Process for top surgery at Helen Joseph, Johannesburg, South Africa #topsurgery #transgender #bilateralmastectomy

Process for top surgery at Helen Joseph, Johannesburg, South Africa

Remember:

• I am only the second person (we know of in the trans community), that went to Helen Joseph for top surgery. A trans friend went a year ago, and the processes have changed COMPLETELY from his experience.

• I had to go through endless different processes to him and learn the new system. So I made a lot of ‘mistakes’, because I followed the same procedure he did.

• I am writing down my experience, and trust that it will be the same general process for you.

• This is the information I have, at MY stage in MY journey, for FTM/Nonbinary top surgery. I am a nonbinary trans person on testosterone having top surgery, so my experience is different to what you might need. ALL the info I know is here.

• Please don’t ask me anything else because I DON’T KNOW.

• Go to the hospital with the referral letters from your own doctors, therapists, psychiatrists and ask hospital what to do next. If you don’t have doctors, etc. get referral letter from TIA, GenderDynamiX or Iranti.org (go here for contact info for these resources and more), phone the hospital or go to hospital and ask them what to do. 

BUT: this is the process I followed under my specific circumstances as a white trans person on testosterone for over a year, who has been with a therapist for two years, who has been with a psychiatrist and who brought referral letters (images towards the bottom of the blog post) from: Therapist, HRT-prescribing Dr and Plastic surgeon at Charlotte Maxeke (Jhb Gen) – public hospital in Parktown, Johannesburg. (I’d had my breast reduction there in 2010 and had a great experience. I chose not to do the surgery as they charge R30,000 as they see the surgery as cosmetic and not medically necessary – in other words, they don’t see this surgery as necessary for a transgender, queer or LGBQIA+ person). See this experience at Charlotte Maxeke here.

Your experience will be different depending on your circumstances.
But here is a general guideline to follow.

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Important general info

• The clinic (Breast and Plastic Surgery) is THE best in South Africa, as confirmed by many cisgender women who use it for post-cancer reconstruction of breasts. When you speak to the women in the queue who have been going there for years, they will tell you only good things. These doctors train other doctors. They are therefore as good, if not better, as plastic surgeons in private practice.
• Please note: The staff at Helen Joseph are AMAZING, from nurses, to security, to Doctors. They are SUPER helpful and friendly if you remain calm and friendly. The system is what it is, but works very well if you just keep asking which queue you should be in and double-checking all the time. But:
• These surgeries are called “sex change” surgeries at Helen Joseph, which is a completely incorrect and outdated term, but necessary for their processes, so best is just to nod and agree while it is extremely triggering. They also misgender you and use a lot of other problematic trans terminology. They do NOT know what nonbinary is, so for the purposes of getting the healthcare you need, play along with them and refer to yourself as the relevant FTM or MTF.
• While this is problematic and causes dysphoria and justified anger, this is the process right now. We can choose to refuse service and get upset, and then go and pay 3-10x the prices at private hospitals. Or we can choose to make the very difficult decision to play along with these difficulties at a hospital where they DO understand that this is for your health, and they ARE VERY sympathetic and they UNDERSTAND that you are not sick, but need these surgeries to be healthy. So my advice is focus on their genuine care and concern, deal with the dysphoria and anger caused by the outdated language (this is NOT their fault, but the South African healthcare’s fault in general) and get the healthcare you need that you can ACTUALLY afford.

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My experience of the process from applying for top surgery to getting top surgery 

I will put the steps you should follow in green. Read the rest, but only do the things in green. It’s just to show you what I went through and what to expect if things don’t go right.

Timeline:

• 12 Jan – Opened hospital file at general hospital entrance. 
  Do this step first. Get referral letter from the Dr prescribing your HRT, referring you specifically to Helen Joseph for top surgery; open a file and book appointment at Psych. Clinic. If you are not on HRT and want to be, you will need a letter from your GP or the resources here, referring you to the Poly Clinic, who will then refer you to HRT doctors (endocrinologists), therapists, psychiatrists, etc. You will have to wait and be on T for a year (as far as I understand; but check this with them). Read “Exact details of experience” (next purple heading) steps below to find out more about this, waiting times, and costs.
  Then went to Plastics Clinic. Was told to come back to see him and team of surgeons at the Breast Clinic (only opens on second week in January). Same plastic surgeons at plastic clinic, but chest surgeries done through Breast Clinic in Breast Ward by plastic surgeons). Confirm which day by phoning the front desk at Helen Joseph.
• 19 Jan – First visit to Plastic Surgeons at Breast Clinic; I brought referral letters as mentioned in the list above in blue. They said these weren’t enough and asked for a letter from my personal psychiatrist. (This is especially if you have a history of mental health issues). The 19th is the first day the clinic is open, so see the Psych. Clinic at the end of December or in November already. Once you’ve seen the Psych Clinic in November/December and you have your letter from Psychiatrist (details below in green), book at Breast Clinic to see Plastic Surgeons (around the 19th Jan).
• 26 Jan – Second visit to Plastic Surgeons at Breast Clinic – you will be seen by head of plastic surgery (Dr Grubnik – a woman, for clarity’s sake); said that letter from personal psychiatrist not enough; need to see Helen Joseph psychiatrist.  
• 2 Feb – First visit to Psychiatric Clinic (open on Wednesdays): Awesome experience with receptionist, nurses and Dr Kim Laxton (Senior Psychiatrist) is THE most trans-friendly and generally caring Psychiatrist I’ve ever met. So surgery was confirmed! Just needed it confirmed by Plastic Surgeon. 
• 9 Feb – Third visit to Breast Clinic: Helen Joseph Psychiatrist’s referral letter handed over; surgery confirmed confirmed and booked, and visit to Finance office to get price and organise payment. Went to Finance office (Nandi) to get quote for surgery (but they have these quotes at the breast clinic. Just ask. They will give you bank details. You will have to pay the amount up front before surgery date will be booked (for me, as unemployed, was R21,000).

