KOLLAM, Kerala — S Alexander sat cross-legged in his small hut near a railway track in Kollam, gazing at a photograph of his 28-year-old daughter and the candles flickering next to it.
More than a week had passed since Anannyah Kumari Alex was found hanging from the ceiling of her rented apartment in Kochi, but the retired bus driver was keeping the flowers fresh and the candles burning in the shrine that he had made for her.
Alexander told us that he had filed a complaint with the Kochi Police, demanding an investigation into whether it was a botched sex reassignment surgery that drove his daughter to take her own life on 21 July, 2021.
“After the surgery, she told me many times that there was severe medical negligence and that she was not even able to walk properly,” he said. “I have promised Kerala’s transgender community that I will stand with them to ensure justice for Alex.”
While trying to hold back his tears, Alexander said, “In her suicide note, she said that she wanted to be buried wearing a colourful sari and a lot of flowers.”
Alex was making her way in the world as a transgender rights activist and an aspiring politician. Her bio on Instagram, punctuated with red heart emojis, says, “History maker, Kerala’s first transgender activist in Legislative Assembly election, Kerala’s first trans RJ, make up artist, anchor, and TV news presenter.”
When Alex came out as a transgender woman, Alexander said that he was unsure of his own feelings, but he was determined to support her, even if it meant breaking with his wife and son. Last year, he was gripped with a sense of foreboding when he traveled to Kochi to be with his daughter on the day of her surgery.
“I have very little education and exposure. I don’t know anything about the mental make up of transgender people. However, I did whatever possible on my part to support her surgery,” he said.
The colon vaginoplasty was done by Arjun Ashokan, a plastic surgeon, on June 14, 2020 at Renai Medicity, a private hospital in Kochi, Alex said in an interview before her death.
We reached out to Ashokan via the Public Relations wing of Renai Medicity, but did not receive any response.
In a statement issued on 21 July, Renai Medicity refuted allegations of medical negligence, claiming that the surgery was conducted on Alex after completing all relevant procedures including counselling.
Renai Medicity said, “Alex had developed intestinal obstruction after the surgery. As it was a common complication associated with the surgery, we addressed it by the procedure. During the time of discharge, she was delighted with the treatment and care provided by us.”
The hospital also said that after Alex complained about “surgically implanted body parts and urinary issues,” they recommended another surgical procedure to resolve these issues, but she refused for reasons known to her.
The Kerala Police have ordered the hospital to stop performing sex-reassignment surgeries.
Ever since the colon vaginoplasty, her friends told us that Alex had been living a tortured existence, battling immense pain and emotional trauma. After spending more than two lakhs on the surgery, Alex’s friends say she had no money left. The last year of her life was consumed not just by physical suffering, but mental agony, as no one seemed to take her allegation of medical negligence seriously.
In her suicide note, she said that she wanted to be buried wearing a colourful sari and a lot of flowers.
The Kochi Police told us that Alex had filed a complaint at the Edappally Police Station in August 2020 alleging that she had been overcharged by the hospital, but they had not investigated the matter.
In March, Alex filed a complaint at the Edappally Police Station alleging medical negligence and demanding compensation from Renai Medicity.
A police officer at the police station, speaking on the condition of anonymity, said that no FIR was registered against the complaint and there was no investigation.
Noting that the hospital was promoted by one of Kerala’s leading business groups – Polakulath Group of Hotels, Resorts and Healthcare – the police officer said that he had advised Alex to lodge a complaint in a local court seeking police investigation and only then could they take up the matter.
Following her death, the Kerala government has promised stringent action in her case, with the Health Minister Veena George and Social Justice Minister R Bindu ordering investigations.
A 2019 study by Queerala, an organisation for Malayali LGBTIQA+ Community, says that in 2015, Kerala became the first Indian state to implement a comprehensive policy for the welfare of transgender persons, but the state continues to be an unsafe space for transgender persons because of lack of proper implementation, continued social stigma, among others.
“Most transgender individuals continue to suffer because of lack of access to gender affirmative procedures, or because of medical malpractice by doctors,” the report said. It said that government facilities for gender-affirmative healthcare were non-existent or rare, and all transgender people who seek sex reassignment surgery go to private hospitals.
Three days after Alex’s death, her partner Jiju Girija Raj killed himself at a friend’s house in Kochi.
These tragic events have traumatised the transgender community in Kerala.
Pinky Vishal, a transgender woman and a friend of the couple, said that Raj looked desperately sad at Alex’s funeral in Kollam.
“We were not able to provide him with enough emotional support,” she said.
Ananyha Kumari Alex
Alex’s life had been fraught with pitfalls but she had always picked herself up, Alexander said. Her mother had disowned her after Alex came out as a transgender woman. After she dropped out of school before completing class 12, Alex had worked in a petrol pump and as a rag picker to earn a living.
