Mimi Rivard is Everybody’s Nurse
Equitas is expanding gender-affirming care in hopes of becoming a Midwestern model.
Visits to the doctor used to cause trepidation for Jae Washburn. Perhaps there would be an unwanted touch, uncomfortable questions or physicians using incorrect pronouns. But the biggest problem for Washburn, who is transgender and uses they/them pronouns, was that practitioners punted when trans health care came up. Doctors seemed empathetic, but they declined to provide treatment or referrals. “They couldn’t help me,” Washburn says. “And they weren’t afraid to say that.”
Washburn wanted hormone-replacement therapy. So did Hannah Schwab. She’d tried to get it at a Columbus-area clinic, but it wasn’t open regularly enough to offer medications quickly, a priority for her. Transgender people seeking such treatments—especially those on Medicaid or without insurance—often struggle to access care or face hurdles like pretreatment psychological evaluations. Both Schwab and Washburn eventually found the gender-affirming care program at Equitas Health, a statewide nonprofit provider based in Columbus.
Gender-affirming care typically involves hormone therapy, and sometimes surgery, but its foundation lies in simply treating someone’s physical, mental, social and emotional well-being in a way that supports their gender identity. Early on at Equitas, the gender-affirming program consisted of just one woman—nurse practitioner Mimi Rivard. She started trans health services there in 2016, and people flooded in. They drove from all over and slept in the parking lot, says chief medical officer Dr. Chad Braun.
Many came due to their trouble accessing treatment elsewhere, but they also came for Rivard, who’d started her career during the AIDS epidemic and spent two decades working with HIV-positive patients, many of them in the trans community. Her gender-affirming model draws on her experience in palliative and end-of-life care, when time is short to get to know someone. She says she brings that same urgency to all patient interactions. “We like to know about their family. We like to know about their life, what has worked for them in the past—who they are, really, as a person.”
Rivard’s program emphasizes establishing personal relationships and then prioritizing patients’ goals. Teagan Vaughn, an Equitas clinical pharmacist, says those relationships are critical because many transgender people don’t have supporters outside of health care.
Or, traditionally, within it. Rivard doesn’t mince words about the medical field’s mistreatment of trans people—“neglectful malevolence,” she calls it—and many of her incoming patients had undiagnosed diabetes, high cholesterol, hypertension and HIV when she started the gender-affirming program. Their health has since improved drastically. For example, in 2020, Equitas reported that 96 percent of its trans patients had healthy blood pressure, compared to 68 percent within the American population.
Rivard has trained 10 other Equitas providers, and she became the nonprofit’s systemwide director of gender-affirming care last November. Her goal is to have every physician and nurse practitioner—more than 20 in all—practicing it by the end of 2021. Vaughn, who’s partnering in the effort, says their larger ambition is to train external providers and elevate trans care across the Midwest.
Equitas aims for more outcomes like that of Washburn, who came just for hormones but received “life-changing” care from Rivard. A few years ago, Washburn went to a transgender symposium at Ohio State to hear her speak. Filled with excitement, Washburn leaned over partway through the talk and said to another attendee, “You know, Mimi’s my nurse.” The person replied, “Oh girl, Mimi’s everybody’s nurse.”