#Medical Access Primary Care

[accesshealthcarephysicians]

The Benefits of Regular Check-Ups with Your General Physician

Regular check-ups with your general physician are important for maintaining good health and preventing the onset of chronic conditions. Here are some benefits of scheduling regular check-ups with your general physician:

Early Detection of Health Issues: Regular check-ups can help detect potential health issues early on before they become serious. This can help your general physician develop a treatment plan to address the issue before it worsens.

Improved Management of Chronic Conditions: If you have a chronic condition such as diabetes or high blood pressure, regular check-ups with your general physician can help manage your condition and prevent complications.

Prevention of Health Issues: Regular check-ups can help prevent the onset of health issues by identifying risk factors and providing recommendations for lifestyle changes or preventative measures such as vaccinations.

Screening Tests: Regular check-ups often include screening tests for various conditions such as cancer, heart disease, and diabetes. These tests can help detect the presence of a condition before symptoms develop, allowing for earlier treatment and better outcomes.

Personalized Health Plan: Your general physician can provide you with a personalized health plan based on your individual needs and health goals. This plan can help you maintain good health and prevent future health issues.

Referral to Specialists: If your general physician identifies a potential health issue that requires specialized care, they can refer you to a specialist to ensure you receive the best possible care.

Building a Relationship with Your General Physician: Regular check-ups can help establish a relationship with your general physician, allowing for open communication and trust. This can make it easier to discuss health concerns and develop a plan of care that works for you.

In conclusion, regular check-ups with your general physician are important for maintaining good health and preventing the onset of chronic conditions. Early detection of health issues, improved management of chronic conditions, prevention of health issues, screening tests, personalized health plans, referral to specialists, and building a relationship with your general physician are just a few of the benefits of scheduling regular check-ups. By prioritizing preventative care, you can improve your overall health and quality of life.

[sadgirlautumn]

I’m currently very upset about the American healthcare system. Like I hope they know that they are making people actively sicker 🫶

[buttercuparry]

HELP ALAA ACHIEVE €6,000 IN THE NEXT 2 DAYS!

THIS IS URGENT! Please have a look at this fundraiser. It belongs to Alaa Amsee ( @alaakh99 ) who is a loving mother to two beautiful children named Maria and Hamza. 

Alaa has had her tumblr account terminated for the SECOND TIME, resulting in her being unable to continue her efforts to campaign for herself and her children at a VERY  crucial time. It should infuriate you to see this happen, especially in light of the recent smear campaign against palestinian gfms. We can assume now that many of the Palestinian blogs have been deactivated, because of baseless reports of being scams.   

THE LAST DONATION CAME IN 23 HOURS AGO. PRIOR TO THAT, SOME DONATIONS CAME IN 2 DAYS AGO!!

We CANNOT  let this fundraiser be stagnant.  Alaa and her two children are suffering from hepatitis, and malnutrition. Their lives are on the line and they need medical care ASAP! 

Her life wasn't always like this! Before October 7, Alaa led a peaceful life  with her family which consisted of her children, husband, in-laws and immediate family, but soon the nightmare began and came to a head on October 28, when her neighborhood got bombed in its entirety. 

Alaa escaped certain death that night as her house collapsed and trapped her family in. Debris choked them all, and they had to be rescued from under the rubble and shattered glass. Alaa describes what she witnessed that night as "unimaginable"- death, corpses and blood, surrounded the family. 

Even after this tragedy, the pain did not let up and chased them to the Rimal neighborhood. The bombing continued and Alaa had to put wet masks on Maria and Hamza, so that the children could endure the terrible smoke and burning smell. Things got so bad throughout the next few months that Hamza who is only 3 years old, now talks only of bombings, rockets and tanks. 

I want to remind you that Maria, Alaa's little daughter, has contracted hepatitis after being displaced for the third time, where they had to flee to Rafah. Being overcrowded, one can only access shared bathrooms which are primary causes of such viral infections. The children have suffered from epidemics and skin diseases, and the little tent Alaa has managed to acquire can barely sustain life in summer heat 

On top of that, there is hardly any nutritious food and clean drinking water- which means that at one point, the family had to survive on weeds and bread made from animal feed. I cannot tell you how horrible this is! How Alaa and her children still suffer even now. In fact, at the moment of writing this post, Alaa  messaged me about her tent shaking due to bombings nearby. 

So I urge you not to ignore her, please, and help her reach her short term goal of 6K within the next 2 days !!

Her fundraiser  has been up since May and has only reached €4543 which is a little above 4% of her end goal! Please donate and share! I also request you to follow Alaa ( @alaakh99 ) and help her save her children from this genocide!

( verified by 90-ghost )

[ephemeral-earthling]

Some days I actually feel like I'm settling into this job as a program manager and I'm fucking killing it, ya know. I am 27. I'm in the region I want to live in forever. I'm managing, coordinating and facilitating multiple community education programs every week. I'm onboarding and placing volunteers. I've got a dog and am on a mission to be consistent training her every day and have training goals. I wake up feeling so stressed with this pit in my stomach most days but I really need to remind myself that that's just my brain and anxiety and doesn't actually mean I'm not "doing a good job" or that something is wrong or whatever. Things are so good, and I just have to keep reminding myself of that fact until my body can believe it and settle in here.

[qqueenofhades]

I am FULLY ONBOARD the Harris/Waltz train, tho before this i was leaning towards Mark Kelly (AZ is a swing state! He's an ASTRONAUT!) If you want or have time, no pressure, but any thoughts on what makes Waltz a better pick?

