All inclusive service

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Pharmacies are an essential service. When someone needs medical or personal care products and services, including prescriptions, the pharmacy is the main or only option. This brings an added responsibility, or even duty of care, to create a safe, inclusive and accessible environment for everyone, including trans and gender diverse people.

Teddy Cook is the Acting Director, Community Health & Wellbeing at ACON, NSW’s leading LGBTIQ health organisation. He says around two to four per cent of the population are trans “or some beautiful variety of gender-expansive”.

“A good chunk of those people, not all but a good chunk, will be seeking pharmacy services through dispensing gender-affirming hormones,” he said. “It’s important for these people to have a good relationship with the place that’s providing really important and essential gender-affirming healthcare.”

He warns that deadnaming, the act of referring to a transgender or non-binary person by a name they used prior to transitioning, can not only make for a poor experience in the pharmacy, but can also increase risk for someone inside the building – “if other people are listening, for instance, and wanting to express some level of discomfort”.

A spokesperson for LGBTIQ+ Health Australia Trans and Gender Diverse Advisory Group says pharmacies need to take greater responsibility for creating and maintaining a safe and inclusive space.

“We’ve had reports of trans people going into pharmacies without sufficient or changed identity documents and being misgendered and deadnamed by pharmacy staff,” the spokesperson said.

“This has had some catastrophic consequences whereby the trans or gender diverse person has been triggered and got so upset that they’ve walked out of the pharmacy without collecting the prescriptions they were getting filled.”

While it’s (hopefully) unlikely that you or your colleagues would intentionally say or do anything to cause offence to a customer, raised awareness and small changes can go a long way to ensuring a safe and welcoming space for trans and gender diverse people.

“This isn’t about political correctness,” Transgender Australia CEO Mama Alto said. “It’s about good customer service, treating people with respect and empathy.”

Addressing customers 

When it comes to addressing customers, it’s long been considered polite to use terms such as ‘Madam’ or ‘Sir’. But it’s best not to assume a term is appropriate unless you already know that person.

“This isn’t just about trans and gender diverse people,” Ms Alto said. “There are masculine women and feminine men, so you can never truly guess how someone might want to be referred to. Take their lead or find a non-gendered term like ‘this customer’ instead of ‘this man/woman’, or try ‘Hello there!’ instead of ‘Hello Madam/Sir’.

However, LGBTIQ+ Health Australia Trans and Gender Diverse Advisory Group warn that using terms such as ‘this customer’ can also be problematic because this is “othering” a trans or gender diverse person and placing them into a third category of sex and/or gender.

“This can be as offensive to some trans people as referring to them as ‘it’,” a spokesperson said.

“This can be just as equally offensive to trans men and women who simply identify with cross-binary type gender identities as men or women or as male or female because it’s invalidating their identities. This is extremely hurtful, and disrespecting and invalidating trans people who’ve spent many years undergoing hormone replacement therapy and endured the financial hardship and pain that comes with having surgery to simply be accepted and respected as men and women.”

It’s much more respectful to the customer, says the spokesperson, to move to a more private location away from other customers and for their preferred name and pronouns to be used.

“A trans or gender diverse person’s preferred name and pronouns should always be used when calling the customer to the counter and during any interactions with the customer or other staff,” the spokesperson said. “You’ll find that many trans people would prefer this because that is validating experience for that person. If a pharmacy wants all their customers to have a positive experience, then this is best practice.”

Ditch the euphemisms 

Gendered products or aisles can also be an issue, often needlessly so. Consider the common aisle descriptor, ‘feminine hygiene’. While some retailers, such as Woolworths last year, have made the switch to the term ‘period care’, others have been slow to follow. Aside from implying women are unclean for having a period, it also negates the fact that, as menstruation education researcher, comedian and founder of the #periodpositive movement Chella Quint says, “not all women menstruate and not all menstruators are cis women”.

The inclusion of the word ‘feminine’ can be offensive to trans men or those who identify as trans masculine who still menstruate, says the LGBTIQ+ Health Australia Trans and Gender Diverse Advisory Group.

“Manufacturers, suppliers and retailers also don’t seem to realise that post-operative trans women who have undergone reconstructive surgery but don’t menstruate sometimes require products such as pads and tampons post-surgery if they still have any bleeding or discharge,” the spokesperson said.

Trans women and men might also need other products, including vaginal washes or douching products, as well as such products as Ovestin, Vagisil, Vagifem, etc.

“The fact that such products are categorised as ‘feminine’ products is also insensitive and offensive to trans men or trans-masculine-identified people,” the spokesperson said.

It’s important to note that euphemisms such as ‘feminine hygiene’ don’t just cause distress for trans or non-binary customers, but also represent a disservice to others in the community, says Ms Alto.

“Labels such as ‘menstrual hygiene’ or ‘period products’ are more accurate and precise language, assisting not only gender diverse communities but potentially culturally and linguistically diverse people,” she said.

Staff 

Another important point to consider is that there will certainly be pharmacists and pharmacy staff who are trans, gender diverse and/or non-binary.

“Consider what their experiences are as an employee of a pharmacy and if they can expect to have a safe and affirming tomorrow at work,” Mr Cook said. “If name badges have pronouns and names, for instance.”

Creating a safe and inclusive workplace is an essential OH&S consideration, says Ms Alto.

“It’s important to be guided by a person – what name, pronouns, honorifics and descriptors they use – while also not placing a burden on that person to be an educator,” she said.

LGBTIQ+ Health Australia Trans and Gender Diverse Advisory Group recommend taking the time to provide regular training for best practice inclusive policy and retraining to all staff, monitoring staff performance and addressing any concerns or complaints without delay.

“All new staff should be inducted with this training, but also longer serving staff should also undergo regular retraining to remind them of these types of best practice inclusive policies because cisgender people seem to quickly forget such policies.”

Resources for inclusivity 

A wealth of information and resources is available to those looking to create a safe and welcoming space for trans and gender diverse people.

  • transhub.org.au/clinicians – features resources written in collaboration with leading health professionals who specialise in the healthcare and affirmation needs of trans and gender diverse people across Australia.
  • transhub.org.au/training – ACON’s Trans Health Equity team has worked in partnership with a range of organisations and teams to provide training that meets the current best standard in trans-affirming care, language and practice.
  • tgv.org.au – Victoria’s leading body for trans and gender diverse people can provide customised training and resources on best practice inclusivity to help make your pharmacy safer, more inclusive and more welcoming for both customers and staff
  • support@transhealthaustralia.org – Trans Health Australia can provide a referral to other NGOs who can provide information or training.

This feature was originally published in the April issue of Retail Pharmacy Assistants e-magazine.