🌞[Checklist] How to make healthcare services friendly and accessible?

Adopting an LGBTQIA+ affirming framework in your service provision is crucial in upholding and delivering a standard of care that meets the specific needs of the population in line with international human rights standards.

Two levels of enhancement can be made - individual level and health care setting level. Both are important. This section explores the framework application from the following levels:

Becoming an LGBTQIA+ affirming practitioner or service provider

As you meet with LGBTQIA+ patients, it is important to incorporate specific skills or values to make them feel comfortable, respected, and included in the overall experience.

🥰 Use affirmative languages

Derogatory and pathologizing language, such as pondan, is widely used against LGBTQIA+ people in Malaysia. Using such language in healthcare services is not only discriminatory but it can also increase a lack of trust and willingness to continue to seek treatment or care.

Always introduce yourself and your pronouns when you see patients. If their preferred name and pronouns are not available in their registration form or medical charts, ask them for their name and pronouns. Always use respectful and gender-neutral language. The use of gender-neutral language is especially important for medical practitioners when referring to or describing body parts.

At the same time, LGBTQIA+ people have varying levels of access and exposure to LGBTQIA+ affirming information. Some LGBTQIA+ people may use derogatory language to refer to themselves or others. The practitioner should refrain from following suit. Use respectful and advocacy language such as lesbian, gay, bisexual, trans woman/man, queer, non-binary, or gender-diverse.

Some people may not be familiar with labels, concepts, and terms, like SOGIESC, LGBTIQ, etc. It is important to not force any labels or terms on them. Instead, provide them with the necessary information and resources.

💆Critical self-reflection

Continuously engage in critical self-reflection to become more aware of any implicit and explicit attitudes, beliefs, values, and assumptions based on biases or stereotypes so that these prejudices do not come in the way of providing the best care possible. This includes heteronormative, cisnormative, and gender binary assumptions, stereotypes, and biases. Counter heteronormative and gender normative bias by assuming a new patient in your care is LGBTQIA+. This helps to build trust as the patient recognises assumptions are not being made about them and that the practitioner is affirming.

Be mindful of body language, facial expressions, and other non-verbal cues, such as showing discomfort or disgust, staring or avoiding eye contact, or avoiding necessary physical touch during physical examination.

🤹 Upskilling yourself

Seek education on knowledge and skills to address the specialized intersectional needs of LGBTQIA+ people. Remember that LGBTQIA+ people may also have other marginalized identities. Hence, knowing unique needs of diverse populations can benefit you in providing better services.

The following knowledge is essential to LGBTQIA+-affirming services:

• Sexual Orientation, Gender Identity, and Expression, Sexual Characteristic (SOGIESC) sensitization

• Socio-legal context of LGBTQIA+ people in Malaysia

• LGBTQIA+ population-specific health needs. For example, trans-specific healthcare, intersex health need

Free online course https://aptnschool.thinkific.com/

Further reading resources

• Queer Affirmative Counseling Practice Resource Book\

• Creating an LGBTQ- friendly practice

• SOGIE Safer Places Toolkit by Albert Health Services

• The eQuality Toolkit: Practical Skills For LGBTQ and DSD Affected Patient Care

• Breast Health Toolkit for Health Care Providers caring for the LGBTQ Community

Establishing a clinic or a health service center that is LGBTQIA+ affirming.

Creating an affirming healthcare setting is as important as being an affirming practitioner. Tailoring your service according to what is needed by LGBTQIA+ people can also help in making your patients feel comfortable and respected.

🤗 Making your existing clinic or health service inclusive to LGBTQIA+ people

Creating LGBTQIA+-inclusive services means ensuring that all health services are sensitive and inclusive to LGBTQIA+ patients. Even if you do not provide LGBTQIA+-specific healthcare services, for example, HRT for trans people, you can still adopt measures to ensure that the general services that you provide are inclusive. You may do so by incorporating the following into your practice.

1. 📋Revise intake forms

2. 🔐Ensure confidentiality and privacy protections

3. 📚Provide trainings for staff

4. 🤝Provide necessary referrals

5. 🧜Engage with LGBTQIA+ groups

6. 🦸Create an affirming service environment for LGBTQIA+ people

🤩 Provide holistic services that cater to LGBTQIA+ patient needs

As there are many health gaps faced by LGBTQIA+ people, you can expand your services to include LGBTQIA+-specific healthcare services, such as HRT and gender dysphoria assessments or have healthcare providers who specialize in LGBTQIA+ healthcare.

🦑Designing and implementing policies within clinic or health service center

The introduction of policies and guidelines can ensure your healthcare practice is inclusive and that it protects the rights and comfort of LGBTQIA+ people.

1. 🧑‍⚕️Patient’s Bill of Rights

2. 👨🏻‍❤️‍👨🏾LGBTQIA+ inclusive policies

3. 🗣️Feedback, complaint, and response mechanism (FCRM)

🤓Recruiting and retaining LGBTQIA+ people/experts

Look for clinical staff who are either experienced in providing treatment to LGBTQIA+ people or who have a strong desire to learn more about it.

Job listings may specify a particular qualification or expertise, such as delivering hormone therapy that promotes gender identity. If looking for experts, the job application may be shared with LGBTQIA+ organizations as they may have connections to affirming practitioners.

Hire people who match the ideals and values of the organization, whether they are LGBTQIA+ or not. However, having LGBTQIA+ employees on staff does not ensure an LGBTQIA+-affirming service. Ongoing training and education will be necessary to ensure the adequate delivery of LGBTQIA+-affirming services.

Further reading resources:

• Creating an LGBTQ Affirming Clinic: A Guide for Practice Managers and Providers

• Creating Safer Spaces For LGBTQ Youth: A Toolkit for Education, Healthcare and Community-Based Organizations.

• Proud to Care: LGBT and Dementia (a Healthcare Guide)

• LGBTQIA+ Inclusive Palliative Care - A Toolkit For Carers And Healthcare Professionals