I like Mark Kelly too, and since he's married to Gabby Giffords (having run for public office after she got shot and could no longer do so) he would have been an amazing pick in terms of supporting the first female POTUS. But he is a less charismatic public speaker than Walz (for whatever that's worth, but politics is a mess of Aesthetics and Vibes that matter as much and/or more than actual facts) and more moderate/conservative. He's been a great senator and picking him would defuse some of the BORDER IMMIGRATION BLAH BLAH!!! scaremongering that Republicans love to run on, but it would also leave open the possibility of losing a special election and other dangers with the Democratic senate that we really need to minimize. So Walz is a better choice for that alone, but also:

He really has serious progressive credentials as governor, even if he was a fairly mainstream Democrat (who flipped a rural red House district in Minnesota that Democrats have not been able to win again after he left) during his 12 years in the House. This is an INCOMPLETE LIST of what he was able to do in two years with a one-seat Democratic majority in Minnesota:

A Climate Action Plan that included:

Investing in energy infrastructure

100% carbon-free electricity by 2040 goal

Transition off of fossil fuels and onto clean energy resources

Building more electric vehicle charging stations

Providing funding to help workers acquire new skills through apprenticeship programs in clean energy fields

Direct state funding for transit

Money for rail

Tax credit for e-bikes

Permitting form to fast-track clean energy projects

And that was in addition to:

Codified abortion access in Minnesota

Guaranteed paid sick time and paid family and medical leave

Funded replacing ALL LEAD PIPES IN THE STATE

Free school breakfasts and lunches for all

Made public college free

Stronger labor protections

Drivers’ Licenses for All

Voting Rights Act to reverse recent court rulings that make voting harder, including restored voting rights to convicted felons

Banning medical debt from credit bureaus

The "Taylor Swift Bill" requiring all ticket "junk fees" be shown up front

Banning most "junk fees"

No book bans

Protection for tipped workers

Banned non-competes

Legalized recreational cannabis

Gun control, including increased penalties for straw purchases of firearms, expanded background checks and enacted red-flag laws, passing gun safety measures that the GOP has thwarted for years

Made MN a Trans Refuge State, and required health plans to cover “medically necessary gender-affirming care.”

Pay increase for Uber and Lyft drivers

Elimination of the so-called “gay panic defense”

A ban on “doxxing” election workers

A prohibition on “swatting” elected officials

In March, during the height of the Gaza/uncommitted primary protests against Biden, Walz said that young people should be listened to and they had a right to be speaking up and the situation in Gaza was horrible and intolerable, without directly slamming Biden or getting involved in the issue in a way to draw negative headlines. Regardless of what you think about any of it, that is a very deft way to handle it and pairs well with Kamala's better responsiveness on the Gaza issue overall. That was a big part of the reason why Gen Z/younger voters were very excited about Walz despite him being an "old" (actually the same age as Kamala but he has joked that teaching high school for 20 years will do that to a guy) white guy. If half the battle in politics is making the right pick to excite your core voters and reach out to new ones, then Harris nailed it. As I have said in earlier posts, there was just too much energy with young voters FINALLY checking in when Harris became the candidate, to risk introducing a big ideological split with Shapiro.

Aside from that: the most insufferable Smart White-Bro Political Pundits (TM) are big mad about Walz, many Never Trumper Republicans thought they were entitled to a "moderate" in exchange for oh-so-generously lending us their vote against Trump and not run the risk that we might end up with someone *gasp* progressive, and the regular MAGA Republicans are hysterical, which means they're terrified. It's also incredibly hard to paint Literal Midwestern Stereotype Dad (football coach, social studies high school teacher, military veteran, etc) as THE EVIL END OF AMERICA in the way they desperately want to do, though the fact that they're trying shows that they've got literally nothing. The fact that Kamala picked Walz against the PREVAILING WISDOM!!! that she had to take Shapiro (for whatever reason that might have been) is also a good sign, because by far the most genuine and extensive enthusiasm that I have seen from Democratic voters, especially those feeling burned out or disillusioned or angry with specific policy choices of the current administration, was for Walz. Having everyone excited for the pick beforehand, effectively using the "weird" line, and rallying behind the guy, only for her to actually go for him, is inspiring. It makes people feel like they're being heard and the Democrats have decided to win by being progressive, and not just endlessly Catering To The (Imaginary) Middle as they have always been told to do (and often done). That alone is MASSIVE.

Walz is tremendously funny, personable, has Democrats from AOC to Joe Manchin praising it (again, shocking), was right out the gate supporting Kamala, has already been majorly successful on TV, was by far the most progressive-on-policy picks of the VP finalists, is incredibly, hilariously wholesome and small-town Midwestern (he's the JD Vance that they wish JD Vance was), and is already sending ActBlue gangbusters with donations again. And when you're getting this kind of response on the Cursed Bird Hellsite, just:

Just. I don't know what's happening either. But let's enjoy it, and then work hard, because we gotta fucking do this and for possibly the first time this entire year, I really think we might. Heck yeah.

[chronicallycouchbound]

I feel like people often don’t talk about the experiences of disabled people who have caretakers because so much of the conversation is about us—not including us.

I receive in home care for 30 hours a week (+ 4 hours/week for respite). This is paid for by Medicaid (state insurance). Outside of paid hours, my primary caretakers care for me unpaid and assist me most of the time. I’m very rarely left alone due to my high support needs. Often, when I am left alone, I am completely bedridden or at minimum housebound. I have frequent emergency life threatening health problems, falls, and serious injuries even with support in place, and these things significantly increase when I’m on my own.

I’m extremely lucky that my paid caretakers are my partner, my sister (the only family member I have regular contact with, I’m estranged from the rest of my immediate family and most of my extended family) and my best friend.

I used to have agency staffing which was horrible for me and borderline traumatic. At several points, before doing the self directed care option (which allows me to choose my own staff, hire and train them myself and dictate hours for them), I opted to not have any staffing. I was regularly in the emergency room. I can’t drive, so I was having to walk and if I was lucky enough to be able to take the bus on occasion or get a ride from a Facebook acquaintance, they were few and far in between. I don’t have family support, and even my sister who is supportive wasn’t living in the state at the time and doesn’t have a car most of the time.

