Labarai

Carly kawai ta dawo Louisiana don kallon fim tare da budurwar ta kuma ta zauna.Ya kasance a cikin bazara na 2017, kuma kimanin makonni biyu da suka gabata, Carly, mace mai shekaru 34 da haihuwa, an yi mata tiyata a cikin farji: wata hanya ta wani lokaci bayan rauni ko ciwon daji, amma mafi yawan lokuta don kulawa da canji.Carly ta zaɓi likitan fiɗa, Dokta Kathy Rumer, wanda ya ƙware kan hanyoyin tabbatar da jinsi a yankin Philadelphia.
Sun yi ta Skype a cikin watannin da suka wuce kafin tiyata, amma ba su taɓa saduwa da mutum ba kafin tiyata.Carly ta ce ta ziyarci likitan a takaice kafin a tura ta cikin dakin tiyata, amma ba ta sake ganin Dr. Rumer ba a cikin kwanaki uku da ta yi jinya a asibiti.Bayan mako guda da yi mata tiyatar, ma’aikaciyar jinya ta yi mata booking domin yin alƙawari.
Bayan dawowa gida daga fim din "Louisiana", Carly ta kalli sabuwar farjinta.Yayin da akasarin vulva na mako biyu da haihuwa ba su da kyan gani, Carly ta gigice lokacin da ta sami "babban guntun fata mai girman girman babban yatsan yatsa," in ji ta.Washe gari ta kira lambar gaggawar da aka bayar ta aika da sakon email zuwa ofishin Dr. Rumer.A ranar Litinin, ofishin ya shawarci Carly da ta yi imel da hotunan wuraren matsala don likitocin tiyata su duba.Bayan 'yan kwanaki, Carly da mahaifiyarta sun ce sun ji ta bakin wani likita da ke hutu kuma ya gaya wa Carly cewa ba ta da wata damuwa.Dokta Rumer ta ce mahaifiyarta, likita mai ritaya, za ta iya yanke buɗaɗɗen fata idan ta ci gaba da jin zafi.
Shawarar ta girgiza Carly da mahaifiyarta.Tace al'aurarta nada kamshi sai labbanta tayi wani siririn fata.Mako guda bayan ta yi magana da Dr. Rumer, Carly ta ce ta je wurin likitan mata na yankin, wanda ya firgita ya kai Carly zuwa Asibitin Baptist na Oshner da ke New Orleans don yin tiyatar gaggawa.Wani ɓangare na farjin Carly ya shafi necrotizing fasciitis, kamuwa da cuta wanda ke da haɗari a kowane aiki.Wannan yakan haifar da asarar nama a yankin da cutar ta kamu da ita.
Wasu gungun likitoci ne suka yi wa Carly tiyata, babu wani daga cikinsu da ya samu gogewar farji ko farji—al’aurar bayan-op ya dan bambanta da na cisgender.Ta yi kwana biyu a sashen kula da lafiyar jiki, sannan ta yi kwana biyar a asibiti.Ita da mahaifiyarta sun ce yawancin kiraye-kirayen da mahaifiyar Carly da OB/GYN dinta suka yi zuwa ofishin Dr. Rumer ba a amsa su ba a wannan lokacin.
Lokacin da suka sami amsa daga ofishin Dr. Rumer - wani rikici na gudanarwa tare da bayanan Carly - likitan likitan ya damu da cewa Carly ba ta shirya jirgin zuwa Philadelphia don likitocin su gyara matsalar ba.In ji Carly da mahaifiyarta, Dokta Rumer ta tarho su ta wayar tarho tare da mahaifiyar Carly: “Na tuna sosai na ji labarin a ranar,” in ji Carly, wadda ta ji zancen.“Dr.Rumer ya ce, "Na bi ka'idodin WPATH don kula da majiyyata.Idan kana ganin za ka iya yin abin da ya fi, me zai hana ka ba ta farji?
Dr. Ramer yana magana ne game da kungiyar kwararrun duniya don lafiyar Transgeender, wanda ke taso ka'idoji da mafi kyawun ayyuka don samun lafiyar duniya.Ƙungiya da ke aiki a matsayin mai tsaron ƙofa tana da tsauraran dokoki da ke ba marasa lafiya damar yin tiyatar da ke da alaƙa da canjin yanayi, amma ba ta sarrafa ayyukan aiwatar da waɗannan hanyoyin.Majinyata masu yuwuwa kamar Carly suna da kan kansu idan ana batun neman likita don tiyata.
