Trans women experience multiple impacts from air pollution. Many live near pollution sources and do not have good coping skills.
The thermometer showed 33 degrees Celsius. The heat enveloped the 2×2 square meter rental room in North Jakarta. The occupant, Lily, not her real name, flushes and fans her face with her hand. She is getting ready to busk.
She walks to a small cupboard in the corner of the room and retrieves her make-up kit. She expertly applies powder to her face, draws her eyebrows, puts on fake eyelashes, and applies bright red lipstick to her lips.
Once her make-up was done, Lily styles her hair into a simple bun and pins it up. “I do this every day,” Lily told Konde when we met her on January 10, 2023.
Lily is the 13th of 16 children. She is a trans woman from Bogor District who moved to Jakarta in 2013 to earn a living. Lily busks from noon until 5.00 pm. When her singing income is not enough, she continues to make money as a sex worker in the evenings.
“There have been times when I spent time busking all day long, spent money paying fares, but returned home with no money at all,” she said.
Her busking earns her IDR 1.7 million monthly. She uses Rp 500,000 to pay for her room, and sends Rp500,000 to Rp 600,000 to her mother in her home village. The rest is spent on food, work expenses, a mini speaker, soap, and makeup.
This lack of income is why Lily often borrows money from fellow trans women. Lily is trapped in a vicious cycle.
She takes the train from Duri station and arrives in Tangerang some 30 minutes later around 2:49 pm.
“It’s really hot today. First I will wait for Ashar to finish, then I will busk and dance,” Lily told Konde.com. She adds that it would be improper to sing or dance while people are praying
The hot weather made sweat run down her face and she has to pat her face with a tissue to keep her make-up from smudging. She sometimes sounds short of breath.
“Now I have shortness of breath. When I breathe I tend to sound like someone snoring,” said Lily.
She says that the thick air pollution sometimes made her unable to work. Lily also suffers from hypertension. “I have a disease that must be checked once a month. I have high blood pressure and must take medicine every day. I have vertigo and often have sore throats,” she said.
Not just resting, she also visits a doctor to check her body’s condition. She has to take several types of medicine, such as Paracetamol caplets 500 mg, Dexamethasone tablets 0.5 mg, Amlodipine Besilate tablets 10 mg, and Metformin HCL 500 mg.
The Food and Drug Supervisory Agency (BPOM) website, shows that Paracetamol is a drug commonly consumed to relieve fever, mild pain, and headaches, including aches and flu. Dexamethasone is for allergies, arthritis, and autoimmune diseases, Amlodipine Besilate is for hypertension, and Metformin HCI is an anti-diabetic drug that regulates blood sugar levels.
Before Lily got her Health and Social Security Card (BPJS Kesehatan) in 2021, Lily had to spend Rp110,000 monthly on treatment and hypertension medication. “After having BPJS, I only need to pay transportation costs when traveling for a check-up,” she said.
Another trans woman, Lina – also not her real name – is also in a similar situation. She escaped to the capital after being traumatized by an incident in her home province of Aceh. This is where Islamic Sharia laws are partially in force.
In 2014, Lina, who worked as a sex worker, became the victim of violence. Her rented room where she exercised her profession was raided by unknown persons. Lina was dragged out of the house and paraded to a village post near her home.
“Like a sea of people,” recalled Lina, who admitted that she could not forget this incident when she met Konde in November 24, 2022.
“I was beaten, grabbed, shaved. They paraded me naked and threw sewage water at me,” she said of her ordeal as she was paraded around. She was later forced to sign a statement that she would not repeat her deed or risk public flogging under the Qanun laws.
Migrating to Jakarta, Indonesia’s capital, never crossed Lina’s mind.
The most significant change she felt was in her health. Once in Jakarta, Lina started having shortness of breath every time she worked. She said Jakarta’s air pollution also made it difficult to earn more. While working, she wears a mask to protect herself and reduce coughing. But this results in her regularly reapplying her makeup.
“Not to mention the climate, which is now really hot. And pollution is everywhere,” Lina said.
These conditions also made her prone to sickness. She suffered from bad cold cases. At that time she did not have a health and social insurance card (BPJS Kesehatan). She had to spend money from her own pocket to buy medicine.
