Today was the day of my appointment with the surgeon at the clinic in Erding. I managed to get up despite barely sleeping at all last night. I headed there with a friend with him driving the car. We arrived at the clinic after about four hours, just in time. There it turned out that for some reason my appointment had been scheduled in on Tuesday the next week. This wasn't a big problem, fortunately, as the surgeon would have time for me after the surgery he was in at that time. This gave me time to fill in the usual permission and information forms and handle the related formalities.
The chat with the surgeon was in many ways brief and to the point. To my relief there was no real physical examination, with the surgeon just taking some photos of the area he would be working on as reference during the preparations. During the discussion afterwards he explained that while he could give no guarantees about the result since he didn't know whether he would find a usable vagina or just related tissue, he was nevertheless ready to give it a go. This did lead to one major issue, however.
To create the labia during the reconstructive he would need more skin than the now empty scrotum can provide. Normally he would use the recycled penile tissue for this (with transgender sex reassignment surgery), but as I had indicated that I wanted to keep that side, this would not be possible. This left me with the options of no surgery, having just a hole without labia or giving up the penis after all. Having decided years ago already that I feel the most happy keeping my body intact without giving into society's concept of 'right' and 'wrong', this third option left me quite upset, as did the thought of the first option.
Not having surgery at this point would be unacceptable to me. Having come this far and to give up on what - thinking about it - essentially is merely decoration around the vagina entrance would be unwise. The surgeon after some discussion agreed to this surgery and then we moved onto the topic of the health insurance: whether the Krankenkasse will actually cover this, as the surgeon explained that they tend to cover surgeries involving someone going from one side to another, not keeping both sides. My surgery might not get covered.
In the end it was agreed that the clinic will send a letter with the request for coverage to the Krankenkasse with a reply expected in about three weeks. A surgery date also got scheduled, for July 14th, so in about 2.5 month. Not very soon, but it will have to do. Wondering about what the surgeon will actually find the surgery and will be able to do with it will likely consume much of my thoughts and energy of the past months. There is also the possibility of the Krankenkasse refusing coverage, requiring me to cover the about 10,000 Euro surgery myself.
Assuming that the surgery goes well and I end up with a connected vagina, I will be essentially at the point where many hermaphrodites start at, with an externally visible and accessible hole to the vagina. The next step will be to somehow create labia, the only method for which I am aware of which will work is that of having the proper type of skin grown from stem cells, something which is decidedly experimental and even then only in places like the USA. The possibility of getting this surgery performed is slim to none. I may have to accept that I will never have labia, as a kind of poignant reminder of my imperfect birth.
In the end today means progress, but also the first of what will undoubtedly be many bitter pills to swallow. I will forever be reminded of my birth defect. Maybe giving up this lunatic dream of being a hermaphrodite is something I should honestly consider. It would make so many things so much easier if I just became a regular woman and had this horrendous part of myself chopped off and recycled for parts. There is no joy or point in being a hermaphrodite. It only means fighting for every single scrap while being terminally unhappy.
I just don't know. Some choices and situations are just too big, too much to be handled by a single human being.
Maya
Showing posts with label insurance. Show all posts
Showing posts with label insurance. Show all posts
Friday, 25 April 2014
Thursday, 27 March 2014
Intersex Discrimination Hearing Results And My Ambiguous Feelings On The Netherlands
On Monday the 24th I travelled to my current home city of Karlsruhe, Germany to Utrecht in the Netherlands. There I met up with a friend of a friend at whose place I would be spending the night. The next morning I made my way to the office of the College voor de Rechten van de Mens (Human Rights Institute) for the hearing which took place there against my former health insurance company Univé. Representatives of the general health insurance organization CVZ and from the Ministry of VWS (Health, etc.) were present as well.
During the hearing which took well over an hour the facts as they had been gathered in the letter exchange of the past months (detailed on this blog as well) were put together. In essence it came down to that the Ministry hadn't done anything untoward as the legal article they had written was neutral and implicitly inclusive. The interpretation of this article by CVZ was addressed, however, as the interpretation they had provided of said article had been unclear and focused on transsexuals. The question to CVZ by the College thus was how they defined 'intersex' and whether this falls into their interpretation of this law article.
CVZ seemed to be quite ignorant of what intersex exactly was, quoting a statement by one of their medical advisors that only three types of intersex were defined before (hermaphroditism, semi-hermaphroditism, gonadal), something which is patently false. They then went on to reference DSD as the new and current term, which would be better because it is more inclusive. While I vehemently disagreed with this statement, I did not interject or otherwise object against these statements as it did not directly affect my case. CVZ ultimately did agree that there are a lot of conditions which would also fall within the reference frame when applying this law to individuals. The conclusion here was that with me being intersex, I should have received full coverage.
Finally Univé was left to make a statement on how it wished to proceed from this point. Here a clear tactical retreat was made, with the Univé representative stating that they might be willing to retroactively cover all of the costs I have made while undergoing the hair-removal therapy over the past years (over 6,000 Euro still uncovered), if they could verify via an independent Dutch physician that I am in fact intersex. The College asked Univé to clarify what kind of medical information they would further need to prove that I am intersex, quoting a section from a report from the surgeon from Hamburg in which he stated that I have an intersex body in his professional opinion. Univé responded that they did not know this information and would ask their medical advisor.
Then the College asked me to comment on this proposal. I objected against the demand that it would have to be a Dutch physician, explaining the complete disagreement between Dutch and German physicians on my physical state. I suggested that the reports by the now four German medical teams would qualify as 'independent' since they have no connection or relation to me, Univé, the Dutch medical system or anything else which might make them not impartial. Finally I mentioned my visit to a German reconstructive surgeon next month who will reconstruct my female side. In my view this already fully proved that I am in fact intersex.
A brief recess was called. Outside the hearing room the representatives and I talked about the case, finding that we pretty much agreed on everything I had said and finding no points of disagreement. On the contrary, we all agreed that it was a very weird case, especially with the unusual reports from the Dutch physicians who completely counter-indicated everything the German physicians said, despite the surgery done in Germany in 2011 decidedly refuting the Dutch reports. As the recess ended we went back into the room.
The College asked me whether I would be willing to take Univé up on this offer upon which I repeated my objections. Univé responded to this by saying that they would talk with their medical advisor again and would let both me and the College know in about two weeks time what information they would require from me. This I found to be acceptable, changing the case into the mediation situation whereby Univé and I will try to settle our differences. I argued to the College that if Univé covers the costs I have made it would be sufficient for me as this is what I initially set out to accomplish.
With this the hearing ended. It'll take about two weeks now before I know whether I can settle matters with Univé or that it has to go back to the College for judgement. All depends on what Univé thinks they require to prove to themselves that I am intersex. Apparently the Dutch judge's ruling in 2012 that I am in fact intersex and a stack of reports from four German medical teams doesn't suffice. If they keep up their claim of only accepting a Dutch physician's report, then I fear that it will have to go back to the College for a ruling. Dutch physicians at this point have proven themselves to be completely and utterly unreliable if not untrustworthy when it comes to handling intersex cases.
My way back to Germany after the hearing was uneventful. Walking back to the train station in Utrecht I observed everything around me, but didn't really detect any sense of longing or loathing. My feelings towards the Netherlands in general are more of an uncomfortable sadness. While I loathe the Dutch medical system with all my might due to what they have inflicted upon me, I do not dislike or hate the country in general. Having spent a few months living in Germany I also got impressed by just how small the Netherlands is, in a physical sense. It makes me question the relevance of spending much time on achieving justice in such a small country.
Crossing the border back into the Germany I mostly felt relief. The Netherlands hadn't felt welcoming or pleasant to me. While I recognize much of the sights and of course speak the language fluently, it would be amiss to claim that I in any way feel a connection with the country. It's just another country, albeit one which has done me considerable harm. I just don't know what to think, really. In fact, the next day I noticed that I felt much better about living in Germany and Karlsruhe now. Everything just feels more relaxed and pleasant here and I even get proper medical care. The Netherlands feels like strife to me, whereas Germany - though not a vacation - actually offers me possibilities. In a way I actually feel more human in Germany.
Here is to a quick resolution to the Univé case. Two years is a long time to fight over something so silly.
Maya
During the hearing which took well over an hour the facts as they had been gathered in the letter exchange of the past months (detailed on this blog as well) were put together. In essence it came down to that the Ministry hadn't done anything untoward as the legal article they had written was neutral and implicitly inclusive. The interpretation of this article by CVZ was addressed, however, as the interpretation they had provided of said article had been unclear and focused on transsexuals. The question to CVZ by the College thus was how they defined 'intersex' and whether this falls into their interpretation of this law article.