And before I could even choose which staffing option, even though medically it had been deemed essential for me to have in home care, even though my insurance covered it, I had to wait several years (I was 18 when I was approved) until I was 21 to qualify to start. The reason why: I was legally an “adult disabled child” because of my high support needs (which is funny because I STILL don’t have SSI at age 24) and thus legally unable to consent to my own care plan. I needed a blood relative to consent, and that same blood relative (who had to have proof of such!) couldn’t care for me. At the time, my sister was the only person who could’ve been my caregiver and also she is the only verifiable blood relative I have contact with for safety reasons, and my only relative on this side of the USA.

The first business day after my 21st birthday I immediately got things set up to get in home care.

This is out of date, I get assistance with more than just these highlighted ADL (activities of daily living) tasks now.

In short: my day-to-day life is entirely dependent on others.

And there’s power imbalances that exist between me and my caregivers, even with my current caregivers being amazing and anti-ableist. They will always exist. We talk about the power dynamics of me being dependent on them for my survival, and how heavy that weight can be for each of us.

Having caregivers often means that accessibility is extra difficult— I’ve been told straight up multiple times that I can’t have assistance from my caregivers to help me change in a changing room when we’re out shopping. That they can’t go into the bathroom with me, that they can’t help me get un/dressed during appointments, that they can’t come into spaces with me.

I’ve been denied access to psychiatric care because I can’t do my daily living tasks (ADLs- the highlighted items) independently. And when I’m in a hospital or emergency room, I can’t have my in home workers be paid to care for me, there’s an expectation that the nursing staff at the hospital will do it. Even though my caregivers were specifically trained to learn my body and needs for weeks and have been working with me for years. I have severe cPTSD and showering in front of a stranger is something I cannot do. I would rather fall or faint or get injured or just not shower than deal with that. But I’m expected to just let anyone have access to my body just because I’m physically disabled and need support.

When I faint/fall/get injured/have life threatening health issues arise while I’m not clothed, or when I’m otherwise vulnerable, I’m supposed to let strangers just touch me however they want to. I have to show them my chest (for my cardiac care) and let them poke and examine me. I can’t object without losing access to vital care.

I have agency. I have rights. I have autonomy. I deserve to be able to exercise these things.

[trans-axolotl]

(Described in alt text)

“I found out that I was intersex several years before I became more disabled by my other chronic illnesses, so my intersex identity felt more relevant to my life at first. When I was first diagnosed in 2015, I had an incredibly hard time trying to discover any information about intersex community. It took a lot of research in archives of primary sources just to find out that intersex people did have a powerful history of activism.

Embracing my disabled identity was a parallel process in so many ways. As a wheelchair user, it’s really important for me to define my own disabled identity outside of the medical system or ableist ideas from an inaccessible society. For me, one of the most important parts of my disabled identity is the powerful community we build to fight for justice. In both the intersex and the disabled communities, we get really good at caring for each other. When you're part of a community that's been excluded from accessing knowledge about your body, your health, and your needs, it’s meaningful when we can redistribute power from medical authority back into the hands of intersex and disabled people.

Even though there are many similarities and solidarity between the intersex and disabled communities, sometimes I still feel complicated about whether I want to consider my intersex variation a disability. “In an environment with so much pathologization through Disorders of Sex Development language, it can feel difficult to publicly talk about our intersex variations as disabilities. [Like many intersex people, I have felt] like we have to be the representative of every intersex person ever, rather than having the space to exist with a lot of complexities. For a while, I wondered if I would be betraying intersex activism if I also acknowledged the fact that part of the reason I was losing my mobility was because of my intersex variation.”

In an intersex and disabled future, I want us to have space to celebrate all parts of ourselves without feeling like we have to hide. Not only do we exist, we’re out here existing joyfully, and I want our intersex and disabled futures to reflect the power of our liberation. By Elliott L.”

-7 Disabled Intersex People Explain How They Embrace Their Identities, Teen Vogue, Courtney Felle

[intersex-support]

Intersex Support Resources

Intersex 101: 

http://4intersex.org/#yourself

Intersex Organizations 

Intersex Organizations by Country 

Intersex Variations 

Intersex Variations Glossary by InterACT

Intersex History, Art, and Politics 

Compilation Post

Intersex Flag 

Morgan Carpenter on the Intersex Flag

Intersex Surgery 

“I Want to be Like Nature Made Me” Report from Human Rights Watch

Intersex Human Rights by Bauer et al, 2020

Legal Discrimination 

US Anti-trans bills also harm intersex Children by Human Rights Watch 

Intersex Legislative Toolkit by InterACT

Medical Records

InterACT Guide to accessing medical records

Intersex Health

Intersex affirming hospital policies from InterACT

Intersex affirming Primary Care from National LGBTQIA Health Education Center

Intersex and osteoporosis from Intersex Support Australia

Sexual Health 

Intersex Inclusive information for Sex Ed from Puberty Curriculum

Scarleteen Sex Ed

What Intersex People Want you to Know about Sex by Maddie Rose

I’m Intersex. Here’s How That Affects My Sex Life by Mark Hay

Intersex and Disability 

Liberating All Bodies: Intersex Justice and Disability Justice in Conversation

Intersex Mental Health 

Mental Health

Intersex Justice and the Care We Deserve: “I Want People to Feel at Home in Their Bodies Again” by Zena Sharman

A national study on the physical and mental health of intersex adults in the U.S. by Rosenwohl-Mack et al., 2020

Crisis lines that don’t call the cops: 

Trans Lifeline 

Thrive Lifeline

For Parents of Intersex Children 

Supporting your intersex Child by IGLYO

[brucewaynehater101]

the empire starts noticing that their baby emperor will often be more than a little banged up when he comes to see them in person and they are very worried for their baby, competition to be the imperial physician is fierce but also very stressful for the ones with the position because humans aren't exactly new in space anymore but they're not precisely common either. The position of imperial chef and other positions that concern taking care of the emperor and the imperial consorts is even fiercer.