Realizing the importance of the BPJS Kesehatan, she applied for it with other trans women. “I have BPJS now,” she continued.
Even though they work at night, said Lina, it does not mean they are free of air pollution. While working on the street at Taman Lawang, a leafy park in Central Jakarta, a condition she believes is slightly better. However, not when they have to leave the park.
Additionally, construction activities in Jakarta are mostly carried out at night, releasing dust that she inhales. “I often feel my throat itchy. It’s even difficult to breathe when I go out,” she said.
To keep her stamina, Lina spends hundreds of thousands of rupiah each month on vitamins and supplements. She takes them every day to maintain her health. Without it, she would feel sick when outside.
“Like it or not, I have to buy supplements,” said Lina while showing Konde her medicine box.
*Chart above shows air quality in six cities in Indonesia in 2021.
Mama Atha, the founder of Sanggar Seroja, a community-based group of trans women in the Greater Jakarta area, agrees with Lily and Lina’s tales. Mama Atha said trans women are susceptible to pollution and its impacts.
According to Atha, trans women face the double burden of earning a living while also staying healthy for the kind of work they do.
“Sanggar Seroja cares about their trans woman peers, especially those who busk. They spend a lot of time under the sun, and often get the flu, colds, sore feet, or skin health problems. So BPJS Health is required for every trans woman at Sanggar Seroja,” Mama Atha said.
In 2021, the BPJS Kesehatan campaign for trans women began. It coincided with the government’s efforts in promoting an ID card program for transgender people in a number of regions. But Sanggar Seroja didn’t want to stop at ID cards. They started enrolling trans women in BPJS employment and health programs.
Sanggar Seroja also advocated for trans women to be exempted from paying monthly fees for the BPJS program. This should be covered by the BPJS Health Recipient Contribution Assistance (PBI) program allocated to the poor and underprivileged.
Konde contacted BPJS Kesehatan President Director, Ali Ghufron Mukhti, via WhatsApp for an interview but received no response.
Trapped in Jakarta’s air pollution
Lina and Lily’s experience is part of the challenges faced by transgenders in Jakarta. Suara Kita, an organization that focuses on trans women’s rights, said that there are 1,889 trans women in the DKI Jakarta area. All are susceptible to air pollution impacts.
Meanwhile, Sanggar Seroja noted that at least 25 of its members are affected by air pollution. Atha believes their condition is exacerbated by weather anomalies.
“For example, sometimes it rains, and suddenly it is hot. This is the effect of climate change, and we cannot predict the weather. It is unpredictable. Yesterday was also rainy, then hot, causing coughs and flu. Right now, the heat is burning. Before that, it was very cold” said Atha.
Jakarta is one of the world’s most polluted cities. World Air Quality data over the past 4 years confirms this.
In 2018, Jakarta ranked as the 10th worst polluted city in the world with the highest PM2.5 concentration. Jakarta came first in Southeast Asia. In 2019, Jakarta climbed the rankings to fifth in the world, but in Southeast Asia, Jakarta fell to fifth.
In 2020, Jakarta was ranked ninth in the world, and seventh in Southeast Asia. In 2021, Jakarta ranked 12th in the world but sixth in Southeast Asia.
During those 4 years, Jakarta’s air was allegedly polluted with PM2.5 concentrations that exceeded the Indonesian national annual ambient standard threshold of 15 μg/m3 and the latest WHO guidelines for annual ambient standards of 5μg/m3.
WHO stated that exposure to more than 25 μg/m3 of PM2.5, fine particulate matter measuring less than 2.5 micrometers — much smaller than a human hair strand diameter of 50-70 micrometers — within 24 hours is detrimental to human health.
*Chart above shows the air quality in Southeast Asian countries in 2021.
Chairperson of the Indonesian Pulmonary Specialist Doctors Association (PDPI) Agus Dwi Susanto on January 19, 2023 told Konde.co that there are at least four main pollutants that are very dangerous and present in the air in urban areas.
He cited them as Particulate Matter (PM), Ozone, Nitrogen Oxide (NOx), and Sulfur Dioxide (SOx).