CVZ seemed to be quite ignorant of what intersex exactly was, quoting a statement by one of their medical advisors that only three types of intersex were defined before (hermaphroditism, semi-hermaphroditism, gonadal), something which is patently false. They then went on to reference DSD as the new and current term, which would be better because it is more inclusive. While I vehemently disagreed with this statement, I did not interject or otherwise object against these statements as it did not directly affect my case. CVZ ultimately did agree that there are a lot of conditions which would also fall within the reference frame when applying this law to individuals. The conclusion here was that with me being intersex, I should have received full coverage.
Finally Univé was left to make a statement on how it wished to proceed from this point. Here a clear tactical retreat was made, with the Univé representative stating that they might be willing to retroactively cover all of the costs I have made while undergoing the hair-removal therapy over the past years (over 6,000 Euro still uncovered), if they could verify via an independent Dutch physician that I am in fact intersex. The College asked Univé to clarify what kind of medical information they would further need to prove that I am intersex, quoting a section from a report from the surgeon from Hamburg in which he stated that I have an intersex body in his professional opinion. Univé responded that they did not know this information and would ask their medical advisor.
Then the College asked me to comment on this proposal. I objected against the demand that it would have to be a Dutch physician, explaining the complete disagreement between Dutch and German physicians on my physical state. I suggested that the reports by the now four German medical teams would qualify as 'independent' since they have no connection or relation to me, Univé, the Dutch medical system or anything else which might make them not impartial. Finally I mentioned my visit to a German reconstructive surgeon next month who will reconstruct my female side. In my view this already fully proved that I am in fact intersex.
A brief recess was called. Outside the hearing room the representatives and I talked about the case, finding that we pretty much agreed on everything I had said and finding no points of disagreement. On the contrary, we all agreed that it was a very weird case, especially with the unusual reports from the Dutch physicians who completely counter-indicated everything the German physicians said, despite the surgery done in Germany in 2011 decidedly refuting the Dutch reports. As the recess ended we went back into the room.
The College asked me whether I would be willing to take Univé up on this offer upon which I repeated my objections. Univé responded to this by saying that they would talk with their medical advisor again and would let both me and the College know in about two weeks time what information they would require from me. This I found to be acceptable, changing the case into the mediation situation whereby Univé and I will try to settle our differences. I argued to the College that if Univé covers the costs I have made it would be sufficient for me as this is what I initially set out to accomplish.
With this the hearing ended. It'll take about two weeks now before I know whether I can settle matters with Univé or that it has to go back to the College for judgement. All depends on what Univé thinks they require to prove to themselves that I am intersex. Apparently the Dutch judge's ruling in 2012 that I am in fact intersex and a stack of reports from four German medical teams doesn't suffice. If they keep up their claim of only accepting a Dutch physician's report, then I fear that it will have to go back to the College for a ruling. Dutch physicians at this point have proven themselves to be completely and utterly unreliable if not untrustworthy when it comes to handling intersex cases.
My way back to Germany after the hearing was uneventful. Walking back to the train station in Utrecht I observed everything around me, but didn't really detect any sense of longing or loathing. My feelings towards the Netherlands in general are more of an uncomfortable sadness. While I loathe the Dutch medical system with all my might due to what they have inflicted upon me, I do not dislike or hate the country in general. Having spent a few months living in Germany I also got impressed by just how small the Netherlands is, in a physical sense. It makes me question the relevance of spending much time on achieving justice in such a small country.
Crossing the border back into the Germany I mostly felt relief. The Netherlands hadn't felt welcoming or pleasant to me. While I recognize much of the sights and of course speak the language fluently, it would be amiss to claim that I in any way feel a connection with the country. It's just another country, albeit one which has done me considerable harm. I just don't know what to think, really. In fact, the next day I noticed that I felt much better about living in Germany and Karlsruhe now. Everything just feels more relaxed and pleasant here and I even get proper medical care. The Netherlands feels like strife to me, whereas Germany - though not a vacation - actually offers me possibilities. In a way I actually feel more human in Germany.
Here is to a quick resolution to the Univé case. Two years is a long time to fight over something so silly.
Maya
Saturday, 22 March 2014
This Could Be The End Game Or Just More Of The Same
On Monday I'll be boarding the train towards the Netherlands in order to attend the hearing at the Human Rights Institute (College voor de Rechten van de Mens) in Utrecht as I announced in my previous post. I have prepared it as well as possible, with a nice place to stay during the night of Monday on Tuesday and the Insitute's offices within walking distance. My train tickets to and from Utrecht have been booked and I have taken up the necessary free days from my work. I have read up on the details of the case already quite a lot due to the blog posts I have written on the responses from the Minister of Health, CVZ and the like. While everything seems to be heading into my favour with this case, there are still many ways that this could play out.
Most negatively, the Institute could determine that my claim that my former health insurer Univé discriminated against me for being intersex - when determining whether I could get full hair-removal therapy coverage - is invalid due to some or another reason or loophole. Since Univé's statements have included phrases such as that 'intersex in no way comparable is with transsexuality' (paraphrasing), while CVZ's statement counteract this, it seems that a more positive outcome is likely. It is hard to tell what this might be exactly.
Also quite negatively would be if my claim would be found to be valid, but no further measures would be taken. Not against Univé, not against CVZ, not against the Minister of Health. More positive outcomes would be Univé getting disciplined or fined, either through the government or CVZ. CVZ itself deserves disciplining as well for so easily dismissing me before in the 2011/2012 case at SKGZ as being intersex. SKGZ itself falls outside the Institute's case, but the Minister of Health should get reprimanded by the Insitute at least for so completely ignoring and forgetting about a group of people in the Netherlands much larger in count than that of transgenders while drawing up and revising law articles.
We'll know in a few months when the verdict of the Institute becomes known. At any rate I hope it doesn't turn out like my case at the Medical Disciplinary Commission in Amsterdam against the VUmc gender team last year which was fully dismissed. That was a bitter defeat. Yet even in this case at the Institute I do not expect I will get any apologies or findancial compensation for the emotional and financial costs of the past years due to Univé's refusal.
At least partially I seem to be correct about Germany so far. The medical professionals here seem to be far more human when it comes to more unusual cases. When I first visited my new family doctor (GP) a few weeks ago, she learned about my intersex condition only there during that first appointment. Yet it didn't phase her one bit, taking it in stride, only commenting on it being very unusual for her, but immediately drawing up plans to find me the proper help and having no issues with contacting this German surgeon I had found for me. During our email conversation this week she even commented on how interesting she found my case to be, if only as a very educational experience for herself. I cannot remember for the life me when any medical professional or similar in the Netherlands has ever said anything like that to me.
Anyway, to make a long story short: I have an appointment with this surgeon on the 24th of April at 11.00, so just over a month to go. The clinic the surgeon works at is in the Munich area, so that's going to mean another bit of logistics. Since it's a 3-hour trip by ICE from Karlsruhe to Munich alone, that will make doing it in a single day a tough task. I think I would also like to have someone accompany me on this initial consult appointment for both practical and mental support.
While this appointment is 'merely' a consult, the surgeon has already looked at my medical files and MRI scans before so we both will go into it with the goal of setting up a surgery. Here my dreams of regaining my body by having my female side restored through a reconstructive surgery will meet this surgeon's professional reality and the limits of his skills. Here I know that I can take small disappointments and compromises. If I can get access to all that my body has been born with, that is all that I need right now. All I fear here is a repeat of last year's disappointment when I thought I had found a surgeon in the Netherlands, yet he turned me resolutely down at the last moment without a proper excuse.
To think about this surgery actually happening and it being over with in maybe two months from now is almost inconceivable to me. For a decade now I have been stuck in this infinite loop where any hope to get medical help got squashed mercilessly. No recognition, just accusations of me being a lying, self-deceiving, impossible to handle transgender person who was just making life hard for itself by being so difficult and suffering from those self-delusions about somehow having an intersex condition. Only thanks to German medical evidence have I been able to partially break out of this loop, but only a successful surgery will fully break it forever.
When I think about after this potential surgery, that I could reach down there and feel the changes. This thought doesn't carry any kind of sexual energy with it, only sheer and utter relief, enough to send me wailing into tears of thankfulness, that it's all finally over, done with it and never will come back again. This would be the end game: the proper conclusion to a decade of suffering due to the rigid, patronizing and human rights violating attitude in the Netherlands towards medical minorities.
Or just another series of horrible disappointments, sending me back to square one.
Maya
Most negatively, the Institute could determine that my claim that my former health insurer Univé discriminated against me for being intersex - when determining whether I could get full hair-removal therapy coverage - is invalid due to some or another reason or loophole. Since Univé's statements have included phrases such as that 'intersex in no way comparable is with transsexuality' (paraphrasing), while CVZ's statement counteract this, it seems that a more positive outcome is likely. It is hard to tell what this might be exactly.
Also quite negatively would be if my claim would be found to be valid, but no further measures would be taken. Not against Univé, not against CVZ, not against the Minister of Health. More positive outcomes would be Univé getting disciplined or fined, either through the government or CVZ. CVZ itself deserves disciplining as well for so easily dismissing me before in the 2011/2012 case at SKGZ as being intersex. SKGZ itself falls outside the Institute's case, but the Minister of Health should get reprimanded by the Insitute at least for so completely ignoring and forgetting about a group of people in the Netherlands much larger in count than that of transgenders while drawing up and revising law articles.
