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Pekin trans woman supporting others with gender dysphoria

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PEORIA, Illinois. – Dana Garber has always identified herself as a woman.

The imagination was crystal clear to the lifelong resident of Beijing until the world came in and the water became cloudy. The first time it happened on Garber’s first day of school. Her kindergarten teacher let her use the boys’ toilet.

“I got into the girl’s row,” Garber said when he was recently in her office at Planned Parenthood in Peoria. ‘The teacher grabbed my hand and pulled me out of line and said,’ No, honey, you’re a boy, you have to go to the boys ‘bathroom.’ I didn’t understand and everyone laughed at me. I got humiliated and went to the bathroom and literally felt sick. ‘

Garber went home from school early that day. Her mother explained the situation after she picked her up.

‘She said,’ Well, honey, you are a boy. Boys and girls have different bodies. You can’t go to the bathroom with the girls, you have to go to the bathroom with the boys, ”said Garber.

It was the first of many instances in which the world has forced Garber into an uncomfortable role. Back in the early 1960s, there were few opportunities for people who did not identify with their gender assigned at birth. It was considered a mental disorder and could lead to institutionalization. Doctors believed that therapy could “cure” it.

“The mental health community has come a long way over the past 50 years,” said Garber. “They realized that gender identity disorder is a stigmatizing term, and they started calling it“ gender dysphoria, ”which is an incongruity between your mind and your body. They also realized that there is no cure of gender identity disorders, it is a condition that they can treat. So what is the treatment for gender dysphoria? It’s changing. ‘

Although it took Garber more than 50 years to begin the transition, today, at 63, she lives a life consistent with her gender identity. She also helps others on this journey through her role as Coordinator for Adoption of Transgender Health Programs at Planned Parenthood.

“When I became a happy person, I just got so excited I wanted to help everyone else,” said Garber, who was offered the job shortly after Planned Parenthood began offering gender-specific hormone therapy in central Illinois in 2016.

“I conduct interviews with the new patients to find out what their needs are and what their goals are,” said Garber. “We explain how the program works and what to expect from hormone therapy, and they sign the consent forms. After that we give them a prescription and they come back in 90 days and we do an exam and some blood tests. They come back every 90 days until we get a stable dose that their labs are best at. ‘

Sex-affirming hormone therapy is no walk in the park. It is an effective therapy, administered to men and women as part of gender-based care, that helps people acquire physical traits that match their gender identity. Garber was thrilled when she started seeing softer skin and less body hair, but she also experienced mood swings.

“The hormones blew me away. The first half year is hell, ”said Garber. “I had everything on the PMS list except menstruation.”

Hormone therapy and sex confirmation surgery that Garber had in 2018 aren’t easy things. But for them, making the transition was a matter of life and death. After living a man for 55 years, Garber went through a difficult period – a time when depression led her to thoughts of suicide.

Garber quickly divorced after 27 years of marriage, lost her 20-year-old son in an accident and was retired after downsizing at the Powerton power plant, where she had worked for 35 years.

“I found a good adviser in Peoria and I saw her for a little over two and a half years. We talked about everything, my relationship problems, my gender identity, my grief. There was just a bunch of stuff on my plate, ”Garber said. “One day she finally said to me, ‘You know, you figured it out for yourself, you just need confirmation’ … Her recommendation was’ you just have to try. Cross-dressing doesn’t hurt in trying to live in this gender role. If it isn’t for you, go back to where you were. If it’s right for you, go ahead. ‘ I wasn’t even a crossdresser at the time, I was around 57. So I said OK and started getting dressed in fall 2014. “

Garber also started visiting gay bars in the area where she met other LGBTQ people. She was quickly accepted into a loving and supportive community.

“One night in Diesel I met a person who was a member of the Peoria Transgender Society. I was standing at the bar and this person came up to me and said, ‘Hey, are you trans?’ And I said, ‘Yeah, why?’ I turned around and he was a trans man. … We started talking and he told me about the Peoria Transgender Society. I didn’t even know it existed. So I started going to meetings. It was very empowering to meet other people like me, ”said Garber.

It was through this group that Garber learned of a weekend event in Oklahoma City – an outing that would prove crucial to their trip.

