I sat on the table at my doctor’s office feeling like a responsible adult in a cotton Johnny tied delicately in the back. I had gone to this small family practice in Portland for nearly eight years and was on a first-name basis with the nurses. I felt comfortable discussing anything at this office. I was there for my annual physical and routine pap test. I’d been working out, eating healthy and even managed to floss on a regular basis. I was on top of my game this year. I’m also very fortunate to be in good health and have insurance. It was going to be a good day. After a quick co-pay, I was headed back to the office. My usual nurse practitioner was out, and I was assigned a new doctor for the visit that day.
Every gay person must eventually come out to their health care provider. While I can go to my car mechanic without discussing my private life, the health care system is a different story. It became clear to me as I was lying on the table, feet in the air, that the doctor hadn’t read my chart. She ignorantly assumed I was straight. Suddenly my mind went spinning. It had been so long since I came out. How do I break the news to her? Why does she keep assuming? Was it something I said? Maybe she’s making a political statement? Why does she keep saying “boyfriend” and “husband” to me?
I waited until I had my pants on to tell her kindly that she had made an assumption. She blushed quickly and became defensive: “Well, why didn’t you tell me? That’s important to know!”
I was silenced immediately. I was unaware that it was my responsibility to correct her. I was instantly transported back to the trauma of my coming-out days nearly 15 years ago. I felt shame. I even questioned getting a physical next year. Although I work confidently with service providers every day, something about this interaction left a debilitating sting.
Now imagine the possible impossible: I’m not at a routine doctor’s visit. Instead I’m in a bustling emergency room at 11 p.m. on a Saturday night because I was just sexually assaulted by a girlfriend. Or imagine I’m transgender, and an acquaintance of mine has just sexually assaulted me. I’m a victim of a crime. I have the usual trauma response that most have: I’m shaking, cold, exhausted and blaming myself for everything. My life is falling apart all around me, and, on top of everything else, the doctor and police assume I’m straight or make an oblivious comment about my gender. The 60 seconds of energy it takes for me to correct these service providers adds anywhere from 6 weeks to 60 years to my healing and recovery from this assault.
Sexual assault happens at the same rate to lesbian, gay, bisexual and transgender people as it does to heterosexual people. If anything, it is more pervasive in LGBT communities because perpetrators are motivated by hate and homophobia. The National Coalition of Anti-Violence Programs reports that lesbian, gay, bisexual and queer people were three times more likely to report sexual violence and-or harassment compared to heterosexual people who reported to NCAVP in 2010. One in 10 transgender individuals have been sexually assaulted in a health care setting, according to a study by the National Gay and Lesbian Task Force and the National Center for Transgender Equality.
As an advocate, I sit with victims of sexual assault and guide them through the process of forensic examination. It can be challenging to leave my personal judgments at the door when working with victims, but it is absolutely essential to their healing process. But being what we call “culturally competent” goes a step beyond not judging someone based on race, class, gender, ability, etc. It’s about evaluating one’s own personal assumptions and expanding our knowledge to include world perspectives. It’s about examining our power and privilege in interactions with clients and using language that is inclusive, rather than exclusive.
In an effort to provide quality services for LGBT clients, the Maine Coalition Against Sexual Assault has participated in many cultural competency trainings and studies. A recent partnership with Forge Forward of Milwaukee, Wis., taught us that Maine rates above national averages regarding transgender clients accessing sexual assault services, but there is still a lot of cultural competency work left to do among our coalition and the service providers with whom we partner.
LGBT clients still fear hostility, rejection and abuse when seeking services. And as I learned from my own very personal experience, it is not necessarily about having a separate LGBT brochure in your waiting room. It’s about incorporating different cultures into our practices organically and having an appropriate system to review those interactions. Cultural competency is about being open to anyone who walks through our office doors.
Amy Raina is the education program manager for Sexual Assault Response Services of Southern Maine and a gynecological teaching assistant for Maine Medical Center. Visit www.mecasa.org and www.forge-forward.org for more information. She may be reached at email@example.com.