We'll know in a few months when the verdict of the Institute becomes known. At any rate I hope it doesn't turn out like my case at the Medical Disciplinary Commission in Amsterdam against the VUmc gender team last year which was fully dismissed. That was a bitter defeat. Yet even in this case at the Institute I do not expect I will get any apologies or findancial compensation for the emotional and financial costs of the past years due to Univé's refusal.
At least partially I seem to be correct about Germany so far. The medical professionals here seem to be far more human when it comes to more unusual cases. When I first visited my new family doctor (GP) a few weeks ago, she learned about my intersex condition only there during that first appointment. Yet it didn't phase her one bit, taking it in stride, only commenting on it being very unusual for her, but immediately drawing up plans to find me the proper help and having no issues with contacting this German surgeon I had found for me. During our email conversation this week she even commented on how interesting she found my case to be, if only as a very educational experience for herself. I cannot remember for the life me when any medical professional or similar in the Netherlands has ever said anything like that to me.
Anyway, to make a long story short: I have an appointment with this surgeon on the 24th of April at 11.00, so just over a month to go. The clinic the surgeon works at is in the Munich area, so that's going to mean another bit of logistics. Since it's a 3-hour trip by ICE from Karlsruhe to Munich alone, that will make doing it in a single day a tough task. I think I would also like to have someone accompany me on this initial consult appointment for both practical and mental support.
While this appointment is 'merely' a consult, the surgeon has already looked at my medical files and MRI scans before so we both will go into it with the goal of setting up a surgery. Here my dreams of regaining my body by having my female side restored through a reconstructive surgery will meet this surgeon's professional reality and the limits of his skills. Here I know that I can take small disappointments and compromises. If I can get access to all that my body has been born with, that is all that I need right now. All I fear here is a repeat of last year's disappointment when I thought I had found a surgeon in the Netherlands, yet he turned me resolutely down at the last moment without a proper excuse.
To think about this surgery actually happening and it being over with in maybe two months from now is almost inconceivable to me. For a decade now I have been stuck in this infinite loop where any hope to get medical help got squashed mercilessly. No recognition, just accusations of me being a lying, self-deceiving, impossible to handle transgender person who was just making life hard for itself by being so difficult and suffering from those self-delusions about somehow having an intersex condition. Only thanks to German medical evidence have I been able to partially break out of this loop, but only a successful surgery will fully break it forever.
When I think about after this potential surgery, that I could reach down there and feel the changes. This thought doesn't carry any kind of sexual energy with it, only sheer and utter relief, enough to send me wailing into tears of thankfulness, that it's all finally over, done with it and never will come back again. This would be the end game: the proper conclusion to a decade of suffering due to the rigid, patronizing and human rights violating attitude in the Netherlands towards medical minorities.
Or just another series of horrible disappointments, sending me back to square one.
Maya
Sunday, 16 March 2014
Final Hearing In Intersex Discrimination Case Against Unive
I received a letter from the Human Rights Institute (College voor de Rechten van de Mens) this week informing me that I'm obligated to appear at the next and apparently final hearing in the intersex discrimination case against my former Dutch health insurance company, Univé. This regarding Univé's decision to not fully cover a therapy for me which they fully cover for transsexuals. Their reason for doing so was that supposedly the Dutch Minister of Health as well as the central health insurance organization CVZ have only specified full coverage for the latter group and not intersex individuals. During the discovery phase the past months it turned out that this was not the case. CVZ has made it clear that this therapy coverage can also apply to intersex individuals.
The hearing itself is on the 25th of March, at 11.00 AM at the Institute's office in Utrecht (Kleinesingel 1-3) and is open to the public. This means that I will have to travel to Utrecht on the 24th and spend the night somewhere as the trip from Karlsruhe takes about 6 hours, which would force me to board an ICE around 3 AM to make it to Utrecht in time. I'm still sorting out the logistics of how and where I'll stay. Any help with this would be most welcome. Somewhere in Utrecht would be the most practical, I'd imagine.
This will also be my first time back in the Netherlands after migrating to Germany in December last year. To me it brings back many painful memories and feelings, both positive and negative. It reminds me of how much I miss the Netherlands in some ways, but also of why I had to leave it. Dealing with these contradictory feelings combined with my PTSD and having to organize the logistics of the whole trip is putting me pretty much at the limits of what I can take emotionally.
At the end of the hearing on the 25th it will be announced when the Institute will pronounce their official conclusion in this case. Though they can not enforce Univé to do anything, it would nevertheless set a strong precedent for any future legal case, whether by myself or others. I do not think that there is a reasonable chance that I will see back the around six-thousand Euros I should have received back with full coverage, but it is something which has to be done nevertheless. Justice is more important than anything else.
Maya
The hearing itself is on the 25th of March, at 11.00 AM at the Institute's office in Utrecht (Kleinesingel 1-3) and is open to the public. This means that I will have to travel to Utrecht on the 24th and spend the night somewhere as the trip from Karlsruhe takes about 6 hours, which would force me to board an ICE around 3 AM to make it to Utrecht in time. I'm still sorting out the logistics of how and where I'll stay. Any help with this would be most welcome. Somewhere in Utrecht would be the most practical, I'd imagine.
This will also be my first time back in the Netherlands after migrating to Germany in December last year. To me it brings back many painful memories and feelings, both positive and negative. It reminds me of how much I miss the Netherlands in some ways, but also of why I had to leave it. Dealing with these contradictory feelings combined with my PTSD and having to organize the logistics of the whole trip is putting me pretty much at the limits of what I can take emotionally.
At the end of the hearing on the 25th it will be announced when the Institute will pronounce their official conclusion in this case. Though they can not enforce Univé to do anything, it would nevertheless set a strong precedent for any future legal case, whether by myself or others. I do not think that there is a reasonable chance that I will see back the around six-thousand Euros I should have received back with full coverage, but it is something which has to be done nevertheless. Justice is more important than anything else.
Maya
Friday, 14 February 2014
Dutch Health Minister's Response To Intersex Discrimination Case
Last year I filed a discrimination case with the Dutch Human Rights Institute (College voor de Rechten van de Mens) against insurance company Unive for refusing to fully cover hair removal therapy for intersex individuals where they do fully cover this procedure for transsexuals. During the hearing at the Human Rights Institute in Utrecht on November the 25th the representative from Unive was asked to justify its decision. Unive's response was that they were just following the ruling by the central organization for health insurance companies in the Netherlands, CVZ. According to CVZ the situation for transsexual and intersex individuals when it comes to such a therapy is vastly different.
This therapy involves the removal of facial hair in a permanent fashion for individuals who wish to transition to a female role, but have had sufficiently high testosterone levels that they began to develop facial hair at some point. After lowering testosterone levels this hair growth does not stop by itself, ergo this therapy is required. Why the situation for transsexuals (who 'choose' to transition) and for intersex individuals (who are born like this) when they move towards a female role would be different is something which was asked by the Human Rights Institute after the hearing to CVZ and the Dutch Minister of Health. After a long delay of many weeks because bureaucracy is a busy process, I recently received the answer from the Minister of Health, Edith Schippers, or more specifically the director of health insurances, drs. G.G.J. Ikkink.
The Minister of Health got asked a total of three questions, the first one being: 'Do you share the opinion of the CVZ? Please further motivate your answer to this question.'
The response says that they support this opinion of CVZ, because it fits with the regulations concerning the health insurance law.
The second question: 'Could you provide further information or explanations regarding the relation between the CVZ and the Minister of Health, in particular whether the Minister of Health can provide mandatory instructions on the question of how this health insurance law can be interpreted?'
The response basically details how the Minister of Health determines the extent and scope of health coverage. CVZ hereby has the duty to explain and interpret this law, whereby the Minister of Health can not force CVZ to change its interpretation because the healthcare law does not include such a provision.
The third question: 'During the development of the healthcare law, did the coverage options for a person with an intersex condition, such as in the relevant situation, get determined or considered? If so, can you detail this?'
The response denies that any such consideration was made for intersex individuals. They claim that because intersex individuals are not named specifically in the relevant law, this therefore does not apply to such people. It is made clear that at no point in the decision process intersex individuals were ever considered.
---
What is striking about this response is most of all that if you put the actual law article next to it ('Besluit zorgverzekering', article 2.4, first member, part b) [1] it never actually mentions transsexuality except for the fifth item in relation to sex-reassignment surgery. The first and second item are decidedly neutral in their formulation:
1°. afwijkingen in het uiterlijk die gepaard gaan met aantoonbare lichamelijke functiestoornissen;
(aberrations in one's appearance which are due to measurable physical functional disorders)
2°. verminkingen die het gevolg zijn van een ziekte, ongeval of geneeskundige verrichting;
(mutilations which are the result of disease, accident or medical actions)
Transsexuality falls under item 2, due to the need to remove facial hair in the case of a male to female transition which is the result of medical actions (hormones, surgery). The hair removal therapy is thus part of the whole medical procedure of the transition.