“It was right after I got dressed for the first time (as a woman). When it was really late at night I went to a couple of bars in Peoria hoping nobody would see me, ”Garber said with a laugh. “So I went to this event and I knew it was going to be good for me. I contacted the organizer and said, ‘I’m scared to death’ and she said, ‘Honey, each of us started out like you. The girls are going to love you. Come down here and have a good time. ‘ So I went and left all of my boys clothes at home. I got dressed and made up, drove down Missouri and Oklahoma, stopped, got something to eat and went to the bathroom, and I was scared. But when I got down there I was having so much fun, I just felt great. I decided on the drive home that as soon as I had enough clothes, I would dress like a woman all day. And I never looked back. ‘

Garber’s experiences are helpful in mentoring others. Their customers come from all over central Illinois and even as far as Missouri. Her oldest customer is 74 and has been dressing according to her gender identity for years. You recently decided to start hormone therapy. And while Garber cannot treat anyone under the age of 18, she has the occasional opportunity to speak to teenagers who are questioning their identities. She recently spent time with an 11-year-old girl at a community festival.

‘This boy said,’ Can I run around with you? ‘ and I said, ‘You have to clarify this with your parents first.’ You agreed to it. She talked the whole time. At the end of the day I went back and gave her mom my card and said, ‘If you need help finding some counselors to take her to, here is a list of trans-friendly counselors I can with you, ” said Garber. “The mother said she was hoping that this would be a phase and that it would outgrow. I said, ‘Well, maybe it is, and maybe it isn’t. Just support them. If it grows out, no damage has been done. And if she doesn’t, you probably need to provide some assistance. ”

Although community support for transsexuals has improved in recent years, there are still many challenges facing people.

“Most of our topics revolve around employment and income differences. Gender identity and expression are protected classes in Illinois, but you know as well as I do that if an employer looks at you and doesn’t like you, they’ll find a legal reason not to hire or fire you. And that’s a real problem for the community, especially the black community. Especially the black trans community, trans women, ”said Garber.

Discrimination is everywhere, in the workplace, in the family, and at home, and a lack of understanding can lead to mental health problems and, in some cases, substance abuse. Homelessness is another issue. Trans teenagers can find themselves on the streets after coming out to their parents.

All in all, though, Peoria isn’t a bad place to be LGBTQ, Garber said. There is a strong LGBTQ community out there to provide support and the availability of medical services has improved in recent years.

Garber has seen many changes in her 63 years and she is glad that young trans people are growing up in a more accepting world where they are more likely to find support. Although it took Garber more than 50 years to live as an out-trans woman, she says she wouldn’t change the past.

“Everything I’ve been through has made me who I am now. I wouldn’t go back and change anything if I could. I have a wonderful daughter who loves me and my family is quite accepting of it. When I came to my parents when I was 55, they were in their early 80s and late 70s. My father is 90 now and my mother is 85, and I’m closer to my mother than ever, ”she said.

The fact that Garber is happier than he used to be has helped attract a few reluctant family members. The transition helped her to dispel the cloud of anxiety and depression she had lived under for many years.

“I had to change my life if I wanted to stay on top of the dirt – it really was that simple. For me it was a life or death decision. And I’m glad I made the decision to move forward because I’m still here and happy now. Better late than never.’

___

Source: (Peoria) Journal Star, https://bit.ly/3jyY0za

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Serious gaps in mental health care in Washington prisons, report warns

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Inadequate psychiatric care in Washington prisons puts some prisoners at increased risk of self-harm and suicide and contributes to long stays in solitary confinement, according to a new report from the Ombudsman.

The report, which has been in the works for months, raises the alarm over numerous shortcomings, including high-case psychiatric staff and desperate prisoners waiting to see a psychologist.

Other issues identified by the Office of the Corrections Ombuds (OCO) include problems with prescribing psychiatric drugs and a disciplinary process that often fails to take into account the mental health of the detainee.

“The big realization is that we need more mental health services for incarcerated people,” said Joanna Carns, director of the OCO.

In response to the report, the Department of Corrections (DOC) recognized the continuing challenges in the delivery of mental health care to prisoners and pointed out the way it addresses many of the issues, including by working with outside prison reform groups.

The Ombuds Report is the latest in a series of OCO investigations that focus on the state of mental health care in Washington prisons – a strategic priority for the independent bureau, established in 2018.

Previous reports have focused on prisoners who have died from suicide, the effects of solitary confinement, and concerns related to the quarantine and isolation of prisoners due to COVID-19. Future OCO reports will examine the use of violence and restraints among prisoners with mental illness and the well-being of transgender prisoners.

The latest research paints a picture of a prison system that is ill-equipped to meet the mental health needs of a complex population of approximately 15,000 prisoners, spread across 12 prisons and 12 layoffs. Of particular concern to investigators is anecdotal evidence that inmates of color with mental disorders are treated differently. The report also highlights the particular challenges LQBTQ prisoners face.