Dokta Rumer ƙwararren likita ne: ya gudanar da aikin kansa tun daga 2007, yana kula da marasa lafiya na transgender tun 2016, kuma yana aiwatar da hanyoyin tabbatar da jinsi na 400 a kowace shekara, ciki har da gyaran fuska, gyaran nono da GRS.A cikin 2018, Dr. Rumer ya bayyana a cikin wani shirin NBC game da canjin ɗalibin kwaleji.A cewar shafin yanar gizon ta, tana ɗaya daga cikin ƴan likitocin filastik mata da suka sami takardar shedar hukumar a yankin Philadelphia's tri-state, memba ce ta Cibiyar Nazarin Orthopedic ta Amurka, kuma shugabar tiyatar filastik a Kwalejin Philadelphia na Magungunan Osteopathic (PCOM). .da Zumunci a cikin Reconstructive Surgery.Ta kasance memba na WPATH tun 2010. (Cikakken bayani: Na yi shawarwarin tiyata tare da Dr. Rumer ta hanyar Skype a ƙarshen Satumba 2017, amma a ƙarshe ya yanke shawarar ganin likita daban.)
Yawancin marasa lafiya da suka zo wurin Dr. Rumer don aikin tiyata na hip sun gamsu da sakamakon.Amma ga wadanda ba su gamsu da tsarin su a hannun Dr. Rumer ko wasu ba, yana da wuya a mayar da martani mai ma'ana ga kokensu.A cikin duniyar da aka fi yin siyasa sosai ta aikin tiyatar tabbatar da jinsi, yana iya zama da wahala a sami amsoshin tambayoyi game da daidaitattun kulawa.Masu ba da shawara sun bayyana ayyukan tiyata daban-daban da "cibiyoyin ƙwaƙƙwaran transgender" waɗanda asibitocin gida da kwamitocin kiwon lafiya na gwamnati ke kulawa.Ofisoshin na iya bambanta sosai idan ya zo ga ƙimar haƙuri-da-likita da kuma takamaiman horon da likitan fiɗa ke da shi.
Lokacin da wannan ya faru, zai iya zama da wuya a yi magana game da irin wannan batu na sirri - Carly ya nemi sunan sa don tsoron ramuwar gayya kuma ya nuna irin wannan lamari na sirri ga manema labarai a bainar jama'a.Da yake magana a lokacin da mutane kaɗan ke samun damar samun kulawar likita bayan wani rauni mai rauni za a iya amfani da su ta hanyar masu fafutuka masu adawa da transgender ko kuma masu fafutuka suka fassara a matsayin mataki na baya.
An buga kalmomin Carly a kan dandalin anti-transgender lokacin da ta buga game da kwarewarta tare da Dr. Rumer a kan allon saƙo don gargaɗin sauran marasa lafiya.Kokenta ga Sashen Kwararru da Sana'a na Pennsylvania bai haifar da wani mataki na hukuma ba.Jezebel ta yi hira da wasu mutane huɗu da suka ce suna da matsala game da hanyoyin da Dokta Rumer ya yi, tun daga zargin rashin kulawar bayan gida zuwa tsarin farji wanda ya jawo musu ciwo mai tsanani, ko kuma farjin da bai yi daidai ba.Matsala.Bugu da kari, tun daga shekara ta 2016, an yi kararraki guda hudu a kan likitoci kan batutuwa iri daya, wadanda dukkansu sun kare ne a cikin shari'a ba tare da kotu ba.A cikin 2018, Hukumar Kula da Lafiya ta Pennsylvania ta tuntubi likitan tiyata bayan wani rukuni na masu canza jinsi da suka ga ta yi magana a wani taro kan maganin transgender sun shigar da kara suna zargin cewa likitan ya gurbata adadin nasara, amma ba a dauki matakin ladabtarwa ba.
Kamar yadda Dr. Rumer ta rubuta a shafinta na yanar gizo kuma ta yi muhawara a kotu, da alama waɗannan rikice-rikicen sun samo asali ne sakamakon rashin bin umarnin ofishinta na bayan tiyata, ko kuma wani ɓangare na haɗarin kowane irin wannan hanya.Amma sa’ad da Jezebel ta je wurin Dokta Rumer da cikakken jerin tambayoyi da kuma bayanan haƙuri, mun sami amsa daga lauya.A watan Afrilu, lauyoyin Dokta Rumer sun yi ƙoƙari su ba ni sammaci a cikin wata shari’ar batanci da ba ta da alaƙa, suna neman in ba da “dukkan bayanin kula, imel, takardu, da bincike” masu alaƙa da labarin.Jim kaɗan kafin a buga, Dokta Rumer ta sake ƙi cewa komai kuma, ta hannun lauyoyinta, ta yi barazanar ƙara Jezebel a cikin ƙarar bata mata suna da ake jira.