An intersex case whereby one wishes to portray a female role while suffering from excess facial hair would fall under both items 1 and 2, as often medical actions are involved, though it's also due to physical characteristics which one was born with which could be classified as a disorder.
For the Dutch Minister of Health to thus defend the decision by CVZ to reject coverage for intersex individuals and to pretend that that it only covers transsexuals despite the law itself being completely neutral in its construction is simply patently ridiculous. It further suggests a more widespread and fundamental discrimination against intersex individuals, something which I have encountered among the Dutch medical community between 2005 and 2013 in a very significant manner as well.
At this point I'm very curious as to what the response from CVZ to a similar set of questions as those listed above will be. If they are indeed the final authority on interpreting and explaining healthcare laws then they should be able to provide us with a reasonable, well-reasoned explanation for why they found that the above law article's members can only be explained as applying to transsexual individuals.
CVZ had until February the 3rd to send in their answer. As soon as I receive my copy of their letter I will update my blog with the details.
Maya
[1] http://wetten.overheid.nl/BWBR0018492/geldigheidsdatum_14-02-2014#Hoofdstuk2_1_Artikel24
This therapy involves the removal of facial hair in a permanent fashion for individuals who wish to transition to a female role, but have had sufficiently high testosterone levels that they began to develop facial hair at some point. After lowering testosterone levels this hair growth does not stop by itself, ergo this therapy is required. Why the situation for transsexuals (who 'choose' to transition) and for intersex individuals (who are born like this) when they move towards a female role would be different is something which was asked by the Human Rights Institute after the hearing to CVZ and the Dutch Minister of Health. After a long delay of many weeks because bureaucracy is a busy process, I recently received the answer from the Minister of Health, Edith Schippers, or more specifically the director of health insurances, drs. G.G.J. Ikkink.
The Minister of Health got asked a total of three questions, the first one being: 'Do you share the opinion of the CVZ? Please further motivate your answer to this question.'
The response says that they support this opinion of CVZ, because it fits with the regulations concerning the health insurance law.
The second question: 'Could you provide further information or explanations regarding the relation between the CVZ and the Minister of Health, in particular whether the Minister of Health can provide mandatory instructions on the question of how this health insurance law can be interpreted?'
The response basically details how the Minister of Health determines the extent and scope of health coverage. CVZ hereby has the duty to explain and interpret this law, whereby the Minister of Health can not force CVZ to change its interpretation because the healthcare law does not include such a provision.
The third question: 'During the development of the healthcare law, did the coverage options for a person with an intersex condition, such as in the relevant situation, get determined or considered? If so, can you detail this?'
The response denies that any such consideration was made for intersex individuals. They claim that because intersex individuals are not named specifically in the relevant law, this therefore does not apply to such people. It is made clear that at no point in the decision process intersex individuals were ever considered.
---
What is striking about this response is most of all that if you put the actual law article next to it ('Besluit zorgverzekering', article 2.4, first member, part b) [1] it never actually mentions transsexuality except for the fifth item in relation to sex-reassignment surgery. The first and second item are decidedly neutral in their formulation:
1°. afwijkingen in het uiterlijk die gepaard gaan met aantoonbare lichamelijke functiestoornissen;
(aberrations in one's appearance which are due to measurable physical functional disorders)
2°. verminkingen die het gevolg zijn van een ziekte, ongeval of geneeskundige verrichting;
(mutilations which are the result of disease, accident or medical actions)
Transsexuality falls under item 2, due to the need to remove facial hair in the case of a male to female transition which is the result of medical actions (hormones, surgery). The hair removal therapy is thus part of the whole medical procedure of the transition.
An intersex case whereby one wishes to portray a female role while suffering from excess facial hair would fall under both items 1 and 2, as often medical actions are involved, though it's also due to physical characteristics which one was born with which could be classified as a disorder.
For the Dutch Minister of Health to thus defend the decision by CVZ to reject coverage for intersex individuals and to pretend that that it only covers transsexuals despite the law itself being completely neutral in its construction is simply patently ridiculous. It further suggests a more widespread and fundamental discrimination against intersex individuals, something which I have encountered among the Dutch medical community between 2005 and 2013 in a very significant manner as well.
At this point I'm very curious as to what the response from CVZ to a similar set of questions as those listed above will be. If they are indeed the final authority on interpreting and explaining healthcare laws then they should be able to provide us with a reasonable, well-reasoned explanation for why they found that the above law article's members can only be explained as applying to transsexual individuals.
CVZ had until February the 3rd to send in their answer. As soon as I receive my copy of their letter I will update my blog with the details.
Maya
[1] http://wetten.overheid.nl/BWBR0018492/geldigheidsdatum_14-02-2014#Hoofdstuk2_1_Artikel24
Sunday, 26 January 2014
In Last Week's Episode, Or: Parties Are Terrifying
Yesterday I went to a party organized by the company I work for. Suffice it to say that I'm not really the party kind of person, for a number of reasons. Nevertheless I figured I should give it a try. Finding the location of the party was easy enough, yet after that things are blacking out for me a bit. I remember standing and sitting in places, mostly just feeling absolutely alone and frighteningly out of place. On top of that many colleagues came with their partner, the sight of which dragged me regularly down into the murky depths of my traumas. I mostly felt terrified and on the verge of panic during the first few hours of the party. I had to remind myself that I could just grab my coat and leave any time I wanted to stave off a full-blown PTSD attack.
As the evening progressed into the night and people got more and more drunk this didn't improve much, though fortunately by then I had found some people to talk to, which fortunately gave me something to cling to. In the end I was one of the first to leave, together with the children of the colleague at whose place I'm currently staying. At close to 1 AM I thus went to bed and pretty much collapsed. I slept about eleven hours. Even as I'm writing this I'm still feeling tired, with the headache I started the day off with fortunately almost gone. I don't think that parties are a good thing for me, at least not yet. Too many impressions and too many triggers.
Just learning to be part of and get along with a family as I have to where I am staying is already quite a struggle in many ways. It wasn't until I came here that I began to realize for just how long I hadn't been part of a family, but just locked away inside my own room with everyone in the house living their own separate lives. To communicate and helping each other at daily tasks is an almost alien concept to me, though I'm more than willing to learn those things which should be second nature to most.
Much of what I'm doing these days is about building my life up from scratch. One of the essential items I'm still working on is getting a place of my own, which I'll hopefully get good news about next week. On Thursday I went with my boss to view an apartment in Karlsruhe which I found to be much to my liking. As I'm not the only one interested in this place, I hope that being backed by my boss and his company will increase my chances there. I'd much prefer to start planning moving into this new place next week than to start from the beginning on apartment hunting.
Also part of building up my life here is all the little details like a bank account, which has been completed aside from receiving the last details for using my cards, and getting health insurance. On that last item I sent an email to the company which I got registered with if everything went well, and asked them what the status is. Once that's taken care of I'll have to soon contact my surgeon about making an appointment. That, or maybe ask around a bit more for a good surgeon for this so very important surgery for me. I will probably only get one shot at this, so it better be a skilled surgeon.
Directly related to this surgery are the period pains I have every month. They seem to be worsening the past few months. I can not really call them menstruation pains because I shouldn't have the relevant organs to menstruate. The exact medical explanation for these pains so far completely eludes me based on my admittedly somewhat limited knowledge of the processes involved. The pains themselves are located in the lower abdomen, mostly on the right side, but also center and left, and vary from a burning to a sharp, stabbing sensation. The pains also extend to the groin region where it's mostly a burning sensation with a painful numbing of the skin upon touch, the hips which are painful whether sitting or walking, the right leg which feels sore and itching, burning and stabbing pains in the area of the vagina.
Compared to the confirmed female organs I have this is curious. The vagina by it shouldn't play much of a role here, beyond maybe a change in its wall's internal structure, but shouldn't cause any cycles. My hormone therapy is constant and not cyclic. The only reasonable explanation I have so far is that I do in fact have ovarian tissue in some kind of configuration capable of inducing the hormonal changes which are part of menstruation. Whether I have any tissues which respond to this outside of the vagina is unknown. I do know that if any tissue exists anywhere which conforms the inside of the womb, this will massively change due to these hormones and eventually shed the new tissue at the end of the cycle. This discarded tissue is a massive risk factor in the causation of sepsis. Based on my symptoms every month it seems reasonable to assume that something major is happening, but without any idea of how dangerous this could be to my health, long-term.
It is my hope that I'll get this apartment next week so that I can finalize that part and start focusing on my physical health. The last half of this week I have felt exhausted and worn out, with a near-constant headache and feeling just ready to sleep before half of the day is over with. Maybe I'll start feeling better once this month's period is over with. So far it's driving me to near-despair. As soon as I have this apartment and my health insurance taken care of I can go to the general practitioner. Dutch GPs have never taken me seriously, let alone that they would ever consider for real that I experience actual periods. I would gladly stop worrying about what these monthly pains do or do not mean for my health.
