A Queer Predicament

Psychiatrist Dr. Tsang Fan-kwong has been serving patients at Castle Peak Hospital for 25 years. In recent times, he has been helping patients who do not identify with their birth genders, a condition also known as Gender Identity Disorder (GID). Following the retirement of well-known “sex doctor” Professor Ng Man-lun in 2007, Tsang has been the only public doctor with extensive experience in the transgender studies field. However, Tsang has decided to leave the Hospital Authority (HA) and cross over into the private sector. This, combined with the closure of the Sex Clinic at the Queen Mary Hospital in 2005, brings us to the question: can our public medical system accommodate the needs of GID patients?

“Assessing GID patients is a very rare and unique area of expertise,” says Tsang. “A GID patient will have lots of concerns and emotional problems. When a doctor can’t understand these, he won’t be able to work together with the patient to provide help and advice. There are many difficulties at every stage of a GID patient’s life—some of which the patient may not even be able to understand. The doctor needs to help the patient think, and offer suggestions and encouragement.”

Concern groups are also worried about the quality of doctors who conduct assessments for transgendered people. “When patients go through these assessments, they need doctors with the right experience. Now the services are dispersed all over the city and though it’s been five years since the closure of sex clinic at Queen Mary Hospital, it seems that they [the doctors] still haven’t acquired the experience required to help us to go through the assessments,” says Joanne Leung, Chairwoman of Transgender Resource Center.

In Hong Kong, one has to go through rigorous psychiatric assessments before undergoing sex-change surgery. Usually, this takes around two years. After the closure of the Sex Clinic at Queen Mary Hospital in 2005, the HA adopted a decentralization approach to provide such services. In every hospital cluster, there is a “multi-disciplinary team” to serve GID patients. However, the Hospital Authority has not explained what kind of special training and qualifications these doctors have, even though handling GID patients requires very unique expertise and it is doubtful whether a general psychiatrist would be capable of doing so. In defense of the system, the HA says that it “facilitates the access of patients living in different districts to HA service, and minimizes the inconvenience caused by to cross-cluster transportation”.

Navale Chan was born a male, but has always identified as a woman. She decided to opt for a sex-change surgery a few years ago. For her, it was a difficult decision to make because of family opposition and social taboos. At first, she sought help from a private specialist for a psychiatric assessment. However, the consultation fee was too high and she was transferred to a general psychiatrist at the Department of Psychiatry in the Princess Margaret Hospital. However, she was greatly dissatisfied with her level of care. “When I underwent my medical consultation, it felt like I was talking to a radio host,” says Chan. “I don’t think the doctor had any experience in handling patients like me. She gave me no special advice and even admitted that I was her first GID patient.”

Professor Ng Man-lun, who set up the Sex Clinic in 1979, finds the current system for GID patients laughable. “No other country in the world has adopted such a system. This is a joke,” says Ng. He regards experienced staff working together as a team a crucial factor in running a successful program for GID patients. “It’s just like performing an operation. You can only gain experience if you treat patients frequently… it simply doesn’t work if you ask a general psychiatrist or someone with only limited experience to conduct assessments. Not to mention doctors who only handle one or two GID patients per year,” Ng adds.