As one of the few African-American females to serve in the U.S. Marines, Pacific University public health major Irisa Grimes '17 is acutely aware of both the inherent and overt challenges minority populations face.
As such, she is committed to advocating for those most vulnerable, including a subset of fellow military veterans who struggle to utilize available health services because of fear and apprehension.
More than 21 percent of all adults in the United States who identify as transgender are current or former military members. And despite a 14-year-old Department of Veterans Affairs mandate that affirms the rights of transgender vets to receive non-discriminatory care, many entitled to VA benefits don't pursue them because of their own inhibitions and a seeming lack of culturally competent care providers, Grimes said.
Grimes started to pay attention to the issue of the vulnerability of transgender veterans when a close friend and transgender veteran expressed difficulty receiving care through New York's VA system.
Grimes' research indicated that Veterans Affairs has not mandated a timeline to implement Directive 2013-003 procedures to increase the competence of care provided to transgender persons.
"The directive is really just a policy right now, and it's not being put into practice," she asserts.
She hopes to positively affect the directive's intent through Operation SafePort, an innovative education program she created for her senior capstone project at Pacific. Oepration SafePort is designed to reduce healthcare provider bias and stigma for transgender veterans.
Operation SafePort creates an implementation timeline and enforcement strategies for the Portland VA Health Care System. Just as important, Grimes says, the program also includes a research-backed "psychosocial" model to implement directive policies towards cultural competency, education, medical training, recruitment incentives for providers and inclusion of transgender veterans in research and discussion panels.
Risk factors beyond post-traumatic stress disorder for transgender veterans include co-morbid problems, including the level of disability, be it intellectual, physical, depression, anxiety, suicidal thoughts at increased risk.
"Transgender veterans are 20 times more likely to commit suicide than other military veterans," Grimes said.
Grimes says there is a disconnect between training and orientation for practitioners to provide equitable care.
"Operation SafePort uses a psychosocial model to help put a human face on training providers," she says.
Grimes credits Pacific's public health degree program with preparing her to incorporate such a model that designed to change attitudes and, ultimately, behaviors of healthcare providers.
"Most transgender patients use informal networks of friends or others they trust rather seeking out medical care through conventional means because they don't feel comfortable talking to healthcare providers," she said. Trust of both the caregivers and care seekers can help bridge the patient provider relationship.
"One way to help both patients and providers is to increase transgender representation on research panels," Grimes said. "It will help providers see how prevalent the transgender population really is and how important it is for providers to make a concerted effort to be culturally sensitive and competent treating those when they need care most."
Grimes initially discovered Pacific as a place to eventually study occupational therapy, which she plans to do following graduation with a bachelor's degree in public health.
She found much more.
"When I looked at Pacific's mission statement and its commitment to social justice, rigorous academic and research opportunities, I was all about it. The mission is essentially the core of who I am, and I am really excited to be a part of this community."
Grimes adds that the camaraderie she developed with her professors has given her the drive to undertake research on a subject (transgender military veterans) in which previous research is limited. "It is my hope that I what I have gathered, and hopefully will continue to through this project, will add to the collective body of research for future investigators," she said.