Sunday, Oct 02, 2022

Indian Medical Education System Needs To Treat Itself For Queerphobia

There is an urgent need to bring curricular reforms to ensure that Indian health professional students are trained to be competent, scientific and empathetic service providers to LGBTQIA+ community.

 Need for health professionals students to provide empathetic service to LGBTQIA+ community.
Need for health professionals students to provide empathetic service to LGBTQIA+ community. Getty Images

A few weeks back, an unofficial session was held with Muslim medical students of Thrissur Medical College by a religious group to discuss how LGBTQIA+ is anti-Islam and anti-science. While such opinions are commonly promulgated on social media it is a cause for alarm when medical students are indoctrinated with such ideas. While this was an unofficial private event, what is worrisome is that even in the official textbooks and curricula of Indian Medical Graduates there is rampant homophobia and transphobia. 

In the same state of Kerala last year, responding to a plea by Kerala NGOs Queerythm and Disha, the Kerala High Court asked National Medical Commission to remove queerphobic content from the medical books. This was around the same time last year when Justice N Anand Venkatesh of Madras High Court had come down heavily on the National Medical Commission to remove homophobic and transphobic content from the medical textbooks.

The National Medical Commission which regulates medical education in India was quick to issue an order to all the medical colleges and universities to ensure that unscientific and derogatory remarks about the LGBTQIA+ community are not taught and that textbooks with such contents are not included in the curriculum. While the National Medical Commission has been quick to pass the buck, it has not set its own house in order. The NMC's latest competency-based medical education still has problematic references when it comes to intersex persons, the transgender community, and women. This has been repeatedly brought to the attention of NMC but they have not paid heed to it. 

The author (Aqsa) had recently written to NMC and proposed a transgender-affirmative medical curriculum that not just weeds off transphobic content but also includes competencies to ensure that future medical graduates are competent in providing scientifically correct, empathetic, and dignified care to queer persons. This proposed curriculum was developed through consultative workshops with the transgender community, trans medical students and doctors, medical educators, and healthcare professionals providing services to the community, as part of the TransCare project. 

Ensuring that the medical curriculum is revised to make it trans-inclusive is also a mandate under the Transgender Persons Protection of Rights Act, 2019. Section 15 of the act obligates the government to review the medical curriculum to address the specific health needs of the transgender community.

For a long period, homosexuality was not just a criminal act under 'unnatural sexual offences' and punished under Section 377 but it was also considered to be a mental illness. It was only in 2018 that the Supreme Court of India decided that sexual acts between consenting adults of the same sex are not illegal or punishable. Persistent efforts by the queer community ensured that almost five decades earlier in 1973, American Psychiatric Association removed homosexuality as a diagnosis from its DSM manual which is used to diagnose mental illnesses. 

In the International Classification of Diseases by WHO, the eleventh edition of which comes into force this year, transness and homosexuality are no longer considered disorders. Back home in India, the Indian Psychiatric Society has issued a position statement that homosexuality is not a disease and must not be treated as such. It clarified that any form of therapy to treat homosexuality should not be practised as it is not a disease and such ‘therapies’ don’t succeed in any manner.

The Madras High Court prohibited conversion therapy or any attempt to medically cure or change the sexual orientation or gender identity in 2021 in Sushma vs Commissioner of Police. It is noteworthy that no legislation expressly prohibits and penalizes conversion therapy, especially the one that is done with consent. Despite clear guidelines, conversion therapy for homosexuality is still being practised surreptitiously by psychiatrists, doctors, unlicensed practitioners, and faith healers. 

Prodded by the same Madras High Court directive, the NMC has recently clarified that it forbids conversion therapy to attempt to change sexual orientation and gender identity and that such a practice will be considered professional misconduct and acted accordingly. It is interesting to note that while the National Medical Council regulates only modern medical education (allopathy), there is currently no similar guideline for AYUSH systems of medicine or faith healers to which a substantial proportion of our population subscribes. It may take a wider understanding of the Mental Health Act, various Anti-superstition and Black Magic Acts, and guidelines against misleading ads, to rein in such inhuman and unscientific practices.

While the queer community continues to face discriminatory treatment at the hands of doctors trained in a transphobic and homophobic medical system, we need a gamut of reforms – legislative, educational, and social to ensure that future medical graduates are not just spared the queerphobic teaching but also trained into scientific and humane understanding and treatment of their queer patients. We must not limit this to just medical graduates of modern medicine but also include AYUSH medical students and other healthcare professionals’ education like dentistry, nursing, and rehabilitation sciences. 

We must also bear in mind that simply passing orders is not sufficient unless they come into action. In 2022 we cannot allow unscientific, inhuman, illegal, discriminatory and biased indoctrination to inform the current and future healthcare professionals who gatekeep access to life-saving healthcare services.

(The author is an Associate Professor of Community Medicine. She is a transgender woman and has proposed to National Medical Commission to incorporate transgender-affirmative medical education. She tweets with the handle @doctorsaheba.)