulnerable groups, we are not there as well, like people who are considered vulnerable.

And then I think the most scary one is that there’s an article which says specifically about plastic surgery in which in the explanation of the bill, it mentioned that reconstructive and aesthetic plastic surgery is not aimed at changing gender. It also mentioned that change of sex can only be done by court decision in accordance with statutory provisions. So it’s a new thing and it’s very restrictive.

In the current situation, the services are not open, it’s almost not available, but it’s not criminalised, it’s not restricted. But in the bill, it is openly restricting gender transitional health care. If your question is will it open up more space and opportunities for us?

I’m afraid not, yeah, which is really sad. It’s really difficult. But also for it to be explicitly criminalised. Not only that, even if the understanding of surgeries as purely aesthetic, as purely cosmetic, that’s already problematic because for most of us, for a lot of us, that’s a life or death because it has to do with severe mental health issues and stuff like that. And for it to be explicitly right there criminalised, that’s really bad.

Unseen Layers

I want to ask Kak Riska though, in your line of work, because you do lots of crisis response, right? Have you dealt with all of these, the consequences of these terrible healthcare system for trans people and for queer people? Yeah, definitely. They have some pretty bad detrimental effects.

Have you dealt specifically with crises involving these?

Riska Carolina

If we’re talking about the healthcare system, there are several barriers. For instance, like how difficult for the trans people to get the access for the healthcare system, and because lack of the ID, for instance, and also the questioning of their gender, like Kak Tama said.

And also there’s a growing number that talking about the aspect of rehabilitation. I don’t want to give the idea for the government to include those into this bill. CRM has been with those. Several of the cases mostly is about the social protections that related to the healthcare and also about decriminalisations for the people that provide the care services.

But again, they don’t have the education for that. They don’t practice health care for their entire life. We’re talking of the very structural operations for the trans people to get the education to become a doctor or something like that. There’s a lot of layer that did not see by the government about this kind of case.

Yeah, so it’s not just dangerous for trans people but also dangerous for the allies because when we want to help, when we want to the health care providers themselves get criminalised. That’s really bad.

Riska Carolina

Right now, lots of the provider that gave their care for the trans people silently but because of this bill they will be scared to perform or give the services. Oh, God. And also, if I can add a little bit for the vulnerable groups that mentions because if we’re talking about the article that will be affecting the especially for the trans people.

We have two issue actually that will be directing for the trans people in this bill talking about the vulnerable groups, the anti discriminations and so on. Well, Sharia law also mentioned the human rights, talking about the nondiscriminations but still they whip their victim, they torture the perpetrator in Ache for instance. This will be lots of persecutions.

And again, for the second article, we’re talking about the aesthetic. And if I can mention about those article like two, like any person who deliberately perform reconstructive plastic surgery and aesthetic that is contrary to the prevailing norm in the society and aims to chase identity with the aid law and committing be punished for the fine for a maximum of ten years and a fine of the category six. It will be IDR 200 million.

And the article seven and paragraph two constructive plastic surgery and aesthetic might not contradict the prevailing wrong society are not aimed at changing identity with the intention of breaking the law and committing crimes.

But again in their explanations in the bill that what is meant by the changing identity includes changing faces, gender and or fingerprints. Gender, okay.

Direct reconstructive and the aesthetic plastic surgery is not aimed at the changing gender but rather at adapting cell to the actual sex the impact for the transgender woman or the transgender people this article creates a legal barrier and potential punishment for the transgender people for seeking reconstructive plastic surgery to align their physical appearance with their gender identity.

It may divert them from the access essential medical procedure and force them gender dysphoria which can have severe psychological and emotional consequence by explicitly mentioning gender again, this paragraph restricts transgender woman’s ability to undergo gender affirming surgery that may involve genital reconstruction.

It implies that such surgery are against societal norms and could as attempting to pilot the law. This put transgender woman, transgender people sorry at the disadvantage by denying them to the necessary procedure to align their physical appearance with their gender identity.

And last, this article creates legal obstacle for the transgender people for seeking gender affirming surgery and potentially criminalised individual that involved in the performing or undergoing such a procedure.

They perpetuate discrimination, reinforce societal stigma, and deny transgender people the right to access necessary health care to alleviate gender dysphoria. Such a limitation can be severe psychosocial, emotional and physical consequences for the transgender people.

It will impacting their overall well being and human rights. It is important, inclusive healthcare policy that support the transgender individual in accessing the medical care that lead to gender transition. Sorry, it’s a little bit fiery, but I want people to understand this will have a huge impact for the life of my friends that in the transgender community.

Defense Strategy

Yeah. Again, things are not exactly good already, as we are currently, but with this health bill, it’s going to be a lot worse. It’s going to be a step back. And as you mentioned, I was trying to find out if there are still opportunities, but it seems like the best thing we can do is to really just defend what little we have without really the very little that we have are just being taken away from us with this health bill more and more.

So I guess my next question would be what can we do to defend this? What can we do to remove these problematic articles from the health bill, for example, or prevent it from coming to pass or yeah.

What do you think? Mas Tama, maybe?

