Dutch doctor says group will keep sending abortion pills to US women

France24 – AFP, 16 May 2022

Rebecca Gomperts, the founder of abortion-rights groups Women on Waves and
Aid Access, is seen in Amsterdam in September 2020 Remko de Waal ANP/AFP/File

Washington (AFP) – Rebecca Gomperts, a 55-year-old Dutch physician, has spent years fighting for women's access to abortion around the world. 

Made famous by her "abortion boat," as recounted in the 2014 documentary "Vessel," she and her Women on Waves group have anchored the ship in international waters off the coasts of Poland, Spain, Mexico and other countries, offering medical abortions to women otherwise unable to obtain them. 

But it is in the United States that interest has been surging in her other organization, Aid Access, which since 2018 has provided abortion pills over the internet. 

Behind the fast-rising demand is what appears -- based on a rare leak from the US Supreme Court -- to be the imminent end of federal protection for abortion rights. Once the court makes its decision official, probably next month, some 20 states are poised to ban or severely restrict abortions. 

"We're already seeing a huge increase in requests," Gomperts told AFP, saying some people were "panicking." 

"It's not only when this takes place; it has already made people aware how vulnerable they are." 

Aid Access, based in Austria, has been working with physicians to fill requests in the 20 US states where abortion pills can be legally prescribed by telemedicine. 

For requests from the other states, Gompert's group has exploited a legal loophole to send the pills from abroad. 

Demand was strong even before word of the high court's intentions leaked out. In a little more than a year (from October 2020 to December 2021), Aid Access says it received more than 45,000 requests from the United States. 

Reasons for the requests vary: the high cost of other abortion services, the cost and difficulty of traveling to distant abortion clinics, or the impossibility of doing so due to job or child-care demands. 

After filling out a questionnaire, women are instructed on how to take the pills at home. The price is adjusted depending on their ability to pay, and the pills are mailed from a pharmacy in India. Aid Access checks in with the women afterward. 

The most vulnerable

The pills are easy to find elsewhere on the internet, usually for a few hundred dollars. But those websites, also based outside the United States, are purely commercial and provide no medical support. 

For Gomperts, who in 2020 was listed as one of the world's 100 most influential people by Time magazine, the fight for abortion rights is a matter of "social justice." 

"The biggest problem is that the women that are not literate, that cannot read and write, that have no access to internet -- the most impoverished group -- they will not be able to find these solutions," she said. 

Many of them would lack the resources to travel to a state where abortion remains legal. 

"These are the women that might be forced to give birth or that will take drastic measures to end their pregnancy."  

These pills -- mifepristone and misoprostol -- can be used in generally very safe
at-home abortions, experts say; this picture comes from the Plan C advocacy
group Elisa WELLS PLAN C/AFP/File

The certain result, Gomperts said, will be an increase in maternal mortality and morbidity. 

A safe method

According to a 2017 survey of several thousand women in the United States, 20 percent of those who had attempted an at-home abortion used the pills, 29 percent used other drugs, 38 percent used plant-based infusions and 20 percent tried physical methods (some used more than one method, so the total exceeds 100 percent). 

During recent demonstrations outside the Supreme Court, women protesters brandished a disturbing object, something that seemed an artifact from a long-ago era: metal clothes-hangers -- a symbol of highly risky abortions performed clandestinely. 

And yet, up to the 10th week of pregnancy, abortion pills are very safe, experts say. 

A demonstrator holds up a clothes hanger marked 'Never Again' during an abortion
rights rally May 3, 2022 outside the US Supreme Court Stefani Reynolds AFP/File

 Today they represent half of all abortions in the United States (in France, by way of comparison, the figure is 70 percent). And their use outside of any medical setting is a "very acceptable" option, according to the World Health Organization (WHO). 

Two drugs are used: first a dose of mifepristone is taken to block the hormones that support a pregnancy; then, 24 to 48 hours later, misoprostol is taken to induce contractions. 