Previously the empire more or less figured that this mysterious "earth" where their baby emperor makes his primary residence is fairly peaceful and a safe place for him to grow. However, stories finally reach the empire, which started very far from earth and very out of the way of any earth related gossip, about constant invasions that target earth and the general chaos that earth faces on a day to day basis. In hindsight for the empire it makes sense that their baby emperor is from such a dangerous world since he himself is very dangerous despite being so young and adorable. No wonder he's been able to handle their own broken infrastructure and the increasingly large responsibilities that they've put on his little shoulders. There is guilt and there is horror that babies are facing this and, again given their relative condition when they visit the empire in person, obviously they are not being properly cared for.

Finally a delegation from the great Red Bird Empire (robins are an earth species with no equivalent in the empire but there are lots of birds and the color red is known) goes to earth, they arrive in their finest discowing formal fashion to petition the protectors of earth to allow a small group of them to make a base on earth to assist their royal family who has taken refuge on the jl protected planet. They are not there to battle anyone or anything. They are there to make sure their emperor and his consorts are fed, have proper medical attention, and access to an appropriate wardrobe as befits their stations. They might also try to persuade their emperor and his consorts to visit the empire in person more often. While he does a fantastic job of governing from a distance (and at this point Tim has arranged things so he really barely does anything except when a new planet joins and each planet is basically self governing) they miss C4 actually being there.

JL internally freaking out a little because apparently they've had an alien prince? princess? king? goddess? emperor? a royal alien family? somewhere on earth for ages and there could have been a huge diplomatic incident if anything had happen to this royal family, like the family being crushed by a falling building during one of superman's fights, or hit by a tsunami, or earthquake, or even just a stupid speeding car. JL is under the impression that the imperial family on earth fled this empire at some point because of political upheaval and this is a group of imperial loyalists that's only just now gotten enough power to come keep a proper eye on the hidden royals. JL is now worried about alien assassins after the hidden imperial family. At least some part of the JL would like this imperial family to leave earth please.

Based on the delegations costumes, at least one member of the league suspects that the hidden prince of the empire is Dick. This is further supported when the imperial keeper of the wardrobe somehow finds out about Discowing and fawns over Nightwing and goes on about their impeccable fashion sense and how they are revolutionary in the field of haute couture.

Batman may have a small aneurysm when he learns that the alien delegation first thinks to set up in his city. Tim might also panic a little because no, that's too dangerous for them! And instead the Kents suddenly have new neighbors on the farm next door. The Kents are also now on the list of suspected royal family of alien empire even though Ma and Pa are definitely human. Somehow the JL absolutely misses Tim and his life partners visiting the alien delegation and none of the C4 is going to actually admit to anything if they can help it. The delegation is also perfectly happy to keep their mouths shut about the identity of their emperor because it amuses their emperor and also admittedly amuses them. The delegates are frequently rotated with other people who fill their various positions, they set up a schedule, so they can return to the empire and compete to maintain their position as imperial caretaker or end up losing their position to someone else or so they can renew their credentials or even just spend time with their families back in the empire.

Fudge. The choas, miscommunication, and both the delegation and C4 being on board with messing with the JL are precious. Essentially, it turns into various members pointing at each other in suspicion. "Are you the hidden royal family?"

In particular, what do Arthur, Diana, J'onn, and Starfire think about all of this?

I'm also glad the delegation decided to rotate the position on earth. It's like a seasonal job.

I wonder how Ma and Pa Kent feel about their new neighbors. Can they even eat pie?

I'm curious what type of systems Tim sets up for the worlds. It's groovy that he's set the worlds up to be essentially self-sufficient. He probably helps them establish connections, rules, trade routes, etc. for interplanetary trade outside of his empire, but otherwise has set up free healthcare, housing for all, welfare systems, etc.

[floral-ashes]

Gender self-determination as a medical right

Florence Ashley, CMAJ, vol. 196, E833–35 (2024)

Transgender people face many formal barriers to gender-affirming care, sometimes known as “gatekeeping.” Gender-affirming care refers to a wide range of medical interventions that patients pursue to affirm, actualize, or embody their sense of gender. Common forms of gender-affirming care include transition-related surgeries, hormone therapy, puberty blockers, and hair removal. Health care providers may refuse to offer gender-affirming care to transgender patients without an assessment of the person’s gender identity or dysphoria. Adolescents may, moreover, need to show that they have experienced gender dysphoria for several years before receiving care and may be denied care until they satisfy a strict age requirement.

I argue that physicians should rethink barriers to gender-affirming care in light of the principle of gender self-determination. By considering gender self-determination as a presumptive right, physicians are more likely to avoid unnecessary barriers to care. This presumption can be rebutted by showing that encroachments are adequately justified under standards detailed later in this article. Presumptive rights contrast with absolute rights, which cannot be rebutted or derogated from.

Being transgender is a matter of diversity, not pathology. When providers create barriers to gender-affirming care, they impair their patients’ ability to live out their sense of gender. Not every transgender person wishes to pursue gender-affirming interventions — it is a deeply personal choice — but many do. In Canada, 73% of transgender people want to or have pursued some form of gender-affirming care, and another 16% are unsure.2 Yet, only 26% of transgender people have received all the gender-affirming care they desire.

Medical autonomy and everyday autonomy

At the heart of medical ethics lies the principle of autonomy, according to which patients must be free to act “in accordance with a self-chosen plan.” Autonomy is the reason that patients have a right to refuse care, and it underpins health care providers’ duty to properly inform patients so that they can decide whether to accept a proposed treatment. Medical autonomy is, however, asymmetric. Whereas patients have the right to refuse an intervention, medical autonomy does not typically afford them the right to demand a specific intervention from their doctor. Nor does medical autonomy generally prevent providers from imposing discretionary restrictions and conditions on access to care.