A new report from the Office of Corrections Ombudsman finds evidence of numerous shortcomings in the availability of mental health care in Washington prisons. According to the report, prisoners in distress often have to wait to see a psychologist, and a lack of robust treatment options means that some prisoners end up in solitary confinement.

Washington State Department of Corrections /

The report is based on an analysis of more than 300 mental health complaints at the OCO between November 2018 and November 2020. In addition, investigators interviewed detainees, checked mental health data and spoke to DOC employees and administrations.

Countless problems

A key finding is that mental health professionals who are responsible for initial examinations of new prisoners are overwhelmed. According to the report, employees have to do an “extremely high” number of screenings each day and sometimes the location where the screenings are held is not private. This is an issue that the OCO previously reported.

Another persistent problem the report identifies is the lack of access to mental health professionals. This can manifest itself in a variety of ways, from delays after a prisoner sends a letter asking for a counselor to a lack of group therapy options.

Prisoners have also complained that DOC doctors reduced or stopped their existing psychiatric medication, or prescribed medication that was ineffective.

In terms of discipline, the report notes that when prisoners break the rules and get into trouble, “the process does not provide an adequate opportunity to take full account of a person’s mental health,” the report said.

In particular, the report describes a cycle in which an incarcerated person acts based on their mental health and then receives a sanction that does not address the root of the behavior. In some cases, individual prisoners suffer numerous violations due to untreated mental illness.

An example of this was included in the OCO’s 2020 annual report. It was a prisoner who injured himself. When the prison staff tried to hold the person, he hit one of the staff and attacked him. As a punishment, the prisoner was placed in solitary confinement and lost part of his “good time” credit for an earlier release.

Another major concern of the OCO is suicide in prison. Since last year, the OCO has published a number of reports of suicide in prisons, along with several recommendations on how to address the problem. This latest report urges the DOC to adopt these earlier recommendations and warns that in some cases the agency has not properly tracked and tracked prisoners who have harmed themselves or on suicide watch.

Another ongoing concern of the OCO is the use of solitary confinement, also known as intensive management or segregation. The report notes that people with serious mental illnesses are often kept in solitary cells for long periods of time.

“This practice contradicts years of research that have shown that time in solitary confinement exacerbates mental symptoms,” the report said.

DOC has worked with the Vera Institute of Justice, a national prison reform group, for the past few years to reduce the use of solitary confinement.

To address mental health deficiencies, the OCO report makes a number of recommendations, including that the DOC reduce the number of cases for staff examining incoming prisoners for mental health issues.

The report also calls on the DOC to increase its mental health staff to ensure timely treatment and expand opportunities for group therapy. As part of this effort, the report says, it is important that clinical staff reflect the racial and ethnic diversity of prison inmates.

Regarding the disciplining of inmates with severe mental illness, the report suggests that the DOC suggest alternatives to the standard sanctions and, if necessary, seek input from mental health workers.

The report also urges the DOC to reduce the time detainees with severe mental illnesses spend in solitary confinement and to investigate best practices for accommodation and treatment options that do not include segregation.

In addition to hiring more mental health staff, the OCO would also like the DOC to train its frontline detainees to better support the mental health needs of detainees. This includes training on mental health awareness and de-escalation tactics. In response, DOC said it is already prioritizing de-escalation, but there are recognized opportunities for more specific training for people in specialized occupational classes.

One final recommendation urges the DOC to work with the Department of Social and Health Services (DHSH) to facilitate the “temporary transfer” of prisoners in need of inpatient psychiatric care to western or eastern state hospitals.

DOC answers

In a lengthy, formal response to the report, DOC said it plans to ask lawmakers to fund two additional psychology positions as well as funds to improve the prisoner reception process next year.

In the meantime, the agency hopes to have a new assessment of the physical space available in prisons for group therapy sessions by September 30. However, DOC warned that finding suitable rooms and then staffing groups with a correctional officer to ensure security is an ongoing challenge. COVID-19 was another barrier to convening groups.

Next year, DOC plans to broadly roll out a new disciplinary program for people with severe mental illness that it has tested in two prisons. The program is modeled after a similar program by the Oregon Department of Corrections and requires the involvement of the inmate’s primary therapist in the disciplinary process.

The ministry also noted that since 2012 it has reduced the use of administrative segregation by a third and reduced the median stay in isolation by 33 percent. DOC said it has also stopped the use of segregation as a form of sanction and is trying alternatives to solitary confinement such as “transitional pods.”