Complications that might require medical help -- an excessive flow of blood, an infection or an allergic reaction -- are rare. 

So, beyond the medical aspect, the real risk to at-home abortions is legal complications. 

The NGO If/When/How has counted 60 cases in which women who allegedly self-managed abortions, or people who assisted them, were arrested, charged or sentenced between 2000 and 2020. 

The group, which says it envisions "a future when all people can self-determine their reproductive lives free from discrimination, coercion or violence," helps find legal representation for such women. 

It fears the trend toward criminalizing abortion will be greatly aggravated if the Supreme Court rules as expected. 

Such a ruling, said Gomperts, "instills fear in people, and especially in health-care providers -- and that is the biggest impact."

Free handouts of cannabis oil at Bangkok medical marijuana clinic

Yahoo – AFP, 6 January 2020

A cannabis plant mascot entertains patients at the opening of a medical marijuana
clinic in Bangkok

A medical clinic in Bangkok opened Monday offering free cannabis oil to hundreds of Thais seeking relief from cancer, insomnia and muscle pain as the government drives home the economic and health benefits of their gamble of marijuana.

Thailand in 2018 became the first country in Southeast Asia to legalise medical marijuana, although many Thais have long used the herb in traditional medicine.

The government is eager to harvest the multi-billion-dollar potential of weed, investing in tech to extract, distill and market cannabis oils.

"Today marks the beginning," Health Minister Anutin Charnvirakul said at the launch of the Bangkok clinic.

"We are fighting for the better health of Thai people and fighting for a better economy," he told AFP, standing next to a marijuana leaf mascot wearing a doctor's coat.

Patients wait to register for treatment at the opening of a medical marijuana 

clinic in Bangkok

Hundreds of mostly elderly Thais waited to receive the 5-10 mg vials of oil for muscle aches, though some came bearing more serious ailments -- like Natjuta, born with cerebral palsy and confined to a wheel chair.

Her mother Supatra Ulapatorn said cannabis oil helps her daughter to sleep better and stay calmer.

"She does not sleep well which causes me not to sleep either," said the 60-year-old. "She is more calm now, so I think it works."

Anutin, a construction tycoon-turned-minister whose Bhumjaithai party rode a pro-marijuana platform in last year's elections to become a major player in parliament, has promised an economic bonanza to his rural constituents.

He added that the drug has been "de-stigmatised" in Thailand.

Thailand hopes that legalising marijuana products for medical purposes will provide 

a boost to the economy

"If we talk about cannabis extraction, I have a sense people view it as medication rather than it being a narcotic," he said.

Still, a knot of rules govern who can grow marijuana plants and extract cannabis oil, and critics say legislation will limit opportunities for small farmers and likely benefit big agro-industrial firms.

Medical research has shown that cannabis oil can help ease the pain of patients suffering from conditions such as multiple sclerosis and epilepsy, but the science is out on its impact on other serious diseases including different forms of cancers.

Recreational use and trade of marijuana is still illegal and could land anyone caught with a joint with severe penalties of up to 10 years in prison.

Babies born on floor as Zimbabwe's health system totters

Yahoo – AFP, Ish MAFUNDIKWA, with Zinyange AUNTONY in Bulawayo, December 4, 2019

Where a child is born: Esther Gwena, 69, who acts as a midwife but has no
training, lays down sheets in her rundown apartment -- a makeshift maternity
unit (AFP Photo/Jekesai NJIKIZANA)

Harare (AFP) - The floor is dusty, the walls filthy and the furniture decrepit, but for two weeks last month a tiny flat in a Harare township was transformed into a maternity clinic where scores of babies were born.

Its owner, 69-year-old Esther Gwena, says she helped to deliver 250 infants as Zimbabwe's health sector tottered -- a feat that earned comparisons to Florence Nightingale, the pioneer of modern nursing.

Hundreds of junior medics at state hospitals began a strike three months ago because their salaries -- less than $200 a month -- are not enough to live on in a country gripped by 500 percent inflation.

