Healthy Choices

‘100 Smiling Strangers’ campaign helps Sacramento’s Gender Health Center bolster its work

Jovi Radtke wiped away tears with the back of one arm while wrapping the other around Jennifer Russell, an acquaintance made just moments before, to pose for a picture worth a few thousand dollars.

Radtke, a local performance poet, completed Wednesday night a summerlong challenge to take a total of 100 selfies with strangers who returned a smile on the street.

Roaming the midtown sidewalks at dusk, Radtke flashed countless smiles at passers-by – some of whom returned the grin and posed for the photo and some of whom ignored the gesture entirely. Russell’s smile was the 100th in Radtke’s collection, and the key to raking in what will be a substantial gift for the Gender Health Center, Sacramento’s only health advocacy organization specializing in transgender care.

Radtke, who frequents the midtown center and chooses not to identify with either gender, launched a “100 Smiling Strangers” Facebook group in June, where more than 400 people have since pledged to donate $10 or more to the Gender Health Center upon completion of the challenge.

“It’s just nice to be able to hand this to them,” Radtke said. “(Their clients) are so much in need, not just for counseling but for hormones. We need to make sure these folks have what they need to be healthy and thrive.”

Navigating transgender patients’ access to care has been one of the biggest goals for the center over the past year, and the estimated $4,000 from Radtke’s project will likely go directly to those initiatives, said the center’s executive director, Ben Hudson.

In April 2013, the California Department of Managed Health Care, which governs all Medi-Cal and Covered California plans, removed its blanket exclusion of transgender care and began mandating coverage of all medically necessary services for transgender people. Since then, Hudson and his staff have led the charge on putting those policies to the test. When Medicare, the insurance option for people over 65, lifted its ban on gender reassignment surgery in May 2014, Hudson helped ensure that some of his older patients got the procedure.

Just because services related to gender transition, such as hormone therapy and gender reassignment surgery, are now covered doesn’t mean they’re easily accessible, Hudson said. Transgender people still face enormous barriers to care when it comes to finding providers who will treat them in a competent and respectful way, he said.

“It’s great that the advocates worked so hard to get the department to change their regulations – it’s a huge victory,” Hudson said. “But then what? How do we enforce it? How do we make sure the plans are able to do that? We’re creating that macro change through helping folks on a micro level.”

At the center’s twice-monthly hormone clinic, transgender patients can receive hormone prescriptions from UC Davis physicians and interns. At other clinics and by appointment, visitors can receive mental health care. The center’s staff can also help visitors enroll in health care plans through Covered California or Medi-Cal or counsel them on how to better utilize their existing plans.

Dr. Katherine Gardner, a family practice physician at UC Davis and medical director of the hormone clinic at the Gender Health Center, said that having doctors and trainees visit the center can help spread best practices for safely prescribing hormone regimens and administering culturally competent care.

While there are only a handful of Sacramento-area doctors familiar with transgender health issues, many sites are starting to increase their efforts in this area, she said.

“Generally trans people have had bad experiences in the medical setting,” Gardiner said. “They had this mistrust of the medical field because of that and it’s completely appropriate. So one of the things I think is important about the Gender Health Center is it’s a safe place for people to start accessing care that they may not otherwise because of concerns about safety.”

Luke McElwee, a Sacramento City College student, said he originally received his hormones from the clinic but, after applying for Medi-Cal with the center’s help, learned that they would be covered through his insurance plan. Still, he said he’s faced “hefty challenges” getting his provider to approve his transition-related care.

Radtke, who has periodically visited the center for gender-related counseling, more recently sought help enrolling in Medi-Cal there.

“Insurance doesn’t speak people’s language, and the GHC is a brilliant translator,” Radtke said. “It’s way more accessible and way less intimidating.”