In a statement on Wednesday, DOC said it was working with the OCO, acknowledging “known challenges related to the delivery of mental health services.”

“The department continues to work to equip and train its staff with the knowledge and skills necessary to support people with mental illness, and continues to review and revise its workforce to achieve adequate caseloads to maintain mental health services and to provide where the greatest patient needs are, ”the press release said.

The agency also said it is working with the University of California San Francisco’s AMEND program to bring a public health culture into the prison system. The DOC is also developing intensive outpatient treatment options that allow people with severe mental illness to receive treatment in the general prison population while in residence.

The current DOC secretary is Cheryl Strange, who previously ran DSHS and was previously CEO of Western State Hospital. Strange was appointed to the position in April. Carns, the ombudswoman, said she hoped Strange would prioritize the recommendations in the report given her mental health background.

“The goal is that people who are incarcerated are better off than when they entered Germany and receive psychiatric care [are] a critical component of that, ”said Carns.

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Oregon health care workers will be required to get vaccinated or face frequent testing

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Oregon Governor Kate Brown speaks during the June 30, 2021 press conference announcing the end of the state mask mandate.

Kristyna Wentz-Graff

Oregon health workers will need to get vaccinated against COVID-19 or undergo weekly tests, which Governor Kate Brown usually plans to introduce in late September.

As an alarming surge in case numbers and hospital admissions threatens to overwhelm public health authorities and local hospitals, Brown announced Wednesday that it has directed the Oregon Health Authority to enact new rules designed to put pressure on health workers. You can either get vaccinated by September 30th or have frequent tests for the virus.

“The more contagious Delta variant changed everything,” Brown said in a press release. “This new security measure is necessary to prevent Delta from causing serious illness on our first line of defense: our doctors, nurses, medical students and health workers on the front lines.”

The new rule falls short of what the state’s largest hospital association had called for: a new rule or regulation that gives individual health systems the power to require Covid-19 vaccination if they so choose. That would have brought Oregon in line with most other states.

Brown feared that vaccination with no alternative could lead to staff shortages, her spokesman said.

The upcoming rules are similar to the testing requirements President Joe Biden and California Governor Gavin Newsom put in place for federal and state employees during the COVID-19 resurgence. But rather than addressing all state or federal employees, Brown limits her focus to health care workers “who have direct or indirect contact with patients or infectious materials.”

Brown’s office is still considering vaccination and testing requirements for government employees, the statement said. The governor, who in recent weeks has emphasized more localized decision-making over state mandates, urged private and public employers across the state to introduce masking requirements and “facilitate employee access to vaccines” with guidelines such as paid time off for vaccinations and others Incentives.

While vaccination assignments are acceptable as a condition of employment in most sectors, Oregon law prohibits health care providers from making them mandatory unless vaccinations are required by state or federal regulations. The governor’s office said Brown plans to “address” this ban when lawmakers meet early next year.

In the meantime, not all providers are waiting. Kaiser Permanente announced Monday that it will make vaccines mandatory for all employees. PeaceHealth’s medical system announced Tuesday that all of its caregivers must be vaccinated against COVID-19 or submit a qualified medical exemption. Those who do not can be removed from patient care.

Health systems across the state have said they support a change in the law, while the Oregon Nurses Association has warned that if nurses are not part of the contract negotiations, they could result in resignation when morale is low and hospitals and long-term care facilities last are already scarce.

The increased demands come as COVID-19 patients are being hospitalized at a worrying rate. As of Wednesday, 393 people with the virus had been hospitalized in the state, 95 more than last Friday and 14 more than the day before.

State health officials released modeling results last week that suggested that nearly 100 people a day could be hospitalized by mid-August if steps are not taken to contain the spread of the Delta variant. The same modeling suggested that the daily case numbers could rise to nearly 1,200 over the same period. The state reported 1,575 new cases on Tuesday.

The state had 393 available beds in a non-intensive care unit and 110 free beds in the intensive care unit as of Wednesday morning.

Despite worrying trends and calls from their own health advisors to get vaccinated as soon as possible, the new requirements for health workers won’t go into effect until September 30th. Brown’s office said an eight week delay will “give employers time” to prepare for implementation and will give currently unvaccinated health care workers time to fully vaccinate.

Vaccination rates for health care workers are higher than rates for the general population, but they vary widely by region, ranging from a low of 43% in Harney County to a high of 81% in Washington County.

Vaccinations for long-term care facilities are particularly critical, the residents of which were responsible for around half of the deaths in the first year of the pandemic.

Approximately 68% of Oregon long-term care workers have been vaccinated – about 10% more than the national average, according to the Oregon Health Care Association, which represents the industry.