Waɗannan abubuwan da majiyyata suka samu da wahalar neman taimako ba su da alaƙa da likita ɗaya.Yayin da bukatar GRS ke girma, za a iya samun damuwa mafi girma: Ba tare da keɓancewar hanyar bayar da rahoto ga marasa lafiya da abin ya shafa ko wata hukuma da ke da alhakin tsara cikakkun bayanai game da kulawar ba, za a toshe marasa lafiya da ke neman waɗannan hanyoyin.babu tabbacin ingancin sabis a rajista, kuma ba a bayyana yadda za a ci gaba ba idan ba su ji daɗin sakamakon ba.
Duk da yake duk wani tiyata, musamman akan mafi yawan sassan jiki, yana zuwa tare da haɗari, GRS ba ya haifar da haɗari ga mata masu canzawa.Bisa ga binciken 2018, yawan mutanen transgender da suka ƙare da yin nadamar farji sun kasance kusan kashi 1 cikin dari, da kyau a ƙasa da matsakaici don aikin tiyatar gwiwa.A gaskiya ma, dalilin da ya fi dacewa don yin nadama akan tiyata shine mummunan sakamako.
Fasahar zamani ta gyaran fuska an ɓullo da ita a Turai sama da shekaru 100 da suka gabata kuma an yi ta a Amurka aƙalla shekaru 50 da suka gabata.A cikin 1979, Jami'ar Johns Hopkins ta daina ba da GRS don dalilai na siyasa, kodayake yana ɗaya daga cikin manyan asibitoci a Amurka don haɓaka wannan aikin.Yawancin asibitocin da yawa sun biyo baya, kuma Ma'aikatar Lafiya da Ayyukan Dan Adam ta haramta Medicare daga rufe hanyar a cikin 1981, wanda ya sa yawancin kamfanonin inshora su keɓe ɗaukar hoto mai alaƙa da transgender daga tsare-tsaren inshora masu zaman kansu jim kaɗan bayan haka.
Sakamakon haka, ƴan ƙwararrun ƙwararru a Amurka suna ba da ƙarancin tiyatar jiki kwata-kwata, suna hidima ga ƙananan rukunin marasa lafiya waɗanda a zahiri za su iya samun aikin tiyata.Yawancin mutanen transgender an tilasta su biyan kuɗin tiyata daga aljihu har zuwa 2014, lokacin da gwamnatin Obama ta sake dawo da ɗaukar hoto na Medicare don aikin tabbatar da jinsi da kuma dakatar da keɓancewar inshora don tiyatar transgender a cikin 2016. Da zarar an aiwatar da manufofin Obama-zamanin, ƙarin mutanen transgender za su wuce. iya biyan waɗannan hanyoyin ta hanyar inshora ko Medicaid, kuma wasu asibitoci suna gaggawar biyan buƙatun da ake buƙata.
Duk da haka, irin waɗannan hanyoyin suna da tsada: vaginoplasty yana kimanin $ 25,000.Wani bincike na 2018 da masu bincike a Jami'ar Harvard da Jami'ar Johns Hopkins ya gano cewa tsakanin 2000 zuwa 2014, adadin tiyatar tabbatar da jima'i ya karu sosai, tare da karuwar adadin su ana ba da inshora na sirri ko biya ta Medicaid."Yayin da ɗaukar nauyin waɗannan hanyoyin ke ƙaruwa, haka kuma buƙatar ƙwararrun likitocin tiyata," masu binciken sun kammala.Amma akwai 'yan ƙa'idodi masu ƙayyadaddun ƙa'idodi game da abin da "cancanta" ke nufi, da sauran fannonin aikin likitanci suna shafar canjin jinsi.akan matsalar.Likitoci suna ba da rahoto ga cibiyoyi daban-daban da horon GRS na iya bambanta daga kallon mako guda tare da mashahurin likitan fiɗa zuwa shirin koyan shekaru da yawa.Babu albarkatu masu zaman kansu da ke akwai don marasa lafiya don samun bayanai game da ƙimar wahalar tiyata.Sau da yawa, marasa lafiya suna dogara ne kawai akan bayanan da likitocin da kansu suka bayar.