Gender-affirming care, however, also engages the principle of gender self-determination, which is related to “everyday” autonomy: a person’s right to decide the shape of the life they want to live. Gender is a critical factor in how others refer to you, what facilities you use, whom you date, which peers you have, how others treat you, and which social norms are applied to you. Furthermore, a person’s primary and secondary sexual characteristics play a central role in social and sexual intercourse; bodily features influence whether others perceive you as a man, a woman, or nonbinary, or as trans- or cisgender; and having certain body parts also influences your ability to do many things, such as use urinals or have penetrative sex. If you do not feel like your body reflects your sense of gender, you may experience persistent discomfort in everyday life and struggle to flourish in your social or romantic life. Feeling misperceived may also cause you to withdraw from meaningful relationships and can be a source of substantial distress.

Gatekeeping gender-affirming care therefore imposes important limits on liberty, dictating critical aspects of transgender individuals’ social, interpersonal, and embodied life. The impact on transgender people of gatekeeping gender-affirming care extends far beyond the medical realm, permeating the deepest reaches and crevices of transgender people’s lives and defining their ability to live as themselves.

The principle of gender selfdetermination

Gender self-determination means that individuals have a right to define, express, and embody their gender identity as they see fit. It is one of the cornerstones of the Yogyakarta Principles, developed in 2006 by leading human rights experts, which state that

Each person’s self-defined … gender identity is integral to their personality and is one of the most basic aspects of self-determination, dignity and freedom. … No one shall be subjected to pressure to conceal, suppress or deny their … gender identity.

The principle of gender self-determination can be derived from and is supported by many long-recognized rights, including the right to free speech, equality,  privacy, identity, and dignity, and to live and act with integrity. As explained by Loukēs G. Loukaidēs, later of the European Court of Human Rights: “For [someone] to be able to function freely, in the full sense of the term, [they] must have the possibility of self-definition and self-determination: the right to be [oneself].” Gender self-determination is implicitly and explicitly recognized by multiple international actors, including the European Court of Human Rights and the Inter-American Court of Human Rights.

Gender self-determination as a medical right

The principle of gender self-determination shapes the ethical obligations of health care providers. Given the impact of gender-affirming care on people’s ability to express, embody, and live out their gender in everyday life, a presumptive right to gender-affirming care for transgender people would seem essential to supporting the principle of gender self-determination. Transgender patients are, in this sense, in a special situation that expands the traditional scope of medical autonomy, a reasoning perhaps best expressed in the decision of the European Court of Human Rights in Van Kück v. Germany, which explained that “the burden placed on a person to prove the medical necessity of treatment, including irreversible surgery, in the field of one of the most intimate private-life matters, appears disproportionate.”

Medical care often constrains everyday liberty, but there are differences of kind and degree when it comes to gender-affirming care. Gender-affirming care is a way for the person to shape themselves from a gendered perspective, not a means of treating an underlying pathology. If transgender existence is understood, as it should be, in terms of diversity rather than pathology, gender self-determination comes to the fore as a medical right, and approaches to gender-affirming care rooted in a conventional diagnostic-and-cure model seem out of place. Gender-affirming care can be considered along similar lines as abortion, which is also desired for its own sake and often framed as a right.

Reconsidering barriers to gender-affirming health care

Gender self-determination is a presumptive right, meaning that it can be outweighed by other considerations. The burden of justifying barriers to care should fall on the health care providers who erect them and not on those seeking care to affirm their gender. A barrier to gender-affirming care would be justified if there were clear and compelling evidence that it prevents harms of sufficiently great magnitude to unambiguously outweigh the barrier’s negative impacts on gender self-determination and well-being. The harm that barriers seek to prevent must be sufficiently serious to outweigh individuals’ autonomy in defining the most fundamental aspects of their personal identity, bearing in mind also that impairing one’s ability to live out one’s sense of gender is psychologically and socially harmful. It is important to remember that autonomy includes the right to make bad decisions for oneself. The freedom to make only good decisions would be meaningless.

For illustrative purposes, I wish to briefly touch on 2 common barriers to gender-affirming care: the requirement that adolescents prove several years of gender incongruence and rigid age requirements. The requirement that adolescents experience “several years of persistent gender diversity/incongruence” before initiating hormone therapy or surgery is not grounded in evidence that immediate access to gender-affirming interventions, without waiting several years, is associated with regret or negative mental health outcomes. Similarly, the use of rigid age requirements for certain interventions lacks empirical evidence and does not take into consideration differences in youths’ cognitive and emotional maturation. Contemporary understandings of autonomy recognize its gradual development and heterogeneity across the population, an understanding that is recognized in Canadian law under the mature minor doctrine. In the words of the Convention on the Rights of the Child, youths’ views must be “given due weight in accordance with the age and maturity of the child.” This calls for an individualized approach that is incompatible with rigid age lines. In the future, providers should also consider whether there is sufficient evidence justifying requirements for transgender adolescents and adults to prove their gender identity or dysphoria before offering care.

Conclusion

In this article, I have argued that providers of gender-affirming care have an ethical duty to respect the gender self-determination of patients and accordingly bear the burden of justifying the barriers they erect on access to gender-affirming care. Health care providers working with transgender communities should carefully examine their gatekeeping practices to ascertain whether they are justified by clear and compelling evidence and abandon those that cannot meet this justificatory threshold.

[omegaverse-anthropologist]

going feral

i’ve mentioned feral alphas and omegas in a few posts before, but what does that mean? this post will discuss ferality,* its causes, common feral behaviors, and treatment.

