Paige Behan, a trans woman who underwent gender reassignment surgery in Munich last month, says she was denied urgent treatment when she presented to St James’s Hospital A&E, in Dublin, with a wound infection.

The 26-year-old trans woman first became unwell on Wednesday, August 14, and the following day, she contacted her GP, who recommended that she go to A&E and referred her to St James’s Hospital. Paige arrived at the hospital on Friday, August 16.

“I told the triage nurse I had had surgery and that I was displaying symptoms of a bacterial infection and I was feeling nauseous at that time. I had no appetite, but I also had signs of a temperature two days before,” she said, recounting the experience.

Paige recalled how she was first seen by a regular doctor, who transferred her to the Plastics and then Gynaecology department, which both refused to see her. She was then referred to Urology who said they couldn’t treat her because the department ​​is not suited to wound management.

After that, she was advised to go to Holles Street Maternity Hospital in Dublin 2. “I had a cannula in my arm at this stage,” Paige said. “They put a cannula in my arm, but they were refusing to admit me for IV antibiotics, because I would have been admitted and they would have been liable for my care then.

“I was offered no form of patient transport, and I had to get a taxi myself to Holles Street street,” she added. Moreover, once she got to the Maternity Hospital, she found out that they hadn’t been informed of her arrival, despite it being standard procedure when transferring patients.

“Holles Street were brilliant. They admitted me and provided me care that St James’s didn’t. But the fact that I had to leave St James’s Hospital bleeding and go to a maternity hospital when all I had was a wound infection was ridiculous,” the trans woman said.

“The issue that I’m having is that I went to a public hospital with a wound infection and wasn’t treated because I had transgender reassignment surgery, but I was sent by the HSE to have the surgery,” Paige explained.

As she clarified, she had travelled to Munich in July to undergo gender reassignment surgery after being sent there by the HSE. “I went and seeked gender-affirming care in a country that could provide it to me, because my own country failed to do so,” Paige said.

“I had to leave my country in order to access care that, I’ll be very honest with you, is as necessary as a life-saving procedure for me,” Paige shared. “I was hospitalised numerous times over the years for suicidal ideation, for suicide attempt, self-harm, overdose… all because I suffered immensely with gender dysphoria.

“It’s a basic human right to access healthcare,” she said. “Something needs to change, and I’m not going to stop until something changes.

“I’m not going to stop until something’s done about this, because I have had to fight for my own health care and I’ve had to advocate for my own rights for so long, and I’m tired.

“If I have to call everybody, if I have to write emails every day of the week, if I have to sit outside places, I will. Because, God forbid, a younger transgender woman like myself in a situation like that… it could have gone a completely different way, and that’s something that I refuse to accept,” Paige said.

When asked for comment, a spokesperson for St James’s Hospital replied that they “cannot comment on individual patient cases. Maintaining a patient’s confidentiality is not only an ethical requirement of the hospital, it is also a legal requirement as defined in the General Data Protection Regulation (GDPR) along with the Data Protection Acts 1988-2018.”

“When a patient or family makes personal information public, this does not relieve St James’s Hospital of its duty to uphold patient confidentiality at all times,” the spokesperson said. “If any patient has any concerns about the treatment they received at St James’s Hospital, we encourage them to get in contact either by phone, email or letter. The hospital is committed to listening, responding to, and learning from people’s lived experiences to improve the services the hospital provides.”

Regrettably, Paige’s experience at St James’s Hospital is not an isolated incident and is part of a broader issue with trans healthcare in Ireland. As reported by Trans Healthcare Action, the lack of healthcare options for trans people has been debated among health officials for years.

A 2004 report published by the Equality Authority and a 2009 report on LGBTQ+ health published by the HSE acknowledged a “lack of essential health services” for trans people in Ireland. The latter report also states: “Furthermore, when people do access services, they can experience delays and barriers, such as lack of knowledge and awareness of the specific healthcare issues and prejudice on the part of some healthcare providers, which cause unnecessary hardship (TENI, 2007).”

The 2013 TENI Speaking from the Margins research similarly highlighted the lack of health services for trans folks in the country. Meanwhile, the Being LGBTQI+ in Ireland 2024 report published by Belong To found that the vast majority of the 100 trans people who responded on the topic of post-surgery aftercare said that there was no such care in Ireland, with some reporting similar experiences to Paige’s.

“The mistreatment that Paige experienced is utterly unacceptable, and unfortunately not a unique story,” Trans Healthcare Action said. “The lack of appropriate aftercare for trans people forced to have surgery outside Ireland has been documented for 20 years, and yet the HSE didn’t ensure this was available when they referred her to Munich. Transgender healthcare in Ireland needs a radical rethinking, trans people need to be at the centre of designing a system that provides for our needs and that includes postoperative care.”