Mario Prajna Pratama

Okay, first of all, I think it’s very important to educate the community, the trans community and LGBTIQ in general, about how this health bill are affecting our lives, because people are not aware about this.

So we have to build that awareness because we cannot move, just, like, only, like, ten of us, we cannot change the bill. We cannot ask for the House of Representative to revise the bill or not to pass the bill. We have to work together. So we have to ensure that the community understand what is wrong with the bill, how it affects us, and what can we do together. So it’s like building a strategy together.

And also, the second thing is to educate the people in general, the allies, including about, for example, aesthetic surgery or aesthetic health care, it’s not only about trans. Everyone is doing that. Everyone needs that. Why should be different between you, who are not allies, who are not trans, and us? What’s the difference between us?

Some people want their chin to be their chin to be more, I don’t know, sharp or anything, or their cheeks to be more plumpy. And some people wants to do the breast reduction aesthetically.

So there’s no difference between us. It’s just a level. Like, we are trans people and you are not. But we are restricted and you are not. So let’s say something about it. So people have to understand that it’s like a need, which is for everyone, not only for trans people.

And also what we need to educate to the lives and the people is that this Is not only about physical things, as you mentioned before, Bonnie and this guy, this is about Mental health, this Is About life. When it comes to gender affirming care for trans people, it’s not only about changing our body. It’s about helping us to live our best life, to be ourselves.

This is by providing the best health care, gender affirming care for trans people. It means preventing suicide, for example. It means preventing poverty, it means helping us to be ourselves. And then so that we can also be very if we are alive, we can also contribute to the society. They need to understand that.

So again, it’s not only about physical, it’s not only about surgery and everything, it’s more about how to protect the life of trans people.

So yeah, I think that’s my point. So education, both the trans people, the allies and people in general.

Riska Carolina

Probably want to add about more in the advocacy and stuff. Yeah, advocacy right now, I’m second Kak Tama because right now, unfortunately, this issue of the health bill did not receive spread well in the community itself because right now in Indonesia, we have lots of the bill that will become the threat for the LGBT people.

We’re talking about the penal code, we’re talking about discriminatory local regulations that we have right now. It’s like a 56 of local regulations that discriminate us. And this bill, it’s quite new and so many articles in this bill and sadly it’s so fast.

We’re talking about the process of this bill and we hope that in the future, alongside with the SRHR community and also for the LBQT community as well, to advocate for this bill. And maybe we can have one on one session, probably like hearing with the Ministry of Health office that basically a little bit neutral with our issue and we need our allies talking about this bill specifically for our issue because without them we cannot have the connection with those people.

I really hope that there’s a willingness and I’m really happy that the New Naratif have the time to invite me to raise our issue and we hope that the allies will invite more and more the organisational that talking about people in this bill.

And second Kak Tama, we hope that there’s a strategy for this bill and we need that ASAP because they will pass it soon.

Mario Prajna Pratama

Yeah. Also, I think we have to talk. We need to have conversation with health care providers as well, because they are affected by this. And we need to encourage them to go with us, like be the part of the movement. Or the struggle how to actually because they have the good heart and have the good intention to provide health care for everyone, not only for trans.

Basically they are doing the nondiscriminatory principles right so it’s a good thing. So we need to involve them and have conversation with them and encourage them not to back down, not to stop providing what they are providing right now. And then we need to hear from them as well, because they are the expertise probably in the health care service area and how to best move forward in advocating these bills.

Riska Carolina

Yeah, about the not back down the health care services, I think we can go hand in hand together with the SRHR organisation. They’re talking about the abortion services, these safe abortion services that we have in the same case, actually for the transgender people, for the health care services in this bill.

We hope that we can go together with them so it will reduce the stigma to the queer people when we talk to the health care provider, because we have the same thing. We wisdom to not baking down about those health care services and be a good ally.

And again, before that, we need to have the strategy about what we will give them in return, for instance, because that’s basically what they asked us when we met them. Like, what is it for me if I still giving you the healthcare system? What is it for me?

Yeah, I think it’s in the next discussion with the bigger allies right now because we have the same thing that we want to push to them.

Mario Prajna Pratama

Funny question. Yeah. What is it for you? Of course you’re going to be like very good health care service provider. We have to raise this in the international level as well because this is definitely this is violating human rights.

And if we talk about trans specific issues, these are against the latest revision of ICD from the International Classification of Disease from World Health Organisation, which already mentioned that trans people are not what is it? Yeah, transgender are not disorder.

And then on the other way, actually, gender dysphoria is a condition that should be taken care by the health care providers. So it’s a must for the health care providers to give us the care, the services that we need. So we need to raise the issue as well in the international level so that we can get attention.

What can we do?

Yeah. Again, as you mentioned, what’s in it for them? I mean, health care providers have an oath to provide health care for everyone without discrimination. And you mentioned, I think not a lot of people know.

I think a lot of people when we say trans healthcare people are, you know, that seems kind of foreign. Well, at the same time, it’s like, obviously the specifics, the purpose and everything else might be different, but it’s not a new thing.

