What is the first thing you think of when you hear “trans health care”? Many of us would probably say hormones, surgery, maybe even mental health therapy. This is problematic and I will explain why.
Centering gender affirming care solely on medical transition denies us the whole reality of our wellness needs. But isn't medical transition important? Of course! So is dentistry, physical therapy, oncology, and even acupuncture. Trans and gender expansive people also get back pain, diabetes, bunions, IBS, and sports injuries. We want bodywork, corrective lenses, night guards, and getting our weird moles checked out. Practitioners of all disciplines should be obligated to provide affirming and safe care to people of all genders whether or not they are assisting in medical transition.
Gender affirming care must also be actively anti-racist and anti-colonial. Colonization prioritizes white washed ideas of gender over racialized experiences. What identities, roles, and expressions did we have before colonizers attacked our ancestors? Colonizers in places like the Philippines persecuted people who did not fit European binary gender constructs. Even if we are including options beyond a gender binary, are these still framed by a white-centric experience?
So where do we go from here? Don't just start a book club and suddenly invest in cultural competency training. These are meaningless without processes for accountability and structural changes. White supremacy can show up as over-intellectualizing issues into performative ally-ship – talking the talk, but not walking the walk. Open-mindedness and invitations are not enough. They're a cover-up for structural inequities. Can you show me that you're doing the work without telling me you're doing the work? Can you do it without a DEI or values statement? When I'm seeking care I look at the relationships a practitioner has built to see who they are accountable to. Who do they redistribute resources to? I look at the language used in communications, website, social media, and intake forms. Is ally-ship stuck at pronouns are have we moved beyond that? I look to see that there is deep ongoing work rather than a shallow static checklist.
Years ago I used to collaborate with a yoga studio run by white queer folks in a predominantly BIPOC neighborhood. On the surface everyone was very trans and queer inclusive – there some QTBIPOC teachers and students. We did workshops together and referred clients back and forth. Months later in response to increasing coverage of police brutality, I find out the studio owners started organizing “fireside chats”...with cops. The idea was that friendly chats between BIPOC and cops would resolve the violence. The message was that BIPOC needed to be more civilized, that this was about an interpersonal dispute rather than institutional, white supremacist violence. We know that BIPOC, especially Black trans women, are particularly targeted by cops. Gender affirming care also intersects with abolition and racial justice. This was just one grievance at the studio wrapped up in an environment of “love and light”.
At the time I was so hungry for a space that promised queer and trans safety I ignored my initial cringe at these white queers teaching yoga. There is so much nuance involved in understanding what gender affirming care ought to be. We are much more than a tangle of genitalia and hormones disconnected from experiences of race. If we choose not to actively engage in these nuances, they are already at play in how we participate in each other's wellness and what we are complicit with. I look forward to envision what our care could be, but I also look back. My ancestors thrived before Capitalism, colonization, and the medical industrial complex and they also made me.
Decolonizing needs to happen at all aspects of medicine including how we fund or do energy exchange for it. I use the term “energy exchange” because money is is a relatively new way of exchange for labor and goods, but it is not the only way. Prior to colonization, the Philippines did not have Capitalism. Healthcare was not dependent on extractive monetary transactions that focused on individual financial responsibility. Reciprocity was practiced through gift giving and being in relation to one another. Healers had a divine responsibility to care for the community and they, in turn, were cared for by the community.
The introduction of Capitalism and White European and American culture to the Philippines brought a disconnect with how traditional medicine was valued and accessed. The expectation of traditional healers to care for the community without monetary payment remained, but this existed within the context of a money-based system where most people lived in poverty. An ecosystem of traditional, mutual care was completely disrupted.
Decolonizing our energy exchanges for medicine is more complicated than replicating traditional customs – we can't just go back to how things were. We need to be in dialogue with our traditions and our current context. For me that has looked like the following:
I'm sitting here today writing as I vacillate in and out of anxiety mode. This isn't about forcing myself to be productive through an unstable mood. I want to share what this is like because:
There are times in my life when depression and anxiety immobilize me. As I write this, I am trying to record audio for my podcast. I keep hitting “pause” so I can hyperventilate and cry. My body is shaking. My heart races. My perception of time is weird. I'll blink and all of a sudden an hour is gone – I call this time travelling. Primm, my ESA dog, pokes me with her nose to take me for walks and remind me of our routines (including her feeding schedule). She slowly paws my hand if I'm stuck doom scrolling.
