Coming out again and again

Ashwin Upadhya speaks to Radhika Holmström about realising he was gay at 12 and choosing his career path at 17

Critical care physiotherapist Ashwin Upadhya
Ashwin Upadhya critical care physiotherapist

‘Coming out is a constant process,’ says Ashwin Upadhya. ‘Every time you move to a different city or a new job you have to do it all over again, and every time you do it in a way that’s strategic, that you know will be safe. It’s exhausting. You never really leave the early experience of shame and discrimination behind completely.’

And at the same time, he adds, by comparison with some of his experiences growing up, it’s relatively minor. Ashwin grew up in a conservative South Indian family, living in a small suburban town outside Mumbai. 

‘My Asian identity co-exists with my LGBTQIA+ identity. I first realised I was gay at the age of 12 but I struggled with my identity until I was about 21’. 

That struggle, in fact, played a major role in his initial choice of a career.

I had an accident when I was 17 and ended up with physiotherapy for back problems. Chatting to my physiotherapist, I realised this was a profession that could take me all over the world. 

He went to train in Bangalore, where already his world started opening up – personally and professionally. ‘In my second year I realised how much physios were the people involved with patients, with holistic care and the opportunity to speak to patients at length was great. I love talking to people. I fell in love with the profession.’ 

Meanwhile on campus he was expanding his social circle, spending his weekends with gay friends. ‘I was living quite a double life - remember, it was still illegal to be gay in India at that time.’(Gay sex was only decriminalised in India in 2018.) ‘It was nice to be able to talk to other people going through the same experience because a lot of the time it wasn’t easy for me with fellow students.’

Out and proud in the US

After finishing at college, he returned to his family home and continued that ‘double life’ while working in a trauma centre. However, he explains, ‘My father started making his own plans for me, including arranging me a marriage. At that point I applied for and got a postgraduate place in the US.’ He arrived in the Midwest in 2008. 

‘I was 23 and I’d never been outside India. That first day, when I stepped outside the airport, I felt I could finally live my life the way I wanted.’

The first thing he did at university was join the Pride society. ‘There were so many safe spaces for me, and I spent a lot of time out socialising and enjoying my new life.’ That also meant, however, making a deliberate break from the other Indian students on campus. 

‘They were still giving me the same kind of judgement and treatment that they’d always done. I’ve carried that sense of shame since I was a teenager, and I refused to do so now that I was abroad.’

After graduating in 2011, Ashwin moved again: this time to New York, where his world opened up even further. One of his best friends came out as trans, which was a massive learning curve for him, he explains: ‘I’d kind of lived in my gay bubble.’

He started dating the man who later became his husband, and in 2016 the two of them moved to the UK. Ashwin now works as a respiratory physiotherapist and is currently based in Liverpool.

Acceptance of a kind

Today, Ashwin and his husband live in Liverpool, in a country where their marriage is legal. However, he explains, he still faces quite a lot of barriers from his family (almost all of whom either don’t know about his sexuality, or refuse to acknowledge it openly); and also from South Asian colleagues and patients. 

‘Patients ask me about my wife when they see my wedding ring, and I have to behave in a heteronormative way in case it affects the clinical relationship. I’ve never had overt homophobia in the workplace – certainly not compared to what I experienced at home – but there’s still plenty that I have to try to brush off, and probably do brush off far too often. You never know when it’ll come, that question or that “banter”. The cultural intersection makes it harder, because the implication is that I’ve let my community down in some way. We are a very collective culture where other people’s opinions matter. I’ve ended up retreating from my South Asian community in many ways.’  

‘I’m okay with you’ is not okay

In other ways, though, he definitely hasn’t retreated. ‘The first day I get to work I make sure everyone knows who I am, as a person. I’ve been upfront from the beginning.’ He adds: ‘I have also had some wonderful colleagues who have been very supportive and don’t treat me any differently. I’ve been lucky enough to have supervised only students from either LGBTQIA+ or Black/Asian backgrounds and I’ve always had positive feedback. But it only takes one hurtful comment or microaggression to retreat back into a world of shame and discrimination. 

I don’t need responses like “I’m okay with you”, because I’m not asking for validation or approval. I feel I constantly have to make the effort to be included, rather than a conscious effort to include me.

This is a key reason why Ashwin is now getting more involved with equity, diversity and belonging work in the profession. And, he stresses, this has to be much more than a checklist. 

‘A diversity strategy isn’t good enough on its own. Training isn’t good enough on its own. Equity, diversity and belonging is talked about as a concept, but it needs the groundwork. You need focused sessions, led by people who can lead the conversation as members of the community. I feel a lot of work needs to be done in the rural areas and the smaller towns, too. I live in an almost exclusively White area now, and in one where attitudes are very different from London. We need to think not just in terms of the workforce but also about the community we are serving. Education is not just about treating your staff well but also the patients.’ 

He is now the EDI (equity, diversity and inclusion) champion for the Association of Chartered Physiotherapists in Respiratory Care (ACPRC).

He concludes: 'When people think about LGBTQIA+, they think about sex. Not about love, or domestic life. I just want to be treated like anyone else in the team rather than putting my characteristics at the front of the conversation.'

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