I am a feminist medical anthropologist who recently made the transition from a teaching career to employment in the public sector. Last year I was thrilled to become involved in supporting the LGBT (Lesbian, Gay, Bisexual and Transgender) Program Coordinators for Patient Care Services at Veteran Affairs (VA). In December 2012, I started participating in a workgroup for LGB health care for the Veterans Health Administration (VHA), charged with designing and delivering educational materials to help develop VHA providers’ cultural and clinical competencies in health care issues affecting LGB Veterans. Members of this interdisciplinary workgroup were brought together by their shared passion for this mission. My position with the workgroup allows me to apply my skills, expertise and training into the creation of educational products and policy recommendations.
My anthropological training enables me to address bias and understand culture as a multi-faceted system. From my perspective, years of institutionalized homophobia and heterosexism in the United States military, codified in policies such as “Don’t Ask, Don’t Tell,” have spilled over to the culture of the VHA, resulting in an environment which some LGB Veterans have experienced as unwelcoming. To create change, we must take into account all of the different facets of this culture, including the beliefs and needs of individual patients, the training of providers, and protocols derived from overarching institutional policies. Members of the LGB workgroup agreed that change at a systemic level required consideration of the VA as a culture and development of educational products for those who serve LGB Veterans.
As a first step, the workgroup created two separate webinars for health care providers, an LGB information letter, and an internal LGB education website to serve as a repository for these and other materials. I am responsible for leading an ongoing team tasked with creating LGB awareness posters to increase VA staff awareness that many Veterans identify as LGB and that all Veterans, regardless of sexuality, deserve excellent care at the VA. Posters and similar print media have long been used in public health campaigns, such as “HOMOPHOBIA in HEALTHCARE is UNHEALTHY” and “TRANSPHOBIA in HEALTHCARE is UNHEALTHY.”
The poster campaign is intended to both educate and constitute tangible evidence of a cultural shift within the VA. In order to do so, the workgroup recognized the need to produce media that directly connected military service with LGB identity. But how should we do so? We do not yet know very much about LGB Veterans, nor the most basic sketch of LGB Veteran health. For example, do LGB Veterans comprise a population with unique health disparities? Do LGB Veterans respond to the potential for discrimination and victimization with increased resiliency? As a medical anthropologist, I presume that LGB Veterans have a unique constellation of social factors which influence their health, but given the rapid work cycle demanded by policy, I have to rely in part on my knowledge of other subpopulations of LGB individuals, anecdotal evidence, and an emergent body of research.
Like many feminist anthropologists, I see my work as a part of a larger fight for justice for the disenfranchised, in this case, LGB Veterans. At the same time, I struggle with how to properly engage the VA culture, working within and respecting the existing social structure while working towards change. These ideas were not just theoretical, but translated into very practical considerations when trying to design this poster (eg, How much and what kind of LGB content should be on the poster? How much and what kind of military content should be on the poster?).
We worked carefully to select our final text, in both English and Spanish, with the final copy being: “We Serve All Who Served. Excellent care has no boundaries. VHA is committed to serving Lesbian, Gay, Bisexual and Transgender Veterans.” We decided early on that it was imperative to include the words lesbian, gay and bisexual on the poster copy, to ensure our meaning was not reduced to generic bid for diversity, and, more importantly, to let LGB Veterans see these words treated respectfully as a token of the respect they will receive at the VHA. It was our hope that seeing these words on the walls of the VA medical centers, rather than symbols or euphemisms, would serve to demonstrate to LGB Veterans that the VA is an inclusive health care setting.
One final point: as the LGB Education workgroup, our charge was educational materials designed to increase LGB Veteran awareness, not transgender Veteran awareness. In 2011, the VHA created a nationwide transgender directive guaranteeing access to care for transgender Veterans, and since that time, various departments and workgroups have created educational products aimed at increasing awareness of the needs of transgender Veterans. LGB and transgender individuals are believed to have different needs in the clinical environment, and to conflate these would do both of these groups a disservice. However while the workgroup wanted to recognize this particularism, it seemed disrespectful to render transgender Veterans invisible by not including the word “transgender” on our poster.
As an educator, I remain doggedly optimistic that the creation of educational products such as these posters will enable cultural transformation, creating a healthcare environment that LGBT Veterans view as welcoming. And I’m happy to report we just started working on a second poster campaign, so there’s more to come!
Lexi Matza is a postdoctoral fellow for Boston University School of Medicine affiliated with VA Boston Healthcare System.
**The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
Sarah Ono, Heather Schacht Reisinger and Samantha L Solimeo are contributing editors of Anthropology in the Public Sector.