Educating health care workers about transgender patients When Greg, a happy little boy who enjoyed rough-and tumble play with the other little boys in the neighborhood, asked, shortly after a new brother was introduced to the family, about the difference in their anatomy, he received a rude shock. “It’s because you are a little girl,” his mother told him. For Howard, the problem was different. He would fantasize in bed at night about being taken away from home and returned . . . as a girl. After years of adjusting and a number of surgeries, Greg, now 49, was able to freely live as male. Similarly, Howard, now 61 with a woman’s name, realized his childhood fantasy of a female existence. Like many of us, Greg and Howard (not their real names) don’t look forward to medical appointments. But people such as these—transgender—fear more than bad news about their health: many also fear ignorance from nurses and doctors about who they are. Sarah Morgan, who recently completed her Ph.D. in nursing, is working to increase knowledge among health care providers about transgender patients. “Nursing is known as the caring profession,” she says. “But we have this idea of gender as a dichotomy, and the problem is that it really marginalizes anybody whose experience with gender doesn’t fit in that model.” Transgender is often used as a broad umbrella term to include a wide variety of people who transgress societal norms of gender, Morgan writes in her dissertation. “This may include female-to-male (FTM) and male-to-female (MTF) transsexuals, cross-dressers, drag queens, drag kings, masculine women, and feminine men. An FTM is a person who is biologically female but whose gender identity is male. An MTF is a biological male whose gender identity is female.” During her doctoral work, Morgan found no previous nursing research offering guidance to health care practitioners serving transgender patients. That can be a problem, particularly for a health care provider confronted with an elegant-looking woman who needs a prostate exam, or a short man in a threepiece suit requesting a pap smear. If not handled with the care and respect given any other patient, Morgan says, chances are these patients will not return to get the health care they need. For that reason, her dissertation on transgender life and expe- riences delved into the lives of 11 transgender adults. She conducted in-depth interviews about their involvement in the health care system; their bodily experiences; the recognition, development, and management of their transgender identities; and their relationships with family, friends, and partners. Among her discoveries were that gender identification was determined from a very early age, and that Greg’s experience wasn’t unique for transgender femaleto- males. “A lot of the female-to-males expressed a strong sense of boyhood,” she says. “They expressed thinking they were boys until either they were told or realized otherwise.” The male-to-females did a l ot of fantasizing, and all indulged in cross-dressing as children, until caught. One, after admitting she wanted a female wardrobe, was beaten so badly she missed two days of school. Puberty was a traumatic time for many of Morgan’s interviewees, particularly females-tomales. Many felt betrayed by their bodies; all came independently to a single decision. “They went into a period of biding their time until they could transition,” she says. “Male-tofemales had masculine careers. Some fathered children. One, who was beaten by her father as a child, was a Vietnam Veteran who joined a motorcycle gang.” Female-to-males didn’t conform to the same extent, Morgan says. Some became involved in romantic relationships with women. But, she says, they didn’t identify as lesbians. All 11 people Morgan interviewed would still like to have further surgeries, but many are now living as members of their preferred gender, and use the same word—comfort—to describe what they felt when they could finally do so. “They all talked about how much more comfortable and at peace they felt in their heads and their bodies,” she says, “and the thing that I think is the most important about that is that most nurses don’t have a lot of experience with transgender people. They think of them as other, or different from themselves.” Morgan points out that comfort is important for both the transgender patients and those who care for them. “For nurses, being comfortable providing care to transgender patients is a process that will have to develop over time. But I think what’s important to understand is that if nurses are reluctant to help people in their transition process, they can be reassured by the fact that they’re providing comfort.” Teaching students about transgender issues before they ever encounter a transgender patient can reduce providers’ sense of patients’ “otherness,” Morgan says. Integrating education into existing nursing practice is also important. Health care professionals— nurses