The basic summary is that despite the progress I am making there are still far too many things for me to get far too stressed about, which probably exacerbates these same issues.
Maya
As the evening progressed into the night and people got more and more drunk this didn't improve much, though fortunately by then I had found some people to talk to, which fortunately gave me something to cling to. In the end I was one of the first to leave, together with the children of the colleague at whose place I'm currently staying. At close to 1 AM I thus went to bed and pretty much collapsed. I slept about eleven hours. Even as I'm writing this I'm still feeling tired, with the headache I started the day off with fortunately almost gone. I don't think that parties are a good thing for me, at least not yet. Too many impressions and too many triggers.
Just learning to be part of and get along with a family as I have to where I am staying is already quite a struggle in many ways. It wasn't until I came here that I began to realize for just how long I hadn't been part of a family, but just locked away inside my own room with everyone in the house living their own separate lives. To communicate and helping each other at daily tasks is an almost alien concept to me, though I'm more than willing to learn those things which should be second nature to most.
Much of what I'm doing these days is about building my life up from scratch. One of the essential items I'm still working on is getting a place of my own, which I'll hopefully get good news about next week. On Thursday I went with my boss to view an apartment in Karlsruhe which I found to be much to my liking. As I'm not the only one interested in this place, I hope that being backed by my boss and his company will increase my chances there. I'd much prefer to start planning moving into this new place next week than to start from the beginning on apartment hunting.
Also part of building up my life here is all the little details like a bank account, which has been completed aside from receiving the last details for using my cards, and getting health insurance. On that last item I sent an email to the company which I got registered with if everything went well, and asked them what the status is. Once that's taken care of I'll have to soon contact my surgeon about making an appointment. That, or maybe ask around a bit more for a good surgeon for this so very important surgery for me. I will probably only get one shot at this, so it better be a skilled surgeon.
Directly related to this surgery are the period pains I have every month. They seem to be worsening the past few months. I can not really call them menstruation pains because I shouldn't have the relevant organs to menstruate. The exact medical explanation for these pains so far completely eludes me based on my admittedly somewhat limited knowledge of the processes involved. The pains themselves are located in the lower abdomen, mostly on the right side, but also center and left, and vary from a burning to a sharp, stabbing sensation. The pains also extend to the groin region where it's mostly a burning sensation with a painful numbing of the skin upon touch, the hips which are painful whether sitting or walking, the right leg which feels sore and itching, burning and stabbing pains in the area of the vagina.
Compared to the confirmed female organs I have this is curious. The vagina by it shouldn't play much of a role here, beyond maybe a change in its wall's internal structure, but shouldn't cause any cycles. My hormone therapy is constant and not cyclic. The only reasonable explanation I have so far is that I do in fact have ovarian tissue in some kind of configuration capable of inducing the hormonal changes which are part of menstruation. Whether I have any tissues which respond to this outside of the vagina is unknown. I do know that if any tissue exists anywhere which conforms the inside of the womb, this will massively change due to these hormones and eventually shed the new tissue at the end of the cycle. This discarded tissue is a massive risk factor in the causation of sepsis. Based on my symptoms every month it seems reasonable to assume that something major is happening, but without any idea of how dangerous this could be to my health, long-term.
It is my hope that I'll get this apartment next week so that I can finalize that part and start focusing on my physical health. The last half of this week I have felt exhausted and worn out, with a near-constant headache and feeling just ready to sleep before half of the day is over with. Maybe I'll start feeling better once this month's period is over with. So far it's driving me to near-despair. As soon as I have this apartment and my health insurance taken care of I can go to the general practitioner. Dutch GPs have never taken me seriously, let alone that they would ever consider for real that I experience actual periods. I would gladly stop worrying about what these monthly pains do or do not mean for my health.
The basic summary is that despite the progress I am making there are still far too many things for me to get far too stressed about, which probably exacerbates these same issues.
Maya
Sunday, 12 January 2014
Optimistic Positivity As A Life Philosophy
Once again I'd like to start with the disclaimer that I may be somewhat incoherent and rambling, this time due to a party I had last night, resulting in a slight lack of sufficient sleep. I guess it's a good sign that I'm actually building up a network of friends and acquaintances, even if it can be quite tiring at times.
The last time I wrote on my blog I was about to move to a new place. This has since happened, moving me to the other side of the Rhein river, opposite of Karlsruhe. Other things have also happened or are in the process of doing so. The first is the health insurance with the German Krankenkasse. This turned out to be quite easy as my employer will set this up for me, with me only having to indicate which insurer I'd like to be with. This I took care of last Friday, together with the request form for a German bank account. Hopefully this will take care of these issues.
Next week I'll register as officially living in Germany and the colleague at whose place I'm staying will be contacting a real-estate agent about a house which is for rent. Hopefully I will have my own place by next month. The old apartment I hope to be rid of next week as well. It appears that my TODO list is finally shrinking somewhat.
That's not to say that I'm feeling happy or content in any sense, though. As I mentioned in my previous post it's a struggle for me to fit into a normal life, having to adapt to a life style I am unfamiliar with as well as having to fit all of my memories of especially the past nine years into this new life. I'm not sure that's even possible. I noticed that with the party last night, for example. Regular social interactions work out okay for me because I know how I'm supposed to respond and act based upon previous observations. I also liked the movie we watched: Dark City. For some reason my PTSD got triggered during the movie without there being any obvious triggers in the movie. It was probably more due to the stress I'm under at this point.
The main sensation as the dissociation which accompanies a PTSD attack set in was one of being lonely, abandoned and unloved. I just saw myself lugging this body around to places when people told me to, but it never amounting to anything. Eventually the dissociation got bad enough that I couldn't move or feel anything any more. Fortunately the student at whose place I stayed before was present as well, and she knew how to deal with dissociation. After a brief bout of crying I snapped out of the mood, more or less. The hours after that I'd gradually normalize and stabilize again.
At some point the party's guests had divided themselves into two groups: the men and the women, me obviously being in the latter group. As seems to be standard when you put a group of women together, the talk invariably turns towards periods and sex, not necessarily in that order. As far as the first item goes, I do have periods, but since I lack an open vagina and other organs it's not as messy, just really painful and inconvenient. The student was quick to point this out to the others as an advantage. The second item really doesn't have any advantages to me, however. When asked at one point I could only say that until my final surgery has succeeded, sex will remain something traumatic to me.
While sitting there with the other women it made me realize that while I have virtually nothing in common with men, even physically, I do not feel completely in my place with regular women either. It's not that I feel embarrassed or anything, but more that I realize how much my life has deviated from that of such women. My first period involved me having gigantic cramps for over an hour, but since it's all internal and no one saw anything I merely got scolded and made fun of by my family for making a fuss. Similarly, all of the other usual things were experienced in such a different manner by me that I almost feel like I'm some different species. Not a woman, not a man, not a human. Just something vaguely like it.
The past days and weeks I have been talking a lot about my experiences in the Netherlands, my hopes for the future and the details of my intersex condition. I'm not sure whether this is responsible for the surge of emotions and memories I'm struggling with recently. It feels as though a certain numbness is gone and the pain about my treatment by Dutch physicians is only now turning up to full strength. The apprehension I feel when I think about the upcoming surgery must be fuelling it as well, with this same apprehension being fed by those traumatic memories in a hellish feedback loop. The urge to break down in crying is almost too strong at times.
If I have to say what my life's philosophy is, I'd have to say that it's about seeking out what is positive, while avoiding that which is negative. While going through life all these years I have only sought out that which is negative when I expected that by going through the negative part I would gain something positive. Call it optimistic positivity if you wish. I suffered through years of medical incompetence because I knew I had to find the positive solution to the problem I was having, no matter the cost. This year again, seeking contact with a surgeon and baring my soul again to the possible backlash if things do not turn out the way I had hoped, or if I somehow have to defend myself again. All because I know that there is only one possible outcome which is fully positive and that is through such an uncomfortable experience.
Even if I do not end up with a fully usable vagina after the surgery, I won't be too horrible upset. Disappointed, yes. Yet I realize quite well that just the fact that I have a developed vagina is biologically speaking something of a minor miracle. As long as it's in some way usable and perhaps fixable would be infinitely preferably over just leaving things the way they are now. Optimistic positivity. I think and hope that with a successful surgery behind me I can finally successfully fight back against those horrible recollections of Dutch physicians. There just is no other way to conclude this medical chapter.
I guess that meeting this surgeon and the surgery which should follow it are at this point the biggest items on my TODO list for the coming weeks and months. It's looming up for me like a gigantic iceberg out of the darkness. Looking at its impregnable surface I can only shut off my emotions as well as possible and just continue. One second, one minute, one hour, one day at a time.