Duk da yake mutane da yawa sun amfana daga ɗaukar hoto na GRS, wani sakamako mai ban sha'awa wanda ba a yi niyya ba shine abin da likitan likitancin jinsi na San Francisco Dokta Marcy Bowers ya kira al'ada "bankwana".asibiti a cikin lokacin da aka ba su, kuma ba za su mutu daga wani mummunan yanayi ba, ko kuma a sake musu asibiti sau da yawa, "in ji ta, "hakan ne suke auna nasara."zama “masu samarwa da aka fi so” ta hanyar jawo hankalin sabbin marasa lafiya yadda ya kamata zuwa aikin su bisa waɗannan ma'auni.
A cikin Mayu 2018, 192 marasa lafiya transgender postoperative sun rubuta buɗaɗɗen wasiƙa zuwa WPATH suna bayyana wasu damuwa game da tsarin da ake ciki yanzu wanda likitocin fiɗa ke ba marasa lafiya iyakantaccen albarkatu " tiyata kyauta ko maras tsada don samun ƙimar wahala tare da ba da shawara na farko ".wallafe-wallafen ilimi da magana na jama'a game da ƙwarewar tiyata, aikin tiyata na gwaji ba tare da izini ba, ingantacciyar bayanin likita da aka bayar ga marasa lafiya, da rashin isasshen kulawa ga marasa lafiya.
"Har yanzu akwai rashin daidaituwa tsakanin buƙatu da adadin mutanen da aka horar da su a cikin waɗannan hanyoyin," in ji Dokta Lauren Schechter, shugaban zaɓaɓɓen shugaban ƙungiyar likitocin mata na Amurka.“Hakika burinmu shi ne mu kara wayar da kan jama’a domin kada mutane su yi tafiye-tafiye, a kalla a muhimman wurare… Don haka akwai kuma jinkiri tsakanin koyar da mutane yadda ya kamata da kaddamar da cibiyoyi [da] asibitoci.”
Rage jinkiri don biyan buƙatun haɓaka hanyoyin tabbatar da jinsi sau da yawa yana nufin rage ƙimar horo ga asibitoci da likitocin fiɗa."Ainihin, matakai biyu gaba da mataki daya baya," in ji Jamison Green, tsohon shugaban WPATH kuma darektan sadarwa na yanzu, na karuwa a cikin tiyata.Da yake ɗaukar matakin baya, ya ce, wasu likitocin na iya zaɓar yin horo a ƙarƙashin yanayi mafi wahala: “Ba sa shiga WPATH.Ba su yarda a koya wa kansu ba.sai su ce, "Eh, yanzu na san abin da zan yi."Kamar yadda wani likitan fiɗa da ba a bayyana sunansa ba ya yi ƙaulin wani bincike na 2017: “Wani yana zuwa wurin mutane masu suna;sun yi karatun sati guda sannan suka fara yi.gaba ɗaya rashin ɗa’a!”
Canza tsare-tsaren inshora da dokokin da ke tafiyar da kamfanonin inshora na Amurka suna nufin cewa masu canza jinsi sukan nemi irin waɗannan hanyoyin don tsoron cewa masu insurer na iya canza ka'idodin ɗaukar hoto lokacin da suke tantance yiwuwar likitocin fiɗa.Inshorar inshora yakan bayyana inda marasa lafiya ke samun kulawa, kamar Danielle, wata mata mai shekaru 42 da ke zaune a Portland, Oregon kuma ta dogara da Medicaid.A cikin jiharta, wasu ayyukan tiyata na tabbatar da jinsi suna cikin shirin Medicaid na jihar, amma a cikin 2015, Danielle ta ji bukatar yin hakan da wuri-wuri yayin da kulawar likitanci ga masu canza jinsi ya zama manufar siyasa ta Republican.
"Na yi tunani kafin mu sami shugaban Republican, ina bukatan samun farji," in ji Jezebel a wata hira ta bazara 2018.Lokacin da Medicaid ta aika da ita zuwa Portland don ganin Dr. Daniel Dougie, ta gaya mata cewa ita ce majiyyacinsa na 12th transvaginoplasty.Lokacin da ta farka daga al'aurar, an gaya mata cewa za a yi mata tiyata sau biyu domin al'aurarta ke da wuya a bude.
