A week in my sexual assault clinic: ‘The work can be tough but there is a lot we can do to help victims’

There is considerable variety in my working week as I have several roles, none of which is full-time. I am a consultant in infectious diseases (ID) and genitourinary medicine (GUM) at the Bon Secours Hospital in Galway and medical director and forensic medical examiner (FME) at Galway Sexual Assault Treatment Unit (SATU). I am also a lecturer in medicine at NUI Galway Medical School and honorary consultant in genitourinary medicine at the Guide clinic in St James’ Hospital, Dublin, which is a free STI, HIV and infectious disease service.

Being a wife and mother of two children aged six and four means I have had to hone my organisational skills and learn patience in traffic. I am fortunate to have a very supportive husband, a wonderful childminder and the world’s best mother-in-law to help keep things running smoothly at home.

After the school run every second Monday morning, I catch the train to Dublin which gives me a chance to catch up on some reading and emails. On Monday afternoons, I see patients at the HIV outpatient clinic at the Guide clinic at St James’s. A new diagnosis of HIV can be devastating and at Guide the patient is supported by a team that includes clinical nurse specialists in HIV, medical social workers, and pharmacists. When the time is right, patients are started on antiretroviral medication that attacks the virus at different stages of its lifecycle. The outlook for people infected with the HIV virus has improved dramatically since the virus was first discovered. Now, using a combination of different drugs, we can suppress the virus in the bloodstream and prevent the development of Acquired Immune Deficiency Syndrome (Aids). While there is no cure for HIV, if it is diagnosed early it can be very well managed as a chronic condition.

Men and women from all over the country come to the clinic at St James’s; it was the first HIV clinic in the country and was set up by Prof Fiona Mulcahy, who has been a wonderful mentor to me. In recent years there has been a decrease in the number of intravenous drug users being diagnosed with HIV, but there has been an increase in the infection among men who have sex with men. Heterosexual patients may have picked up the virus either in Ireland or abroad, and some are first diagnosed in pregnancy.

STI prevention

You can’t tell by looking at a person if they have HIV or a sexually transmitted infection (STI), so you may be putting yourself at risk if you are having unprotected sex. I think the message about HIV and STI prevention has got somewhat lost. Both young and middle-aged patients are often unaware of the risks and are shocked when they pick up infections.

On Tuesday mornings I run a mixed infectious disease (ID) and genitourinary medicine clinic (GUM) at the Bon Secours Hospital in Galway. I see a wide variety of patients with infections of all kinds including screening and treatment of STIs, follow-up of former inpatients with, for example, bone or urinary tract infections and new referrals from GPs with ID problems.

The STI patients largely self-refer and I aim to offer a discreet and nonjudgmental service: no one can tell why you are in the waiting room, as the clinic is for general ID. In countries such as Australia and New Zealand, people attend STI clinics for regular checkups, but unfortunately there is still considerable stigma in Ireland regarding sexual health. Of concern in recent years is the development of resistance to antibiotics in some infections – including gonorrhea, for which we now have to use an injected antibiotic. It is not unrealistic to expect that some strains of gonorrhea may become incurable unless new antibiotics can be developed.

Later on Tuesdays I am busy with ID consults and follow-ups on the wards at the Bons. I will usually follow each patient through their hospital stay and sometimes as an outpatient if necessary.

My husband does the school run on Wednesdays so I can attend a medical case conference to keep up with continuing professional development. Then I teach undergraduates at NUIG medical school. I started this a year ago and I very much enjoy working with the students. There have been many changes in medical education since I was a student, particularly in the way information technology is used. However, the art of medicine is still a skill that needs to be taught at the bedside with the generous assistance of patients.

Sexual assault

I have responsibilities in the management and development of the Sexual Assault Treatment Unit (SATU) and participate nationally in guideline development and training. We meet quarterly with the interdisciplinary team which includes gardaí, Rape Crisis Centre counsellors and social work colleagues. I may also see SATU patients for follow-up STI screening or because they require post-exposure prophylaxis for HIV following their assault.

There is a network of six SATUs across Ireland with an additional out-of-hours service in Limerick. In Galway, we have the only colocated adult (age 14 and over) and paediatric SATU service in the Republic. Children from this region are seen at SATU by my colleagues from the Child and Adolescent Sexual Assault Treatment Service. In fact, there is no out-of-hours sexual assault treatment service for under-14s anywhere else in the Republic.

My main clinical commitment to SATU is as an out-of-hours on-call forensic medical examiner, which I do about six times a month, usually at weekends. Ireland is lucky to have highly trained forensic nurse examiners who provide most of the daytime and a considerable amount of out-of-hours forensic and medical care to victims of sexual assault and rape.

Usually the patient is brought to see us by gardaí at a dedicated unit that can be accessed 24/7. Here they are met by the forensic medical or nurse examiner, an assisting nurse and a Rape Crisis Centre volunteer. A history is taken and physical examination with documentation of injuries and forensic swabs is performed. A common misconception is that there must always be injuries if non-consensual sex occurred: this is not the case. We also provide aftercare for patients with medications to treat potential STIs, and provide emergency contraception if appropriate. The typical case we see at SATU occurs after 9pm and, as DNA degrades with time, we try to examine patients as soon as possible to get the best forensics. The SATU work can be tough, but is professionally satisfying as there is a lot we can do to help victims.

On Thursdays I teach undergraduates at NUI Galway Medical School and later I’m back on the wards at the Bon Secours .

Fridays vary: I might have a teaching session, a course or conference to attend or a new patient to see on the wards. Letters and administration are neverending and I am lucky to have a fantastic secretary, Anne, to help me on that front.

Out of hours Spending time with my son and daughter is my favourite pastime; they are at a lovely age right now. I wish I could say I exercise regularly, but Pilates is as active as I get. My guilty pleasure is reading crime fiction on my Kindle when everyone else in our house is asleep.