Minding the gap. Malcolm Smith

The only place Ingrid Berkhout felt comfortable getting a cervical exam in the mid-1990s was in a stranger's South Seattle basement, where she went for a mobile screening organized by the Lesbian Cancer Project. "I had questions I couldn't pose to a regular medical provider," says Berkhout, who now heads the breast and cervical health program for the local YWCA. "I wanted to talk to someone who knows about being a lesbian," she says.

Since the 1970s, a burgeoning women's service and advocacy movement had established a growing number of lesbian health organizations, including the Lesbian Resource Center, Aradia Women's Health Center, and the Lesbian Cancer Project. That last organization went on to found Verbena Health, a full- service health-care provider and outreach group on Capitol Hill for lesbians and transgender people. Verbena's free wellness center included a clinic, programs to help clients quit smoking, cancer detection screenings, and support groups for cancer patients and survivors.

In their collective zenith around 2003, all the organizations seemed to thrive at once. But then, in a hairpin turn, the momentum reversed.

"The Lesbian Resource Center is gone, Black Pride is gone, the LGBT Center—where are they?" asks Berkhout in her slight Dutch accent. "We don't know. I [drove] by and they were gone, and I was like, what the heck happened?" Indeed, just last month, Verbena Health announced that its executive director, Michelle "Mo" Malkin, was resigning under charges that she had embezzled from the organization's coffers, and the organization had ceased all services.

While Verbena's demise was the direct result of the embezzlement charges, other lesbian-focused groups cited a lack of funding for their decline.

What's revealing about the collapse of most of these organizations is that it happened at the same time as a high-profile movement for same-sex marriage was emerging across the country. As illustration, marriage-driven Equal Rights Washington (ERW) started out as a one-desk project in the LGBT Center in 2004. Last month, ERW had to move into a downtown office large enough for its growing 14-member staff, where it now provides a rent-free desk for the one remaining staff member of the LGBT Center.

Seattle City Council member Sally Clark, who is gay, says Verbena's passing "definitely left a hole. The fact that their doors are closed means there are people seeking services or delaying care for something because they don't know where to go next."

Verbena's board members are still reeling, trying to match clients with services, such as cancer recovery groups and smoking recovery meetings, at other organizations. But "that's really just a stopgap," says board chair Christoph Hanssmann. "If the programs aren't situated together, it loses power." In the meantime, Hanssmann hopes community leaders will step in to help rebuild Verbena (or a similar organization) to fill the void.

The need for culturally sensitive health care for the lesbian and trans communities can be striking. "I hear astonishing stories all the time," says Leslie Calman, executive director of the Mautner Project, a national lesbian health-care advocacy group. "Women who are lesbian or bisexual are told [by doctors] that they don't need internal exams because there's no penis involved."

Fear of intolerant doctors keeps lesbians and transgender people from getting regular check-ups, says Calman. Moreover, butch-identifying lesbians are less likely to seek breast exams, and lesbians tend to initiate health-care contact later than straight women, who start seeing doctors in their teens and 20s, when they begin taking birth control.

Fortunately, in Seattle, some mainstream health organizations are stepping in to fill that void.

Berkhout, of the YWCA, is about to hire an outreach worker dedicated to the LBT population, in part to fill the need left by Verbena. And as this article was being written, she called to announce a new website (LesBe Healthy.org) to help link up clients with existing services until Verbena, or something like it, can return. But, she says, "You can't put it all in virtual space. We all need to work together, maybe all in one organization." recommended

dominic@thestranger.com