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When Esra, an Oakland-based DJ and event producer who wanted to only go by their first name because of safety concerns, started feeling pain from standing for long hours during gigs, they didn't even consider going to a doctor. Esra describes their gender as non-binary, which means someone who doesn't identify as being exclusively male or female. Esra, who is of Middle Eastern background and has long dark hair, said they are easily mistaken as a cis-woman. So, to avoid difficult conversations, they would often present as such at the doctor's office. "But then I couldn't be my whole self," they said, which made for anxiety-ridden appointments.
"As someone who knows that my physical pain has come from trauma and from the experiences of my identity, I can't have a conversation about pain with a Western doctor," they said.
Instead, Esra started treatment with Paolo Flores Chico, a trans acupuncturist in Oakland who organizes acupuncture and sound healing events specifically for queer and trans people of color. (Chico also cofounded the popular queer dance party Ships in the Night). "We had become friends through working in nightlife, and that's nice because I feel like as a patient they understand me fully," they said.
Queer and trans communities have a long history of being subjected to anti-LGBT bias in health care. Up until 1973, homosexuality was listed as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, as was "gender identity disorder" until 2013. Labeling homosexuality as a disorder fueled extreme anti-gay conversion measures like forced institutionalization and electroshock therapy. While those practices are now rejected by all major mental health organizations, discrimination is still one of the reasons people are pushed away from the mainstream medical system.
"I have a lot of trans patients and friends who haven't had positive experiences with Western doctors, and when we seek services for health and wellness, we have to deal with being retraumatized over and over again," said Chico, referring to things like gender labels on intake forms and physicians who don't use correct pronouns.
That can make people feel "punished" for their identity, argues Elokin Orton-Cheung, a queer community herbalist based in Oakland who sees patients as a primary care provider. The medical system has a long history of being "used as a way to control communities," she said, citing medical experimentation in Black communities and the history of forced sterilization in hospitals and prisons.
In a survey of lesbian, gay, and bisexual people by the Kaiser Family Foundation, more than half of all respondents reported that they have faced cases of providers denying care, using harsh language, or blaming the patient's sexual orientation or gender identity as the cause for an illness. According to the same report, many transgender people say they've been denied care or encountered violence in health-care settings.
Historically, marginalized communities have found ways to care for themselves. Women's liberation activists opened clinics in the '60s specifically as a response to sexist attitudes in health care. The Black Panthers designed "survival programs," including free medical clinics and food programs, to help African Americans and other oppressed peoples meet their basic needs because state systems weren't doing so. The Panthers' free breakfast program started in Oakland and, at its peak, fed thousands of kids daily in 23 programs across the country. While the federal government's efforts to destroy the Black Panthers led to the dismantling of the program, it's believed to have been the template for the current free breakfast programs in schools — and it remains an inspiration for many food and healing justice activists.
"There's always been a level of care that exists in these communities, and elders that have held onto healing practices from ancestral lineage — that's always been part of communities of color in Oakland," said Iris Garcia of the Akonadi Foundation, whose mission is to eliminate structural racism. Garcia manages Akonadi's So Love Can Win Community Response Fund, which supports community-rooted solutions to promote safety and healing in communities of color. "But I think what we're seeing is that there are more conversations about what it means to have care and wellness outside of these historically clinical systems," said Garcia.
The idea for the fund, which supports a number of projects featured in this article, came about in the summer of 2016, when Alton Sterling and Philando Castile, both African American, were killed by police, and 49 people were gunned down in a mass shooting at a gay nightclub in Orlando, Fla. At the same time, Garcia said gentrification was having visible effects in Oakland, with an increase in homelessness and an exodus of the Black population. The staff, reeling from the events of the summer, met with community partners and came up with an idea to provide resources to promote safety and create space to mourn the dead from state violence, which created solidarity between movements.
This was in step with national movements that began institutionalizing indigenous and cultural practices of self-care. The Medic and Healer Council at Standing Rock camps acted as first responders for water protectors and provided herbal remedies for activists there for the long haul. The Black Lives Matter movement is credited with starting a growing conversation about self-care in Black and other communities, where the repeated exposure to racial violence can be triggering.