I.Organisational details

Project title: / Trans people's healthcare experiences
Reporting period: / February 1st 2014 – February 28th, 2015
Implementing organisation: / Trans-Fuzja Foundation
Contact information (post, e-mail, phone): / Noakowskiego 10, lok. 66
00-666 Warsaw, Poland

Contact person: / Wiktor Dynarski,
Date of report submission to ILGA-Europe: / March 6th, 2015

Number of people working on the project (staff and volunteers): 9

Changes in the project leadership (if different from the application): n/a

II.Narrative Report

1.What kind of information did you collect?

In search of data relevant to trans people's experiences in healthcare, Trans-Fuzja collected information concerning:

  • General healthcare
  • Healthcare regarding transition

◦Healthcare related to court proceedings (legal gender recognition)

◦Appointments, surgeries related to transition

◦Trans-specific healthcare (healthcare outside of transition spectrum, focused on other needs, such as male gynecology)

2.What methodology did you use to collect the information? If it differs from the methodology initially planned, please provide explanations.

Research methodology was created almost from scratch, using, however, experiences (i.e. scope of identities) gained in the 2013 study concerning court proceedings of legal gender recognition.

Matters regarding general healthcare have been studied in the scope of last five years. On the other hand, matters regarding court proceedings, appointments and surgeries related to gender recognition, as well as trans-specific healthcare, were analyzed without a specific time framework.

The following groups were qualified for the research:

- transsexual persons, transgender persons, transvestites,

- intersex persons

- gender non-conforming persons.

For the purpose of this research, the method used was non-reactive, quantitative, and the selection was non-probabilistic, based on the availability of the respondents.

An online survey consisting of 149 open-ended and closed-ended questions had been prepared for the purpose of this research. One could argue that a survey with such a number of questions is deemed to fail, because the respondents will grow weary and will not answer, or that the collected data will have no scientific value. Previous studies confirmed that the analyzed groups prove to be reliable in responding to requests from Trans-Fuzja to take part in such surveys. For this reason it has been decided to carry out an in-depth analysis of the standards of healthcare in Poland regarding the said research group. The gathered data were analyzed statistically.

3.Please describe main success / challenges / difficulties of the project. How did you deal with them?

Successes: For the first time in Poland, the issue of trans healthcare was studied in such details. Results of the survey were published in major news outlets, stirring up a debate on the effectiveness of the Polish healthcare system in general. Results were used during meetings with stakeholders and have been quoted as supportive of putting gender reassignment procedures back on the national healthcare plan. Further advocacy activities on that matter are currently developing.

Challenges: The pilot version of the research received much comments from participants and a number of aspects have been changed. This has delayed launch of the survey for a week. It did, however, contribute to an acceptable version of the final survey.

Difficulties: Not enough planning went to the promotion of the research and reach out to medical communities. Although Trans-Fuzja received support from one clinic specializing in intersex health, there were fewer intersex respondents than previously hoped for. In general, the survey received little to no attention from the medical community until its results were published.

Cooperation with graphic designer and printing companies caused a serious delay in the project, as reported by the grantee. Because of that remaining money from administration costs had to be used for report printing.

4.Did you have any partners in this project? If yes, please briefly describe the role of each partner.

Although Trans-Fuzja was solely responsible for the project, the project working group consisted of persons affiliated with other institutions including the University of Warsaw, Warsaw University of Social Psychology and the Independent Institute of Social Thought “Sapere Aude”. The research also received patronage from the Office of the Polish Ombudsperson and the closing conference was officially supported by Anna Grodzka, MP.

III.Project impact

1.What product has come out of the project if any (e.g. report, CD ROM, survey)? Please, give a short description.

  • A report publication including results of the research, questionnaire overview and recommendations for the government on how to better the current healthcare situation of trans people in Poland (Polish version of the report and English translation of results are attached to the report)
  • A brochure for healthcare providers (with specific sections for medical doctors, psychologists and nurses) on transgender issues, explaining general terminology and approach to pronouns and names, (Polish version attached)
  • A brochure for trans people on health, right to healthcare, discrimination, patients' rights, including a number of instances were one can label a healthcare provider's behavior as discriminatory or suspicious (Polish version attached).

