Alex Keuroghlian and Kevin Kapila are world travelers. Authorities on LGBTQ medical and mental health care, the Harvard Medical School and Fenway Health psychiatrists have circled the globe providing education and training workshops in countries such as Malawi, Nigeria and Uganda.
But their trip to South Korea in October was different. Their journey to Camp Humphreys in Pyeongtaek, formally known as U.S. Army Garrison-Humphreys and the United States’ largest overseas military base, came at the invitation of base medical commanders.
“It was a tremendous learning event for our providers and medical personnel,” said Col. Andrew Landers, commander of Brian D. Allgood Army Community Hospital at the base. “We are a learning organization, and we appreciate any time we can have experts in their respective fields come and educate us all.”
Humphreys houses nearly 30,000 troops, their family members and contractors. Home to the most active U.S. Army airfield in Asia and to the U.S. 2nd Infantry Division, the base covers 3,400 acres—about the area of central Washington, D.C. It has four schools, five churches and one hospital, which is where Keuroghlian and Kapila enter the picture.
“We put together a longitudinal, three-day training and implementation program that focused on the concepts and terminology related to sexual orientation and gender identity, how stigma is related to health disparities in this population, and a deep dive into best clinical practices” said Keuroghlian, HMS assistant professor of psychiatry, part-time, at Massachusetts General Hospital.
Kapila, medical director of behavioral health at Fenway Health, and Keuroghlian, presented health care providers at the base with best practices for building an inclusive, affirming environment that promotes effective communication and care for LGBTQ patients. They also recommended the creation of a policy framework staff and clients can follow.
“I was very heartened by how progressive and thoughtful the operations on the ground are, compared to the news stories we hear every once in a while about the climate within the military for gender and sexual minority people,” said Keuroghlian.
“Over the three days, I didn’t encounter any resistance among the staff to be trained,” Keuroghlian said. “There was an openness, a curiosity, a humility and an eagerness to build an inclusive and affirming environment for all of the military who serve there.”
Kapila said at first he felt he was in uncharted territory, because military bases have their own unique culture. Initially, he wasn’t sure how well the training session would be received, but he was impressed with the honesty and curiosity of the staffers he taught, which he found extremely gratifying.
“I felt with this audience there was a real hunger to hear what we were talking about and to ask really honest questions,” he said. “It just blew me away, the richness of the conversations.”
A focus of the three-day workshop was on LGBTQ intimate partner violence and trauma-informed care, as well as the integration of mental health services into primary care.
The HMS doctors spent the first third of the training time providing a baseline primer on LGBTQ health care, and they focused the remainder of the sessions on domestic violence issues by providing lectures, case scenarios and small group activities. Kapila said he focused on medical and behavioral health issues—how to do medical exams and what signs to look for in cases of domestic abuse.
“They are very committed to improvements within an environment that, you know, has not always allowed LGBTQ+ people to serve openly,” said Keuroghlian.
“Because it can go against your standing in the military ... people are very reluctant to talk openly about it,” said Kapila, who is also HMS instructor in medicine and an internist and psychiatrist at Beth Israel Deaconess Medical Center. “Not only the person who may be perpetuating the violence, who wants to get help, but also the survivor, because this is their partner who could lose their job, their income.”
Both Kapila and Keuroghlian were impressed with a Camp Humphreys program that allows personnel to report incidences of LGBTQ domestic violence privately, without jeopardizing their military status or livelihoods. Some of the health care personnel attending the workshop also suggested that more LGBTQ domestic violence training might be useful for military police.
Keuroghlian said his most memorable experience at the workshops was meeting a lesbian health care provider stationed at Humphreys. She has been in the military for five years, and both she and her wife serve at the base.
“She never thought she would have an opportunity like this, to so boldly be able to share her own experience with her colleagues and engage them in a process of optimizing care of her own community,” said Keuroghlian. “I was very moved by that and very grateful that we were able to create that moment and opportunity for her.”
“People struggle with how to be sensitive to someone’s needs when [a patient] finally wants to come out,” Kapila said. He and Keuroghlian provided clinical examples and asked staffers how they might respond. They also polled the providers on reactions to difficult work situations and offered suggestions on how staff can cope with challenges, so that they can continue to provide the most compassionate care.
“For me, this is probably one of the most gratifying trainings I’ve done,” said Kapila.
A clinical psychiatrist, educator and researcher, Keuroghlian’s practice focuses on sexual and gender minority health. He directs two federally funded centers geared toward LGBTQ health education as well as the Mass General Psychiatry Gender Identity Program. He is also director of education and training programs at The Fenway Institute and course director for HMS’ fourth-year clerkship course on caring for patients with diverse sexual orientations and gender identities.
Keuroghlian said HMS and Fenway are leading the way when it comes to providing care for groups that have been marginalized when seeking health care by providing national continuing education conferences that have attracted participants from 40 states and multiple foreign countries and working with 125 health care centers across the country, training them in transgender health.
“It’s an exciting opportunity to pioneer and lead [this effort] nationally,” said Keuroghlian.
With the Camp Humphreys training well received, Keuroghlian said he hopes the U.S. Department of the Defense will consider scaling the program out to other U.S. bases.