Nurses are only working two days a week.

Those who can't afford private care -- the majority of the 14 million people reeling under an economic crisis compounded by acute food shortages -- suffer at home or seek help from people like Gwena.

Senior doctors, in a letter last week, said state hospitals had become a "death trap" and warned of a "slow genocide".

Gwena, a widow and member of the local Apostolic Faith sect, is a self-taught midwife.

When the health services strike peaked last month, she came to the rescue.

In need: Monica Bepu, 33, heavily pregnant with her second 

child, sits on a bench in the passage outside Esther Gwena's 

two-room flat in Harare (AFP Photo/Jekesai NJIKIZANA)

'I had to do something'

"A man came to me and said there were two women in advanced labour at (a nearby clinic) but the place was closed because the nurses were on strike," she told AFP in her two-room flat in Mbare township.

She rushed there and found that one of the women had a baby which had died.

"I took the other one to my place, where I helped her. The baby survived. From that time, I knew I had to do something," she said.

Word that she was helping deliver babies for free spread quickly.

The state-owned television ZBC described her as "a modern Zimbabwean version of Florence Nightingale" and First Lady Auxillia Mnangagwa visited Gwena and donated food, detergents and blankets.

A funeral services company chipped in with a mobile water tank and pitched a tent outside to serve as a waiting room for women before they went into advanced labour.

"I helped to deliver 250 babies ... (they) are alive and kicking and at home with their mothers," Gwena said.

Two weeks later, the government asked her to stop after a nearby maternity clinic reopened.

Winnie Denhere, 35, cradled her two-day-old baby boy outside the clinic, where she had taken him for an immunisation injection.

"Everything went very well, she didn't ask us for money," she said, speaking of Gwena, who brought her child into the world.

A moment for prayer: Gwena belongs to an Apostolic religious sect where she 

says she got her calling to take up midwifery. She says she has delivered as 

many as 250 children (AFP Photo/Jekesai NJIKIZANA)

'People dying'

But while some laud Gwena as a selfless do-gooder, doctors worry that she exposed herself, the mothers, the babies to infection.

"We need to do something about our facilities so no one goes to her," Harare's director of medical services Prosper Chonzi, said.

Medicines have been in short supply and broken machines go unrepaired.

The government has fired 448 junior doctors for striking.

Senior doctors last week also stopped work in protest over the sacking of junior colleagues. Dozens marched in Harare on Monday.

"People dying has become the order of the day in our hospitals," said the vice-president of the Senior Hospital Doctors Association Raphael Magota.

He told AFP machines were breaking down and that intensive care units were only able to treat two or three people "due to lack of equipment".

A senior doctor, speaking on condition of anonymity, said the situation has become untenable.

Gwena collects water in a bucket as she prepares for a long day (AFP Photo/

Jekesai NJIKIZANA)

"There is no public health in Zimbabwe at the moment; everything has come to a standstill," he said.

Even the scarce equipment is often not right.

"One needs gloves that fit just right when performing delicate operations, but we get old gloves that are too big," said another doctor.

A UN special rapporteur on food security, Hilal Elver, last week spoke of "disturbing information" that public hospitals had exhausted food stocks, forcing them to seek humanitarian aid and that medical equipment in some cases was "no longer operational".

In the second largest city of Bulawayo, Zimbabweans living abroad are helping in a small way by crowdfunding and sending money back home to offer health care for the vulnerable.

One such initiative is Citizwean Clinic, which opened its doors last month and attended to hundreds of patients in the first five days -- providing free consultation and drugs.

"We go to the hospital these days it's bad, there are no doctors. We heard that there were doctors here," said hypertensive patient Elina Dzingire, 63.

"We've really been helped here," she told AFP from the clinic in the city's Cowdray Park township.

Health Minister Obadiah Moyo admitted the situation in hospitals is constrained but says the government will soon advertise the posts left vacant by the sacked doctors.

