The sun shone brilliantly on the friends and family who gathered on a breezy day to share food and make connections as queer families on June 13th, 2015, when Green Mountain Crossroads (GMC) hosted its first specifically family-oriented event at the Pride Family Picnic at Living Memorial Park in Brattleboro. Co-hosted in partnership with the Pride Center of Vermont, the picnic was inspired by one of the GMC board members, Emily Marker, a teacher in Brattleboro and parent of three-year-old, along with her girlfriend Ellen Rago.
"We really wanted to start doing stuff that was more inclusive and specifically geared towards families, especially with school-age kids," said GMC Executive Director HB Lozito.
Building relationships among queer rural folks and families is what GMC is all about.
Scout, who attended the picnic from North Charlestown, New Hampshire, said, "As a genderqueer queer dad of a 20-year-old, things like this, family picnics, that everybody can come to with friends, family, extended family, chosen family, were so important in my own confidence as a parent and in my son's confidence as a kid of a queer parent." Scout also noted that feeling alone and isolated as a rural queer person can feel like a lot to overcome and especially if you have family responsibilities.
"If you don't fit the stereotypical queer mold because you do have kids, there can be this assumption that you must be part of a heteronormative relationship," said Scout. "Even if you are living in a beautiful space, it’s good to know that you are not all by yourself."
Paula May Boyher has recently moved to the area from Maine, and says that GMC events provide a way for her to get out of the house and participate in the community. "I'm single! Dating is hard everywhere. I think events like this are important because it gets me out, and I really enjoy people. I'm transgender, and living and working as a male, my weekends are girl-time."
Rural areas often lack the infrastructure and organization to support and connect LGBTQ individuals and families, and GMC was founded, in part, to meet this need. The Pride Family Picnic was the first GMC event for Susan Buchan, who moved back to New England six months ago with her wife and young son and shared how different queer life was when they were living in Palm Springs.
"There were huge festivals and lots of signage, concerts and drag shows, all kinds of things all the time, if you wanted to go to them," she said. "You didn’t have to look very hard to find queer community."
Although this profusion of choice is mostly not the case for small town and rural queer folks, one upside to rural queer events is depth. Susan noted, "Those bigger events are less personal. After talking to people here, I can see how I might run into people and make connections with them after meeting them here, probably deeper and longer friendships with people. You just got to find each other."
Jennifer Shooer and Liz Sampson, now divorced and both remarried, co-parent their two children within a four-parent family unit, which includes the partners of their new marriages and a third child Liz raises with her current wife.
Jennifer asked 5-year-old Maisie to share what she'd said in the car on the way to the picnic. Why is it that Maisie feels so lucky?
"Because I have four moms!" Maisie said.
"We co-parent and we're all very close, so it works out very well," added Jennifer.
"I think it’s important for the world to see that we are families in all of our different ways," said Liz.
Ellen Rago, who lives of Putney with her girlfriend Emily Marker and three-year-old son Max, echoed this sentiment, saying, "It’s really nice to know that Max will grow up in a place where he can see other queer families and have it be normalized for him in that way."
Shela Linton, the mother of two daughters, said that she feels similarly. "I'm super excited to be here today and to connect with other family," offered Shela, who works as an organizer for the Vermont Workers' Center and is a collective member of the Root Social Justice Center. She attended the picnic with her 13-year old daughter and said, "I really want my daughter to grow up in a supportive community where she can be her full self and where others can be their full selves too. I think its great for networking, to see who else is out there, so we can support each other as parents and families."
Family events offer our queer community something that can be challenging to find for some: intergenerational opportunities.
Alex Fischer is 31 years old and active in the Brattleboro community as owner of Open Bookkeeping, a Root Social Justice Center collective member, and a GMC Board Member. But the main reason they were excited to come to the picnic?
"I get to hang out with my three-year-old friend Lucy Wren," says Fischer about the freckled daughter of mothers Laura Stamas and Abby Mnookin.
Showing up to GMC events is not only important for making social connections, said Jennifer Shooer. "I'm part of this community as a lesbian woman," she said, "and there are things I still don't know about, like issues for the trans community. I'm always learning. I feel it's important for us to know that we are all here, and we are all together."
