Healthcare should be equally accessible for everyone. Today that’s not the case. Trans* people face a larger risk of discrimination, bad treatment and trans unawareness in the healthcare system because of professionals lack of knowledge, and also problematic attitudes and unawareness towards trans people. This is a reality for our trans friends, lovers and the trans community that we’re closely connected to. We hope to be a part in giving the power and possibility to find healthcare that matches ones needs, and avoid healthcare that don’t.

Mina has been working with LGBTQI issues for the last ten years, both voluntary, as elected and as an employee. Minas main focus in their work has been hiv/STI-prevention, sex education and trans health and rights. Björn has been working with programming, web design and user experience for almost 20 years. Both of us are activists and a part of the LGBTQI-community in Stockholm and Berlin. The challenge for trans persons of finding good an avoid bad healthcare is something that we've experienced very close. We decided that if we combine our knowledge and experience, we mabye could add a little contribution to the work with conquering this challange.

With the digital service we've developed, our aim is to:

  • make it easier to find healthcare other trans people have good experiences from
  • be aware of healthcare where people who are trans have a bad experience
  • share your experience of healthcare with other trans people
  • give healthcare that has a good reviews a positive feedback for doing a good job
  • point out for healthcare with not so good reviews that it might be a good idea to work on their treatment of trans patients.

We’re really hope that this service can be used by people in the entire trans community, and also mabye by trans allies who want to choose healthcare where trans people get a good treatment.

'* In this context, trans is used as an umbrella term to refer to people whose binary or non-binary gender identity and/or expression differ from the sex they were assigned at birth. The term trans in this context includes, but are not limited to, people who are ftm/transmasculine/trans men, mtf/transfeminine/trans women, non binary, genderqueer, two spirit and gender non-conforming people.

What it does

The service we've developed gives trans people the possibility to review health care facilities based on one's own experience, both by rating and in free-text reviews (something like trip advisor, but about health care and just for trans people. For people moving to a new city, or just wanting to find a trans friendly endocrinologist, hiv/STI testing facility, gyneacologist or General Practitioner, we hope that this platform can be a big help.

Filters can be applied to narrow down the search to the kind of healthcare, and reviews from people with a certain kind of sexual orientation and trans experience. For example you can search for clinics that prescribes gender confirming hormones reviewed by people who are transsexual, or hiv/STI-clinics that have got reviews by gay trans guys.

This platform will hopefully be used globally, the outspoken aim is that it should be used in several different countries. A clinic appears on the platform as soon as someone reviews it, independent on where it is located. Since one of the challenges we want to facilitate solving is finding the healthcare providers you need when moving to a new country, which quite often can be an obstacle for people who for example need to find somewhere to get hormones and check up values, find a hiv/STI-testing clinic where you can feel safe as a trans person.

How we built it

The work has been done in close connection with or network of trans friends, family members and lovers, as well with the trans community and individuals at trans/LGBTQI NGO:s (TGEU, ILGA Europe and The Swedish Youth Federation for LGBT Rights). The work process has been:

  • discussing the idea with trans individuals and persons working at trans/LGBTQI organizations and integrating their input in the work.
  • constructing an online questionnaire as a prototype of review form, where we also asked for imput to the app. The questionnaire was distributed to people in the target group globally through social media with help of our network. In the questionnaire we asked the respondents to give in their e-mailadress if they wanted to be in further contact with us in the creation of raTe.
  • the input we got through the questionnaire where used to continuously improve the review form.
  • identifying aspects key features/function for the actual technical soloution through a series of internal workshops and discussions with NGO:s and individuals in the target group.
  • making visual prototypes for key functions in the platform and get input on them from different kind of user views and improve the prototypes based on the input.
  • merge the final stages of the different prototypes into "raTe", a platform built in perl.

Challenges we ran into

The main challenge we have experienced is the distribution of the prototypes and getting actual reviews. We get lots of positive feedback about the project and that this platform is something that people has been longing for and really think is needed. The amount of reviews that we have gotten so far does however not correspond with the positive feed back we have gotten. A part of this is probably that it feels less inspiring to send in feedback in a prototype where you don't know what the end result will be, than giving reviews on a platform that's online and working. But one challenge has definitely been to get people to do actual reviews, and not only saying that it's a really good and needed project.

Another challenge has been to find a balance between how much background info you want to have about the reviewers, and how much details to ask about in the review function. For some people, lots of details are good, both about the reviewer and the clinic. On the other hand, some people don't think it feels good to be asked to much questions about yourself, and too many questions in the review function can be a big barrier for giving a review.

How to be correct with all rules concerning storage and display of personal data was a field that was new to us, and that at firs felt like quite a bit of a challenge. But after communication with The Swedish Data Protection Authority (our servers are based in Sweden) and checking up European and international legal system concerning this field, we feel that we're safe and know what we're doing.

Accomplishments that we're proud of

We're really proud about having spoken and gotten feedback from so many people in the target group and with organizations working with sexual health and trans rights and health. All in all, we've reached out to approximately 200 people so far, which feels like a big accomplishments. We're also happy for having gotten our work mentioned in national Swedish radio in a program with about half a milion listeners. And at last, we're really proud about all the positive feedback we've gotten from individuals, NGO:s, our network and other parts of the trans community.

What we learned

We learnt lots in the work with the different prototypes of the review form and all the feedback we got through it. Individuals that have given us feedback have lots of different views, sometimes totally contradictory. Trying to find ways to fulfill the wishes for as many as possible has been a rewarding challange.

Since we really wanted to be sure that everything we do is in line with applicable laws, we've learnt quite a bit about the legal system around data use and storage. Another technical stuff we learnt was programming with the Google map API.

On a personal level, we've learnt about working together, something that was new to us. We've known each other for several years, but have never worked in a project together before.

What's next for Trans accessability to healthcare

First of all, we of course hope that the platform will make it easier for many trans people to find good healthcare, and that it will be widely known within the trans community. As mentioned before we have been in contact with several trans and LGBTQI organizations/networks in the making of the platform. One future possibility we see for the platform is that any of these take over the administration of the platform. Also other actors could be in question for taking over the platform and the administration of it. The most important thing for us is that the actor has approach, values and attitudes in line with ours as well as deep knowledge about trans issues, and that the motives for taking over the app not is just commercial but also ideologically based.

Another future alternative for the platform is that we continue to administer it ourselves, and to look for some funding for the administrative work with and distribution of the platform. Another way of sustainable funding could be to offer education to health care services in need of improving their trans competence in countries and regions where there don't exist good trans/LGBTQI education programs for health care services.

With the technical solution, we see several developement possibilities. A push notification when leaving an adress where google has a clinic listed is something we have been discussing. Technical integration with Grindr, where for example high-rated clinics for hiv/STI-testning shows on the search grid or come sup as a pop-up when being close, are other possible functions for further development that we have been discussing. Another thing we've been thinking of is to extend the target group for the platform to involve the entire LGBTQI-community. Even though trans people most often face challanges with finding suitable health care, other parts of the LGBTQI-community also struggle with this challenge from time to time.

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