When I am in this emotional place, I can't take care of anyone, let alone myself. How can one work as a healer then? Doing healing work is so intimate, vulnerable, and sacred. Acting without being present and grounded could hurt someone (even natural medicine can have side effects). So, if I am off my game, what can I do? I can be human. I can give myself all the care I might give a patient. I can regularly reflect on what my capacity and boundaries are so that I can be competent in my work.
I need ongoing work on self awareness so that I am not frequently surprised by a “sudden” dip in mood. It took me a while to realize that I often experience emotions somatically. For example, I may not think I feel anxiuos, but my digestion may have been off for a week or I won't have slept in days. I have learned to be expansive about how I anxiety and depression feel. It allows me more agency in my response. It's time for Choose-Your-Own-Adventure:
What has been humbling during the pandemic is re-learning my relationship to mental health and my role as a healing practitioner. The collective emotional strain is real. The primary, secondary, tertiary trauma and grief is real. My threshold for feeling “okay” are not the same. My recovery times are not the same. My prevention is not the same. What I have access to is not the same.
What I am continuing to learn is that my relationship to my wellness is dynamic and it always has been. My body, mind, heart, and spirit fluctuate, respond, expand, and contract. Medicine cannot be effectively practiced in a static, non-adaptive way. In order to show up for others, I need to be engaged in my own healing actively and consistently. It is not about being perfectly well, but being informed and held. Being in relationship with my limits means I can practice medicine more safely and compassionately within an ever-changing context.
[This is written from personal experience and is not medical advice or therapy. I am not a mental health therapist. Please seek the support you need if you are struggling <3]
Whenever you walk into a Filipinx household, the first question you are are asked is, “Did you eat?” Food is incredibly important to us. Whenever I am on the phone with my dad, he wants to know: What am I eating? What did I eat yesterday? What am I going to eat later? Sometimes when he misses me, he just sends me photos of his cooking. Food is the language in which we communicate and show affection. Food is one of my most important forms of medicine – a way to care for my mind, body, and soul. The effect of colonization on me as a child was so strong that for a time, I forgot all of that.
One of my earliest memories from elementary school was being bullied for my food. The nourishment my family provided for me became stinky and weird. Some days I would walk over to the trash can and dump my entire lunchbox into it. I wanted sandwiches and Lunchables, Carpi Suns, and Hi-C juice boxes like the white kids. Internalized racism taught me to reject something that gave me strength.
On a public health level, Filipinx suffer disproportionately high rates of chronic diseases, such as heart disease and diabetes, that are diet-related. Much of this is due to industrialized and Westernized food systems. Traditional foods with fresh vegetables and fish are replaced with highly processed products containing white flour, white sugar, and preservatives. This is true for many BIPOC groups.
Filipinx have a tradition of ancestor veneration. Our venerated ancestors, sometimes referred to as anito or ninuno, watch our for us and protect us. One of the ways to honor them is to give food offerings, atang. White culture not only distances us from feeding ourselves with life-promoting traditional food, it distances us from caring for our ancestors as well. Consuming food is a way for us to feed our ancestors. They no longer have corporeal form except through the body of their descendants. I am an accumulation of their lives and genetic material and food is a way for me to honor the survival and sacrifices of those who cam before me. Consuming traditional food is a way of taking up space and reclaiming history, nourishment, and pride. It is a transformation of shame and pain.
I find it offensive when white culture exploits stinky or “bizarre” food as entertainment. It is a novelty and a cheap thrill, a game of “I dare you...” This consumption is rooted in appropriation and Orientalism instead of a deep cultural appreciation. (I considered adding links to Youtube videos to cite sources, but it makes me too angry. You're on your own for that.) A chef friend once told me that cooking for someone is one of the most intimate activities – the food literally becomes a part of the other person on a cellular level. What an insidious way for racism to teach BIPOC to reject themselves on at that same level.