Health minister presses on with abortion pill plans, despite Christian opposition

DutchNews, June 27, 2016   

 Photo: Regering.nl 

A pill which triggers miscarriage in the very early stages of pregnancy should be available via family doctors, health minister Edith Schippers has told parliament. 

The minister plans to introduce legislation which will allow GPs to prescribe the pill at the end of the year, according to the Volkskrant on Monday. The pill, named Sunmedabon, is currently only available in hospitals and abortion clinics. 

Women are often more comfortable approaching their own doctor so this will make it easier for them to request the pill early, Schippers said in her briefing to parliament. ‘In addition, family doctors play an important role in prescribing contraception, so preventing further unwanted pregnancies after an abortion,’ she said. 

The pill should have been made available via family doctors last year but MPs from the small Christian parties have so far refused to back the measure and their support is crucial in the upper house of parliament. The anti-immigration PVV, the Socialist Party and the Christian Democrats also have their doubts about the plan, the Volkskrant said. 

Limits

Although the pill can be used up to nine weeks into a pregnancy, experts say doctors should be able limited to prescribing the pill up to six weeks and two days – or when women are two weeks late with their period. 

Doctors will have to report all prescriptions to the health ministry inspectorate. 

There are some 30,300 abortions in the Netherlands a year, and over half took place in the first seven weeks of pregnancy. The Netherlands has one of the lowest abortion rates in the world, at 8.5 per 1,000 women.

Sierra Leone's first Ebola-hit community reconsiders its traditions

Yahoo –AFP, Jennifer O'Mahony, May 12, 2016

Bendu Alliou sits with her infant daughter outside a hospital in Kailahun, eastern
Sierra Leone (AFP Photo/Marco Longari)

Kailahun (Sierra Leone) (AFP) - Violently coughing up blood, the woman was close to collapse when brought to Kailahun hospital in eastern Sierra Leone from her village close to the Guinean border.

For nursing staff, the spectre of the killer Ebola virus had returned.

"My staff went into PTSD (post-traumatic stress disorder)," said Samuel Massaquoi, medical superintendent of the hospital. "People said that if she came from near Guinea she had Ebola."

Hard hit by the Ebola virus the capacity

of the small hospital in Kailahun, Sierra

Leone, has been stretched over the 

course of the epidemic (AFP Photo/

Marco Longari)

Urging calm, the doctor immediately implemented the screening measures used at the outbreak's height, when Ebola cases arrived on a daily basis.

That was one month ago -- the patient was instead diagnosed with advanced tuberculosis -- but it is a clear example of how the the fear of Ebola still grips the heart of this community.

The district was the first in the country to record cases back in May 2014 after the initial outbreak in southern Guinea.

The virus killed around 230 people in Kailahun but its impact did not end when the area was declared Ebola-free a year ago: residents say entrenched attitudes to health and tradition have changed significantly.

"The outbreak started here. Every patient at that time was considered a suspected case," Massaquoi said, standing metres from the now empty triage building, where health workers in hazmat suits once worked in scenes resembling a horror film.

His hospital received a real boost, he said, with extra funding for equipment from the United Nations Population Fund (UNFPA), and targeted training for staff from Britain's Liverpool School of Tropical Medicine.

"It was not like this two years back. It has improved significantly," the general practitioner said. That was reflected by an uptick in the number of patients admitted post-Ebola, many of whom previously viewed the hospital as a place of death, not healing.

Traditions upended

Kailahun's first spate of cases is believed to have originated from the funeral of a traditional healer in a village close to where the Guinea, Liberia and Sierra Leone borders meet.

Ebola sufferers were crossing to see her from Guinea before she too succumbed to the virus. Many west Africans believed Ebola was a curse, and turned to their local witchdoctor rather than attempt the long distances and meet the elevated costs of government health facilities.

"Ebola came, but it came with lessons. Most of them who treated Ebola patients died," Massaquoi said.

"It was only when the powerful healers started dying that people started believing this is real. We lost quite a good amount of them," he said, with many no longer as convinced of their invincibility.