*note: i will be using ‘ferality’ as opposed to the technically proper ‘ferity’ because the latter is based on the latin root and sounds pretentious, and the former is based on the english word and is more accessible

what is ferality?

ferality is a medical emergency caused most commonly by social isolation. it causes those afflicted to behave erratically, and is the most common cause of forced bites. it is one of the top ten causes of death for those over 80 years old. it is also called ‘loneliness disease’ or ‘bite fever,’ and is often euphemistically described as ‘losing oneself.’ in the past, more than a week of ferality was incurable. today, synthetic hormones and careful medically supervised management leads to over 90% of those afflicted to make a full recovery if treated before one week, and over 80% to regain most normal function if treated before two weeks. outcomes become less positive the longer someone experiences ferality, but there have only been 1,762 documented deaths directly from ferality in the US since 1980.

why does it happen?

humans in the omegaverse are pack animals not only because their ancestors saw practical advantages to living, hunting, and raising pups in groups, but because they were biologically dependent on one another. in simplest terms, interacting with pack aids the body in maintaining its optimal balance between the twelve dynamic (i.e., alpha, beta, and omega) hormones. prolonged lack of social support means that these hormones become unbalanced, leading the body to a state of multi-system disregulation.

ferality greatly reduces people’s access to the areas of the brain responsible for decision making, planning, empathy, and abstraction. it is the body’s desperate bid to regulate itself by any means necessary. those afflicted become impulsive, aggressive, and violent in some cases, so it is essential both for the afflicted person and those nearby that if you spot a feral person, you call emergency services immediately.

how do you spot it?

feral humans are fairly easy to spot based on their unusual, erratic, impulsive behavior. they may sniff the air (or other people) unsubtly, grab or touch things (or people) and fail to respond to spoken language. ferality is most commonly associated with inappropriate scent marking and biting for good reason: a feral person’s primary drive is to share scent with someone to help bring themselves back into balance. there are also some behaviors that can generally be attributed to the different dynamic sexes:

alphas

feral alphas tend to make aggressive eye contact as a posturing behavior

growling, snarling, and clicking at no one in particular

clenching and unclenching the fists and shifting from foot to foot

violence, especially toward other alphas

an acrid scent, like burning rubber or sulfur

betas

feral betas’ eyes tend to shift rapidly, settling on nothing for very long

humming, clicking, huffing at no one in particular

similar to alphas, they clench and unclench the fists and shift from foot to foot

general restlessness, moving quickly

climbing and perching inappropriately (e.g. on tables, vehicles, or buildings)

a rotting scent, like old meat or milk

omegas

feral omegas tend to make glancing eye contact—they meet someone’s eyes, hold, and look away several times

whining, purring, and clicking at no one in particular

baring the neck indiscriminately in a bid to entice a bite

hiding/burrowing (e.g. under tables or in closets. there have been several cases of feral omegas in clothing stores nesting in the clothing racks)

a chemical scent, like bleach or ammonia

how is it treated?

if you spot someone afflicted by ferality, it is essential to call for an ambulance immediately.

treatment begins in the ambulance. typically, EMS technicians anesthetize the individual for everyone’s safety. once it is safe to do so, the technicians draw blood and begin measuring vital signs and hormone levels to ensure that the individual truly is feral. in the past 30 years, rapid tests have made measuring hormone levels faster than ever. these levels are recorded and passed off to hospital triage, along with a record of any emergency hormones administered.

the hospital then brings the individual to the feral ward, where they have an individual room and nesting material marked with synthetic pheromones of all three dynamics. if the individual has been feral for less than ~three days, typically this is enough to trigger their body to begin regulating itself. in some cases, the individual may need direct scent marking in order to jumpstart regulation. if it’s necessary, a nurse or technician will swab the individual’s face and neck with a cotton swab soaked in a synthetic pheromone solution.

in more moderate to severe cases, the individual may need further assistance regulating themselves. in these cases, the individual will receive intravenous hormones and extremely frequent monitoring.

typically, after a few days of hormone therapy, the individual’s body will have reached a state of equilibrium and will be able to maintain the balance itself again. however, in some severe cases, the individual’s body may be unable to maintain the balance. these people will need hormone therapy every other week indefinitely. in some cases (especially those where there is also malnutrition or other severe condition), the issue will resolve itself with time. in others, the hormone treatment is for life.

how is it prevented?

the best prevention is maintaining healthy pack bonds. if, for some reason, this is inaccessible, clinics, health departments, and hospitals typically have nesting materials marked with synthetic pheromones. in the past five years, some nesting material companies have begun offering materials marked with synthetic pheromones. in addition, matching agencies sometimes offer scent-marked clothing or nesting materials for sale, though this practice is judged fairly harshly.

[djuvlipen]

Every hour, a woman in Afghanistan loses her life during childbirth

It was midnight when another wave of pain struck. Begum, 35, thought it was finally time for her child to be born, but there were no signs of the baby coming.

“I woke my husband and told him to get a car to go to a hospital. He rented one from our neighbours,” Begum said.

The mother of four travelled while in labour from Ridkhord area in Badakhshan’s Zibak district to the Shahid Ustad Burhanuddin Rabbani Hospital in the provincial capital Faizabad.

Her fifth child, struggling to be born, did not survive the journey.

Begum lived, but many mothers in similar circumstances do not.

Abdullah is currently waiting to hear if his wife will survive their child’s birth.

He and his wife, residents of the province’s Yafta-e-Bala area, came on foot to the central hospital in Faizabad when their baby was due to be born.

“In Yaftal-e-Bala, there are four health centres. However, because of inadequate medical facilities and no doctor available, we had to walk for four or five hours to Faizabad for delivery,” Abdullah said.

“We encountered many challenges along the way, but I couldn’t do much until we reached the hospital.”

Doctors said that because his wife had walked a long distance, it led to severe bleeding and possibly harmed the baby in the womb.

“The mother’s condition is not good and there is little hope for the baby to survive,” Abdullah said doctors told him.