2.What are the main outcomes of the project? Give details here on:

a)How you plan to use this information - for advocacy or other purposes (at local, national and/or European level)?

  • Research results, especially the estimate of gender reassignment costs are currently being used to argue for coverage of these procedures by the National Health Fund, they have also been useful in building alliances with the medical community, especially those members who hold important position as government consultants. These contacts will be used at a later stage to create broad and working alliances aimed to bring new standards of care to current transition-related care, as Trans-Fuzja plans to translate the WPATH Standards of Care version 7 to Polish and receive official patronage from the Polish Sexologist Society.
  • Brochures for healthcare providers have been distributed to trans-aware centers and individuals with a healthcare providers background and will also be promoted through social media to encourage trans people to practice self-advocacy using both of these toolkits.

b)Who is your key target audience who needs to understand the collected information?

  • For the research project the target audience consists mostly of stakeholders associated with the Ministry of Health and the Agency for Health Technology Assessment,
  • Second target audience are the healthcare providers who work with trans people on various occasions,
  • Third target audience are trans people themselves who very often are not aware of their own rights.

c)Provide a short description and concrete steps on how you plan to approach your target audience.

  • Trans-Fuzja already established connections with the Ministry of Health and has distributed research results within these structures. The Ministry does not only support state-funded transition-related healthcare, it also supports easier and faster gender recognition (contrary to the Ministry of Justice),
  • The Agency for Health Technology Assessment and Tariff System will be approached with a motion to include gender reassignment medical interventions (including surgeries, hormone therapy and other means) on the National Healthcare Plan. The motion will be put forward by Trans-Fuzja Foundation and the National Sexology Consultant, as Trans-Fuzja's efforts have been officially backed by the medical community,
  • Healthcare providers will be approached through befriended channels and asked to distribute information in their circles. Apart from that Trans-Fuzja will contact major medical associations to let them know about a new toolkit and its availability
  • Trans people, as the most diverse group have been approached through social media, email and support groups and the resource has been widely distributed.

d)What impact will this have on legislative / decision-making level (e.g. change in laws/policies, new relations with policy makers etc.), if any.

  • Results from the research will be used in the motion put forward to the Agency for Health Technology Assessment and Tariff System. Before the project, Trans-Fuzja lacked hard data on the issue and the argumentation was not fact-based (and fact-based argumentation is preferred by policy makers in Poland),

3.What impact (positive/negative) had the project on your organisation?

  • Positive effects include: broadening the Research Working group and creating a strong, stable team, receiving hard data to use in advocacy activities, learning how to approach the media and with what kind of information, building alliances with the medical community, especially with sexologists who create the Polish Standards of Care for transgender patients,
  • Negative effects (with positive outcomes): due to the work load the organization need to restructure the Research Working group and introduce a new way to plan and implement projects, difficulties with graphic designer and printing, although stressful at the time, helped the organization look for new service providers in that area.

4.What are the lessons you have learned internally? What learning would you share with others undertaking similar projects?

  • Although planning is important, there is always a chance that a task may be delayed or somethings may not work out as planned and it is important to do damage control in the organization and be open about challenges as soon as they happen,
  • Building alliances with medical communities can be difficult to manage, as the Polish example shows that medical experts tend to not see others as experts in their own field. Hence activists who are willing to cooperate with the medical community an ally with it, are in great need of studying and understanding both the area of work and tools used by these communities. In the case of Trans-Fuzja, what helped was the fact that one of Research Working group members is a psychologist specializing in sexology. Trans-Fuzja would definitely recommend to include someone of similar background when creating such alliances, as it is easier to put some messages across.

IV.ILGA-Europe

How satisfied you are with the quality of cooperation with ILGA-Europe? Please, give a maximum of three positive and three negative points / examples, preferably with suggestions on how the latter can be improved.

  • Very satisfied when it comes to responses to challenges – ILGA-Europe actively cooperates with its grantees where crises are to unveil,
  • ILGA-Europe clearly understands that different countries have different perspectives and that activists themselves are experts in their respective local realities,
  • Although a system of Skype calls is in place to see how the projects are doing, Trans-Fuzja would like to suggest an email follow-up every 3 months. This keeps the organizations on track.

V.Financial report

Financial report (attached in a separate excel sheet) includes comments and explanations where changes were made.