Author and counselor Jimmy Evans says we have four basic human needs that drive us at all times: These are acceptance, identity, security and purpose. These issues seem to be at the centre of the raging transgender / transsexual debate in Kenya today. The debate has been fuelled by the recent move by one Audrey Mbugua, who has gone to court to compel the government to recognize ‘him’ as a woman. This is a new phenomenon in Kenya, and in Africa, where matters of sexuality are not openly discussed. But Audrey has broached a taboo subject, which many would not like to talk about. Dr. Martin Wesonga, a Bible scholar and theologian says that in traditional African societies, no one came out to openly speak about their sex-related conditions like transsexualism or intersexism. “In African tradition, that was considered a curse and the person would be an outcast. He/she was liable to be thrown in the forest and some communities even killed such people,” he says. Audrey is a 29 year old lady. She is today the face of the transgender/transsexual community in Kenya. She was born a man and lived as Andrew Mbugua until later in life when she felt that she was living a lie. She says that she was a man on the outside but a woman in the inside. It is that uncomfortable feeling that led her to want to be identified as a woman. But this has been fraught with challenges. All her official documents indicated that she was a man. Getting a job has become difficult. With time she started changing her way of dressing and looks to suit what she wanted. With that done, she needed to change her academic and identification documents. This led her to the high court in Kenya. Audrey suffers from what is medically referred to as Gender Identity Disorder (GID). Audrey’s case, among others, has forced the Medical Practitioners and Dentists Board to invite proposals on the way people with Gender Identity Disorder ought to be treated by the medical profession. It called a stakeholders meeting early this month to develop guidelines on sex change operations. Currently, the Medical Board Code of Professional Conduct and Discipline states: “Gender reassignment is not permitted on demand. The specialist attending to the patient with gender problems shall constitute a team of specialists whose decision would be based on anatomical and special needs of the patients, but whose decisions must be based on the right to health and other fundamental rights in the Constitution.” The constitution of Kenya 2010 in Article 10 outlines fundamental principles governing the relationship between the government and its citizens. Some of the values it espouses include human dignity, equity, social justice, inclusiveness, equality, human rights, non-discrimination and protection of marginalized groups. This means that if the policy guidelines that will be developed identify GID as a medical and/or mental condition, then transgenders will have a right to be recognized as persons before the law and are equal and entitled without any discrimination to protection by law. Article 43 of the constitution further states that: “That every person has the highest attainable standard of health, which includes the right to health care services, including reproductive health care”. This would compel the government to make available to the transgenders all necessary health care services that they require. Through the Transgender Education and Advocacy (TEA) organisation, Audrey has filed submissions with the Technical Working Committee of the medical board over the challenges faced by individuals suffering from the disorder. Audrey, in many media interviews, laments that the country lacks clear legislation and guidelines to ensure that people who suffer from the problem feel as part of the society. She says that she has met over 40 transsexuals across Kenya. The meeting called by the medical board was to be attended by surgeons, psychiatrics, Kenya National Commission on Human Rights, gynaecologists, the Law Society of Kenya, pharmacists, and religious leaders, among other stakeholders. Audrey was not allowed to participate in the meeting since she was an interested party. Some time back, she had gone to Kenyatta National Hospital requesting for an operation that would have removed her male organ so that it could be fashioned to female genitalia, and had also sought for therapy with female hormones. This did not happen and it prompted the hospital to seek advice from the medical board, lest they were found going against the medical code of practice. The head of mental health services at Kenyatta National Hospital Dr. Margaret Makanyengo says the situation of the transgenders is unfortunate because it is a deep psychological problem. She says that it begins at between 2 to 4 years, and at adolescence, they start to manifest persistent strong feelings of discomfort about whom they are. She says the situation can be so bad that some of them want to commit suicide because they have depression. The people around them may not understand them. Some are mistreated by family and friends; some are even physically assaulted by those who are expected to protect them like law enforcement officers. The problem is not only personal to the transgenders; some family members are embarrassed about them and even abandon them. Institutions like banks don’t allow them to change their personal information once they decide to change their identity. “We (mental health practitioners) are in a dilemma on how to handle them. We are seeking for policy guidelines to help us know how to deal with them,” she says, because there are currently no clearly-laid out laws on how to support or treat the transgenders. “This is something we cannot ignore…we cannot mistreat them because of the oath that we (medics) took…we counsel and offer them support,” she says. Audrey’s aunt, Mary Esther Wanjiku, however is sympathetic to her condition. She says that there are many parents who are living in denial because of the condition of their transgender children. “Their children have the same condition but they don’t want to admit, they think it is witchcraft, “this is not a normal child”…we have to deal with such issues,” she said in a televised interview. Identification is an important concern for transgender people, because until it reflects how they live, they can be subject to discrimination, denied services or assistance, sometimes jailed, or subjected to violence. Closer home in Uganda, we have the case of Juliet Victor Mukasa, a transgender activist, who fled Uganda and launched a lawsuit against police who he claimed harassed him when he begun to speak out as a transgender person in 2005. Transgender people (and some of the other groups that have overlapping issues) tend not to be treated very well. Physical violence and rape are the most visible issues that they face, but some of the less visible problems are also sometimes the hardest to deal with. Identification documents (birth certificates, etc) pose the biggest problem, because it affects a person’s ability to live, find work, access health care, get police assistance, get an education, or access banking services. It might practically shut them out from several areas of day-to-day life. Health care is another concern, because for transsexual people who need to medically transition (involving hormone therapy, surgery or surgeries, and sometimes things like facial hair removal), it can be difficult or nearly impossible to find