Health workers in Sierra Leone are battling a teenage pregnancy epidemic that 

peaked when the Ebola crisis was at its height late in 2014 (AFP Photo/Marco Longari)

The Red Cross sought to engage the healers in the fight against the virus, persuading some to advise visitors that they could not cure Ebola, and pointing them to dedicated treatment centres.

Prevention in the form of better hygiene is highly visible in the proliferation of hand-washing stations at the string of villages that dot this rural district.

Another influential group has altered its activities post-Ebola in Kailahun: the female secret societies that dominate rural life in this part of west Africa, whose primary role is to initiate girls into womanhood.

Traditionally they would carry out female genital mutilation (FGM), a practice performed on 90 percent of girls in Sierra Leone, according to UNICEF.

But in 19-year-old Baindu Alie's village, they have stopped.

"(Families) are afraid, so there is less trust in the societies," she said.

The girls' loss of blood during the excision, usually performed with a razor, was now known to be a possible transmission point for Ebola, medical professionals in the community confirmed to AFP.

Survivor communities

Naima Morie, 20, lives down the road from the district hospital and is an Ebola survivor. Three of her family members were not so lucky, including a sister who died in her arms.

Morie had symptoms of fever, headache, vomiting and diarrhoea when she arrived at the Ebola treatment unit (ETU), and was driven there semi-conscious.

When she came round, "my whole system was very hot, boiling hot inside," she told AFP.

Morie made a full recovery, and in February gave birth to a baby boy named Joseph.

Health workers carry the body of a suspected Ebola victim for burial at a cemetery

in Freetown December 21, 2014. Reuters/Baz Ratner/File Photo

"When I was out of the ETU and went back home they were all rejoicing," she said, describing the reaction back in her village. "Now babies that are sick, they visit the hospital after seeing me survive."

Not everyone is so accepting. The stigma of Ebola remains a problem, and survivors have held protests in recent months against the government, claiming free follow-up treatment and scholarships for their children have not been delivered as promised.

According to Doctors Without Borders (MSF) there are more than 4,000 Ebola survivors living in Sierra Leone, and the virus killed many of country's already limited number of health workers.

Ebola is one in a long list of epidemics that have ravaged this community, each leaving its own generation of survivors and broken families.

Huge roadside signs in the district now proclaim: "It's not the end for Ebola survivors; it's the end for stigma", alongside more faded billboards that read "An HIV test saved my life".

Health workers assist a patient suspected of having Ebola on their way to a

 treatment centre run by the French Red Cross in Patrice, Guinea, on

November 21, 2014 (AFP Photo/Kenzo Tribouillard)

Related Articles:

WHO declares Ebola outbreak over

"Revelations of Darkness" - Oct 1, 2014 (Kryon Channelling by Lee Carroll) - (Text version)

“ .. The Role of Gaia in Human Consciousness

One of those times might be frightening for you to know about, since it was a full cooperation with Gaia for your termination, and a pandemic almost wiped humanity off the map. A pandemic! Now, you say, "What has that got to do with Human consciousness, Kryon?" Pay attention, dear ones, because this is the day where the teaching was given by my partner, and he put together the Nine Human Attributes. One of the attribute sets included three Gaia attributes and one of them was the consciousness of the planet. Gaia is related to Human consciousness!

Are you starting to connect the dots? You are connected to this planet in a profound and spiritual way. As goes humanity goes the planet's consciousness. Gaia, Mother Nature, whatever you want to call it, cooperates with Human consciousness. If you spend 1,000 years killing each other, then Gaia will do its best to cooperate with your desires! Gaia will look at Human consciousness and try to help with what you have shown you like to do! Did you know this role of Gaia with you? It's a partner with you, fast tracking what you give to it. You may wish to review what the indigenous of the planet still understand. Gaia is a partner!

