Transgender Women Of Indonesia Have A Champion In A 26-Year-Old Doctor

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Below a highway overpass in Yogyakarta, Indonesia, college students eat fried noodles and spicy chicken stew from brightly lit food stalls that fill this gritty space. The noise of cars and trucks rumbling overhead mingles with the sound of jets landing at the nearby airport.

A singer's voice begins to pierce this dense cacophony. She has woven palm fronds into her hair to create a headpiece that crowns her sparkly pink outfit. Diners tip her before turning back to their meals.

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The busker's name is Madame Ruly and she is a fixture in the Yogyakarta community of waria — loosely, though imperfectly, translated as transwomen. The word combines two Indonesian words: "wanita," or woman, and "pria," or man. As a third gender, waria — biological men who live as women — have been part of Indonesian society for as long as anyone can remember, many years before the modern gay rights movement in the country. Yet they are often disowned by their own family members who disapprove of their children coming out as transgender.

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Day-to-day survival can be a struggle. To make a living, many waria in Indonesia do sex work or sing on the street for tips. Both of those jobs are technically illegal but are often tolerated by the authorities.

Despite the obstacles they face, the waria find strength in asserting their identity. In a sense, it's unifying, "because they're marginalized by everyone," says Sandeep Nanwani, a 26-year-old doctor and a candidate for a master's in global health delivery at Harvard University.

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Nanwani is an irrepressible spirit who seems both wise beyond his 26 years and full of youthful energy. Growing up in Indonesia's capitol, Jakarta, he lost his mother to cancer when he was in middle school. The experience inspired him to become a doctor.

Nanwani took some time off from his medical studies in Indonesia to volunteer in public health clinics. The doctors he worked with were trying to account for the efficacy of their HIV/AIDS prevention. Specifically, they wanted to know if condoms that were distributed were being used. Nanwani's job: sort through the trash in men's restrooms to count the used condoms.

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Today, as part of his graduate school field work, Nanwani helps provide medical care to many of the waria in Yogyakarta. Byron Good, a professor of medical anthropology at Harvard, says the young doctor's commitment to social justice is rare even among global health physicians. Good compared him to the MacArthur "Genius" winner, Dr. Paul Farmer, who is known for working to provide health care to the rural poor in Haiti.

"Sandeep has a remarkable commitment to the poor and to issues of social justice," Good said. "It's difficult to find physicians anywhere in the world like that. But he also has a commitment to spend the time and go hang out with the poor. To hang out with the waria."

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At an abandoned patch of land behind a strip of hotels that serves as an informal housing complex for many older waria in Yogyakarta, Nanwani checks in on a patient: Madame Wiwik. In her late 60s, Wiwik has a bulbous nose and eyebrows drawn on in dark pencil. Wiwik sits on a mattress on the floor in a dark concrete room, one of the unofficial (and illegal) dwellings the waria rent. She plays a recording of a songbird on her phone and winces in pain. Madame Wiwik recently had a stroke and her words are slurry; she struggles to lift her arms above her shoulders. Dr. Nanwani says Madame Wiwik has no medication, "not even aspirin to prevent future strokes. Nothing."

That need for medical care among waria became critical in the early 2000s, when the HIV epidemic exploded here. Sandeep says the toll on the waria was devastating.

An older waria named Vinolia Wakijo watched the epidemic decimate her community. Today, Wakijo, whom everyone calls Mami, is 61. She's effectively the matriarch of waria in this city. In 2007 she established Kebaya, a group home for people with HIV that receives some government funding. In the ten years that she has operated Kebaya, 46 people with AIDS have died there.

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Today ten people live in the home, and the Kebaya family continues to grow. For the first time, there's a baby living there: an 11-month old girl named Nira. Her mother was a sex worker who died of AIDS, and the warias have taken her in. Nira has her own room and a slew of de facto aunties who take turns holding her and trying to make her giggle.

Nanwani is known throughout the waria community of Yogyagarta and is clearly more than a doctor. He comes to Kebaya almost daily, he says, just to check in. But it's not an easy community to work with. Sometimes clients simply disappear. With no fixed address it can be impossible to track them down or find out what happened to them. Nanwani still wonders whether he could have done more to help some of his patients, who became friends — and then vanished.

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Still, Nanwani says the rewards from working with the waria are profound: "They provide care for me as much as I provide care to them. Waria endure suffering through humor and laughter, and I just love that."