GMC exists because queer space and events and community is a hard thing to find in rural places, and funding to support those things is even harder to come by. The support and funding to continue events like this and other engagements is dependent on community-based funding. What goes into throwing an event like this?
"I do everything from design and outreach to strategic planning, so some funding goes to support me and the time I put in. We also buy supplies like food and picnic materials, and we do a lot of outreach," explained HB. "Also, GMC doesn't have a physical space of our own, and space and visibility is something we think about a lot as a rural queer organization, and this is also related to funding."
HB says that GMC is trying to "move away from the unpredictability and volatility of grant funding" through this year's new fundraising strategies. "We are looking for 22 new one-time donors, first-time donors who are interested in supporting us financially this month, and we're also looking for five new monthly sustainers in June," said HB. This sort of grassroots financial support helps GMC "be more accountable to the people who are actually in our community, their needs and interests, instead of being beholden to the interests of outside funders who are not necessarily directly a part of our community."
GMC is a community organization with one part-time employee (HB!), which means that GMC is always looking for volunteers, committee members, and board members. Volunteer picnic photographer Davida Carta is originally from Italy and has lived in Brattleboro for several years. "I'm here because I like to take pictures," said Davida, "I found GMC on Facebook and I like contribute to the community. I'm still trying to get to know the area and know people, it’s still hard sometimes, and I thought this would be a good way to meet people and get involved."
If you're interested in attending an event, volunteering, or otherwise participating with GMC (allies welcome!) get in touch through our website, facebook page, or contact HB Lozito at hb(at)greenmountaincrossroads(dot)org.
In the winter of 2014, I met Leo Kline at the Translating Identities Conference at the University of Vermont in Burlington. He and Rachel Inker, a physician at the Community Health Centers of Burlington, were giving a workshop on the state of trans-competent healthcare for Vermonters. This past month, Leo took some time out of his schedule to share his perspectives on providing queer and trans healthcare.
GMC: Will you share a little about yourself and the work that you do?
LK: I just started my position as a nurse practitioner at the Community Health Centers of Burlington. Previously I worked there as a nurse and even before that I worked there as a medical assistant, so I have some pretty good longevity at that clinic. I got my Masters of Science in Nursing in January, my role as a primary care provider. I hope to serve the LGBTQ population and provide a safe space for people to come and get care that's informed and affirmative. I've pitched that to the folks that hired me as one of my goals and they were very receptive. I think that support is pretty unique, certainly in rural healthcare, so I feel privileged to be working there.
GMC: How did you arrive at nursing?
LK: In college I was an athletic trainer's assistant, and enjoyed that work enough to get EMT training. In college I studied printmaking and other visual arts. I worked in different studios in Colorado and Massachusetts but unfortunately developed a repetitive nerve injury from doing the manual labor of printmaking. I had to switch careers at that point and thought back on my time as an AT assistant and EMT. I started working on an ambulance with a rescue squad in Richmond, Vermont. The medical field was a good fit for me, so I applied and was offered the position of medical assistant at CHCB. I loved the people and the work, and I thought ok, this is what I'm meant to do. I went back to school at the University of Vermont to be a nurse practitioner while working at CHCB.
GMC: Will you tell us about the trans clinic you work at, how it came into being, who it serves, and why it's so awesome?
LK: The main clinic is a federally qualified health center. It is very large, with many providers, a functioning lab, and a number of off-site clinics, including two homeless clinics, one for youth and one for adults and families. There's a practice on Pearl Street that, on Thursdays, is specifically a trans clinic. Dr. Rachel Inker and myself worked to get it up and running in 2010. We started it out as a pilot to see if there was the need, and it was very successful. It became very popular and has actually overflowed that spot, meaning Dr. Inker has to see people who would probably preferred to see there at the Pearl Street location, up at the main clinic instead. The hope is that is that I will meet some of that need and provide other avenues for trans patients and also anyone who might fit under the LGBTQ umbrella. I would like to broaden the scope of what we provide to encompass more of the queer community. That's one of my goals, and Dr. Inker and the medical director is all for it, so we can be really supportive to each other in that way.