In 2014, the Transgender Survey Kerala reported that 54% of transgender people in Kerala earn less than ₹5,000 as their monthly income and only 11.6% have a regular job. Nearly 58% of transgender people in Kerala drop out of school due to taunts from fellow students, teachers, neighbours and family.
When she planned to contest for the Kerala state election in April, Alex said, “Only through education can any community attain self-esteem and recognition. For us to hold our heads up, we need solid education.”
When a reporter asked her why she was running in the state election, Alex said, “I do not intend to live in some corner of the world not known by anyone. I want to leave evidence of having lived in this world. All my efforts are to fight and win.”
I want to leave evidence of having lived in this world.
Eventually, Alex did not contest. While dropping out of the race, she accused the Democratic Social Justice Party (DSJP) — the party that had nominated her — of harassment and threatening her.
Being someone who felt things deeply, Alex felt humiliated that her first attempt at fighting an election had failed, Alexander said. This setback exacerbated her misery and poor health.
“It wounded her morale,” he said.
Days before her death
In an interview published in Malayalam in The Cue on 15 July, Alex said, “Even after a year since the surgery, I have to change at least a dozen sanitary pads daily. Long travel is difficult as I have bowel movements at least five times a day. My stomach is fully infected with scars. My vagina looks like a sliced piece of meat.”
The reporter who interviewed her, Ralf Tom Alex, told us that she had described herself as a “living casualty of medical negligence.”
On July 16, Vaiga Subrahmanyam, a transgender woman and a close friend of Alex, said that Alex had tried raising allegations of medical negligence at a Clubhouse event organised by the Oasis Transgender Cultural Society, a collective of the LGBTQ community, to discuss the discrimination against the transgender community in Kerala.
Subrahmanyam, who attended the session, recalled that Alex spoke of how she had been in excruciating pain, not being able to urinate or laugh, while blaming Arjun Ashokan, the plastic surgeon at Renai Medicity, who was also a speaker at the event. The surgeon, Subrahmanyam said, called it character assassination and asked that Alex be removed from the panel. The hosts complied, she said.
“I was a listener at the meeting. As I was not in the list of speakers, I could not protest,” she said.
Sruthy Sithara, a member of the Oasis Transgender Cultural Society, and a transgender woman who spoke at the session, said that the conversation turned ugly after Alex leveled allegations against the doctor. “In the highly charged situation, one of the admins removed her without anticipating it would lead to further complications,” she said.
Subrahmanyam said that Alex initiated her own discussion on Clubhouse later that day and continued speaking about her botched surgery.
“She told me that she was in severe depression since the Clubhouse meeting,” she said. “She said that she felt abandoned by some people in her own community.”
She told me that she was in severe depression since the Clubhouse meeting.
Concerned friends and activists
PK Prijith, president of the Queerythm, a LGBTIQ community in Kerala, said that Alex was not given adequate counselling and she was not made aware of the nature of the surgery she had agreed to.
“The surgery she underwent was complicated. You have to be mentally prepared for it. Alex wasn’t. She told me that she did not know that the nature of this surgery was so complicated,” said Prijith. “She did not know what her body would be put through.”
In its statement, Renai Medicity said that Alex was told that sex reassignment surgery was risky, and she was briefed about its complications.
Seeramayi, convenor of the Oasis Transgender Cultural Society, a transgender woman and a close friend of Alex, said that not only had paying for the surgery left Alex without any savings, the hospital administration did not give her the treatment records.
“She told me that she faced difficulty standing for a long time, sneezing, laughing or even brushing her teeth,” she said. “She said she was also experiencing breathing difficulties.”
Bismi Gopalakrishnan, head of the department of the School of Indian Legal Thought at the Kottayam-based Mahatma Gandhi University, said that information she had gathered suggested that no urologist or gynaecologist was present while conducting the surgery, and that the post-operative treatment was meagre.
“The government must institute a monitoring body to check the competence and the expertise of doctors who are performing such surgeries,” she said.
J Devika, a noted feminist in Kerala, who had started speaking with Alex after her she found out about her case, said that Alex felt the only just outcome was for the hospital to provide her the money to get corrective surgery done elsewhere.
“In the last year, she suffered heightened depression and daily panic attacks. These all were a result of her surgery which went wrong. This was not just a cosmetic mistake. It caused her severe physical pain,” said Devika.
“Alex spoke out because she was in excruciating pain. She knew that she did not deserve what happened to her body,” she said.
Alex spoke out because she was in excruciating pain. She knew that she did not deserve what happened to her body.
KA Shaji is a journalist based in South India. He writes on human rights, environment, livelihood, caste and marginalised communities.