REMEMBER: This IS a lot of money, but this is still MUCH cheaper than the R40,000 – R80,000 private. And the waiting lists are not as long as Steve Biko (who only see a limited number of trans patients, Baragwanath and Groote Schuur (Cape Town – VERY long waiting lists). So rather than waiting for a year or 5, etc., save money for a while and go to Helen Joseph. And the doctors are just as good as private doctors, if not better. ALL doctors are trained at government hospitals, so the head doctors are the best in their field, and because transgender surgeries are so ‘new’ in government hospitals, the head of plastic surgery (Dr Grubnik) will do your operation, who has YEARS of international and South African experience.

• 16 Feb – Third visit to Breast Clinic: Proof of payment given to doc and surgery booked for 14 March. So if I’d known the process and cost from the beginning, I would have seen the surgeon on the 19th Jan. and had surgery scheduled for two-three weeks after that. 

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Going first thing in January is the best time!
(Clinics only open mid-Jan, so phone and check date):

• This is when they start booking surgeries for the new year. If you follow the exact process I followed (if you followed the same HRT, therapy and psychiatrist elements I followed), and leave out all the “mistakes” I made in red while learning the new process, the process from start to surgery will take about 2 weeks.
• If you are not yet on HRT (you need to be on HRT for a year), you will probably need to wait to be on T for a year, but this is cool, because you can then get the T, the therapy and the psychiatrist’s letter all from Helen Joseph, which is what you need to do anyway, regardless of how many letters I brought in from specialists outside of Helen Joseph.
• I’m not sure what the process is for nonbinary people not on T, but go and find out anyway because cis men go there for gynecomastia – chronic “man boob” syndrome, so they should be open to it.

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More details here about surgery prices and other trans, queer and LGBQIA+ surgeries.

Read more below for exact details, prices and expected waiting times below.
Only focus on the things in green for you.

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Exact details of my experience: Read for prices and waiting times

12 January 2017

• I got to the hospital at 8am on a Monday. Would recommend getting there at 7 as I waited in file opening queue for almost 2 hours.
• Go to first counter on left in main entrance (queries). Get numbered ticket for queue to Window 4 to open hospital file (if you haven’t been to Helen Joseph in last 5 years). Queue well organised and adhered to. File opening went quickly and smoothly.
• Then wait in queue for Window 10/11 for about 5-15 minutes. They’ll call your name. You then pay (R40-R80, depending on employment status).
• 10:38: Arrived at Plastic Surgery Clinic. Only 5 people in queue.
• 11:18: Just seen Dr. VERY knowledgeable, no issues. Told him I was transgender and here for chest surgery. He gendered me correctly and was great. Have to come to Plastics/Breast Clinic (a day for Plastic surgery to do with breasts) on Thursday, though. They have a big team, including him, so there’s better and more considered treatment by a team of doctors, not just one. Mondays are for general plastic surgery, Thursdays for breast-related plastic surgery. So DON’T go to Plastic Surgery Clinic AT ALL! (on Monday). Go to Breast Clinic and see Plastic Surgeons there on a Thursday. 