Ko da yake ta ce sakamakon na gani da na ji yana da kyau, abin da Danielle ta samu a asibiti ya bar abin da ake so."Babu wanda ke wannan unguwa da ya san yadda zai magance raunukan da mutane ke samu," in ji ta.Ta ce ta ji an yi watsi da ita kuma ta garzaya don taimakawa bayan wani dogon lokaci da cin zarafi.Jezebel ta yi magana da da yawa daga cikin sauran majinyata Dougie, kuma tare a ƙarshe suka shigar da ƙara a asibiti.Yayin da korafe-korafen Daniella ya kasance game da kwarewarta na kulawa bayan tiyata a asibiti, wasu sun yi fama da matsaloli masu tsanani, ciki har da yoyon fitsari da kuma rashin natsuwa bayan tiyata.A cewar wata majiya da ke da masaniyar tattaunawar da kungiyar ta yi da asibitin, kungiyar ta yi imanin cewa asibitin ya fi sauran asibitocin da ke ba da irin wannan tsari.
Da yake amsa tambayoyin Jezebel da yawa, Dr. Dougie ya ce asibitin ba ya yin mu'amala ta musamman tare da marasa lafiya saboda dokokin sirri, amma ya yarda cewa ma'aikatan sun yi magana sosai tare da marasa lafiyar transgender.“Mun halarci tarurruka da dama na fuska da fuska tare da daidaikun mutane da kungiyoyi na tsawon lokaci.Wadannan tarurrukan sun ci gaba har sai da aka cimma matsaya kan matsalolin marasa lafiya na yanzu, an cimma burin tattaunawar, kuma an samar da shirin rigakafin sake dawowa," Dr. Dugi ya rubuta a cikin imel.
Musamman, asibitin ya kafa Kwamitin Ba da Shawarar Al'umma na masu canza jinsi na gida da wadanda ba su yarda da jinsi ba wadanda ke tuntubar ma'aikata da gudanarwa na OHSU Transgender Health Programme, Patient Affairs, da sauran masu ruwa da tsaki.
Dokta Dougie ya sanar da Jesabel cewa ana lura da rikice-rikicen tiyata a asibiti kuma ana amfani da su don inganta sakamako, tare da rikice-rikicen ƙima ko wuce sakamakon da aka buga daga wasu ƙwararrun likitocin."Likitocinmu na tiyata suna ƙoƙari don samun ƙwarewa, amma wani lokacin ana samun rikitarwa," in ji shi."Dukkanin likitocin OHSU suna gudanar da bita na cikin gida akai-akai game da sakamakon aikinsu na likita da tiyata ta hanyar cututtuka da tarukan mace-mace wanda darektan ingancin kowane sashe ya daidaita."
Dokta Dugi ya lura cewa damuwar ma'aikata game da ingancin kulawa da sakamakon an tashe su zuwa tsarin bitar takwarorinsu wanda daga nan za a iya mika su ga kwamitocin bita na hukumomi."Dukkanin cibiyoyin kiwon lafiya suna bin wannan ka'ida kuma ƙungiyoyin sa ido na ƙasa sun ƙaddara su," in ji shi.
Yayin da marasa lafiya na OSHU suka tattauna yiwuwar gyare-gyare tare da kula da asibiti, wasu tsofaffin marasa lafiya na Dr. Rumer sun wuce iyaka.A cikin 2018, tsoffin majinyata huɗu na likitan fiɗa sun shigar da kararraki daban-daban a gaban kotu na Gundumar Gabashin Pennsylvania.Kowannensu ya wakilce su da kamfani guda ɗaya kuma sun yi iƙirarin cewa aikin Dr. Rumer ya yi muni a cikin shari'o'in su har masu gabatar da kara (dukkan New Yorkers) suna buƙatar tiyatar gyarawa a Dutsen Sinai.
Kowanne daga cikin masu gabatar da kara ya bayyana kunkuntar da lalacewa ga urethra, canal na farji, da labia, da kuma kumburi ko nakasar huffin clitoral, batutuwan da aka fi sani da "lalacewar dindindin" kamar yadda masu karar "ba za su sake yin jima'i ba."