GMC: Will you talk a little bit about makes a queer-competent clinic?
LK: I think there's a big picture view and then the minutiae of what creates an affirmative space. The big picture view would be that all staff involved in the care of queer patients would have some level of training and comfort with language and the needs of the population. It’s important to talk about how to create a safe space, including things we think would be difficult and try to problem-solve as a group. Awareness of one’s own biases and having an openness to talk about some of these complex beliefs is also important. For example, some of the patients are very out and proud about their trans identity and other people live a very stealth existence, where they would prefer others not to have any knowledge of that part of their life.
So the provider, nurses and front desk staff might work together on how to create a
space that is safe and acknowledging of both of those perspectives. The main clinic is a pretty busy bustling place, there's a big waiting room, while our little clinic on Pearl Street has two exam rooms, and there's a handful of staff there. It's much less intimidating in a way. Whoever's at the front desk needs to be very comfortable with different gender presentations and exhibit an attitude of non-judgment, which we are very fortunate to have with the people we currently work with.
More obvious manifestations of a safe space include stickers that say safe space, a queer flag, and having handouts that are appropriate to the population. Once people get to the exam room, we need to be comfortable discussing all aspects of healthcare, so that means providers and nurses need specific training. Attending conferences that focus on queer health, learning risks and behaviors and health outcomes, and studying the data to plan how best to meet the needs of the population. So training is involved both at the clinic itself and beyond that. We also offer a social worker onsite, who can meet with people who are in any form of distress or who need to discuss resources. It's a very holistic model of care.
GMC: I read a little bit of your graduate thesis online. Will you talk about your research?
LK: My study tried to understand if Nurse Practitioners who watched a short video of trans folks talking about their healthcare would express more desire to learn the guidelines of treating trans folks or express more interest in treating trans folks, as compared to a group of NPs who hadn't seen the video. The study gave some information but no statistical significance could be drawn due to low response rates to my survey. What I did learn, though, was that the majority of the people sampled had not learned about the guidelines and were willing to learn more.
GMC: I'm struck by the word comfort. A provider may not know the actual protocols or guidelines around trans healthcare, and whether they are interested in or motivated to learn or do the research to become more competent may have to do with how comfortable they are with gender and sexuality. Even if a provider has the appropriate language, the patient can really sense if the provider is uncomfortable.
LK: Absolutely. I think it's about being willing to walk through that discomfort and ask for feedback from the patients, get your feet wet and reach out to other providers. It is a different part of medicine in some ways, and in other ways it isn't at all, no more complex than talking to a young woman about birth control. In some ways you have to have a different sensitivity and awareness that many mainstream people may not be thinking about. To a provider who is swamped with a million things, that might feel intimidating. If they don't seek the training, they may feel underprepared, and end up referring people to a different provider. That was what I was grappling with when I wrote my thesis: what makes somebody say, "Hey I should take the time to learn more about this." I thought hearing a trans person on the video say "I deserve healthcare just like anyone else" might sway a provider to do some introspection and ask, "Why couldn't I provide this?"
GMC: Was there any training around queer health care in your nursing program?
LK: Yes. I wouldn't say it was extensive. We had one training covering all of LGBTQ health, not super trans-specific. I know that the med school at UVM is working toward incorporating more training too, so we're sort of on the cusp of having more attention paid to these issues. There's definitely room for improvement.
GMC: Why do you choose to do this work?
LK: I want be present for the LGBT folks that need it. I see that many people in that community fall through the cracks because they don't feel comfortable in a healthcare setting, so its important to me to be a person who is openly inviting anyone from that community to come and get safe care, that their values and needs will be respected. I recently wrote my bio for my new job, and looking through the bios of my colleagues, I noticed that Dr. Inker is the only other person who mentions transgender medicine in the bio. To me it is important to have providers say outright that they are there for different populations, and I'm happy that I can provide that for someone. Who knows, just reading that bio could be a turning point for a queer or trans person to decide to seek care.
