Care Practices for LGBTQIA+ Students at the UNR Student Health Center
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“The LGBTQIA+ community has some unique health needs and tends to fall into some different risk categories,” says Julee DeMello, Clinic Manager for the UNR Student Health Center. “We look at the forms students fill out at the self check-in and try to figure out if there’s gender equity in filling them out. This one person had been embarrassed because the form asked for their mother and father’s information. “
For DeMello, part of working in the healthcare field and in the Student Health Center specifically, is understanding the experiences of all students who enter, in order to build inclusive care practices.
The front desk person had said to them, ‘you know you didn’t fill this out’, and the student, he said, ‘I have two fathers I wasn’t raised with a mother’. I think the front desk person was like, ‘what?’.
“The front desk person really shouldn’t have been so shocked, but taking somebody out of their comfort zone like that, it’s the kind of thing we try through training, having a health educator, being a part of different wellness advisory groups and different communities on campus that we’re hoping to learn more and see what we can do. There are practices we are catching up to and many we’ve already remodeled. We decided not to label our restrooms as men’s and women’s.”
Julee DeMello graduated from the University of Nevada, Reno with a degree in business. She stands at an average height, slim, and appears late middle-aged with straight, short brown hair and bangs. Her sunny windows shine on the many papers, frames, and trinkets on her desk with a thick textbook-like binder similar to the many on her tall bookshelf in the corner.
“I was assigned female at birth and that’s how I’ve always identified, but I remember I was such a tomboy growing up. I had short hair and was in that awkward 11–12 year old stage. I was with my grandmother in San Francisco in a dressing room and this lady was really upset that I was there. It was very awkward and I couldn’t understand. My grandmother asked the lady, ‘Why what’s going on? This is my granddaughter.’ Then I was embarrassed. My grandmother was embarrassed. The lady was embarrassed.”
So I always think back to that and never assume that the way someone looks is how they identify.
In the LGBTQIA+ community, transgender, nonbinary, and gender nonconforming students specifically, can face barriers in healthcare such as the use of pronouns on forms and interactions in person that can be uncomfortable and discriminatory.
“When students check in through our health record system they can select their pronouns. This works from the front and the back. You can’t just educate a provider. You have to educate the front office and the nursing staff too. We have psychiatry, dermatology, and nutrition services that we try to make equally accessible for everyone.”
“Maybe it’s your insurance. They’re getting better but can be very black and white. You could be assigned male at birth and have male genitalia, so your insurance company identifies you as a man but that’s not who you identify as. The best thing is to not make assumptions.”
The SHC asks students for specific information like insurance information, to help identify available services, find the most cost-effective solutions, and be able to accurately refer students to the best available resources.
“For a while in the healthcare record, you could see the person’s pronouns with a preferred name in parentheses. Then one day it disappeared. We think it had to do with our electronic health record interfacing with MyNevada and that something stopped talking with an upgrade to some system.”
So myself and the front office supervisor started creating pretend patients and checking them in to see how it feels to check in at the Student Health Center. Is it easy? Do you feel like you have some privacy?”
“We were able to figure out what happened with the electronic health record company. The system had originally been working that way with MyNevada for years but had stopped. Now, with our patients, a preferred name is one of the first questions that they get asked by the computer so they don’t necessarily have to have that conversation in person. So far it’s been working out great.”
The Student Health Center knows that a student’s visit may be the first time students are accessing health care on their own and that, “maybe they never felt comfortable at the pediatrician’s office discussing the fact that they’re transgender and this might be their first real encounter with a physician or health care provider that they’re disclosing this to.”
“We’re open to change and feedback. We’re here to serve the students in any capacity that we can with being inclusive, sensitive, and building that confidence and trust.”
The SHC Clinic Manager, Julee DeMello, can be contacted at her office phone (775) 784 - 6598 or through her email jdemello@unr.edu
*This story was written before the ordered statewide stay at home orders in Nevada and evacuation of residence halls at the University of Nevada, Reno in response to the corona virus.