Kararrakin, wadanda ke bayyana “walakanci” da “mummunan rauni na tunani” da aikin Dr. Rumer ya haifar, da farko an yi kira da a yi shari’ar juri, amma daga karshe an koma ga sasantawa na sirri na son rai.A wata shari'ar, lauyoyi sun yi niyyar gurfanar da Dr. Jess Ting, wani likitan tiyata kuma farfesa a fannin likitanci wanda ya kware a GRS a Dutsen Sinai, a cewar wata sanarwa da aka yanke kafin shari'a.Ana sa ran zai ba da shaida cewa ko da bayan tiyata uku, aikin Dr. Rumer bai ba masu kara damar "cimma inzali ko gamsuwar jima'i ba tare da jin zafi ba", da kuma magance wasu muhimman matsaloli, ciki har da "ƙwararrun ƙwararru ba tare da garkuwar ƙwanƙwasa" da gashi ba. babu kwarin gwiwa.cire daidai.
“A matsayina na likitan fiɗa, zan iya gaya muku cewa kowane likitan fiɗa yana da sakamako mara kyau,” in ji Dokta Ding Jezebel.“Dukkanmu muna da rikitarwa kuma abubuwa ba koyaushe suke tafiya yadda muke so ba.Lokacin da kuka ga yanayin sakamakon da ke nuna cewa likitan fiɗa bazai kai matsayin kulawa ba, kuna jin buƙatar yin magana. ”
A cikin wata taƙaitacciyar taƙaitacciyar ƙarar shari’ar da aka shigar a ƙarshen Fabrairu, kafin ƙarar ta kai ga sasantawa, lauyoyin Dokta Rumer sun yi jayayya cewa likitan fiɗa bai yi sakaci ba, bai kauce wa ma’auni na kulawa ba, kuma matsalar majiyyaci “abu ce mai rikitarwa. ”"[c] Farji.Har ila yau, korafin ya nuna cewa majinyacin "bai yi aiki ba yayin da Dokta Rumer ke kula da shi" kuma mai shekaru 47 bai ba da rahoton manyan matsalolin ba sai fiye da shekara guda bayan tiyata.Ba a bayyana cikakkun bayanai game da tsarin sasantawa da sakamakonsa ba, v. Rumer Babu ɗaya daga cikin masu gabatar da kara a cikin shari'ar digiri na uku da ya amsa buƙatun da yawa don yin hira.
"A matsayina na likita, babu wanda ke son rashin aikin yi," in ji Dokta Dean.“Wannan batu ne mai matukar damuwa a gare ni a matsayina na wanda ake tuhuma da aikata rashin gaskiya.Bayan na faɗi haka, ina jin cewa a matsayinmu na ƙwararru a wannan ƙaramin ƙaramin yanki, muna bukatar mu kula da kanmu kuma mu kiyaye ƙa'idodi.
Jezabel ta tuntubi sanannun likitocin likitancin jinsi don tambayar yawan tsoffin majinyatan Rumer da suka sake yin aiki don gyara bincikenta.Mafi akasari sun ki cewa uffan, amma mutanen ukun da suka nemi a sakaya sunansu, sun bi majinyata sama da 50 da suka fara tuntubar Dr. Rumer kan GRS tun daga shekarar 2016.
"Dukkanmu muna son mutanen transgender su sami ƙarin zaɓuɓɓuka don tiyata, kuma muna yin duk abin da za mu iya don ilmantarwa da haɓaka kyakkyawan sakamako," in ji Dokta Bowers, wani likitan mata na San Francisco.rikice-rikicen tiyata, fushi da ƙiyayya ga masu gunaguni, rashin samuwa ko lissafi.Ta kara da cewa Dr. Rumer "ya kuma fahimci raunin marasa lafiya da ke matsananciyar tiyata tare da 'yan kalilan likitoci."”
Hannah Simpson, 'yar shekara 34 da haihuwa daga New York, ta ce bayan makonni biyu da yin gwajin GRS tare da Dr. Rumer a lokacin rani na 2014, ta lura cewa farjinta ya fara kama da asymmetrical kuma sassansa suna ja sosai.kuma kumbura.Duk da tabbacin Dr. Rumer cewa komai yana da kyau, Simpson ya ci gaba da necrosis na vulva.
Simpson, wacce ke karatun likitanci a lokacin, ta bayyana sabon farjinta: nakasasshiyar clitoris mai “gefe daya” da kuma labia mai “kamar kumbura fiye da kifaye biyu.”Simpson kuma yana da wasu matsaloli, ciki har da gashin farji wanda likitocin fiɗa suka yi alkawarin cirewa da kuma rashin wuri na urethra.Bugu da kari, Dr. Rumer ya bar karin nama a kusa da kofar farji, wanda hakan ya sanya dila din bai ji dadi ba, in ji Simpson.A kwanan wata, sannan kuma a cikin imel na gaba wanda Simpson ya raba tare da Jezebel, Dokta Rumer ya zargi mataccen fata a kan wani nau'i na Depends Simpson wanda Simpson ya sawa sosai a asibiti, wanda Simpson yayi la'akari da matsalar gujewa.Dokta Rumer ya ƙi amsa tambayoyin Jezebel game da yadda ta bi da wannan majinyaci ko kuma wani majiyyaci.
