Playing it safe
This season, a bandaged finger on the curb makes fun of the population's irresponsible demands on the emergency department in an attempt to encourage responsible behaviour, given our larger-than-life reactions to disasters which, mildly put, are little more than minor inconveniences.
Yet, while a public service announcement is chastising our partiality for hyperbole, it is also, in a sense, highlighting the anomalies which govern the ways we sift information, as we are led by the politics of the press and state. The result is that we often make a big deal of trivial items and make little of more pressing issues which, ignored, have the potential to cause widespread suffering and misery.
In Malta, we are so plagued with prejudice that a good number of locals believe that the Maltese get sexually-transmitted infections by behaving irresponsibly when they go abroad. In other words, Maltese are infected by foreigners.
In his position as consultant in charge of the Genitourinary (GU) clinic at Boffa Hospital, Philip Carabot was quick to point out to me how false an assumption this is. Basing his expertise on years of dealing with cases of STIs and investigating suspected cases of STIs on a regular basis, he told me that the number of cases where Maltese pass infections to foreigners is usually on a par with cases in which the exact opposite happens.
Going by the current spate of writings attacking the global media's inability to tell the truth, the choice between complacency and action is, at times, based on false reports. From Hugh Pennington's level-headed analyses of, among others, the Sars outbreak and smallpox, to Nick Davies's book Flat Earth News, we are urged to seriously think about the media's propensity to present fiction as fact.
As some quarters of the news industry polish the phoney well enough to make it look real, governments all over the world are sometimes equally guilty of irresponsibility. This may happen, for example, when they fail to act quickly enough or not at all in implementing measures which complement the gains of science.
Collective action is required to limit, among other problems, the spread of illness and illiteracy. If the recommendations of researchers and educators go unheeded, we are short-changing ourselves and our children.
When I asked some people for their thoughts on the subject of Malta and sexually-transmitted infections, Peter*, 23, voiced his concern for teenagers, in general, and his siblings, in particular. "I happen to know that STIs are rampant," he said, "but I fear that if I were to ask my 18-year-old sisters what they are, they would probably not know since they are unaware of the signs and symptoms."
We find death unacceptable yet we ignore the caution exerted by our ancestors. In the words of Amanda Ripley, we "flirt shamelessly with risk". In a Time feature entitled How To Survive A Disaster, she draws attention to our increasing lack of foresight. We have been seduced to believe that there is, indeed, a pill for every ill.
Robin*, 34, had another way of putting it: "A vast majority of young people (and maybe even the not so young) refrain from using any protection whatsoever. It must be the 'it-will-never-happen-to-me' syndrome. An extra effort is needed to drive the message home to those who practise casual sex: Use protection or abstain."
At the beginning of the 1990s I remember a distinct feeling of helplessness when prospects for AIDS patients were very bleak. Precaution was the order of the day. The basics of safe sexual behaviour were drilled in the public's psyche in what was looking like a do-or-die scenario. Undoubtedly, viral infections will continue to challenge the medical community in spite of the fact that vaccines for a few of them have become a reality.
In view of the recent spike in STIs, both in Malta and abroad, it looks like good health is being taken for granted. People complain when they get a strain of the common cold. They mistake it for influenza, wondering why they bother with the annual flu jab and conclude that getting a cold means that the vaccine did not work. They expect prescription-only medicine to cure a viral infection, unaware of the damage this causes.
Certain practices increase the resistance of bacteria to medicine which has taken years to be put on the market. Using an antibiotic for a throat infection when over-the-counter medicine would suffice spells bad news. "If a medicine starts losing its ability to kill bacteria," Dr Carabot noted, "we are jeopardising our chances of curing serious bacterial infections. We already have a very serious problem with gonorrhoea. The bug has been here way before us and it will be still be here when we are gone. Pharmaceutical companies are in a constant race to outmanoeuvre the bug but when undesirable practices like over-prescribing continue unabated, we risk losing the upper hand gained by dedicated scientists."
In direct contrast to the demand to get rid of a cold quickly because it is a bother, people are sometimes blissfully unaware of asymptomatic infections which, left untreated, have serious consequences on a patient's quality of life. Chlamydia, for example, can cause infertility. Yet a short course of antibiotics, taken before permanent damage is caused, can clear up the infection without any lasting consequences on a patient's health.
The symptoms of STIs may be easily confused with the symptoms of less problematic conditions such as yeast infections. STIs can be bacterial, viral, parasitic and fungal, depending on the cause of the infection. Fungal infections are not, strictly speaking, STIs. However, they can be passed from one person to another during sexual activity.
Bacterial and viral STIs require proper confirmation and cannot be diagnosed solely on the strength of a patient's symptoms if, indeed, there are any. Without a proper inquiry into the sexual history of a patient, followed by screening for a number of STIs, an infection, should this be present, goes undetected and untreated. Left unchecked, it may spread to one or more partners if the infected person engages in unprotected oral, anal or vaginal sex. Hence the importance of going directly to a GU clinic should a person want to get checked for STIs. Dr Carabot and his staff normally screen patients for gonorrhoea, Chlamydia, syphilis and HIV. Further testing depends on a person's history. A patient with a preference for same-sex relationships would be, for example, additionally tested for Hepatitis B. An intravenous drug user, on the other hand, would also be screened for Hepatitis C.
In January 2000, the first GU clinic was set up in Malta. It is normal for people to feel embarrassed or uneasy when it comes to discussing their sexual health with a health professional. A GU clinic helps contain the spread of STIs because it offers, hand in hand with medical expertise, a guarantee of confidentiality which encourages patients to come forward.
In the course of interviewing Dr Carabot about his work at the clinic, I asked for his opinion on the local state of affairs in the light of The Genitourinary Report and its findings.
"Casual sex is very common," he replied. "Sometimes it proves very difficult to trace the partners of an index patient simply because the sexual encounters have been so casual that, in the absence of a name, let alone a contact number, the possibility of contacting a partner or partners to halt the spread of disease is so slim that it is non-existent."
Drew*, 21, had this to say about the rise in STIs: "I feel that one crucial reason for the rapid rise in STIs is the shift in the meaning of sex. Sex has turned into an enjoyment ride rather than a meaningful expression of love between two people. Many people choosing to have sex with different people inevitably increase the prevalence of STIs."
Are people careless when it comes to watching out for themselves and others? Why does a person risk a state of good health by ignoring the recommendations of the medical community regarding the practice of safe sex? Dr Carabot is calling for national prevalence studies carried out at regular intervals in order to get to grips with how serious the situation is.
In Dr Carabot's analysis of the local situation, a lot has changed but education has not been properly tailored to counteract the hazards and challenges of these changes.
"Our country," he noted, "has acquired the European way of life without the necessary life skills to mitigate the effects of this lifestyle. We have not been well-educated in the prevention of STIs and so today's adults, young adults and teenagers are not fully aware of the responsibilities they have towards themselves and others. Effective campaigns are needed to make the upward trends change course. At this stage we have to ask ourselves if we are happy with the current situation. If not, what is being done to organise a nationwide effort in response to the problems we are facing?"
In Gomorrah: Italy's Other Mafia, Roberto Saviano describes how a clan stopped HIV in its tracks at a time when it was afflicting the rest of the world. Anyone who was infected had to be eliminated immediately. It was not in the clan's interest to prolong the life of the seriously sick. I find myself wanting to raise my finger and ask a question: If it easy for us to ignore a rise in STIs in, more or less, the same way some callously shrug when lives are lost on the way to our shores, why then, should the clan's disrespect for life shock us so?
*Names have been changed.
• An appointment at the GU clinic can be made by phone on 2122 7981.