Transgender patients seeking medical care face discrimination even in liberal, cutting-edge San Francisco.
But this being liberal, cutting-edge San Francisco, they also have a champion: Cecilia Chung, a transgender woman serving on the Health Commission.
Appointed to the commission overseeing the Department of Public Health by Mayor Ed Lee in April, Chung made news by pushing the department to pay for gender reassignment surgeries for uninsured transgender patients - making San Francisco the first city in the country to do so.
Now, she's developed and is leading sessions for staff members throughout the department called Transgender 101, designed to help everybody - from doctors to nurses to receptionists to janitors - create a respectful atmosphere for transgender patients, increase sensitivity, and understand policies and laws related to medical care for transgender patients.
"We want to make sure everyone is on the same page when it comes to cultural competency," said Chung, 47, an Excelsior resident who works internationally as a health care consultant and advocate. "This is really walking the walk in terms of cultural competency and inclusion and making sure all of our community feels safe."
Eventually, it will lead to more advanced courses for specialists that she's developing called, you guessed it, Transgender 102 and Transgender 103.
Chung grew up in Hong Kong and said she always knew the girl she was inside didn't match her boy's body. She was flamboyant and effeminate, had a high voice and was so androgynous looking, people would mistake her for a girl.
Her family moved to Los Angeles in 1984, and Chung moved to San Francisco to attend City College a year later. She tried to fit into the gay community but "failed miserably." She had a discussion with her mom about her feelings that she was really a woman, but her mom said coming out would devastate her father.
"She said, 'Can't you do that after your dad goes to bed?' " Chung said with a laugh. "She thought I just wanted to dress up and go out. I told her that wouldn't be honest to myself and that I was living a double life."
She graduated from Golden Gate University in 1987 with a degree in international management and went to work as a court interpreter in Santa Clara County. Eventually, she decided to take control of her own decisions and live as a woman - but at first, rejection from her family and lack of money made it difficult.
"My parents didn't know how to deal with someone like me - having a gay son was difficult enough and having a transgender daughter, I can only imagine," she said. "There's no how-to guide or menu that parents have."
When she began showing up at work dressed as a woman, she lost her job. She's sure it was related, "But no one would say that - not at the court, hello."
She sunk into a deep depression which she used illegal drugs to try to combat. She scored hormones on the black market in the Tenderloin and was homeless for three years. She said she was a victim of sexual and physical violence and struggled to get any kind of health care with no job and no insurance. It was also during this time that she contracted HIV.
She once went to an emergency room with severe stomach pain, but was discharged because doctors were convinced she was just trying to get free drugs. After two weeks of intense pain and vomiting, she went back and was diagnosed with severe bowel obstruction and gangrene in her gastrointestinal tract. She had emergency surgery which she said could have been avoided.
"You want to see the scar?" she asked, lifting up her shirt to show a massive scar up her abdomen.
Chung was gradually able to reconcile with her mother, who realized her daughter's decision was not a personal attack on the family. Chung also formed strong friendships and found employment as an advocate for transgender people. In 1998, she had full gender reassignment surgery in Bangkok and was finally able to put her darkest period behind her.
"I was a much better person with my family behind me again," she said.
She worked as deputy director of the Transgender Law Center and the HIV program coordinator for the Asian Pacific Islander American Health Forum. She has served on many local, national and international boards and commissions related to HIV and transgender people. She served on the city's Human Rights Commission for several years before being named to the Health Commission.
Barbara Garcia, director of the health department, said that she expects more transgender patients to become part of the city's health care system now that it will offer gender reassignment surgeries to the uninsured. Because of that, it's important to educate the entire department on treating those patients with compassion.
"We thought it was appropriate and timely to roll out Transgender 101," Garcia said. "Having a commissioner like Cecilia Chung is really important from a policy perspective. She can certainly help us."
Chung said she knows firsthand how hard it is for transgender people to find quality health care, and hopes she can help ease the difficult road for other people going through the transition.
"Most transgender people have struggled in finding acceptance and finding the cultural competency that we need," she said. "We're hopefully trying to set a new path."
Heather Knight is a San Francisco Chronicle staff writer. E-mail: firstname.lastname@example.org Twitter: @hknightsf