and doctors—who encounter transgender patients in their practices need to remember that first and foremost, they’re patients in need of treatment, Morgan says. “I call it the case of the preoccupied provider,” she says, citing as an example a patient who comes in for routine or acute care—stitches, a broken bone, strep throat. Instead of attending to the symptoms at hand, the doctor or nurse grills the patient about his or her gender issues. Many of Morgan’s interviewees had horror stories, she said, and many tended to avoid contact with the health care system as a result. “I grit my teeth every time I go into a health care situation because of the questions I’m going to be asked,” one told her. Another stated he could count on one hand the number of times he’d been to a doctor. That person, who hasn’t had all the surgery he wants yet, is currently not getting any health care because of his past experiences. Morgan hopes her dissertation will begin paving the way for health care providers to be able to deliver health care in a setting that is, to use the words of the population she’s described, more comfortable. “Patients,” she says, “don’t always want to be the ones doing the education.” Gleaning an ancient cultural landscape through poetry As early as the second century B.C., wealthy Romans began to build seaside villas in the region south of Rome known as Campania. The Romans came to enjoy the magnificent views of the sea and to find respite from Rome’s oppressive heat and from their official duties in Rome. These Romans were particularly drawn to Campania because it was seen as an exotic land steeped in Greek language and culture. As a McNair Program scholar in the summer of 2003, classics major Claudia J. Hough began studying what she terms the “cultural landscape” of Campania through the writings of first-century A.D. poet P. Papinius Statius. “Statius’ poems known as the Silvae are full of allusions to Greek myth, cult, and history,” Hough says. “And no wonder, since Statius, although writing in Latin for wealthy Roman patrons, was the son of a Greek poet and a native of Naples, a major center of Greek culture from the fifth century B.C. well into the fifth century A.D.” Statius’ position as a native Campanian of Greek ethnicity makes the Silvae an important resource for the study of the cultural milieu in Campania during the first century A.D., Hough asserts. A major focus of her study was to identify all references to places and sites within Campania, a task complicated by the mannerist style that Statius employed. References to cult, mythology, and the Greek origins of Campanian cities abound. “Statius’ use of allusion is revealing rather than obfuscating and provides a wealth of information,” Hough says. “Moreover, Statius’ descriptions of villa life give a vivid picture of the lifestyles of the wealthy Romans who lined the shores of the Bay of Naples with theirvillae maritimae.” Reading the poems in the original Latin, Hough also used a number of editions and commentaries published between 1898 and 2003, written in German and French as well as English. “These are the major research languages in the field of classical philology,” Hough explains. Over 180 references to Campania were found within 16 of the 32 poems distributed among the five books of the Silvae. Hough developed a thematic typology which will serve as a foundation for her continuing research this summer. “The examination of literary sources such as the Silvae reveals the pervasive presence of Greek culture throughout the region and its influence on Latin literature,” she says. She also made an observation noted by few previous scholars. As the powerful Hercules labors to build a temple in Surrentum, Statius writes that “[R]ich Capreae and verdant Taurubulae reverberate and the sea’s mighty echo returns to the land.” The word “Taurubulae” is found nowhere else in Latin literature, and has been accepted by many scholars to refer to an island near Naples. This didn’t seem right to Hough. “An echo from a second island did not make sense in terms of an echo from two directions,” she says. On an 18th-century map housed in UWM’s the Golda Meir Library, Hough found a mountain on the Sorrento Peninsula called Monte Toro. If Taurubulae is the Monte Toro of the 1769 map, the temple would be located halfway between Capri and Monte Toro, which would explain the mighty echo coming from two directions. Hough did her initial research as one of 15 students in the Ronald E. McNair Post- Baccalaureate Achievement Program at UWM. Designed to help first-generation college students prepare for graduate school, the program includes GRE training, a weekly seminar on succeeding in graduate school, regular meetings with a faculty mentor and preparation of a published research paper. Hough’s mentor in the McNair Program was Dr. Richard Monti, a philologist and Classics Program coordinator in the Department of Foreign Languages and Linguistics.