Like even hormones, cis people take hormones, right? It’s all right there. But if you’re cis, then it’s free for you. I mean, not free, but it’s easy for you to access. But then if you’re trans, if your life depended on it, then suddenly it gets criminalised, which is ridiculous.

So I do agree that we need to make a lot of noise and to bring this up to an international level, get people talking about it, get people discussing about this, stuff like that before, although it will be passed really quick. So it’s kind of like in a very precarious situation here.

So in relation to that, though, what do you think? We’re hoping the listeners will be listening to this podcast and they’re going to be like, okay, so I can make some noise, I can post on social media and stuff like that.

But is there anything else that we can do, like as allies or as trans people themselves, to actually raise awareness about this, to actually push for revisions, to get the international community talking about this?

Mario Prajna Pratama

I don’t have anything to add about that, but I know what I’m going to say is that we believe in collective care. So the government already criminalised us for years. They already discriminate us for years. But we are here, we are together, we are helping each other.

So the key is to keep the collective care, to ensure that we are safe. We can still like, providing safe space for one another, not to also depend on the hospitals or clinics. We can create our own space, basically learning from other countries, other communities in the other countries.

For example, Thailand. No, in Thailand, they get the support from government. So probably it’s not apple to apple. Probably, for example, UK trans people health, gender affirming care is now restricted in the UK.

But they build their community space in which, again, we care. We are taking care of each other. And of course, if there are medical professionals or medical practitioners who wants to join us, they’re welcome, as you said, because it’s in front of our eyes now that the House of Representatives get up as the bill. Well, if there’s only little thing we can do about that.

But we need to believe in ourselves. We need to believe in our community as well. We’ve been taking care of each other for years, for probably decades. So let’s keep doing that. Let’s keep each other safe.

Yeah. I do think it’s very important to keep in mind that at the end of the day, we’re going to have each other, right? I mean, at the end of the day, no matter what the government wants to do, they want to criminalise us.

It’s very important to fight, to move forward, to just keep pushing for revisions and stuff like that. But I think realising that we have each other, we’re going to always at least there’s an agency for us, right? That’s where the hope lies. Pushing forward together, building solidarity, but also caring for one another.

Sometimes it’s just that simple to maintain the hope for that. And also, like Kak Riska, your work also has to do with crisis response. So that’s also another hopeful aspect of this, right?

So when people start to get criminalised or they’re in crisis or whatever it is, you can come in, you can say, like, your organisation steps into that.

So I think building solidarity, building that kind of building that kind of collective care, as you mentioned, is very important.

Riska Carolina

If we’re talking about the crisis, sure, CRM will be involved in those crisis will help as much as we can to help the crisis for the LGBT people. But if it’s the only crisis and there’s no advocacy for the better future, we will be what is it? Hopeless.

And, well, basically, we’re normalised to have a crisis in our life. And I don’t think it’s a good ideal work for the LGBT people in Indonesia. Not just we focusing on this bill to have a better article, but as well that we also move forward with how the legislation’s antidiscrimination law that will acknowledge the sexual orientation and gender identity in that bill.

Because right now it will just crisis after crisis for the LGBT people and there is no hope better future for us. And it’s only crisis. It’s just like no hope and heart become numb and there’s nothing you can do for only crisis. And it’s so dystopian future for us.

And that with this bill for legislation anti discrimination that comprehensive, we hope that we can have at least not be discriminate for the public, official or the society that I want to add. That’s probably my closing statement.

I think it’s important to remember that this bill, like the health bill, even if it is like, you know, encompasses even if it encompasses a lot of things, it doesn’t stand in a vacuum, as you mentioned.

And also in our previous episode, on discussing the health bills, that it’s tied to various other bills and pushing for this, like revising this, even if it is in front of our eyes, but also pushing for advocating for more SOGIE SC awareness more, less discrimination towards trans people and towards queer people in general.

I think that’s also very important. Again, it moves hand in hand. You’re completely right. We shouldn’t be dealing with crisis all the time then not moving forward, right.

It’s important to have hope, to have a community, to have something to fall back on, knowing that you have something to fall back on whenever there’s a crisis. But it’s also important to have, really this sense of moving forward, pushing for changes, advocating for changes here and there, while maintaining our community and collective care

And, yeah, with that, I think it’s a good note to end on. Thank you so much for the discussion, Mas Tama and Kak Riska.

OUTRO

And that wraps up our discussion with Mario Prajna Pratama and Riska Carolina. Things might look bleak, but the most important thing to do right now is to keep raising awareness and not lose hope.

Amplify the issues with your likes, reposts, and retweets. Comment on the posts and threads, share the discussions with your circles, write about them, support the protests, and help push for the advocacy efforts. It’s extremely important for people, especially for queer people, trans people, and all of our allies, to understand the gravity of the Health Bill.

Build movements, build solidarity, stay angry, and push back. There’s still time for now, but there might not be in the near future. And if push comes to shove, remember that we still have each other.

My name is Bonnibel Rambatan, and this has been Southeast Asia Dispatches. Brought to you by New Naratif, and produced by Dania Joedo. I’ll see you around.

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