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

Nov 2, 2017
Originally published on November 9, 2017 12:00 pm

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.

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.

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.

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.

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."

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.

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.

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."

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ARI SHAPIRO, HOST:

Indonesia is as wide as the continental United States, and it's diverse. In the far west, Sharia law governs Aceh province. To the east, Hinduism dominates the island of Bali. There are pockets of Christianity and Buddhism. And this week, we are looking at some of the things that bind this democracy together.

(LAUGHTER)

SHAPIRO: In the college town of Yogyakarta, a 26-year-old named Sandeep Nanwani is recently out of medical school, and we met him in the field. He works with a group of patients that you can find in every corner of this sprawling country.

SANDEEP NANWANI: So you will have it Aceh, Timor, in Papua. There is in Papua and Sulawesi - the whole Indonesia.

SHAPIRO: He's talking about warias, transgender women in Indonesia who often do sex work or sing on the street for tips. Both of those jobs are technically illegal but often tolerated. Warias have been part of Indonesian society for as long as anyone can remember.

NANWANI: So that's, like, a national identity. Everywhere is the same.

SHAPIRO: That's interesting that while there might be divisions between Muslims and Christians, people of Chinese descent, people of Arab descent, these threads of waria go through the whole country.

NANWANI: Because they are - of course they are because they are marginalized by everyone (laughter) in a sense.

SHAPIRO: Dr. Nanwani takes us to an informal housing complex where he provides medical care to a group of warias.

NANWANI: We are in the space - like, an abandoned land behind a strip of hotels where a lot of warias live. And most of them are pengamen or ngamen or buskers.

SHAPIRO: They sing on the street for tips. In the courtyard, chickens peck at the ground, and a neighbor kid gets water from a pump. Nanwani is here to check in on a waria in her late-60s who goes by the name Madame Wiwik. She has a bulbous nose and eyebrows drawn on in dark pencil.

In a dark concrete room, Wiwik sits on a mattress on the floor. The doctor asks her to raise her arms overhead. She struggles to lift them above her shoulders.

NANWANI: Up, up, up.

SHAPIRO: Madame Wiwik recently had a stroke. Even though I don't speak the language, I can tell that her words are slurry.

NANWANI: She has no medication at all, not even aspirin to prevent future strokes, nothing.

SHAPIRO: Madame Wiwik wants to go busking again tonight. Ngamen is the local term for it. Dr. Nanwani thinks it's a bad idea, but he knows that she needs the money.

NANWANI: I am a bit scared about that she goes ngamen. So I have told her, like, you have to go ngamen with - accompanied by someone, not alone - get stroke in the middle.

SHAPIRO: I can imagine somebody saying, why spend your time and talents on a population of people who are doing sex work, living on the streets?

NANWANI: They provide care for me as much as I provide care to them. Waria endure suffering through, like, humor and laughter. And I just love that.

SHAPIRO: Can you give us an example of that?

NANWANI: So if they get caught by the police and there's a lot of media and so on, they will literally go to the media and, like, strut their stuff. They're shameless. I just love how you survive through being shameless, right? It's so amazing (laughter).

SHAPIRO: And there's another thing that he loves about the warias. They create chosen families. That's true of marginalized groups in a lot of countries. But in Indonesia, these families of choice have official recognition and legal power. Nanwani explains that one way Indonesia creates a national identity is through formal family networks. Everybody in the country has a card listing their biological relatives. It's like a social security card, but it ties everyone to a community. And you need that card to get health care.

NANWANI: What unites Indonesia is a nuclear family. So everybody's registered through the family card. So everybody has a family card.

SHAPIRO: So what happens if your family cuts you off and kicks you out?

NANWANI: So zero care. So, like, that's how they - the waria movement started to work together with the state to find some form of care.

SHAPIRO: Warias are often disowned by their families. That cuts them off from the community they were born into. So some of the elders have created waria families complete with the official legal card. It became really necessary when the HIV epidemic exploded here in the early 2000s. Dr. Nanwani brings us to a group home for people with HIV.

VINOLIA WAKIJO: (Foreign language spoken) Vinolia.

SHAPIRO: It's so nice to...

An older waria named Vinolia Wakijo established it a decade ago. Nanwani calls her Mami.

NANWANI: Like, Mami's whole generation of people completely - just all of them died.

SHAPIRO: Today Mami is 61, and she's effectively the matriarch of warias in the city of Yogyakarta.

WAKIJO: (Through interpreter) I consider them my family because as warias, they are my responsibility.

SHAPIRO: In the 10 years that you've operated this house, how many people who have come here have passed away?

WAKIJO: (Through interpreter) Forty-six people with HIV-AIDS have died here.

SHAPIRO: Dr. Nanwani points out a wall in the front room of the house full of certificates and awards from places that have recognized Mami's work.

NANWANI: She goes, gives lectures every year in the medical school, psychology school.

SHAPIRO: I ask Mami to show us her family card.

NANWANI: Yeah, this.

SHAPIRO: She reaches into a file folder and pulls out a full-size sheet of paper.

How many children list you as their mother on their family card?

NANWANI: (Foreign language spoken).

WAKIJO: (Through interpreter) Three where I take full economic responsibility for them. They're all street kids.

SHAPIRO: The family in this house is growing. For the first time, there is a baby living here, an 11-month-old girl named Nira. Her mother was a sex worker who died of AIDS, and the warias have taken her in.

(SOUNDBITE OF BABY COOING)

SHAPIRO: Less than 20 percent of Indonesians with HIV get the drugs they need. That's partly because so many people in this community live outside of society's formal networks. So Dr. Nanwani is trying to connect warias with a place like the clinic in a hospital where he works.

NANWANI: I used to hang out here every time as a medical student and just gossip with all the people here (laughter).

SHAPIRO: His mentor walks in, the woman who runs this clinic, Dr. Yandri Subronto.

(LAUGHTER)

YANDRI SUBRONTO: Welcome to the (unintelligible) clinic.

SHAPIRO: Dr. Subronto jokes that as a straight woman, she is a minority in HIV research circles. She started doing this work when her colleagues were afraid to interact with people who had AIDS.

SUBRONTO: You feel the thing as a doctor. This is where I'm needed.

SHAPIRO: Dr. Subronto has a no-nonsense demeanor. She starts to tell us about her first AIDS patient who died. And suddenly she begins to lose her composure.

SUBRONTO: They help me to understand life. Why should I not respect them? They're the one who - yeah, they live in a hardship. Because of those problems, they don't have identity. They cannot get access to medications. They cannot get access to treatment or whatever.

SHAPIRO: When you say your patients teach you how to understand life, what do you mean?

SUBRONTO: Acceptance - it's accepting people as they are. Just embrace your life. You understand that it's all beauty. Everyone feels each other. You know, it seems like God teach me that the world is so colorful, and you just have to accept - you know, don't reject what is there. Just try to understand it.

SHAPIRO: That night, we go to a highway underpass with airplanes flying low overhead. This is where the buskers do their work. At brightly lit food stalls, college students eat fried noodles and spicy chicken stew. Out of the shadows, one of the warias we met earlier in the day steps into the light. Madame Ruly has woven palm fronds into her hair to create a headpiece that crowns her sparkly pink outfit. She sings along with the music coming out of her small makeshift boom box, and she looks beautiful.

(SOUNDBITE OF MUSIC)

MADAME RULY: (Singing in foreign language). Transcript provided by NPR, Copyright NPR.