When Tori Gleason speaks about the healthcare inequities for LGBTQ residents in rural Kansas, she’s speaking from experience.
The trans woman is a practicing chiropractor in Goodland, Kansas, and works as an advocate for LGBTQ communities across the state. In her eyes, her sexual identity is one of the least important parts about her, but the part that people seem to focus on the most.
“I’m trans,” she said. “And I’m bisexual. And I’m a chiropractor. And I’m a parent and a leader and an educator and I’m so many different things. It’s funny because some people, all they could see was the trans part… to me that is the least impressive thing.”
But that part of her is what compels her to work with and for people like her in rural communities. Statistics show, she said, that between 2.9 and 3.8 million rural people across the country are LGBTQ. Of those, 92,000 live in Kansas, she said. An estimated 12,400 Kansasans are trans.
“Because we don’t get surveyed, we don’t get to be part of some of the conversations, (and) therefore we don’t get to be in those kinds of health equity discussions that we need to be in,” she said. “That’s a big part of why I do the work that I do and why I serve on a bunch of different boards.”
Gleason currently is a graduate student at Kansas University’s School of Medicine pursuing a master’s in public health, while running her own chiropractic practice in Goodland, Kansas. Previously, Gleason held a seat on the board of the Goodland Regional Medical Center, as well as serving as a consultant to healthcare facilities and their providers on how to better understand sexual orientation and gender identity. She’s also been a board member for the Masonic Cancer Alliance/KU Cancer Center and Equality Kansas.
Helping healthcare organizations understand the importance of addressing LGBTQ health inequities, starts with representation on those organization’s boards, she said.
“In health equity work, there is a phrase which is ‘Nothing about us without us,’ which is to say, ‘Stop designing research projects, stop trying to help us without inviting us to the table,’” she said.
“You’re trying to fix our problems without asking us what our actual problems are… when we have community advisory boards on projects, when it comes to community projects, when it comes to health research, we want that engagement with them.”
In her nomination of Gleason, Ashley Wallace, coordinator for Kansas Office of Primary Care and Rural Health, said a presentation Gleason gave on the importance of representation hit home for her.
“She said, if the folks in power are not diverse from each other and representative of the groups they are looking to help make a difference within, the work isn’t getting done,” Wallace wrote in her nomination. “That means a DEI (Diversity Equity and Inclusion) board working to make things better for marginalized communities needs to include appropriate representatives on their board, not to ‘check a box,’ but to welcome and listen to the knowledge shared by experts that are the members of those communities.”
The impact of not having that representation is something Gleason learned first-hand when she tried to go back to school.
During the Covid-19 pandemic, she decided to go back to school to get her Master’s in public health in epidemiology. When she saw a barrier to healthcare for the LGBTQ community, she wanted to do research on it. But when she went to apply for grants, she found there wasn’t any baseline data for the kind of research she wanted to do. So, she switched her focus to public health in order to do that research.
Now, she said, she’s working on that research that includes the LGBTQ community.
Gleason also works as an advocate for LGBTQ patients in rural Kansas so they can access health care. Something as simple as changing forms from asking for a patient’s sex (male or female) to their gender identity can make those in the LGBTQ community feel more welcomed at a healthcare facility, and therefore more likely to seek healthcare, she said.
And while some members of rural communities may push back on things like gender identity questions, those that resist are in the minority.
“There’s an amazing team at the hospital I work at to educate front desk and back office staff on how you communicate with (a) patient,” she said. “The 86-year-old grandmother that doesn’t understand why you’re asking for (her) pronouns, we tell them, if you don’t want to declare a pronoun that’s fine, but we make it available so that people feel like they’re seen. It’s as simple as that. We all want to feel seen. We all want to feel heard.”
And the reality is, she said, that while it may feel to some like things are changing, nothing has really changed except attitudes about the LGBTQ community.
“You’re going to have people to push back because they don’t understand and because it’s not like it used to be,” she said. “We’ve always been there, that’s nothing new. We may be more visible than we used to be. But the reality is, we’ve always been here.”