Meet the Doctor Who Successfully Lobbied Singapore’s Government for Trans Rights

The Girl

Shonna lived in constant fear as a child. As the eldest child to a hot-tempered and aggressive dentist, she had witnessed her mother take multiple beatings at the hands of her father. Stitches and trips to the hospital had become commonplace in a household that was supposed to represent safety and security. Eventually, Shonna moved to her grandmother’s house, though she kept in frequent contact with her mother and her two younger sisters. This was when her grandmother started dressing Shonna up as a female. In fact, it was through the elderly woman that Shonna was adopted by the Goddess Guanyin (Goddess of Fertility in Buddhism) at her local temple.

Shonna’s teenage years weren’t any better than her childhood. At school, she was performing abysmally and was unsuccessful in her attempts at obtaining a secondary-level certificate. It didn’t help she was often bullied for her appearance. Male students would take her to the movies and force her to masturbate them. Her father tried to get her to work as an assistant at his dental clinic for a while, though this was short-lived. After embarrassing remarks about Shonna’s ambiguous gender, the dentist had banished her to do chores at home. A year before her father died in 1966, Shonna started looking for work on her own. She first worked as a sales girl, then as a housemaid for a European man – whom she had an affair with and subsequently forced her to leave the job. While working as a public relations officer in a hotel, Shonna entered a Miss Beauty contest and won the second prize. As a result, she was allowed to model for advertisements and soon featured in the magazine “Her World”. It was also during this period that Shonna joined a cabaret and started a social escort service. 

While her professional life had started to take off, her personal life was still in shambles. The woman wanted to be a serious model, get married to a man and settle down. These were things that her physical body and laws at the time would not allow her to do. Desperation had driven her to attempt to take her life twice, and had left at the verge of another attempt. 

This was when she decided to seek Professor Ratnam’s help.

The Doctor

Sittampalam Shanmugaratnam (or S Shan Ratnam as he liked to be called) was born in Ceylon in 1928 to parents of Sri Lankan descent. The family soon moved to Kuala Lumpur, where Ratnam’s mother raised him, stressing the importance of helping others:

“You don’t need to pray. You don’t need to go to temple. But every day, try to help someone. That is the better form of prayer than going to temple. And try never to say no to anybody. Because when you say no, you hurt somebody. Even if it is something that you have to give, just give. In giving you help people,” she told a young Ratnam. 

This was taken to heart by Ratnam, who in his later years, described himself to be a “non-ritualistic Hindu” who tried to help as many people as possible. The influence of his mother also affected his career choice. At the young age of 36, Ratnam’s mother was diagnosed with rectum cancer in the middle of the Japanese Occupation. Considering that their bond was “inseparable”, Ratnam nursed and attended to his mother in light of a lack of alternatives. There was no official healthcare nor access to painkillers available during the occupation. As a teenager, he would often cycle in the middle of the night through graveyards and forests to get crude opium or marijuana for his suffering mother. To add to the family’s troubles, Ratnam’s younger brother, who was about three, also passed away due to tuberculous. These events influenced Ratnam to take up medicine as career – he saw the positive and rehabilitative impact that doctors can have on lives.  

After getting a M.B.B.S. degree from Ceylon and specialising in England, he was given the post of Professor and Head of the Department of Obstetrics and Gynaecology in Singapore, a job which he held for 25 years.

The Encounter 

An attractive young woman sat outside of Professor Ratnam’s office. “She was so attractive, I couldn’t take my eyes off her,” said the professor later in his life. Deep down, he knew that something was wrong – the women who would come see him this late and alone usually wanted an abortion or help with an awkward situation. Nonetheless, the professor invited the woman into his office and sat her down. 

“Professor, I want a sex change operation,” she said very frankly. 

A surprised Professor Ratnam leaned back on his chair and responded, “Why come to me? I don’t know anything about transsexualism”. At that point, sex change operations were virtually unheard of around the world, and there was little medical literature surrounding the topic.

“Professor, you have the right to say no, I’ll accept it. But you may not see me alive again,” she said as she pulled down her shirt to show a large cut mark across her neck. Not knowing what to do, the professor referred her to the physiatrist clinic, hoping that she won’t come back. 

Shonna persisted. Every evening, at around six, she would wait outside Professor Ratnam’s office, asking him if there were any updates on her case. Eventually, the psychiatrist wrote back to Professor Ratnam, telling him that Shonna was not only able to give informed consent for the operation, but would also greatly benefit from it.  She had been diagnosed with gender dysphoria, which meant that she possessed a continuous sense of inappropriateness about her anatomic sex and a desire to discard her genitalia and live as a member of the opposite sex. A total of six to nine months of medical and psychiatric tests had to be carried out before the Shonna could take the operation

With this, Professor Ratnam had no choice but to give in.  

