By Madeleine Monson-Rosen
“I’m not a civilian,” Paula Neira says. To demonstrate, she recites the oath of office she took when she received her commission as a U.S. Naval officer. That oath was to the Constitution of the United States, which all officers vow “to support and defend.” Ironically, Neira has been a civilian since she left the U.S. Navy in 1991; yet that oath, and her commitment to serving her country, took her away from the military and brought her to The Johns Hopkins Hospital in Baltimore and to the Center for Transgender Health. Neira — a nurse and lawyer as well as a veteran — will lead the Center, opening this summer.
Under her leadership, the Center for Transgender Health will serve transgender patients, teach health professionals and research health concerns facing the transgender community. And this last point has some urgency. Neira notes that there is still a lot unknown for transgender patients related to gender-affirming care as well as to general health. “You know — what is the health effect of testosterone dosage? What is the most effective dose? There’s all kinds of pieces of information that we want to know so at an academic medical center we can be involved in doing that research,” she said.
Neira will lead and help train a cohort of doctors, nurses and medical students to challenge the bigotries and prejudices she believes still afflict medicine. “We’re going to have providers who train here at Hopkins and go all over the world,” she said. She will also lead Hopkins back into the work of gender affirming surgeries, which it offered from 1965 to 1979. “Right now, in the state of Maryland today there is no surgeon doing bottom [genital] surgery. We will be. So that’s an immediate need. That’s an immediate need for the community.”
Currently, patients seeking genital surgeries sometimes have to wait years, according to Neira. And plastic surgeons and urologists in private practice aren’t equipped to offer transgender patients comprehensive health care before, during and after transition. Transgender patients also often experience difficulties in health care related to a lack of cultural competence among health professionals. Neira, who has most recently been a nurse educator at Johns Hopkins, explains, “If you misgender your patient and are disrespectful to them, you’re not going to get to the higher-level medicine or the higher-level nursing that you want to get to.”
Neira is fighting to change that. She’s been fighting for a long time.
She graduated from the U.S. Naval academy in 1985 specializing in Surface Warfare and then served in Desert Storm. But by the early 1990s, Neira was fighting another battle. Like many LGBT people in the military, she was an extremely high performer; her senior officers saw her potential and recommended her for flight school, a lifelong dream. “But by the time I actually got to flight school, I realized that flying was not going to solve this internal battle. And if I actually got through flight school and got my wings that would have committed me to a full career in the Navy and would have meant having to stay in the closet and fighting this internal battle. I didn’t know if I had the energy to do it for another 14 years.” So she walked away from the Navy, and she began her transition.
After leaving the Navy, she said her first two job offers were rescinded when she revealed she was a transgender woman. So she chose nursing school on a Veterans Affairs’ (VA) scholarship and spent some years working for the VA before shifting to trauma nursing, which she learned at a hospital in rural Kansas.
Seeking an intellectual challenge, she then went to law school. While on the law review, Neira wrote about the impact of the “Don’t ask, don’t tell” policy on the Navy. That work led her to OutServe-SLDN (Servicemembers Legal Defense Network), a legal nonprofit working to fight “Don’t ask, don’t tell” and to protect LGBT servicemembers, as a staff attorney. “What victory looked like in 2001 was keeping a servicemember in the service one day longer,” said Neira. “Getting someone who was being discharged an honorable discharge rather than a general discharge because that’s what the command wanted… that was victory.”
The repeal of “Don’t ask, don’t tell” was, of course, a triumph in the fight for LGBT equality in the military. “That was getting ashore at Normandy,” Neira says, but it didn’t affect the military’s policy on transgender service. That change didn’t take place until 2016. Transgender service members may now serve openly, and they can’t be discharged on the basis of their gender identity. But the battle is still not over. “We’re still talking about it in very binary terms,” Neira notes. “The issue of nonbinary people in the military was a bridge too far.”
Neira doesn’t see her efforts to change the military as separate from her military oath. “When you see something that’s wrong. When you see the injustice of how the equal protections of the Constitution aren’t applied to people. When you swear that you’re going to support and defend the Constitution, that’s what it means,” she said. “It’s not wielding a sword all the time. It’s making sure that the words and the values actually apply.”
At the time Neira took her oath, those words might not have actually applied to her and she gave up her Naval career because of it — the hardest thing she said she’s ever done and something she still regrets, “When I first started with SLDN I had the feeling that, ‘Hey! If we get these rules changed fast enough, and I’m still young enough, I can go back.’” And although Neira gets emotional when she talks about her service, she says she doesn’t have bitterness toward the military or the government for being slow to evolve. “I’m angry about the practical things. … I never had the opportunity for command. I don’t have my retirement. Those are the practical, ego things. Yeah, I’m angry about that. But what I did get the chance to do was something that had a much bigger impact than whether Paula Neira got to be a captain and had more medals and can go play golf today.”
She has come a long way from her Normandy, but Neira still sees her victories in the lives of individuals, just as she did when she was fighting against “Don’t ask, don’t tell.”
“Every day that we can help connect one person to the care that they need, that’s a victory. And then some day, the bigger victory will happen.” What is that bigger victory? Getting people “access to the care that they need to be who they are, access to the care that’s going to allow them to be able to perform and live their life at the highest level.”
“Ever forward” is her personal motto for the Center, toward more tolerance, more freedom and more acceptance.
Madeleine Monson-Rosen is a writer and college professor in Baltimore.
Amy Deputy, cover image, runs a photography business specializing in modern portraits, candid documentary photography and wedding photojournalism. Prior to that, she was a photojournalist and picture editor at The Baltimore Sun.
Copyright © 500 Pens. May 2017.