a doctor who is willing to help because of lack of guidelines. And when transgender people try to form relationships, it doesn’t matter if their partner is the same sex or the opposite sex to the gender the person lives as, it’s often interpreted as a “same-sex marriage” from either direction, putting them in the difficult position of breaking laws if they try to marry at all. Professor of Medical Law and Forensic Medicine Kiama Wangai, the convenor of the LSK’s medico-legal and gender committee, who participated in the medical board’s meeting, says that transgender/transsexualism is a biological phenomenon and a medical condition which needs a mode of therapy for its treatment. He says that many transgender/transsexuals go through a lot of psychological torture and therefore they need to be managed during their transition from one gender to another. Currently, he says, there is no legal regime in place to deal with transgender/transsexual issues. A document by LSK’s medico-legal and gender committee says that in America, GID is categorized as a psychiatric situation and listed in Diagnostic and Statistical Manual of Mental Disorders. It says that the medical world does not regard homosexuality and lesbianism as gender identity issues. It says that the interpretation of Kenya’s legal framework will depend heavily on the definition that will be assigned to the term GID once a policy is in place. Wanting to put a distance between their cause and that of gays and lesbians, TEA says that being a transsexual is not an issue of who you are sexually attracted to (sexual orientation), but one of gender identity, the psychological awareness of one as either male or female. The Registration of Persons Act Chapter 107, and Registration of Births and Deaths Act Chapter 149, both make ‘sex’ one of the particulars required before one can be issued with a national identification document, or before a birth or death can be registered. Both Acts do not provide room for any changes to be made once the documents have been issued. This basically means that in Kenya, sex is either identified as male or female, making no room for identification of a third gender. And herein lies the dilemma for those who cannot fit in either of these categories (like the intersex) or those who want to change their gender. In its presentation to the medical board, the LSK’s medico-legal and gender committee says that it is important that the guidelines that will be developed by the board outline what information will have to be transmitted to the Registrar of Persons for changes to be effected in identity cards and endorsement in the Birth Certificate. It further adds that the guidelines for the management of GID should articulate international professional consensus about the psychiatric, psychological, medical and surgical aspects of care. The medical board has planned for a follow-up meeting to process further the deliberations of the earlier stakeholders’ meeting, whose recommendations will be forwarded to the AG for further action. As all this is happening, gender identity disorder remains a controversial subject. There is disagreement whether it is ethical or even medically appropriate to prescribe sex reassignment to persons “who feel trapped in the wrong gender”, and whether sex reassignment does not compound a psychological problem requiring a psychological remedy. And this is where we find some who argue that changing gender is more an issue of crisis of identity rather than a medical or biological issue. Reverend Matthew Okeyo, CEO of AIC Childcare, a Christian organization, while admitting that the intersexism (intersex refers to a number of medical conditions in which someone is born with ambiguous genitalia or chromosomally indeterminate or between sexes in some way) should be dealt with medically, he says that GID occurs because people do not know who they are and they do not accept how God created them. “Whether one is an atheist or not, they need to ask themselves the question, who is God, who is this Supreme Being,” he says. “If you cannot define that, then you will not know who you are, and you won’t know your purpose in life.” He says that those who want to change the way God created them are trying to be God because they don’t like the way they are. To him, this shows how depraved man has become, accusing God for creating them the way they are. He advises that such people should seek to discover who they are first, adding that they cannot function properly as either male or female after transitioning from either gender. While discussing the issue, it would be good to also consider the experience of transgender/transsexual people in other countries, which has been a bit different from our experience in Kenya. In 2011, Australia allowed a new ‘third gender’ passport system where sex is indeterminate to give citizens a gender option. With a letter from a doctor, transgender/transsexual Australians are allowed to have their passport marked with an X and not M (Male) or F (Female) like before. In the same year, two transgender people won an appeal in Australia’s highest court giving them legal recognition as men despite not completing sex-change surgeries. Mercedes Adell, a writer and advocate for transgender/transsexual people in Canada says that Canada recently passed a bill to officially include trans people in human rights laws, which is awaiting ratification in the Senate. “But the Human Rights Commissions here have recognized trans people to an extent, for several years already, so this will simply clarify and make the recognition official,” she says. Various European countries have created legislation to address transgender issues. The UK issued the Sex Discrimination (Gender Reassignment) Regulations in 1999, which provide specific protections prohibiting employment discrimination for transgendered people intending to, or having undergone gender reassignment. The UK and Spain also have legislation allowing transgendered people to change their names and gender on official documents. On the other hand, we have another group of people, the intersex, who are born with a medical condition that puts them somewhere between male and female. Some of these conditions are not immediately obvious, and a person might go through most of their lives without realizing it, unless a medical issue causes them to find out. Intersexuality and transsexuality aren’t always thought of being the same thing, although both groups of people will face a lot of the same challenges. The South African runner, Caster Semenya, is an example of someone who is intersex, but not transsexual. In 2010, the constitutional court in Kenya dismissed attempts by an intersex convict (Richard Musaya was serving a sentence in prison for robbery) to introduce a third gender into Kenyan law books, by holding that there are no such people. Looking back, Rev. Matthew says that in traditional African societies, intersexed children (or deformed children or those born with albinoism) were not allowed to live because they were associated with bad omens. “Because of superstition, such children were killed because they were thought to signal something wrong that happened in the spiritual world, or that their ancestors did something wrong for which they are being punished,” he says. As Jimmy Evans avers, this issue is all about finding acceptance, identity, security and purpose in life.
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