19 Jan:

• Arrived for Breast/Plastic Clinic at 8 (best time – they take no patients after 10:30). Go straight upstairs (in file room at hospital entrance – stairs behind you, or ask for outside breast clinic entrance (carry on walking past main entrance, and it’s to your left). Go to big desk behind info/reception desk. Tell them you’re here for first appointment for PLASTICS (otherwise you end up in wrong queue for BREAST clinic). They’ll give you two forms and then sit in queue for cashier (to right when facing entrance). They will call your name and you don’t have to wait in queue – 5mins. YOU HAVE TO PAY R317 (CASH!!!). This is a once-off and follow ups (3) will be free. Then sit in Plastics queue (all the way to right). Queue is MUCH shorter than breast queue (10 people ahead of me). Arrived in this queue at 9:33. Drs only arrive at 9, so don’t come earlier than 8.
• Got to see Dr at 10:30. You need to be gendered female on all hospital forms, so prepare for that. Dr took my history, asked what procedure I wanted (call it double mastectomy for sex change. Yes, they still use the term “sex change”). He called in his supervising Dr, Dr Grubner. She insisted that I need a psychiatrist’s letter (because I’m on psychiatric medication for depression). Psychiatrist needs to write letter stating two main things: 1. Mentally stable. 2. “Suffers from gender dysphoria”, in those exact words.
• Things have changed since a year ago. Guy a year ago didn’t need psychiatrist’s letter and paid R80 for his surgery. Drs apparently got into trouble for this and now they charge R21,000, regardless of unemployment (I’m unemployed). Still 2-4 times less expensive than private. She also went on about how Helen Joseph doesn’t really do transgender surgeries (even though they have top and bottom surgeries on their price list on the wall…), and how Steve Biko and Groote Schuur were better options because it’s a multidisciplinary team with psychiatrists, psychologists, gynaecologists and plastic surgeons. I argued that friend had top surgery a year ago and that I have letters from T-prescribing Dr and psychologist. She said that’s not the same as specialised trans hospital team policies and that she needed to speak to admin supervisor and hospital management. I’ll get psychiatrist letter this week and go back next Thursday for next clinic day, and they’ll have an answer for me next week – yes or no.
• So yeah, disappointed and worst case scenario of more red tape came true. But after she left, male Dr said they’ll probably say yes and I shouldn’t worry. But I am, and worried about where I’m going to find R20,000… and that they’re going to say I must go to Steve Biko, where I’ll have to go through the process from the beginning, including therapy and psychiatry, which involves ignorant and offensive questions, and wait for another 6-12 months for surgery, at least. I’m already compromising myself by pretending to be FTM and into women (yes, they ask about sexual orientation…), and even with these lies, so many hoops… 
• Not giving up. Worst case scenario, I go back to Jhb Gen, who would do it for R30,000, after saving up the money. 

26 Jan:

 

All the letters I took with me. (To give you an idea of what referral letters should say, but also take note of the variation in old transgender language, which is not correct, and the more informed and educated transgender language – shows that while healthcare professionals want to help us, their understanding of trans identities vary based on education and awareness of trans politics):

 (Click on each image to read the caption and full letter).

Letter from Dr Paul Timp – HRT-prescribing GP in Rivonia. Use of correct pronoun.

Letter from Dr Steven Eppel, psychiatrist at Linksfield. I had to edit the “Germaine is a female lesbian transitioning to male” out of this one… Notice the ‘she’.

Letter from Casey Blake, counsellor in Linksfield. Notice the COMPLETE respect of trans language and my needs (we used ‘he’ instead of ‘they’ to make it easier to get the surgery as nonbinary identity is NOT understood.

Letter from Dr Grubnik, head Plastic Surgeon at Helen Joseph. Notice the ‘he’, even though Helen Joseph hospital policy is to use ‘she’. Uses ‘gender dysphoria’ correctly, but speaks about ‘sex change’. Correct terminology is ‘gender-affirming surgery’.

2 Feb:

First visit to Psychiatric Clinic (open on Wednesdays): Awesome experience with receptionist, nurses and Dr Kim Laxton (Senior Psychiatrist) is THE most trans-friendly and generally caring Psychiatrist I’ve ever met. VERY short queues and waiting time. Paid R40/R80 for this visit. So surgery was confirmed! Just needed it confirmed by Plastic Surgeon. The letters below show how awesome she is. 

(Click on each image to read the caption and full letter).

Look at the difference in her language compared to the others – still uses ‘she’ because of Helen Joseph policy, but speaks of gender transformation surgery, which I’ve never come across, but LOVE!

 9 Feb:

Third visit to Breast Clinic: Helen Joseph Psychiatrist’s referral letter handed over; surgery confirmed confirmed and booked, and visit to Finance office to get price and organise payment. Went to Finance office (Nandi) to get quote for surgery (but they have these quotes at the breast clinic. Just ask. They will give you bank details. You will have to pay the amount up front before surgery date will be booked (for me, as unemployed, was R21,000).
Letter included to show the difference in the trans languages used by different professionals at Helen Joseph – “sex change” is outdated.

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 Remember: Firstly – 

Remember: Secondly – 

• I am only the second person (we know of in the trans community), that went to Helen Joseph for top surgery. A trans friend went a year ago, and the processes have changed COMPLETELY from his experience.

• I had to go through endless different processes to him and learn the new system. So I made a lot of ‘mistakes’, because I followed the same procedure he did.

• I am writing down my experience, and trust that it will be the same general process for you.

• This is the information I have, at MY stage in MY journey, for FTM/Nonbinary top surgery. I am a nonbinary trans person on testosterone having top surgery, so my experience is different to what you might need. ALL the info I know is here.

• Please don’t ask me anything else because I DON’T KNOW.

• Go to the hospital with the referral letters from your own doctors, therapists, psychiatrists and ask hospital what to do next. If you don’t have doctors, etc. get referral letter from TIA, GenderDynamiX or Iranti.org (go here for contact info for these resources and more), phone the hospital or go to hospital and ask them what to do.