In September 2012, Dr. Haim Kaplan, a high-ranking surgeon at Sheba Medical Center, Tel Hashomer, went on sabbatical. That was more than a year ago. Dr. Kaplan was the only surgeon in Israel who was authorized to perform sex-reassignment surgeries — and since he went on sabbatical, no such operations have been performed in Israel, even though he has since returned.
The fact that Israel has one of the world’s highest doctor-to-patient ratios on earth does not change the untenable situation for Israel’s transgender community, and the waiting list for the surgery is only growing longer.
There is no official data on Israel’s transgender community. Nobody knows its size, how many sex-change operations have been performed in Israel over the years or their success rates. The waiting list for the operation comprises between 12 and 20 transgender men and women, who have completed the approval process and are eligible for the operation, according to the Health Ministry’s sex-reassignment committee.
But for 14 months, no operations have been performed, mainly because the Health Ministry did not prepare in advance for the temporary departure of the only surgeon in Israel who is authorized to perform them.
Dr. Marci Bowers, a world-renowned expert in sex-change surgery, is due to land in Israel next month. Bowers, who underwent the procedure herself, is scheduled to perform five sex-change operations in Israel and then return to her surgical practice in Trinidad, Colorado, a town that has become known as “the sex-change capital of the world” because of her practice there.
Got approval, but going nowhere
For the transgender community in Israel, this is a temporary solution after a long year of waiting. “It’s a hardship,” says a prominent activist in the community. “Not performing the operations in Israel keeps people from living their lives. These are people who have been down the Via Dolorosa of the sex-reassignment committee, received approval to undergo the surgery and now are being thrown to the dogs.”
Regarding a permanent solution, Health Ministry officials say, “Sheba Medical Center has sent a plastic surgeon abroad to be trained in sex-reassignment surgery. He is expected to return in 2014.”
The recent edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, abolished the classification of transgender identity and transsexuality. It is believed that a similar change will be made in the World Health Organization’s diagnostic manual. These changes match the consensus among international professionals, who see transgender and transsexual identity as a human identity, not as a disorder or a pathology.
According to attorney Itai Mack, who represents several transgender people, Dr. Bowers was asked to perform the surgeries here as a result of pressure from him and LGBT community activists to resume performing the operations in Israel. “There was a meeting on August 27 and Health Ministry representatives promised that, within two months, Dr. Bowers would arrive in Israel to perform the operations. Her coming to Israel could set a positive precedent that will lead to the operations being performed by experienced surgeons from abroad. We don’t know anything about the physician who was sent abroad for training, nor do we know exactly when he will be coming back and where he will be receiving his training,” Mack says.
It's free, if you can get it
Sex-change operations are not defined as cosmetic or alternative. They fill a medical need that is recognized by the State of Israel, included in the state-subsidized health basket and included in the medical services funded by the HMOs. They are performed with the approval of the Health Ministry’s sex-reassignment committee, which is headed by Professor Eyal Winkler, the director of the department of plastic surgery at Sheba Medical Center, Tel Hashomer. The committee has five members: a high-ranking plastic surgeon, a senior psychiatrist, a clinical psychologist, a urologist and an endocrinologist.
The committee, which meets according to a Health Ministry procedure set down in April 1986, approves the surgeries only after a two-year waiting period. During those two years, the applicants undergo hormonal treatments to test their physical and emotional reactions to their new gender identity. The process also includes testing by a psychiatrist and a psychologist, who have the authority to deny approval to the procedure if the applicant is found to be emotionally unfit.
The lack of a sex-reassignment surgeon in Israel is pushing those who are fed-up with waiting for the operation — or with the long procedure involved in getting it approved — to undergo the surgery abroad. Those who can afford the operation abroad will pay tens of thousands of shekels to undergo it abroad. The HMOs do not give reimbursement for that kind of surgery abroad for those who have basic coverage. Those who have supplementary or expanded medical insurance will receive only a partial reimbursement from the HMO, according to the policy definitions, which are different for each HMO.
In November 2012, D., a 29-year-old woman from Netanya, went to Thailand to undergo sex-reassignment surgery. “Thailand is one of the best places to have the surgery,” she told Haaretz a year after she had the operation. A month ago, D., represented by Mack, sued her HMO, Maccabi, for a reimbursement of NIS 80,000 — NIS 60,000 for the surgery and NIS 20,000 for mental anguish. In her lawsuit, D. claims that her Maccabi Zahav insurance policy was supposed to cover the cost of the process she underwent, but Maccabi refused to pay before the operation.
The first sex-reassignment surgery was performed in Israel in 1970. Since then, it is estimated that 20 such surgeries are performed per year, on average. Over the years, it has been claimed that members of the Health Ministry committee treated people undergoing the process in a humiliating manner. But members of the LGBT community say they feel new winds blowing. “The previous deputy health minister, Yaakov Litzman, wouldn’t meet with us at all. With the new health minister, it’s already looking different, and we anticipate meeting with her soon.”
Professor Winkler told Haaretz: “I’m making an effort to resume this service at the highest level, in accordance with the mandate I received from the Health Ministry. The most important thing to us right now is the standard of treatment.”
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