The Operation 

Prof. Ratnam (left) with President Benjamin Sheares (right). Source.

In preparing for what was eventually Asia’s first sex change operation, Professor Ratnam referred to a technique created by Singapore’s President (and former gynaecologist) Benjamin Sheares. Called the Sheares Vaginoplasty, the ground-breaking technique was originally used to create an artificial vagina for those born without one. Professor Ratnam adopted and modified this technique to work in sex change operations. He then familiarised himself with the surgery by practising on cadavers.

As Shonna’s operation neared, Professor Ratnam reached out to the Ministry of Health seek permission. The ministry granted permission, so long as the procedure was done in secret, without publicity. Nurses, doctors and other workers at the hospital were informed about these instructions. After consideration of the Shonna’s psychological profile and the medical expertise involved, with the approval of the ministry, it was decided to proceed with the operation.

On 30 July 1971, Professor Ratnam and four other surgeons from the University of Singapore successfully completed Shonna’s sex change in three hours. Photography of the operation was not permitted and everything was kept a secret. That is until a medical student in the operating theatre called his sister, who was then a reporter, to tell her about the history that was being made. The secret was so badly kept that by the time Professor Ratnam returned to his office after the operation, his phone was constantly ringing.

As for Shonna, she went on hormone treatments soon after and was functionally a woman, though she could not conceive or menstruate. She later married a French man and owned a travel agency in Paris, before moving to England.

The Aftermath 

Prof. Ratnam giving a speech at the opening ceremony of the 13th World Congress of Gynaecology. Source.

For the first two to three years after Shonna’s operation, Professor Ratnam conceded that he was very worried. Considering that sex change operations were relatively new, he was fearful that patients would regret and resent the irreversible procedure after a few years. 

Even his own colleagues were talking behind his back about these operations. However, as soon as he started getting letters from patients (some calling him as a “saviour”) thanking him for his help, he knew he was doing the right thing. According to him, even recovered cancer patients weren’t as joyous as these individuals. 

By the end of his lifetime, the professor performed over 500 sex change operations for individuals from around the world. Beyond his work in this specific field, the man is also known as the founder of the in-vitro fertilisation (IVF) programme in Singapore. In 1983, he led a medical team to produce Asia’s first test-tube baby, bringing hope to many childless couples. 

Perhaps an overlooked part of his legacy is his fight for the legal recognition of transgender Singaporeans. Two years after Shonna’s surgery, the professor publically implored the government to allow post-operative transgender Singaporeans to change the particulars on their personal documents. In 2012, it was also revealed that Professor Ratnam had lobbied the government quietly behind the scenes for this policy change. Eventually, the government relented, and the National Registration Department allowed post-operative transgender individuals to change their genders and names on their identification cards (NRICs). This meant that other documents that flowed from that, like passports and drivers’ licences could be amended as well. 

His advocacy didn’t stop there. In the 1990s, the Registry of Marriages suddenly required those intending to get married to produce their birth certificate as proof of their sex status. This obviously precluded transgender individuals from getting married and settling down. The professor heavily critiqued this policy in his book, Cries from Within:

“(This) is yet another blow to this accused minority in our society. Following long years of struggle and pain, preparation, and screening tests, finally, after the traumatic experience of the sex change surgery, they are back to square one again. What if employers follow the lead of the Registry of Marriages and require applicants to produce their birth certificate as proof of their sex status? Where will this lead transsexuals?”

Yet again, the government eventually relented. In 1996, PAP MP Abdullah Tarmugi presented an amendment to the Women’s Charter that allowed post-operative transgender individuals to marry as per the gender stated on their identity card. 

Professor Ratnam passed away from heart complications in 2001. His story today is more relevant than ever, considering that it proves that Singapore has a long legal and historical precedent for the participation of transgender individuals in daily life. It also showcases the inherent policy inconsistencies that Singapore has. How is that we allow post-operative transgender individuals to get married, and be legally recognised, but allegedly not recognise their rights in schools?

These are tensions that we hopefully resolve, sooner rather than later. 

Sources: Singapore InfopediaNational Archives Oral History InterviewsNewspaperSGShocking Asia (1976), Cries from within: Transexualism, Gender Confusion & Sex Change (1991)

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