by Marika Azzopardi

Sitting in the waiting room to the Genito-Urinary Clinic at Boffa Hospital, I wonder what trepidation patients sitting in my seat feel. As one patient emerges with an embarrassed smile on his face and an empty plastic bottle, only to return after a short while, gingerly trying to keep the full bottle out of my line of vision, I try to stifle a smile. Of course, there is nothing to smile about in such places, and once inside a GU Clinic, I have to ask the obvious question – are sexually transmitted diseases on the increase?

Dr Philip Carabot, consultant in charge, is emphatic, “Of course – terribly so. We have a problem. There is still not enough awareness and this sheds serious doubts on what’s being taught to young people in schools. I am sure PSD teachers are doing their utmost on the whole, but I feel most parents are simply relying squarely on the goodwill of teachers to teach their children the facts of life. When in reality, it should be parents who are the prime teachers of their children in this regard.”

Dr Carabot is alarmed for varied reasons. He speaks of our country as acquiring the lifestyle of western developed countries in too short a time span and not being prepared for the full onslaught of such a reality. “I worry about the attitude of people who come here. We see younger and younger patients – 13 year olds having sex with no inhibitions whatsoever, no condoms and a devil-may-care attitude that is especially troubling. The girls aren’t even bothered about landing an unwanted pregnancy anymore and having to raise a child single-handed!” One of the key culprits is the free consumption of drugs and alcohol which remove all inhibitions and lead to uninhibited sex. Then again, drug users are more likely to barter sex for drugs which makes things even worse. Dr Carabot also highlights the importance of adequate inspections and enforcement when it comes to alcohol consumption by minors.

The prime concern is still AIDS. After the ‘apparent’ onset of AIDS in the early eighties, people were initially terrified of the disease especially as there was much media attention to it and no known cure or treatment. People seemed to stay put for a while, behaving well and trying to steer clear of risky situations. Eventually when information fatigue set in and a somewhat effective treatment became available, people began to loosen their wariness. But as Dr Carabot indicates, treatment for HIV and AIDS is not 100% effective, and whilst it does keep an infected person in relatively good health, the treatment itself is fraught with particularly nasty side effects.

The GU Clinic which opened in 2000, has seen a continuous increase in its patient numbers over the years and Philip Carabot is pleased with its success but is quick to point out that the ones who do turn up at the clinic are just the tip of an iceberg. With casual sex being so rampant, diseases like gonorrhoea have increased in Malta and become even more virulent than ever before. “We try to trace the links because for each single case of gonorrhoea there are usually several other cases out there – it is a whole network of infected people who carry the disease around with them unknowingly. It is very rare for a patient to come ahead with names and contacts, so we cannot trace who got infected and ask them to get themselves checked out. That worries us because each infected person out there is a walking time bomb and when one considers how many diseases are initially symptom-free and how women are especially likely to remain symptom-free for many years, the repercussions are enormous.”

He points out that women have the very erroneous impression that when a smear test gives the all-clear, it covers everything and includes STD screening as well. “A smear test can only screen abnormalities linked to cancer in the cervix or uterus. It cannot screen STDs. Women need to be told this, and referred to the GU Clinic if there is a slight suspicion of infection. This is where things are done properly in this regard.”

We pause to talk about the man himself and his past career as an army man. Having qualified as a doctor in 1975, he left Malta for the UK and worked for the NHS between 1976 and 1982. “I did various jobs within the NHS including GU medicine which was of great interest to me. Then in 1982 I decided to enter the British Army. It was a lifelong desire and I had reached an age when army entry was the last port of call and if I missed the boat then, it would never have happened. Coincidentally the British army required a GU doctor and following my standard training at Sandhurst, I was sent out to my first posting. It was a baptism of fire – Belfast at the height of the worst periods of its fighting history. My next posting was in Germany and there I visited several different places. But the highlight of my German experience was during 1984-86.”

Philip Carabot was assigned a rare task indeed – taking care of Hitler’s deputy Rudolph Hoess,  a prisoner of war in West Berlin when the segmented city was in the hands of the foreign powers. The west was controlled by the British, the Americans and the French, whilst the east was in the hands of the Russians. “Hoess was living in Spandau prison which was an eerie place, the kind you see in horror movies. It was a gigantic place being used for one single prisoner – Hoess himself; the other prisoners of war had all been released but for mysterious reasons, Hoess was kept detained until his death, after which Spandau was demolished.  But in the meantime he lived a long life even in such grim isolation.”

Dr Carabot describes Hoess as a strong man albeit his old age, with piercing bright blue eyes under straggly bushy eyebrows. As a doctor of the British army, the Maltese doctor was responsible for Hoess’ health but on meeting Hoess for the first time, he was to be scrutinised at close quarters. “He came up to me and looked me over from head to toe like I was the one to be examined. He was extremely diffident of strangers but once he conceded my presence, it was ok. We never had one private conversation because he was constantly supervised at close range by the KGB. They never even addressed him with his name – he was merely prisoner no.7.”

No.7’s health issues were discussed at a round table including Carabot, the KGB, the CIA and others. A trip to the British Military Hospital needed the organisation of a state visit and the Germans would close West  Berlin’s main thoroughfare just to transfer the man to the Military Hospital and back. Hoess is said to have committed suicide in what were extremely dubious circumstances. Luckily for Dr Carabot, he was away at the time, and that spared him interrogations and questioning.

When Carabot left the British army in 1999, he was approached by Professor Joe Pace then Chairman of Dermatology at Boffa Hospital, who suggested he start off the GU Clinic from scratch. Nine years down the line, Dr Carabot has a new project at hand “We have reached a point where we are presently working on a National Sexual Health Policy. There is an urgent need for a drastic re-look at how we handle the sex issue in Malta and it is a national issue which concerns us all. There is an urgent need for  prevalence studies to better assess the situation and monitor trends.”

As a final word, Dr Carabot addresses family doctors and other specialists who might see patients with a potential STD, “Doctors need to adopt a uniform approach in screening and treating STDs. They are the first contacts with infected patients and need to have a very high index of suspicion. The truth is that the GU Clinic gets very few referrals from doctors and what reaches us are mostly self-referrals. Doctors must stop treating blindly and they must refer more patients to this clinic. It is the only way to try and stall the wave of STDs that is hitting the country.”

Further information on the GU clinic may be accessed on http://www.sahha.gov.mt/pages.aspx?page=173. The contact numbers are 22987115 (clinic direct line) and 21227981 (for appointments).