Afghanistan’s deadly statistics for mothers

According to the latest World Health Organization (WHO) report, each day 24 mothers and 167 newborns in Afghanistan lose their lives due to complications in pregnancy and childbirth.

It’s the highest rate in the world.

“The condition of mothers is highly alarming, particularly for those who travel from remote areas and cover long distances,” a specialist at the Shahid Ustad Burhanuddin Rabbani Hospital, who spoke on condition of anonymity, said.

Having worked in Badakhshan for 22 years, the doctor said that the shortage of healthcare services, especially in remote areas, leads to significant health risks for women.

He recalled a patient who arrived at the hospital from Darwaz district about a month ago after travelling for three days.

“Due to the long journey, the patient’s womb had ruptured along the way, leading to the loss of the baby. The doctors only managed to save the mother’s life with great difficulty,” he said.

Discrimination leading to more deaths

There are concerns the situation is only getting worse as the Taliban place more restrictions on women’s mobility and access to support, and the weakened economy sees healthcare facilities struggle to deliver services.

The WHO reported that in 2023, about 428 health centres were closed because of budget constraints.

Dr Suraya Dalil, WHO’s Director of the Special Programe for Primary Health Care and former Minister of Health in Afghanistan from 2010 to 2014, said that Afghanistan has become one of the most perilous countries for mothers due to insufficient healthcare resources.

Dr Dalil told Rukhshana Media that the Taliban’s discriminatory policies make women more vulnerable in accessing healthcare.

“There is a regime in Afghanistan that systematically discriminates against women. For instance, a few months ago, a directive was sent to the central hospital in Ghazni province stating that women without a male companion would not receive treatment,” she said.

“Similarly, in Herat, a directive was issued prohibiting ultrasound services for women at the central hospital.”

She said that ultrasound examinations are crucial for diagnosis and timely treatment decisions, services that have unfortunately been restricted for women.

Recently, the Taliban supreme leader issued an order for all female employees to receive a reduced monthly salary.

“Recently, we’ve witnessed female employees being allocated a monthly salary of only 5,000 afghanis (US$70), disregarding their rank, experience, and job responsibilities solely because they are women. This is systemic discrimination,” she said.

“The impact of the Taliban’s actions on women extends beyond just health issues. It has multidimensional implications.”

Health professionals strike over reduced salaries

This month several doctors, nurses, and midwives in Kabul hospitals staged a strike in protest of this decision by the Taliban leadership.

At least four female doctors and staff from hospitals such as Wazir Mohammad Akbar Khan, Shaikh Zahid, and Sehat-e-Tefl, speaking to Rukhshana Media,  said they cannot meet their basic living needs with the salary recently set by the Taliban for all female employees.

Homa*, a physician at Wazir Mohammad Akbar Khan hospital, said their protest lasted only three hours after the hospital’s Taliban-appointed director dispersed them with threats.

Orphaned children left to raise each other

Hanifa, 21, a resident of Sarjai area of Panjab district of Bamyan province now takes care of her two younger sisters and two younger brothers after the death of their mother.

She said that there are no clinics in their village or nearby areas, which is why her mother had to give birth at home.

“My poor mother cried in pain, clutching her back, yet she continued to bake bread. With my father and two brothers away working on farmlands, there was no man at home. My mother, assisted by our neighbor, who was a local woman, gave birth at home,” she said.

“She always delivered her children at home and was used to it, but this time, one of the twins didn’t come out, and her bleeding was so severe that the entire house was stained with blood.

“After giving birth, my mother survived only two hours. Despite our efforts, we couldn’t deliver the second twin because there was no accessible vehicle, and my father wasn’t home to help us.

“When my mother realized her bleeding wouldn’t stop, she urged us to take good care of her daughter, who was a baby girl. She remained conscious for two hours, growing weaker with each passing moment until she eventually lost consciousness.”

Karima Sadiq* a gynecologist specializing in obstetrics in remote areas, said stories like these are increasingly common.

“Sadly, since the Taliban seized power in Afghanistan, I have witnessed a rise in maternal deaths during childbirth, particularly in villages and districts. Every 24 hours, 24 to 26 mothers are losing their lives during childbirth, highlighting a disturbingly high maternal mortality rate.”

The United Nations Children’s Fund (UNICEF) recently reported that one-third of women in Afghanistan give birth without access to essential healthcare facilities, and only around 67 percent of deliveries in Afghanistan are supervised by healthcare professionals.

According to UNICEF’s report, it is recommended that pregnant women visit a doctor at least four times before delivery, but only a third of women in Afghanistan adhere to this recommendation.

UNICEF stated that that if a mother gives birth outside of a healthcare facility and without access to a skilled health professional, her life is significantly endangered.

Note*: Names are changed due to security reasons.

[courtkossai]

sometimes can not help but look at what things other folks put in very public introduction posts , and just … ack ! stop that !

there is no need to detail trauma .

there is no need to detail triggers . ( please use tag filters first , and speak with friends privately for anything uncommon . )

there is no need to explain system origins .

there is no need to detail AGAB , trans status , and/or intersex status .

there is no need to detail race or ethnicity .

there is no need to detail full religious journey .

there is no need to detail everything about sexuality .

there is no need to detail disability or sensitive medical information - current diagnoses , suspect diagnoses , history with diagnoses , and so on .

there is no need to share exact age or position in school .

there is no need to explain that alias or nickname is not real name .

there is no need to share face in photography or video .

and so on , and so on .

sometimes might want to talk about things that implicate or expose certain details , but that still do not make necessary to say most things up front . there will be exceptions at times , especially for accessibility requirements or where specific identity is intentionally forefront of discussions , but many other things can actually be zip .

should also realistically be in habit to ask :

is this necessary to say ?

what would happen if someone from physical life find this page ?

what would happen if someone with cruel intentions find this page ?

is there enough here to figure out legal identity and/or place of residence ?

would this really benefit from public eye , or is private journal better ? always consider anything online to be in public eye , even if account seem to be unknown .

look . people who want to question and disbelieve , will do that regardless of how much proof . to explain and detail these points will never convince such people , and only give more ammunition to those who mean harm .

folks often like to say " nothing to hide " but in this world yes , there is plenty to hide . understand fully that folks want to find each other through commonality , but these also often happen to be identities with heavy marginalisation , identities that bigots seek out and target , identities under suspicion and harsh laws .

so please be careful with what information make way into primary public introduction , and public in general . friendship is great , but should not feel need to expose and doxx self just to find .