Don't think. Don't feel. Just look at the positive things and keep moving. It's all that's keeping you sane.
Maya
The last time I wrote on my blog I was about to move to a new place. This has since happened, moving me to the other side of the Rhein river, opposite of Karlsruhe. Other things have also happened or are in the process of doing so. The first is the health insurance with the German Krankenkasse. This turned out to be quite easy as my employer will set this up for me, with me only having to indicate which insurer I'd like to be with. This I took care of last Friday, together with the request form for a German bank account. Hopefully this will take care of these issues.
Next week I'll register as officially living in Germany and the colleague at whose place I'm staying will be contacting a real-estate agent about a house which is for rent. Hopefully I will have my own place by next month. The old apartment I hope to be rid of next week as well. It appears that my TODO list is finally shrinking somewhat.
That's not to say that I'm feeling happy or content in any sense, though. As I mentioned in my previous post it's a struggle for me to fit into a normal life, having to adapt to a life style I am unfamiliar with as well as having to fit all of my memories of especially the past nine years into this new life. I'm not sure that's even possible. I noticed that with the party last night, for example. Regular social interactions work out okay for me because I know how I'm supposed to respond and act based upon previous observations. I also liked the movie we watched: Dark City. For some reason my PTSD got triggered during the movie without there being any obvious triggers in the movie. It was probably more due to the stress I'm under at this point.
The main sensation as the dissociation which accompanies a PTSD attack set in was one of being lonely, abandoned and unloved. I just saw myself lugging this body around to places when people told me to, but it never amounting to anything. Eventually the dissociation got bad enough that I couldn't move or feel anything any more. Fortunately the student at whose place I stayed before was present as well, and she knew how to deal with dissociation. After a brief bout of crying I snapped out of the mood, more or less. The hours after that I'd gradually normalize and stabilize again.
At some point the party's guests had divided themselves into two groups: the men and the women, me obviously being in the latter group. As seems to be standard when you put a group of women together, the talk invariably turns towards periods and sex, not necessarily in that order. As far as the first item goes, I do have periods, but since I lack an open vagina and other organs it's not as messy, just really painful and inconvenient. The student was quick to point this out to the others as an advantage. The second item really doesn't have any advantages to me, however. When asked at one point I could only say that until my final surgery has succeeded, sex will remain something traumatic to me.
While sitting there with the other women it made me realize that while I have virtually nothing in common with men, even physically, I do not feel completely in my place with regular women either. It's not that I feel embarrassed or anything, but more that I realize how much my life has deviated from that of such women. My first period involved me having gigantic cramps for over an hour, but since it's all internal and no one saw anything I merely got scolded and made fun of by my family for making a fuss. Similarly, all of the other usual things were experienced in such a different manner by me that I almost feel like I'm some different species. Not a woman, not a man, not a human. Just something vaguely like it.
The past days and weeks I have been talking a lot about my experiences in the Netherlands, my hopes for the future and the details of my intersex condition. I'm not sure whether this is responsible for the surge of emotions and memories I'm struggling with recently. It feels as though a certain numbness is gone and the pain about my treatment by Dutch physicians is only now turning up to full strength. The apprehension I feel when I think about the upcoming surgery must be fuelling it as well, with this same apprehension being fed by those traumatic memories in a hellish feedback loop. The urge to break down in crying is almost too strong at times.
If I have to say what my life's philosophy is, I'd have to say that it's about seeking out what is positive, while avoiding that which is negative. While going through life all these years I have only sought out that which is negative when I expected that by going through the negative part I would gain something positive. Call it optimistic positivity if you wish. I suffered through years of medical incompetence because I knew I had to find the positive solution to the problem I was having, no matter the cost. This year again, seeking contact with a surgeon and baring my soul again to the possible backlash if things do not turn out the way I had hoped, or if I somehow have to defend myself again. All because I know that there is only one possible outcome which is fully positive and that is through such an uncomfortable experience.
Even if I do not end up with a fully usable vagina after the surgery, I won't be too horrible upset. Disappointed, yes. Yet I realize quite well that just the fact that I have a developed vagina is biologically speaking something of a minor miracle. As long as it's in some way usable and perhaps fixable would be infinitely preferably over just leaving things the way they are now. Optimistic positivity. I think and hope that with a successful surgery behind me I can finally successfully fight back against those horrible recollections of Dutch physicians. There just is no other way to conclude this medical chapter.
I guess that meeting this surgeon and the surgery which should follow it are at this point the biggest items on my TODO list for the coming weeks and months. It's looming up for me like a gigantic iceberg out of the darkness. Looking at its impregnable surface I can only shut off my emotions as well as possible and just continue. One second, one minute, one hour, one day at a time.
Don't think. Don't feel. Just look at the positive things and keep moving. It's all that's keeping you sane.
Maya
Thursday, 9 January 2014
Strangeness, Reality, Adult, Emotions, Life.
The past few weeks have been beyond strange to me. Looking back, the past seems to take on this unreal shade, as if it never truly happened. Maybe this is just what happens when lots of changes follow each other, that one has the sensation of being cut loose from everything, of just drifting from one event to another. I'm really not entirely sure what to think about things, beyond doing the best I can do with my rational thoughts and feelings.
While the initial start in Germany wasn't so stellar, I have had a few weeks now to get my bearings at the place where I'm currently staying. In many ways it's been a return to normal life, something quite unusual to me, as all I have known for the past decades has been a constant push into ever stranger and less familiar territory, culminating into the medical horror story of the past decade. Being caught in this flow of 'normal' life it has finally given me time to think about things I didn't generally spend much time thinking about, such as my own looks. Not in the general sense at least.
It's only at this stage of my life that I don't have to defend or question who or what I am, or what looks back at me in the mirror. I now just have to accept the truths which have crystallized over the years to where it is not possible to deny them. Truths including that of me being an adult. An adult woman. A pretty, adult woman. It casts me back in my memories to 2005 when I was struggling with a similar realization, at which point I could not comprehend in any fashion that I was no longer a child. Rationally I was aware of this fact, but emotionally I could not accept it in any form or shape, let alone that of me being a woman.
Now, nearly a decade later and after a harrowing war fought in the Netherlands against the System, I feel that I have aged far beyond my years in an emotional sense. I no longer have trouble accepting that I am an adult. I can accept that I am an adult woman. I do however not feel pretty. Looking at myself in the mirror I just see the exhaustion and scars. The grime of the battlefield covering everything and the gouges left in my skin.
It was good for me to leave the Netherlands. I had to. Now that I have left it I feel as though I'm at least not standing on the battlefield any more. It still lives inside of me, but I can look around and see a world which is still whole and pure instead of filled with death and decay. Part of the nightmare which still lived in my head has faded away already, even if the countless wounds are still bleeding fresh blood. It will still take more time for them to turn into scars.
At this point I still feel like a child in some respects. I feel at home on the battlefield, where I'm fighting for my own life and for those on my side against the faceless, cruel enemy, just defending and attacking in a continuous cycle until I can no longer feel my arms, or my shoulders and I can not fathom where the oxygen powering my muscles is coming from as my lungs are on fire. Yet place me outside this battlefield and I feel as inexperienced and clumsy as a newborn babe. I'm not used to a world where people are not trying to kill or attack me in some fashion, let alone where I can just go out and get the medical help I require without having to spend a decade of my life fighting for it.
In some ways it's more frightening this way. At least in a battle I know the rules. Here I just feel awkward and fragile. Unprotected. Every time I do something wrong I feel horrible, because I know that I should have known better. Even though I'm learning, ever so slowly, it will still take a long time for me to stop expecting the worst to happen at any point. I expect physicians and psychologists to torture me. So-called friends I expect to abandon and ridicule me. Those claiming to care about me I expect to ruin my life.
There's only survival on the battlefield, no life. Learning to live a life is going to be so very tough.
Tomorrow I'll be moving to another place again where I'll probably be staying until I can find a house to rent on the side of the river opposite to Karlsruhe. After talking with some people about it I feel fairly confident that it is the area where I want to be living for the coming time. Hopefully it will all work out from here, as there's still so much to take care of, from getting a German bank account, health insurance, a place of my own, visiting my surgeon and so many more details.
As long as it doesn't lead me back onto the battlefield, it is all fine with me.
Maya
While the initial start in Germany wasn't so stellar, I have had a few weeks now to get my bearings at the place where I'm currently staying. In many ways it's been a return to normal life, something quite unusual to me, as all I have known for the past decades has been a constant push into ever stranger and less familiar territory, culminating into the medical horror story of the past decade. Being caught in this flow of 'normal' life it has finally given me time to think about things I didn't generally spend much time thinking about, such as my own looks. Not in the general sense at least.
