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Let's Talk About the Rainbow in the Room



Today is IDAHOBIT day, and June will be Pride month. If you don’t know what IDAHOBIT is, or don’t celebrate or acknowledge Pride within your unit – well then this post is for you.

Firstly let’s start with the day. IDAHOBIT is the International Day Against Homophobia, Biphobia, Intersex and Transphobia. It is celebrated each year on May 17, a day chosen as it’s the day that homosexuality was removed from the ICD coding of the WHO. In 1990. Yes 1990, just 33 years ago. When many people you are currently working with, and many of the patients in the units were adults, homosexuality was considered a disease.

Pride month is more than rainbows and is June for a reason. Remember it began as a riot, led largely by transgender women, at the Stonewall Inn in New York after repeated police raids in 1969. Pride month is intended to celebrate, remember and create systemic changes to improve the lives LGBTQIA+ people, through a month long dialogue.

It’s perhaps unsurprising that for many LGBTQIA+ people, health care and hospitals in particular are not considered safe spaces by many in the community.

Now think about the intensive care unit you work in. Think about the diversity of its workforce, its patient cohort. Now think about whether your unit is a safe and welcoming place for everyone.

If we were honest with ourselves, for many of us, the answer is no. From basic demographics where people are registered by the name on their Medicare card, which may not be the name they are known by, through to open hostilities of actively misgendering patients in the computer systems, hospitals often aren’t open to the rainbow.

So back to IDAHOBIT and Pride. The purpose of these events is to advance the rights of those with diverse sexual orientations and gender identities. Sadly Australia isn’t one of the 130 countries that officially recognises IDAHOBIT, even in the year where Australia hosted World Pride. While much of the celebration of IDAHOBIT centres on arts and culture, and the campaigns focus on the countries where same sex relationships are criminalised or being transgender results in punishment and violence, medicine in Australia should be using this day to ensure that our own practices are respectful and open.

What can we do in ICU?

Well we can start by making sure the patients know they are safe with us. Some hospitals in the UK run a campaign called ‘Pride in …’, where members of the LGBTQIA+ community and their allies in each hospital were given rainbow badges to wear on their uniform. This little badge signalled that you are a safe person to talk to, that will advocate for their identity during their hospital stay. And you know it works. Patients and their families are more open to people with the badges, providing a safe pair of ears when the hospital seemed overwhelming. Who knew such a small rainbow badge could be so powerful!

We should celebrate days like IDAHOBIT and Pride to remind ourselves of the barriers to health care that many gender diverse people experience because of fear of how they will be treated. As medical professionals it is our responsibility to make sure health care is safe and open for everyone.

As a college – did you realise we were one of only a handful of medical colleges without representation at World Pride. We don’t have a special interest group or working party for LGBTQIA+ issues. We rarely have any visibility on the importance of making sure ICU is safe and welcoming for everyone.

We can share our pronouns. This, weirdly, has become such a controversial topic. But identifying my pronouns tells the patient that I want to know and will respect their pronouns.

We can call out ignorance and inappropriate behaviour when we see it. This is really hard, but is such an important thing to do. That old line “the standard you accept is the standard you walk past”, is true. And the cool thing is you don’t have to call it out very often before people know that you won’t accept certain behaviours.

I’d love to say that in the many years I’ve been working in hospitals things have dramatically improved. It’s been more than 10 years since I had to explain to an RMO that deliberately misnaming and misgendering a patient was offensive and unacceptable. But it was only 5 years ago that I had to listen to a trauma round describing a patient as an XY female, and a medical colleague trying to make a gay joke out of rainbow popcorn.

Until we all make hospitals and health care a safe space for LGBTQIA+ people, health outcomes will be worse for an already at risk population. So remember to talk about and welcome the rainbow that is already in your unit. Trust me, your days will be better when you welcome everyone.

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