[manonamora-if]

From the Itch page:

Palestinians are being persecuted from their homes in an ongoing genocide. Due to the armed actions of Israel, they lack access to essentials such as food, water, electricity and medical care. 

In response to this crisis, all proceeds from the Palestinian Relief indie bundle will be donated to the PCRF (Palestine Children's Relief Fund). PCRF describes itself as "the primary humanitarian organization in Palestine, delivering crucial and life-saving medical relief where it is needed most". By donating to the PCRF, Palestinians will have better access to medical relief, food and water. 

Want more TTRPGs? You can donate $15 to TTRPGs for Palestine.

Not sure where to start with the bundle? Check out randombundlegame.com or Dominic's list.

Contact

For further queries: email: gamedevsforpalestine@gmail.com | twitter: @vgforpalestine

[sayruq]

I am Dr. Mahmoud Al Tibi, a 27-year-old Palestinian general practitioner currently residing in Argentina. My family consists of 15 members, may God protect them: My father, Mamdouh. My mother, Manal. My brothers: Mohammed (with his wife Hadeel and their son Mamdouh), Ahmed (with his wife Lakaa and their children Mamdouh and Manal), Mustafa, Abdullah, and Yassin. My sisters: Sahar and Heba. Allow me to briefly recount our story. Before October 7th, my family—consisting of my parents, five young brothers, two sisters, and myself—lived in a warm, loving home. Our lives were filled with joy and love until the devastation of war struck. I vividly remember October 6th, a day before the war on Gaza began. It was a day of celebration as we gathered to virtually celebrate my younger brother Mustafa’s graduation from pharmacy school. Little did we know, those pictures captured by my sister Sahar would be the last images of our warm home. The war left nothing but rubble and memories, shattering our once-happy life For the past five months, my family has endured unimaginable suffering in makeshift tents, where the threat of death looms large. I implore you, out of sheer humanity, to contribute whatever you can to save my family. I am left with no option but to seek your support in ending this nightmare. Our needs: Exiting Gaza to safety requires funds beyond my means—$6,000 to $7,000 per person. Your assistance will not only save my family but also restore warmth and hope to their lives. Utilizing Your Donations: Ensuring Safety, Medical Care, and Education Evacuation to Safety: The primary goal is to relocate my family to a safer location outside of Gaza. The funds will cover the expenses associated with transportation, documentation, and any fees required for leaving the region. This includes ensuring safe passage for my parents, my brother Mustafa, and my brother Yassin. Medical Treatment: A portion of the donations will be allocated towards providing necessary medical treatment for my mother, father, and brothers Mustafa and Yassin. This includes access to healthcare services, medications, and any required medical procedures to address their health needs and ensure their well-being. Educational Support: Another priority is to support the education of my brothers Mustafa and Yassin. The funds will be used to cover the costs associated with continuing their education in a safe and stable environment. This includes tuition fees, school supplies, and any other educational expenses necessary for their continued learning and development. By contributing to our cause, donors will directly support our family's journey to safety and provide crucial resources for the medical treatment and education of our loved ones. Your donations will have a meaningful impact on their lives, helping them access the care they need and pursue their educational goals in a more secure environment. We are deeply grateful for your generosity and support during this challenging time.

[cy-cyborg]

I've seen my new GP twice now, and omg I didn't realise how bad things were with my previous one until now. Like I knew it was bad, but having someone who actually listens and cares to contrast to makes the shitty treatment stand out so much more. Some of the highlights:

My memory isn't great, so my partner wrote out a full report of what had been happening with a list of symptoms and a timeline of the most recent events, as well as printed versions of whatever tests results we could get before we arrived. Id summerised it at the top because every doctor id been to never reads what i give them, even when its from other doctors, but he read all of it, and asked clarifying questions as he did to make sure we were on the same page.

He actually read what little bits of my medical history had access to (while I've never seen this doctor before, I attended this clinic as a child, which was when most of the stuff associated with my primary disability was happening, so he could see that) and agreed that there is almost certainly something chronic going on that he will gladly investigate once the immediate issue is dealt with.

The fact I was autistic came up at some point, and I explained that I'm not formally diagnosed. My current psychologist and one other has done all the testing they can and they were both very confident I am autistic, but we can't get the formal diagnosis without a review from a neuropsyc because of something in my history, and I don't have the money to do that. My autistic traits are in my medical files but they're incorrectly attributed to something else. He was incredibly understanding of that and told me not to stress about the diagnosis (unless i want to, in which case he said hed support me from his end if he can) and asked if I could get something from my psychologist to explain how this might effect my treatment (not noticing symptoms, not being able to articulate problems consistently etc) so he knows what additional support I might need in the clinic.

He admitted to not knowing things, and told me how he was going to go about fixing that gap in his knowledge before my next appointment. For example, He admitted to never having a trans patient before, but that he's going to do some research on his own time to learn what he needs to do to be a better Dr for me.

He asked me to get some scans from a previous hospital stay, and picked up that I was hesitant. mum was with me and explained my auditory processing issues and how it makes communicating via phone hard. he told me not to stress and said he can get the receptionist to do it with my concent.

A lot of these aren't big things, but they make the world of difference when you have a complex medical history and its so refreshing just to feel heard after all this