We have all heard the term “food is medicine”. If we are to decolonize medicine, we need to look at how we eat, what we eat, and who gets to eat. So, what can we do about this? Here are some of my suggestions:
What are your ideas on decolonizing medicine through decolonizing food?
Image: several kamote (sweet potato) plants regrown from ONE kamote on my deck.
Today I went for a hike in the woods and had a triggering, recurring experience: white runners, unmasked, forcing me off a path during the COVID-19 pandemic. They are the fast zombies of the here and now – mindlessly running and potentially harming people they should be in community with. Is this rude? Yes, but that is not the whole of it. What I am actually seeing here is a replication of colonial mentality on a micro, mundane scale.
Hiking is supposed to be a pandemic-safe wellness activity – open air, easy distancing, exercise, etc. On a magical and medicinal level, even as an indoor kid, I think it is important to be out in nature and develop a relationship with it. But...who actually gets to take up that space and at who's cost? This is where it starts to look like a small scale replica of colonization. Right at the get go, everyone that I encountered on today's hike was white. In past instances where I was run off the sidewalk or trail it has always been white runners (sometimes cyclists) with no mask. It is not just about rudeness when there is an obvious pattern and repetitive power dynamic. It is a centering of individual need over greater collective wellness. It is an entitlement to space and disregard of who might be harmed in the taking of that space.
I have tried many different responses to the white runners with no great success. Today was avoidance. If I see them coming, I grab my dog and get as far off the trail as I can ASAP (cuz THEY DON'T SLOW DOWN). Most of the time they don't even acknowledge me as I stand awkwardly in a shrub. Occasionally, they'll thank me for moving out of their way and then get upset when I do not respond to their chipper space taking. I am going to assume that the white runners are not concerned with getting infected because people like me move out of the way since the alternative is an even bigger violation of our safety.
Why don't I just stand up for myself? For those who are closer to me I am normally very direct in my communication. Well, I have learned that trying to verbally establish boundaries with the white runners leads to violence – angry yelling, mean mugging, or completely ignoring the MINIMUM 6 feet distance and being close enough to rub elbows with me. Like fast zombies, I can't reason with them. My appeals to their human decency don't really sink in.
Passive aggressive tactics I've tried include coughing really loudly (into my mask + elbow) or yelling that I or my partner might be sick so that they have to go around me (this was before it was easy to get tested). This has actually been the most successful way of getting white runners to stay away from me since it seems to jar people into the reality that they might be harmed. Even though we should all practice universal precautions anyways, I hate using this survival tactic because it is alarmist and costs even more of my energy.
I am also someone who is read as Asian. I am also read as queer, sometimes trans/nonbinary. Let's sit with what it means right now for my safety to at best inconvenience and at worst horribly offend a fast, athletic white person working out whatever Type A, colonizer, white fragility nonsense they are carrying around on their run.
Additionally, can we talk about consent? I know that people are exercising different safety protocols around COVID-19, but shouldn't we assume, until proven otherwise, more conservative distancing and masking? I do not consent to be within 6 feet of people who's risk levels I don't know. I do not consent to endangering other people, even white runner zombies, in very avoidable situations.
These are all aspects of colonization: taking of land and resources, centering colonizer needs and desires at the expense of others (human and nonhuman), disregard or outright violence towards people deemed lesser than, etc...
Are my encounters with the white runner zombies a direct physical assault? No, in the sense that it is not an obvious, severe form of violence where I am at risk of immediate death. It absolutely does not compare to larger scale assaults like murdering babaylan and institutionalizing the Catholic Church in the Philippines. These encounters, however, are a risk of COVID-19 for me and anyone who I am podded with. There are real, tangible effects on my body. Here is what I notice when I have these encounters:
Why is reflecting on incidences like this important to me? Identifying colonization and white supremacy in our lives is crucial to promoting collective wellness.