Lyon-Martin Health Services, located in Hayes Valley, has long been known as the go-to clinic for the lesbian community. Founder Patty Robertson and a tight-knit crew of volunteers started the clinic at a time when health centers were springing up to fight against the AIDS epidemic, catering specifically to gay men.
“It came about from a study at UCSF seeing why patients were seeking care in the E.R.,” clinic director Elizabeth Sekera said. Robertson noted that lesbians were seeking emergency room treatment for health issues that could’ve been prevented, had they had access to primary care. “She found that they weren’t seeking out care, for fear of the discrimination that they were facing. So she started a little clinic in 1979, and we are still here,” said Sekera, a registered nurse who has worked at Lyon-Martin since 2008.
Lyon-Martin has been at the forefront of educating other medical clinics in lesbian and transgender health care issues, garnering national prominence in the area of LGBT health care. Today, the clinic provides care to lesbians and women of color, low-income, older, who have disabilities and are transgender.
“It was really was a natural progression,” said Sekera. “In the ‘80s and ‘90s there were definitely a lot of butch-type identities within the lesbian community, and as more options came available, some of those folks decided that as well as their butch identity they may also have a trans-identity,” Sekera said. “It was around 2002 that we decided that it made sense that if we really were a women’s clinic we should also open up to transwomen,” Sekera said.
Lyon-Martin almost closed in 2011, burdened by roughly $1 million in unpaid taxes and delinquent loans. The financial meltdown, said clinic director Dawn Harbatkin, was the result of poor management, along with changes to a City contract, and the sale of the building in which the clinic is housed.
“Money was owed to the California Primary Care Association Venture Capital Board for a bridge loan, taken out to cover when the state was paying for Medi-Cal with IOUs,” Harbatkin said. “The lack of funds were due to a number of challenges that the previous executive director and board faced, including a very difficult economy and decrease in grant funding and fundraising, poor billing infrastructure and oversight, and a lack of communication between the executive director and the board, which led to a misunderstanding of our financial status.”
According to Harbatkin, the financial challenges elicited an outpouring of community support. By 2012 Lyon-Martin staff and supporters had raised almost $600,000 to stabilize operations. Since then new management and a new board of directors have been brought on.
“Our community saved us, which was a really amazing thing,” Sekera said. “With the new board of directors the goal really became how do we make Lyon-Martin stick around forever, or as long as we are needed? I think the goal ultimately is that queer healthcare can be incorporated, to a certain extent. I think it’s always nice to see your identity reflected among staff, and just wherever you are seeking services. We don’t want to be erased completely, but this sort of care should be more incorporated into general daily practices for all providers,” Sekera said.
Earlier this year Lyon-Martin merged with HealthRIGHT360, a family of health centers and behavioral health programs that serves communities throughout California. The arrangement enabled both organizations to expand their culturally competent primary care and behavioral health services to greater numbers of women and LGBT community members.
“Within the healthcare environment right now, when we’re looking at healthcare reform and just how you survive as a small, nonprofit clinic, there’s not many answers, but one of the obvious ones is a merger,” Sekera said. The union enabled the clinic to significantly reduce its overhead costs, and focus solely on the actual delivery of that care.
“We looked down a lot of avenues, but healthRIGHT360 came out as a real ally and partner for us, and they remain very committed to us keeping our own identity. So instead of changing our name to a health 360 clinic, we are now Lyon-Martin Health Services, A Program of Healthcare 360. We are part of their family of programs,” Sekera said.
Though multiple Bay Area organizations work in and for the LGBT community, according to Sekera it remains an under-served demographic. Lyon-Martin, she said, strives to create a safe and comfortable environment, where people can expect to receive health care regardless of their gender identity.
“If someone is coming in and seeking specifically trans-heath care, maybe seeking transitional services, or perhaps just inquiring as to what that could look like for them, we can definitely provide that. But if they also have a high blood pressure, we want to help them with that too,” Sekera said.
Among the services that Lyon-Martin Healthcare Clinic provides are breast/chest health screenings and referrals, hormone therapy for gender transition, HIV and sexually transmitted disease testing and treatment, chronic disease management, vaccinations, trans-affirmative gynecologic care, family planning, and mental health counseling.
According to Sekera, transgender individuals who are seeking mental health services can have a hard time finding a therapist or a care provider that has experience working with gender identity issues. “Having a space where people know that their therapists know what they are talking about is important. Otherwise it can be very vulnerable for individuals to seek out, without knowing how a therapist, or any care provider, feels or any sort of discrimination that they might face. So it’s really just around knowing, if they do need any mental health services, they know that they can get competent services here,” Sekera said.
Lyon-Martin educates and guides other clinics and organizations, raising awareness about transgender care and providing safe and respectful practices, through Project Health. Under the project Lyon-Martin doctors and nurses visit health facilities that’re interested in providing trans-services but which may by nervous about providing that sort of care, due to lack of knowledge, training, and experience.
“So we’ll go in and we’ll do trainings starting with the front office staff, all the way back to the care providers, to get them up and running on creating systems to be able to serve their clients,” Sekera said “That really came from a lot of clients that were driving hours and hours to seek our services. And so it made a lot of sense to be like, ‘oh! Well there’s other qualified healthcare centers in your area. Why don’t we partner with them, and train them how to do this care,” Sekera said.
Lyon-Martin also sponsors a clinical rotation for nurse practitioner students. “The thing that is really amazing about that is that, yes, they learn about how to provide medical transition and talk about social transition with patients, but they also learn how to make it more about the patients’ overall health, and not only about their trans-health. So it’s really more a model of care that they’re learning here,” Sekera said.
Lyon-Martin runs Trans Line, a web platform in which health care providers can submit questions to the clinic’s staff, receiving a response within two business days.