Health Committee on May 7th, 2019

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

What kind of training is that and how long does it take? Who's offering it? Is it for doctors, nurses or triage people?

[Lorraine Grieves]

We're rolling forward a tiered training model in B.C. Starting from the basics, our shortest is a half-hour online module. It's to whet one's appetite around what we call the trans basics. Sometimes, we'll combine an online module with a live teaching opportunity. We're developing learner pathways for the different parts of the system of care where the training is needed. It's from brief to much longer for advanced practice professionals. It really depends on the setting, and what the intention of the training is.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

In terms of urban and rural differences in trans health, other than the fact that a lot of medical services aren't available to anybody who's more rural and remote, are there specific actions you would recommend we take, to try to address LGBTQ health in rural areas?

[Quinn Bennett]

I just have one thing to mention around that. I think that in communities that are lacking the knowledge or the awareness.... I'm thinking about Doug's comment earlier about his friend who is the teacher who said, “Please don't talk about this.”

In situations like that, I think we really try to identify a community champion. This might be an older trans person who lives in the community. This might actually be a teacher. It might be a supportive mum. It's someone in the community who can act as a bit of a resource, a go-to and a support. Specifically, we're really concerned about youth who are isolated and completely detached from resources that could support their journey ahead. I think that looking for folks in the community who can be those support resources is really important.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Sort of like an ambassador.

[Lorraine Grieves]

Just to add to that, we're having a big piece of work go forward around virtual health options, and we're piloting virtual care where people can be seen right from their home through a private, secure platform, through the provincial health authority. We think that will go a long way towards rural access, as long as people have the Internet. There are many communities in B.C. that might not have that either. There's lots to do there.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Well, it's the federal government's job to put broadband Internet across the country, so we will do that.

[Lorraine Grieves]

Okay, great. There's a recommendation.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

That's the end of my questions. Thank you so much for your testimony.

[The Chair, Liberal, Bill Casey]

Now we go to Ms. Damoff.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Thank you all for your presentations. You are outstanding.

Can we stop calling it “conversion therapy”? This is a comment, not a question. Therapy, to me, implies that it's a good thing. Poor Sarah has heard me moaning about that a lot, and you're not the only witnesses who have said it. I don't have a better term, but surely to goodness, if we're going to change the conversation around it we can stop calling it a therapy.

Lorraine, you've talked a lot about training. We've heard other witnesses talk about that as well. Do you see a role for the Public Health Agency of Canada to provide training to health care workers?

[Lorraine Grieves]

I think so. In our brief, we recommended that there's work to be done with the network of trainers and educators across the country. There are many groups doing this work but without very much dedicated funding. I think any strategy needs to be informed by the strengths and the resources that are already there. I would suggest that PHAC work with the existing network to really figure out how to scale up.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

One of the things I've noticed is that a lot of the stuff we hear during this study has been provincial—education and sex ed curriculum in the schools, and the delivery of health care. I'm trying to focus on what the federal government can actually do. I would think that it could provide some leadership by providing that training so that all of them—health care—do end up getting trained through whatever body it might be.

Another one is access to grants. I was talking to an organization that said they had women and gender equity now but that there were limited places where they could apply. You can apply through the Department of Indigenous Services, but there are very limited grants specific to LGBTQ and—in particular—trans organizations.

[Lorraine Grieves]

That's very true. Prior to Trans Care BC existing, I had six years of federal funding to do this work, but it was a bit cloak-and-dagger. We used the substance use prevention stream to apply for money to work on moving toward GSAs and community action related to LGBTQ2 prevention. You'll find that many groups that do this work have had to kind of find ways to use a disease stream or another stream of funding in order to focus on the population. We could use dollars just focused on the populations we're talking about, for broad health work.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Okay.

Did you want to add, something?

[Sarah Chown]

Definitely, we need to see those funding dollars.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Well, it makes it difficult if other organizations.... We've done a good job of increasing funding with certain different groups. It's never enough, but....

Another one is representation in clinical trials. I was speaking to an organization last night where women of African history are not represented in clinical trials for breast cancer. Is there adequate representation? I'm thinking in particular of trans individuals who are dealing with hormones, and whose physiology—if that's the right word—is different than maybe Robert's or mine would be. Is there adequate representation in clinical trials?

Jack, over to you.

[Jack Woodman]

No, there is not adequate representation. We're doing some work at my organization now around applying a sex and gender lens across all research for any research study that occurs. Historically, that has meant that it needed to include women. Now we're really looking at gender in a much broader way, but that's very new.

The other thing is just accessing sufficient numbers in the studies of trans populations. I will re-emphasize the piece around the ethical guidelines for conducting research in these populations, because there are a lot of things that need to be considered when we're including those folks.

Yes, absolutely, we need more representation, and we also need to encourage researchers through funding to include this within the sex and gender lens and also to apply those ethical guidelines.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Okay. I only have a few seconds left, and this is an easy question. Witnesses last week were saying that when they come to committee, it would be helpful to know pronouns. I prefer “she and her”. It wouldn't cost the government anything to add pronouns to witnesses and to MPs when you're addressing us. Do you folks think that would be a good idea?

[Sarah Chown]

I think that speaks to what I was saying before about the federal government's role in normalizing these conversations. If the federal government had names and pronouns every time, that would lead a lot more people to learn about that and to start doing that as well.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

We could easily even just add it to these sheets that are handed around.

Thank you.

[The Chair, Liberal, Bill Casey]

Now for our final question, we'll go to Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

“He, him....”

Jack, what percentage, or how many Canadians are going to other countries for surgery? I just wonder if there's a particular place where they tend to go for surgery.

[Jack Woodman]

I'm not sure. I would have to get back to you on the percentage of Canadians who are going—

[Don Davies, NDP, Vancouver Kingsway, BC]

The number of people, just to get an idea of the scope.