Necrosis kamar Simpson's necrosis yana da haɗari tare da kowane nau'i na farji kuma ana iya haifar da shi ta hanyar saka tufafi masu mahimmanci a farkon matakan farfadowa bayan tiyata, ko da yake yana iya zama da wuya a gano ainihin dalilin a cikin wannan halin da ake ciki, in ji Schechter.cututtuka a cikin majiyyaci."Kamuwa da cuta, nama necrosis, suture dehiscence - duk wannan yana faruwa tare da kowane aiki," in ji shi.Schecter ya lura cewa tafiye-tafiye bayan tiyata da ƙazanta ko muhallin gida na iya haifar da rikitarwa, amma a ƙarshe dole ne likitan fiɗa ya shawarci majiyyaci kuma ya tabbatar da cewa an rage waɗannan abubuwan haɗari.
Wani tiyata na biyu da wani likitan fida na daban bai yi nasara ba wajen dawo da aikin Dr. Rumer na asali har ma ya haifar da wasu matsaloli, kuma Simpson ba shi da clitoris.Bisa kididdigar ta, yanzu ta tuntubi likitocin fida 36 don sake gina al’aurar ta.Wannan abin da ya faru ya bata mata rai a fannin likitanci kuma ta daina karatun digirin ta na likitanci.Ba ta yi amfani da kowace hanya ta shigar da kara ba, tana tsoron kada hakan ya rage yiwuwar wani likitan fida ya karbi karar ta.
Korafe-korafen Simpson game da aikin Dokta Rumer ya yi kama da na wasu tsofaffin marasa lafiya da suka yi magana da Jezebel.Amber Rose, ’yar shekara 28 da ba ta binary daga Boston ta ce: “A koyaushe ina gargaɗi mutane su guji Rumer.A cikin 2014, sun je wurin Dr. Rumer don tiyata na hip saboda duk zaɓuɓɓukan da tsarin inshora na iyayensu ke bayarwa, likitan tiyata yana da mafi ƙarancin lokacin jira.
Aikin Rose bai tafi yadda aka tsara ba."Rumer ya bar nama mai yawa a ƙarƙashin ƙananan labia na, wanda zai iya zama matsala," in ji Ross."Bai yi kama da vulva ba."Har ma wasu likitoci, sun ce, "aƙalla sau ɗaya yayi ƙoƙarin saka yatsa a cikin fitsari na saboda ba a bayyane yake ba."
Ross ya ce Dr. Rumer bai gina murfin clitoral ba, wanda ya bar clitorin su gaba daya don kara kuzari.Har ila yau, hanyar kawar da gashin Rumer ta kasa kuma ta bar wasu gashi a cikin labia amma ba a cikin canal na farji kanta ba."Ya ci gaba da tara sirruka da fitsari, kuma ya yi wari sosai har na ji tsoronsa tun shekara ta farko," in ji su, "har sai na gane cewa babu gashi a ciki."
A cewar Ross, bayan shekaru shida, har yanzu ba su ji dadin aikin da aka yi musu ba, kuma sun damu da cewa Dr. Rumer yana aiki kan masu canza jinsi.Amma sun ce bacin ransu kuma ya samo asali ne daga matsalolin tsarin da hanyoyin: karancin likitocin GRS da kuma dogon jerin jirage, ma'ana mutane kamar su suna da 'yan zabin zabi daga ciki kuma ba su da isasshen bayani ga likitan tiyata.
Yin tiyatar buttock ga transgender da transgender mutane iri-iri ne kuma yana buƙatar ƙwarewa a cikin tiyatar filastik, urology da gynecology.Kowane ɗayan waɗannan lamuran yana da kwamiti mai zaman kansa wanda ke da alhakin ba da izini.Ƙoƙari na baya-bayan nan don ƙididdige tsarin koyo na farji yana nuna cewa ana buƙatar hanyoyin 40 don cikakken koyan fasaha.Ba tare da yardawar haɗin gwiwa ko ƙa'idodin horarwa daga WPATH ko kowane ƙwararrun ƙwararrun ƙwararrun ƙwararrun ba, dole ne majiyyata su sha matakan aikin tiyata da yawa na sauran rayuwarsu.