Pandemic: Don't you find it odd that in the last 50 years, when you have a population of seven billion Human Beings, with up to 2,000 airplanes in the air at any given moment, going between almost every conceivable place, that there has not been a pandemic in your lifetime? There have been five starts of potential pandemics over the last 20 years, yet none became serious. Did any of you put this together? Dear ones, when the world was far less populated a few hundred years ago, with no mass travel to spread a virus, there were still millions wiped out by a pandemic. With the increased population and mass travel, there is far more danger today than before. It doesn't make sense, does it? What happened to stop it?

When you know humanity's relationship to Gaia, it makes sense. Gaia is a life-force that is your partner, watching you change the balance of light and dark and reflecting what Humans want. It has polarity, too! Perhaps it's time to start your meditations with thanking your planet Earth for supporting you in the spirituality of your Akash, for always being with you, a life-force that is always present. The ancients started their ceremonies in that way. Have you forgotten?

Ebola

Now, I've just set the stage for the next subject, haven't I? Ebola. Are you afraid yet? Gaia is a life-force that is a part of Human consciousness. My partner put it on the screen today so you could see the connections [during the lecture series]. Now it's time to connect the dots. Dear one, Gaia is in the battle, too, for here comes something scary that you haven't had in your lifetime and you're afraid of it - the potential of a pandemic on the planet.

There's a very famous film that has some dialogue that my partner will quote. Some of you will know it and some of you won't, but here it is: "Have a little fire, scarecrow?" What are you afraid of? Darkness? Gaia is in the battle with you and is actively pursuing solutions through light. The energy of the planet is with you in this fight! The ebola virus is a shock and a surprise. It is propelled by ignorance and fear, so it can flourish. Look at where it started and look at how it gets its ability to continue. It expands its fear and power easily with those who believe it's a curse instead of those who understand the science.

Villages are filled with those who refuse to leave their family members because they believe the disease is a curse! FEAR! Instead of understanding that they should be in isolation from the virus, the family dies together through ignorance and fear. This represents how darkness works. Are you going to become afraid also? Dear ones, ebola will be conquered. Know this and be at peace. Pray for light for those in the villages who are afraid, that they can know more about how to keep the spread of this disease and live to see their families. .”

Erasmus hospital trains doctors to use botox, cosmetic fillers

DutchNews, February 29, 2016

Photo: Depositphotos.com 

Erasmus University’s teaching hospital is to train dermatologists to perform cosmetic treatments such as the use of botox and fillers, the Volkskrant reports on Monday. 

Dermatology professor Tama Nijsten told the paper that there is a major shortage of places where cosmetic dermatologists can develop their skills. ‘Everyone does a bit of this and that and after a couple of workshops they set up in business,’ she said. ‘That is why a proper training centre is needed.’ 

‘Society is moving in this direction,’ Nijsten said. ‘I think you have to be careful not to impose your own norms and values on the rest of the country. [Cosmetic treatments] happen and if they happen you should make sure they are done properly.’ 

Taxpayers’ cash 

The six-month Erasmus programme has been criticised by some professionals. ‘I think it is inappropriate,’ Radboud dermatology professor Peter van Kerkhof told the paper. ‘A university teaching hospital should be about making people better… Should we be using taxpayers’ money to train people to carry out beauty treatments?’ 

It is not the first time that academic hospitals have taken a step into the world of private medicine. Groningen University opened a clinic offering cosmetic surgery such as breast enlargements in 2010, the Volkskrant points out. 

The Erasmus programme is being run together with dermatologist Peter Velthuis who runs a string of commercial cosmetic surgery clinics.

Black market hormones one of many hurdles for Thai transgenders

Yahoo – AFP, Delphine Thouvenot and Ju Apilaporn, 21 February 2016

Thai transgender Chalit Pongpitakwiset, who is undergoing a hormone treatment to

change into a man, seen at his home in Bangkok (AFP Photo/Christophe Archambault)

Bangkok (AFP) - Chalit Pongpitakwiset has always felt like a man. Now the 25-year-old wants everyone else to see it too.

But unlike most transgender people in Asia, who are left to self-administer hormone supplements, Chalit is being helped by a pioneering clinic.