Air containing PM 2.5 causes irritation, systemic inflammation, nerve damage, and carcinogenic diseases. PM 2.5, which comes from combustion smoke, reduces oxygen levels in the air. As a result, pollution due to PM 2.5 causes 47 percent of cases of lung infections, lung cancer, and asthma worldwide.
Cardiovascular disease also plagues workers exposed to air pollution. PM 2.5 causes blood vessel constriction, said Susanto. As a result, a person is more susceptible to vascular diseases, including hypertension, as experienced by trans women.
He warns that if this condition is not handled properly, blood vessel narrowing and hypertension can cause heart disease.
“There are still 34 percent of coronary heart disease and stroke related to pollution,” Susanto said at a press conference organized by the Executive Board of the Indonesian Doctors Association (PB IDI), on January 19, 2023.
Ginanjar Syuhada, a researcher at Vital Strategies, an organization in the public health sector, also revealed a link between air pollution and health impact. PM 2.5 could cause oxidative damage and systemic inflammation.
The smaller the particle size, the deeper PM2.5 can be stored in the lungs or transported to other organs, such as the heart, brain, and placenta.
“As a result, there is an increased risk of various chronic diseases, such as cardiovascular and respiratory diseases, cancer, diabetes, poor birth, and child health conditions. These diseases disrupt well-being and lifelong productivity, up to death,” he said via email to Konde, on January 5, 2023.
Ginanjar says Lily and Lina are disadvantaged in this situation. They struggle to meet their economic needs due to discrimination. As a result, they migrate to Jakarta, one of the most polluted cities in the world.
As if that’s not enough, added Ginanjar, that the impact of air pollution this community experiences will be more severe than others.
For example, the frequency and intensity of exposure to air pollution are high due to always working outdoors, living near emission sources, discrimination, and a stigma that has historically marginalized or excluded them.
Plus, the absence of any safety net such as health insurance puts trans women at high risk of experiencing air pollution’s worst impacts.
“Trans women are vulnerable to air pollution effects, both from a health and economic standpoint. This is because when their health is affected, their productivity is also affected because they cannot make a living,” he said.
Several studies in the United States1] 2] 3], said Ginanjar, show that LGBT people are more significantly affected by environmental health issues, such as air pollution. This is part of climate change’s impact.
“Like the high number of chronic disease cases associated with air pollution among LGBTQ+ people such as respiratory diseases, cancer, and hormonal disorders,” he explained.
Economic vulnerability also makes it difficult for trans women to enter the formal sector, so they lack adequate protection in the work environment.
Including the risk of danger to occupational safety and health, as stipulated in Occupational Safety law, Health law, Workers’ Social Security law, and government regulation concerning Occupational Diseases.
“Finally, they are forced to protect themselves, with all their limited resources,” he said. He added that trans women could be less vulnerable to air pollution’s health and economic impacts.
The government, he said, could open access to free health services and notification of air pollution information for groups who have difficulty accessing it. So that marginalized groups, including trans women, receive protection and guarantees from the government.
Ginanjar says the government also needs to partner with civil society organizations that focus on sexual minorities, especially at the grassroots level.
“That way, the government can reach out to trans women who have been untouched by the socialization of government social security programs, hear their aspirations directly, and develop inclusive policies so that their rights to health services and social security can be fulfilled.”
Cynthia Maharani, Gender, Equity, and Social Inclusion Lead at WRI Indonesia, said that vulnerable groups, in this case, trans women, need to be the subject of efforts to improve Jakarta’s air quality.
This is because most vulnerable groups live near pollution sources, and are thus most affected by air pollution. They also lack appropriate coping capacities due to structural marginalization.
These experiences, according to Cynthia, can increase the system’s knowledge and understanding of the local context.
“Emphasizing the involvement of vulnerable communities can help stakeholders to consider solutions and resources that are more responsive and culturally appropriate according to the needs of these communities,” she replied via email on January 13, 2023.
This story was produced with support from Internews’ Earth Journalism Network through the Clean Air Catalyst program, a flagship program launched by the U.S. Agency for International Development (USAID) and led by a global partnership of organizations including the World Resources Institute, Environmental Defense Fund, and Internews.
This story was first published in Bahasa Indonesia by Konde on 31 January 2023.