In Oregon, by July 3, 70% of all health workers were vaccinated. The rates vary depending on the profession: 87% of vaccinated doctors, 74% of registered nurses and 57% of certified nursing assistants.

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It’s time to expand the definition of ‘women’s health’

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Common diseases such as cardiovascular disease are under-researched in women, making diagnosis, prognosis and treatment difficult in women.Photo credit: BSIP / UIG / Getty

More than one eighth of the world’s population has a condition that can cause pain, profuse bleeding, and decreased fertility, all possible consequences of benign tumors known as uterine leiomyomas or fibroids. Fibroids can be debilitating and are a common reason for surgical removal of the uterus.

Still, fibroids have received relatively little attention from scientists, either in academia or in pharmaceutical companies. The cause of the disease – and how to reduce its impact on fertility – has been debated for decades, leaving doctors unsure how best to treat people.

Unfortunately, fibroids are just one of many underrated aspects of health in people who were female at birth. (This includes cis women, transgender men, and some non-binary and intersex people; the term “women” in the remainder of this editorial refers to cis women.) Clinical and preclinical studies tend to focus equally on men: a third of the Individuals participating in cardiovascular disease clinical trials are women, and an analysis of neuroscientific studies published in six journals in 2014 found that 40% of them used male animals only. Two studies and an article published in Nature on Aug. 5 shed light on the advances in women’s health research – and the need for more.

A study examines the molecular origins of fibroids and reveals a possible mechanism by which tumors form. Drugs targeting key molecular actors in this process could open up new treatment options with further studies.

The other study takes a multidisciplinary approach, examining both the genetic mechanisms and epidemiological factors involved in ovarian aging, which leads to menopause and fertility loss. The age at which women experience menopause varies widely – with a range of around 20 years for healthy women – and fertility can drop dramatically for up to a decade before it begins.

This work expanded the list of genes that contribute to early ovarian aging and highlights the importance of DNA repair mechanisms in determining the age at which women experience menopause.

Both studies illustrate the advances that can be made if the health challenges of women are brought to the fore. However, advocates of women’s health warn that the field is often too narrowly considered. The study of health and disease in women should not be limited to conditions that affect women only. Conditions like type 2 diabetes, Alzheimer’s disease, and heart disease affect men and women differently. Such diseases need to be investigated in both men and women, and the diagnosis, prognosis, and treatment may need to differ between the sexes.

Heart attacks, for example, are one of the leading causes of death in both women and men, but women do not always have the “typical” symptoms that men normally experience. Women are also more prone to blood clots after a heart attack, but are less likely to be prescribed anticoagulant drugs by their doctors. Women are 50% more likely to get an initial misdiagnosis after a heart attack than men and are less likely to be prescribed medication to reduce the risk of a second attack, according to the British Heart Foundation.

When it comes to exercise, women are at risk of serious long-term injury if we continue to model head injury training and management on data from men. As our News Feature reports, it is becoming increasingly clear that women experience head injuries and recover from them very differently than men. Understanding why women are nearly twice as likely to experience concussions as men in sports like soccer and rugby requires multi-disciplinary research – and to understand why women take longer to recover from such injuries.

So far, the evidence is sparse, but preliminary data suggest structural differences in the brain. Axons in the brain of women are wired to thinner microtubules that tear more easily; Hormonal fluctuations should also contribute to this. Biomechanics could also play a role – in rugby, for example, it seems that women fall differently when attacked, which could increase the risk of a concussion. Exercise programs designed specifically for women can help alleviate these injuries.

But the clear message from sports researchers is that it is no longer acceptable to exclusively use data from men in these studies. And when women are included, the data needs to be broken down by gender and include a sufficient number of women. A recent study examining MRI images of elite rugby players included women (KA Zimmerman Brain Commun. 3, fcab133; 2021) but of the 44 elite players, only 3 were women.

But the relative lack of women on committees and scientific advisory boards has meant that few of these decision-makers have direct personal experiences with women’s health needs or research gaps. It is all the more important that funders consult the public when determining research priorities.

Since 2016, the US National Institutes of Health has required researchers to conduct preclinical studies in both male and female animals, tissues and cells, or to provide an explanation as to why it is not appropriate to study both sexes. Now it is up to other funders, researchers, and journals to amplify the impact of this change by making sure to include gender-specific data in publications. Funders should also strengthen the resources allocated to support studies of health and disease in women and keep track of how much money is being used to support such research in all areas, not just gynecological diseases. What is measured is done.

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