Asibitoci guda ɗaya suna da alhakin tantance wanda aka ba da izini don aiwatar da wasu hanyoyin a cikin wuraren su.Dokta Schechter ya gaya wa Jezabel cewa allunan asibitoci yawanci suna buƙatar likitocin da su sami shaidar aƙalla ɗaya daga cikin allunan kiwon lafiya sama da 30 a duk faɗin ƙasar, kuma suna iya samun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙa'idodin horarwa na masu aikin tiyata.Amma a cewar WPATH's Greene, babu wata hukumar kula da lafiya da ke ba da takamaiman likitocin likitocin aikin tiyata na musamman na jinsi: “Na kasance ina cutar da likitocin tiyata don samun ƙungiyoyi kamar Society of Plastic Surgery don ƙoƙarin gano yadda ake yin irin wannan aikin. horo.a matsayin wani bangare na jarrabawar hukumar ta yadda za ku iya samun satifiket,” inji shi."Saboda a yanzu, don yin magana, ba a ba su takaddun takamaiman cututtuka ba."
A halin yanzu, Ƙungiyar Likitocin Filastik ta Amurka tana riƙe da takardar shedar hukumar gabaɗaya amma ba ta musamman kan hanyoyin da suka shafi jima'i ba, ma'ana cewa likitocin da ke da alaƙa ba dole ba ne su cika wasu ƙa'idodin horo don yin tiyatar al'aurar ga marasa lafiya transgender.Green ya ce wannan tsari ne na hukumomi wanda bai dace da ayyukan da ake yi ba.“Yanzu muna da likitocin urologist, likitan mata da sauran likitocin da ke da hannu wajen sake gina al’aura.Don haka yana da wahala fiye da da,” inji shi."Amma babu hukumar da ta shirya karbar hakan."
Don cike gibin, likitoci irin su Dr. Schechter da sauran wadanda suka kware a fannin tabbatar da jinsi sun hada kai don fafutukar samar da ingantaccen tsarin ilimi ga asibitocin da ke neman shiga fagen.A cikin 2017, Dr. Schechter ya rubuta wani labarin a cikin Jarida na Magungunan Jima'i wanda ke bayyana wasu ƙananan bukatun horarwa don likitocin likita na gaba.
A cewar rahoton, likitocin da ke yin tiyatar tabbatar da jima'i dole ne su sami horo mai yawa, ciki har da tarurrukan karawa juna sani, zaman ofis, aikin hannu da zaman kulawa bayan tiyata, da kuma ci gaba da ci gaban ƙwararru.Duk da yake waɗannan shawarwarin za su inganta ingantaccen ilimi a duk faɗin ƙasar, sun kasance masu sa kai ga kowane asibitoci da likitocin fiɗa.Ƙungiyoyi masu zaman kansu irin su WPATH sun yi ƙoƙari a al'ada don biyan bukatun horo amma ba su iya yin canje-canjen tsarin da kansu ba.Kungiyar tana gudanar da nata horon aikin tiyata, wanda ya fara a lokacin shugabancin Green daga 2014 zuwa 2016. Amma ga kungiya kamar WPATH, farashin horo na iya zama haramun, kuma ya kasance na zaɓi kuma kyauta ga likitocin da suke son yin aikinsu.
Wasu, irin su masu ba da shawara da ke aiki a cibiyoyin kulawa na farko na LGBT, suna taimaka wa marasa lafiya tare da tiyata masu tabbatar da jinsi, kuma a cikin 2018 sun shirya wata wasiƙar WPATH ta ba da shawarar samfurin "cibiyar kyawawa" wanda masu insurer da ƙungiyoyi masu sana'a ke aiki tare, don tabbatar da inshorar biya kawai. .likitocin da aka horar da su a cikin shirye-shirye na musamman.(Tsarin, in ji shi, ya magance irin waɗannan matsalolin a cikin tiyata na bariatric a farkon 2000s, yana ba da takamaiman sakamako na sakamakon da kuma tsaurara takunkumi kan tiyata lokacin da aka fuskanci irin wannan matsalolin.) Blasdel ya lura cewa yayin da wasu cibiyoyin kiwon lafiya kwanan nan suka fara kiran kansu "masu canza jinsi. center of excellence”, “A halin yanzu babu wasu sharudda da likitan fida ko wata cibiya zata cika domin samun wannan mukami.