It's only at this stage of my life that I don't have to defend or question who or what I am, or what looks back at me in the mirror. I now just have to accept the truths which have crystallized over the years to where it is not possible to deny them. Truths including that of me being an adult. An adult woman. A pretty, adult woman. It casts me back in my memories to 2005 when I was struggling with a similar realization, at which point I could not comprehend in any fashion that I was no longer a child. Rationally I was aware of this fact, but emotionally I could not accept it in any form or shape, let alone that of me being a woman.
Now, nearly a decade later and after a harrowing war fought in the Netherlands against the System, I feel that I have aged far beyond my years in an emotional sense. I no longer have trouble accepting that I am an adult. I can accept that I am an adult woman. I do however not feel pretty. Looking at myself in the mirror I just see the exhaustion and scars. The grime of the battlefield covering everything and the gouges left in my skin.
It was good for me to leave the Netherlands. I had to. Now that I have left it I feel as though I'm at least not standing on the battlefield any more. It still lives inside of me, but I can look around and see a world which is still whole and pure instead of filled with death and decay. Part of the nightmare which still lived in my head has faded away already, even if the countless wounds are still bleeding fresh blood. It will still take more time for them to turn into scars.
At this point I still feel like a child in some respects. I feel at home on the battlefield, where I'm fighting for my own life and for those on my side against the faceless, cruel enemy, just defending and attacking in a continuous cycle until I can no longer feel my arms, or my shoulders and I can not fathom where the oxygen powering my muscles is coming from as my lungs are on fire. Yet place me outside this battlefield and I feel as inexperienced and clumsy as a newborn babe. I'm not used to a world where people are not trying to kill or attack me in some fashion, let alone where I can just go out and get the medical help I require without having to spend a decade of my life fighting for it.
In some ways it's more frightening this way. At least in a battle I know the rules. Here I just feel awkward and fragile. Unprotected. Every time I do something wrong I feel horrible, because I know that I should have known better. Even though I'm learning, ever so slowly, it will still take a long time for me to stop expecting the worst to happen at any point. I expect physicians and psychologists to torture me. So-called friends I expect to abandon and ridicule me. Those claiming to care about me I expect to ruin my life.
There's only survival on the battlefield, no life. Learning to live a life is going to be so very tough.
Tomorrow I'll be moving to another place again where I'll probably be staying until I can find a house to rent on the side of the river opposite to Karlsruhe. After talking with some people about it I feel fairly confident that it is the area where I want to be living for the coming time. Hopefully it will all work out from here, as there's still so much to take care of, from getting a German bank account, health insurance, a place of my own, visiting my surgeon and so many more details.
As long as it doesn't lead me back onto the battlefield, it is all fine with me.
Maya
Saturday, 21 December 2013
Longing For The Past. Longing For the Future.
Last night was the first time in a week that I slept in a real bed again and upon awaking I noticed that not only had I slept about thirteen hours, I was also hurting all over. Mostly my hands and arms/shoulders. All because things worked out in quite the opposite way that I had hoped with my move to Germany.
First there was the first moving attempt, now exactly one week ago on Saturday. The colleague driving a van from Germany to my place in the Netherlands got in a crash on the highway and while he was fine, there was no way to find a replacement van on such short notice. Then I learned that the house I was in had to be empty by 13.00 hours on Monday, forcing me to accept an offer from my older brother to drive a moving van for me against payment. Things had gone pretty wrong even on the Friday before, with my mother (at whose place I was staying) and my brother having unilaterally decided that I should be helping my mother move on that very same day, deep into the early morning hours, despite having my own move the next day and me already being exhausted.
That Friday ended with me getting mild hypothermia as I had to leave the house for a few hours despite it being around freezing outside as my older brother was yelling at me for being a useless, spoiled brat and all that. I only got back into the house again because I was noticing the hypothermia effects and knew that with another hour, maybe two I would be in no state to go anywhere, soon falling into unconsciousness. Upon returning home I was chided for being an utterly useless, ungrateful brat by both my brother and mother, but was allowed to stay in the house and sleep on a thin mattress on the floor in a by then virtually empty house aside from my own belongings.
Then the Saturday happened, leaving me almost panicked, not knowing where to go or what to do. This continued into Sunday, just feeling like there was no way I would ever leave the Netherlands and the current nightmare. I then learned that I didn't have a whole Monday either to come up with a solution, but just the morning. Out of options, I was thus forced to accept the much more expensive and less pleasant option. At least I was on my way, though, and would soon be at the apartment.
Thanks to my colleague 'hase' as his nickname goes, we were soon at the apartment after meeting up at the train station from which he guided us. Unloading the van, I said goodbye to my brother and set to prepare for dinner and my first night at my new apartment. It was a sub-basement apartment, part of an old 1920s villa, meant to store junk in, usually. That first night I found out just how unsuitable this apartment was for living in. First of all, despite the landlady insisting that the neighbours above me wouldn't disturb me, there was the near-constant noise of water. Falling, dripping, splashing water, as all the tubing from drains ran through that sub-basement. This continued through the night.
Then the next morning it was chilly outside, which translated into a very cold apartment as half of the radiators in the place didn't even work and especially from the doors came this massive draft. That morning I was sitting there in my winter coat and snow boots, desperately trying to stay warm. Then hase came to pick me up in the afternoon and drove me to the synyx offices. It was the first time that day that I actually felt warm. Figuring out what to do next was hard, though. Keeping the apartment and somehow having it fixed up seemed impossible as too much was just plain wrong or unfixable such as the drain pipes. With no other place to stay I had to spend the night on the office couch, something which I much preferred over another night at the cursed apartment. I also cooked dinner for myself at the office kitchen, which was kind of fun.
The next night I'd also spend on the office couch, as no other option had popped up yet, and everybody was going on vacation for the holidays, many travelling to family. At least I could have a shower at hase's place, where I stayed in September this year as well. I joined the end of year party there, which was lots of fun and got to see the new cats they have at the place. For Thursday until Sunday I could thus spend the night at a colleague's place who was going away during those days. I didn't make it to his place on Thursday, though, as after the year's end party we held with colleagues at a bowling alley and retro gaming museum it was too late for me. I walked back to the office and crashed there on the couch.
On Friday I went with a colleague at whose place I can stay starting early next year for a longer time back to my apartment to fetch most of my belongings from there and drive them to her place. I'll just have to figure out how to best cancel the contract. Keeping the landlady responsible for not disclosing the reality of living there (the noise) seems like a possible approach there, but I'll see. I'll just have to figure out where I'll be staying from Sunday onwards.
I did sleep quite well last night, everything considered. Even if I'm still feeling tired and stressed, and the pain in especially my right hand is quite severe. I can barely bend my right thumb due to some kind of bruising I suffered there over the past days. My shoulders and neck are also very stiff and painful. Today I still have to get food and I should force myself to work on my autobiography some at least, as it's important that I get those sample chapters submitted to my publisher. I haven't written a single letter for a week now due to this whole situation.
At least I'm getting some time to think about things. Such as moving to Germany. As I wrote before, I do not dislike the Netherlands itself, just the institute. The past days I found myself often longing to see the sights, shops and people at some places in the Netherlands again. Even if I'm well-aware that gradually I'm getting used to Germany in the same manner, especially once this insanity of couch-surfing is over with. I also find myself contemplating the future, which is where I can only see Germany and maybe other countries. I just have to get from my current, semi-homeless situation to this future. Once I'm at this colleague's place next year I can look for houses again to rent. If I can have some certainty and solid footing while arranging things, I'm sure it'll work out. Having to chase a place to sleep at for that day is a terrible thing. If I didn't have the office to sleep at, I'd have spent a few nights outdoors already.
Another thing which is kinda risky is that of my health insurance. I'm no longer insured as my Dutch health insurer has deemed me uninsurable due to living outside the Netherlands and getting all of my income from work in Germany. This means that until my new contract at synyx starts on January 1st and I can become insured again via the German Krankenkasse, I'll have to be quite careful. It's a quite naked feeling that even just going to a general practitioner isn't a realistic option at this point. I'm really glad I stocked up on medication right before I left the Netherlands. Unfortunately it also means that my first appointment with the surgeon will have to be postponed until I am insured again.
The worst part of this in between situation is that of feeling pulled apart by both past and future, while feeling powerless to ever reach this future. It's also not quite how I had imagined the first Christmas and New Year's for me in Germany would go. Not quite the girl with the matchsticks in the snow, but without a place of residence and the like as well as sleeping on couches at random places I feel somewhat like a vagabond. Interesting for sure, but as I noticed with last night's first real sleep, it's taking a very heavy toll on me, both physically and mentally.
Maya
First there was the first moving attempt, now exactly one week ago on Saturday. The colleague driving a van from Germany to my place in the Netherlands got in a crash on the highway and while he was fine, there was no way to find a replacement van on such short notice. Then I learned that the house I was in had to be empty by 13.00 hours on Monday, forcing me to accept an offer from my older brother to drive a moving van for me against payment. Things had gone pretty wrong even on the Friday before, with my mother (at whose place I was staying) and my brother having unilaterally decided that I should be helping my mother move on that very same day, deep into the early morning hours, despite having my own move the next day and me already being exhausted.