GMC: It occurs to me that there are a lot more healthcare options for folks who are not queer than there are for LGBTQ folks, especially in rural areas.
GMC: Do you think your experiences serving LGBTQ communities has had any influence on your capacity or thinking around serving other marginalized communities?
LK: Well, working with diverse populations has been imbedded in my upbringing. CHCB serves a very diverse population. Basically what it comes down to is being open, doing some homework, not expecting somebody else to teach you who they are and where they come from, not faking that you know more than you really do, having a willingness to be humble and ask questions, being respectful. I think those are important things for serving any diverse population.
GMC:I'm an herbalist and you're a nurse practitioner. Do you have any ideas or opinions on the potential for integrative medicine meeting the needs of queer and trans patients or community?
LK: I would love that. I don't know how insurance companies would work with that –– the people that I work with are largely uninsured, underinsured, or insured by Medicaid, and I don't know how to get integrative care covered. I think many health conditions would benefit from a complementary approach of allopathic and naturopathic medicine. I think it would be amazing to have those options.
GMC: What would you tell practitioners who are wanting to provide more or better care to trans patients? Resources?
LK: Do some research and introspection. Get comfortable with the topics surrounding LGBTQ care. You could go to the CDC website, the website for the Transgender Center for Healthcare Excellence, or even do simple Google searches to learn about what's hot right now in transgender healthcare.
Do some introspection, ask yourself what you might do in various situations unfamiliar to you. What's coming up for you? Queer people are all around us, and it would be beneficial to have a game plan and have some knowledge to back that up. The deer in headlights does not go over so well with patients. Basically do some research and think about what your beliefs are around transgender identity and health.
Another thing would be to start creating a network of people. If you know of another provider who has familiarity with caring for gender-variant individuals, why not have a conversation with them? You might ask if they would consult with you when needed. Having a contact may decrease the feeling of isolation. Isolation can become prohibitive to wanting to provide the care. But there are other providers out there offering care to the LGBTQ community, so start reaching out. I think we need to start connecting with each other, there are practitioners all over the state who would benefit.
GMC: Do you have any advice to offer queer and trans patients seeking care?
LK: I think Pride Vermont has a health care provider list. They are a very open organization and easy to talk to. For folks who are younger, Outright Vermont has drop-in clinics, and I know a few of the folks who work there, and they are amazing. It's a safe space to put your feelers out and get some support and learn about resources by word of mouth. It's pretty powerful, for queer people or any vulnerable population, to hear someone they know saying they had a great experience with a provider. I think the personal recommendation carries a lot more weight than getting a list of providers.
In the exams rooms themselves, if folks are feeling like their needs aren't being met or they feel they are being mistreated, feedback needs to be given. I think that can be intimidating, but if you feel mistreated, the organization would likely want to know about it. Maybe the providers themselves are unaware that they have offended the person. If an individual feels that a provider isn't knowledgeable about their needs, they can either verbalize this to the provider and say, "Is there any possibility that you can learn more about this, or do you recommend that I see someone else?" Clearly state your needs. That's what I really hope someone would do with me, if they felt like they needed some more support.
One thing that I've seen is that sometimes trans folks have been waiting a really long time to seek care and to actually address the trans identity needs they have, and for those folks it can feel very frustrating to come in and not have everything addressed in one visit. For example, they may come in, out themselves to their provider, and express a desire to begin hormones. I think there is a frustration that can occur when people can't start on hormones at that visit. So one of the things I'm thinking is that it would be helpful for that person to try to have an openness to the process of transition that lies ahead. This is something we want to work with them on, we want to be safe and treat them appropriately, and that can take a little bit of time. It's not that we are trying to delay their transition, it's that we want to be careful and thorough and not cut any corners, and that is what you would want from really good health care provider.
GMC: Thanks Leo for taking the time to chat. You can contact the Community Health Centers of Burlington where Leo Kline and Dr. Inker works by emailing the general contact on the website and specifying any LGBTQ needs. You can also go to CHCB Transgender Health Clinic website to find out more.
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Naomi Rachel Ullian is a white queer femme writer, herbalist, and performance artist. You can find more of her work at proseforpeople.com