"I am in the hands of doctors," said Chalit, who was born female, but identifies as a man.

"I'm not doing it by myself, so it isn't dangerous," the software company worker said.

Several days after receiving his first testosterone injection, Chalit returned to get a blood test at Tangerine, the new clinic inside a Red Cross centre in downtown Bangkok.

The centre is a pilot programme that organisers hope could be replicated across Asia.

Its location is no accident -- Thailand has a large and visible transgender population and is one of the world's top destinations for sex-reassignment surgery.

Thai transgender Chalit Pongpitakwiset, who is undergoing a hormone treatment 

to change into a man, stretches at a park outside his home in Bangkok (AFP Photo/

Christophe Archambault)

But just like elsewhere in Asia-Pacific, a region home to more than nine million transgender people according UN estimates, long-term care for patients is patchy at best.

The clinic is a rare place providing follow-up treatment, both physical and mental, for those who have undergone sex-reassignment surgeries, procedures where patients are often at risk of infection.

"Most of the centres where the surgery is performed only provide short-term post-surgical care," explained Nittaya Phanuphak, the head doctor at Tangerine.

Unregulated hormones

In Thailand, hormones are commonly purchased on the Internet or in local pharmacies, and administered on advice gleaned from friends or web forums.

Recent university graduate Benyapon Chimsud, who was born a man but identifies as female, said she has been taking hormones for two years.

"I have been taking hormones by myself for two years, I consult with my friends," to determine the proper doses of contraceptive pills, she explains.

Thai transgender Chalit Pongpitakwiset (L), who is undergoing a hormone treatment 

to change into a man, pictured with his girlfriend as they wait for a boat at a pier 

in Bangkok (AFP Photo/Christophe Archambault)

She also gets monthly black market oestrogen injections at a rudimentary neighbourhood clinic.

That leaves her cut off from regulated healthcare, prone to receiving inaccurate medical advice and at risk of over-consuming hormones in a rush to see rapid results.

Chalit, on the other hand, met with a psychiatrist several times before receiving his first injection to prepare for the changes to his body.

"The psychiatrist asked me how long I've wanted to be a man, and whether my friends and other people around me would accept it if I changed," Chalit told AFP.

Now he is getting hormone injections every two weeks.

"The hormones will stop my periods, change my voice, give me a beard and moustache, and develop my muscles," he said. "All things that will help me no longer be a woman anymore."

That should insulate him from the dangers of taking the wrong doses of hormones which experts say can lead to liver and cardiovascular problems. HIV is also always a risk if needles are shared.

Rights groups like the Asia-Pacific Transgender Network (APTN) say this public health issue is largely neglected by the mainstream medical community.

"There are no official guidelines on the administration and monitoring of hormones among trans people," said Joe Wong of the Asia-Pacific Transgender Network (APTN).

Discrimination still commonplace

Although Thailand can appear tolerant on transgender issues from the outside, many segments of society remain deeply conservative.

Thai transgender Chalit Pongpitakwiset (L), who is undergoing a hormone treatment

 to change into a man, chats with his girlfriend at a playground outside their home 

in Bangkok (AFP Photo/Christophe Archambault)

The kingdom's transgenders, often men who become women and are known colloquially as "ladyboys," are over-represented in the entertainment and sex industries.

Despite high levels of education, many struggle to secure full-time work or prominent positions in the workplace.

Same sex marriage is also still not legally recognised, and up until 2012, transgenders were considered mentally ill by the army.

Tangerine doctor Nittaya says discrimination remains widespread in medical centres, making access to proper healthcare a challenge for many transgenders.

But Chalit is one of a small number of people to have been made aware of the dangers and commitment that comes with long-term hormonal therapy.

Several days after starting his treatment, Chalit, who is considering an operation, got a tattoo of the testosterone molecule on his arm.

"I have to take hormones for the rest of my life," he said. "This tattoo will also stay with me for the rest of my life."