That Friday ended with me getting mild hypothermia as I had to leave the house for a few hours despite it being around freezing outside as my older brother was yelling at me for being a useless, spoiled brat and all that. I only got back into the house again because I was noticing the hypothermia effects and knew that with another hour, maybe two I would be in no state to go anywhere, soon falling into unconsciousness. Upon returning home I was chided for being an utterly useless, ungrateful brat by both my brother and mother, but was allowed to stay in the house and sleep on a thin mattress on the floor in a by then virtually empty house aside from my own belongings.
Then the Saturday happened, leaving me almost panicked, not knowing where to go or what to do. This continued into Sunday, just feeling like there was no way I would ever leave the Netherlands and the current nightmare. I then learned that I didn't have a whole Monday either to come up with a solution, but just the morning. Out of options, I was thus forced to accept the much more expensive and less pleasant option. At least I was on my way, though, and would soon be at the apartment.
Thanks to my colleague 'hase' as his nickname goes, we were soon at the apartment after meeting up at the train station from which he guided us. Unloading the van, I said goodbye to my brother and set to prepare for dinner and my first night at my new apartment. It was a sub-basement apartment, part of an old 1920s villa, meant to store junk in, usually. That first night I found out just how unsuitable this apartment was for living in. First of all, despite the landlady insisting that the neighbours above me wouldn't disturb me, there was the near-constant noise of water. Falling, dripping, splashing water, as all the tubing from drains ran through that sub-basement. This continued through the night.
Then the next morning it was chilly outside, which translated into a very cold apartment as half of the radiators in the place didn't even work and especially from the doors came this massive draft. That morning I was sitting there in my winter coat and snow boots, desperately trying to stay warm. Then hase came to pick me up in the afternoon and drove me to the synyx offices. It was the first time that day that I actually felt warm. Figuring out what to do next was hard, though. Keeping the apartment and somehow having it fixed up seemed impossible as too much was just plain wrong or unfixable such as the drain pipes. With no other place to stay I had to spend the night on the office couch, something which I much preferred over another night at the cursed apartment. I also cooked dinner for myself at the office kitchen, which was kind of fun.
The next night I'd also spend on the office couch, as no other option had popped up yet, and everybody was going on vacation for the holidays, many travelling to family. At least I could have a shower at hase's place, where I stayed in September this year as well. I joined the end of year party there, which was lots of fun and got to see the new cats they have at the place. For Thursday until Sunday I could thus spend the night at a colleague's place who was going away during those days. I didn't make it to his place on Thursday, though, as after the year's end party we held with colleagues at a bowling alley and retro gaming museum it was too late for me. I walked back to the office and crashed there on the couch.
On Friday I went with a colleague at whose place I can stay starting early next year for a longer time back to my apartment to fetch most of my belongings from there and drive them to her place. I'll just have to figure out how to best cancel the contract. Keeping the landlady responsible for not disclosing the reality of living there (the noise) seems like a possible approach there, but I'll see. I'll just have to figure out where I'll be staying from Sunday onwards.
I did sleep quite well last night, everything considered. Even if I'm still feeling tired and stressed, and the pain in especially my right hand is quite severe. I can barely bend my right thumb due to some kind of bruising I suffered there over the past days. My shoulders and neck are also very stiff and painful. Today I still have to get food and I should force myself to work on my autobiography some at least, as it's important that I get those sample chapters submitted to my publisher. I haven't written a single letter for a week now due to this whole situation.
At least I'm getting some time to think about things. Such as moving to Germany. As I wrote before, I do not dislike the Netherlands itself, just the institute. The past days I found myself often longing to see the sights, shops and people at some places in the Netherlands again. Even if I'm well-aware that gradually I'm getting used to Germany in the same manner, especially once this insanity of couch-surfing is over with. I also find myself contemplating the future, which is where I can only see Germany and maybe other countries. I just have to get from my current, semi-homeless situation to this future. Once I'm at this colleague's place next year I can look for houses again to rent. If I can have some certainty and solid footing while arranging things, I'm sure it'll work out. Having to chase a place to sleep at for that day is a terrible thing. If I didn't have the office to sleep at, I'd have spent a few nights outdoors already.
Another thing which is kinda risky is that of my health insurance. I'm no longer insured as my Dutch health insurer has deemed me uninsurable due to living outside the Netherlands and getting all of my income from work in Germany. This means that until my new contract at synyx starts on January 1st and I can become insured again via the German Krankenkasse, I'll have to be quite careful. It's a quite naked feeling that even just going to a general practitioner isn't a realistic option at this point. I'm really glad I stocked up on medication right before I left the Netherlands. Unfortunately it also means that my first appointment with the surgeon will have to be postponed until I am insured again.
The worst part of this in between situation is that of feeling pulled apart by both past and future, while feeling powerless to ever reach this future. It's also not quite how I had imagined the first Christmas and New Year's for me in Germany would go. Not quite the girl with the matchsticks in the snow, but without a place of residence and the like as well as sleeping on couches at random places I feel somewhat like a vagabond. Interesting for sure, but as I noticed with last night's first real sleep, it's taking a very heavy toll on me, both physically and mentally.
Maya
Tuesday, 26 November 2013
Discrimination Case Against Unive Not At An End Yet
Yesterday I had the hearing at the College voor de Rechten van de Mens (Human Rights Institute) in Utrecht against my health insurance company Unive for discrimination against intersex individuals. Not too much can be said about the hearing other than that after I summarized the essence of the matter, we just kept spinning in circles as the guy representing Unive could not say why they wouldn't fully cover this hair-removal therapy for an intersex person while they do so for transsexuals. In the end it all came down to that their medical adviser had initially said that it should be like this, then CVZ (the organization representing all Dutch health insurance companies) had released their view on the matter, also limiting coverage to transsexuals.
As the members of the institute who were represented at the hearing correctly mentioned neither Unive nor CVZ ever explained their reasoning behind the exclusion of intersex. With the situation being virtually identical from a legal and medical perspective, it'd be hard to argue for such an exclusion anyway. Both concern the transition from a male to a female role and both involve a higher-than-female level of testosterone which resulted in beard growth (which never goes away on its own) prior to a medical procedure which removed the source of the excess testosterone. The presence of this beard growth is thus regarded by the relevant Dutch healthcare law (2.4) as a 'verminking' (disfiguration) and full coverage to have it removed by a professional is provided.
This matter will now be taken to a higher level as the institute will query CVZ for their reasoning behind this decision to limit this law to just transgenders despite it being an open law. Depending on the response another hearing may be schedule at a later date. At any rate this matter can't be put to rest just yet. It is conceivable that even the Dutch Minister of Health (Edith Schippers) may have to justify or clarify certain matters here. At this point it seems that the claim of discrimination based on gender is well and truly justified here and thus a direct violation of the very first article in the Dutch constitution.
For me it would definitely help to get this discrimination acknowledged and possibly be reimbursed for the money I should have received back from Unive. This too was a question during the hearing, namely how much money I had spent beyond the 200-300/year Unive had covered from the extended insurance. This amount came down to over 6,000 Euro in about 6 years time, or over a thousand Euro a year.
I do hope that this Human Rights Institute can provide some measure of justice here, so that I can at least regain some of my trust in the Dutch justice system after my case against the VUmc gender team got thrown out by the medical disciplinary commission earlier this month.
Maya
As the members of the institute who were represented at the hearing correctly mentioned neither Unive nor CVZ ever explained their reasoning behind the exclusion of intersex. With the situation being virtually identical from a legal and medical perspective, it'd be hard to argue for such an exclusion anyway. Both concern the transition from a male to a female role and both involve a higher-than-female level of testosterone which resulted in beard growth (which never goes away on its own) prior to a medical procedure which removed the source of the excess testosterone. The presence of this beard growth is thus regarded by the relevant Dutch healthcare law (2.4) as a 'verminking' (disfiguration) and full coverage to have it removed by a professional is provided.
This matter will now be taken to a higher level as the institute will query CVZ for their reasoning behind this decision to limit this law to just transgenders despite it being an open law. Depending on the response another hearing may be schedule at a later date. At any rate this matter can't be put to rest just yet. It is conceivable that even the Dutch Minister of Health (Edith Schippers) may have to justify or clarify certain matters here. At this point it seems that the claim of discrimination based on gender is well and truly justified here and thus a direct violation of the very first article in the Dutch constitution.
For me it would definitely help to get this discrimination acknowledged and possibly be reimbursed for the money I should have received back from Unive. This too was a question during the hearing, namely how much money I had spent beyond the 200-300/year Unive had covered from the extended insurance. This amount came down to over 6,000 Euro in about 6 years time, or over a thousand Euro a year.
I do hope that this Human Rights Institute can provide some measure of justice here, so that I can at least regain some of my trust in the Dutch justice system after my case against the VUmc gender team got thrown out by the medical disciplinary commission earlier this month.
Maya
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