Tell Me I'm Okay

by David Bradford

  I soon found people had strange attitudes towards staff who worked full-time in an STI clinic. While most were appreciative of our help, some had us labelled in their minds as inferior beings – either ‘pox doctors’, or ‘pox doctors’ clerks’. Many of the younger patients had never been to a doctor before – at least, not since childhood when they had been taken by their mothers. It wasn’t uncommon that in the course of physical examination I would find some medical condition other than an STI. I came across conditions like hernia, raised blood pressure, varicose veins, and once a suspicious looking skin lesion like a black mole. I would draw the patient’s attention to it and ask what she or he would like me to do about it, and I became familiar with the response, which varied little from patient to patient.

  ‘Oh please, don’t you worry; I’ll see a proper doctor about that!’

  I somehow always managed to take the unintended slight in good grace.

  There were pressing problems that needed addressing. Contact tracing was one. In GUM Clinics in the UK, contact tracers were an essential part of the service. Patients diagnosed with an STI have always caught the infection from someone else. The job of a contact tracer is to ensure that the infected partner (or partners), out in the community, are traced and treated. There is limited value in treating a patient if the person who gave them the infection is still able to re-infect them, or infect other people. Contact tracers interview patients found to have an infection and formulate a plan. Sometimes patients agree to tell their partner (or partners) themselves, and encourage them to attend the clinic for a check-up. At other times, if the patient feels unable, or too embarrassed, to personally contact their partners, the contact tracer does the job for them. The work calls for sensitivity and tact, and requires excellent communication skills.

  There were no contact tracer positions at the MCDC. Most other clinics in Australian capital cities were in a similar situation. One of the first things I did as Director was to lobby the HCV to create two positions. After a couple of years, with repeated lobbying, making the point that Victorian STI services compared very unfavourably with British services, the HCV was shamed into action. In 1983, the necessary funding was found. I advertised the positions, and that same year, two outstanding registered nurses with extensive counselling experience, Beth Hatch and Tom Carter, commenced work. They were ideally suited for the job. Tom eventually retired from the position of ‘partner notification officer’ after chalking up more than 30 years of exemplary work, and Beth retired only a year or two earlier than Tom. In 1983, none of us suspected how vital the new contact tracer and counsellor positions would become in meeting the Clinic’s growing challenges over the ensuing years.

  A Contact-tracing Story

  Between 1980 and 1983, I sometimes had to take on contact tracing myself. So numerous were the cases of gonorrhoea acquired at massage parlours in those days that, without dedicated contact tracers, it wasn’t possible to do anything about gonorrhoea. However, I felt we should make an effort over syphilis, so when a few male patients had acquired syphilis from a particular massage parlour, I would make a visit there and encourage the sex workers to attend for a check-up. People in the parlours often didn’t take kindly to a doctor from the government-run ‘VD clinic’ dropping by with an unwelcome message. They were afraid I might ‘dob them in’ to the police, which of course I had no intention of doing. In the long run, that would have been counter productive. Prostitution was illegal in Victoria at the time, and massage parlours were just a front for sex work. I confess I hated doing these visits but they were rare enough events because I simply did not have sufficient time.

  One day towards the end of 1980, a Lebanese–Australian man in his late twenties came to see me in the clinic. He had a typical chancre on his penis,20 which microscopy confirmed was syphilis. I treated him with a penicillin injection, at the time asking for details of how he had acquired the infection. He named a girl appropriately called ‘Fanny’ whom he said worked for ‘Mrs Browne’ in Fitzroy. He’d visited her a few times over the past three months. He was unwilling to provide an address, so I asked him if he would mind dropping a letter in to Fanny. He said he would, so while he waited, I wrote a short note on MCDC letterhead, saying that unfortunately my patient had acquired syphilis and it would be sensible for Fanny to attend the clinic as soon as possible. My patient went off with the letter. The next day I had a phone call.

  ‘Hello, is that the doctor? It’s Mrs Browne here – I run the house in Fitzroy.’

  ‘Oh, yes, I’m Dr Bradford. I expect you are ringing about my letter?’

  ‘Yes! You say there’s syphilis?’

  ‘That’s right. A patient I saw yesterday had it.’

  ’Well, I’m glad you wrote. A little bit of gonorrhoea now and then is okay, but syphilis I will not have!’

  ‘Well, maybe you could get Fanny to attend and we will check it out for her.’

  ‘Fanny? It’s not just Fanny that’ll have to come! That bugger’s been with all my girls. I’ll have to send the lot of them.’

  ‘How many are we talking about?’

  ‘About a dozen. Give or take. Can I send them tomorrow?’

  ‘Yes, for sure, but maybe you could get them all to come as early as possible in the morning, before we get too busy.’

  True to her word, Mrs Browne sent all her workers. When we opened the doors at 9am next morning, there were ten women waiting on the front step. They were all ages, but predominantly over forty, and all sizes and shapes. They were a cheery lot though. A picnic-like atmosphere reigned in the waiting room. It was probably one of the few times they could chat together without having to rush off to service a client.

  Another doctor and I worked through the group, taking clinical histories, doing swabs and blood tests, and offering reassurance and counselling. I personally saw the famed Fanny. Blood tests subsequently revealed that she had syphilis, as did a couple of others. As Mrs Browne had more or less hinted, we also found gonorrhoea and non-specific cervicitis (due to chlamydia).

  We provided two options for the patients that morning: they could wait until the results were back, and if found positive, have treatment for syphilis then, but in the meantime they would have to ensure their clients used condoms. Otherwise, they could be treated as if they had syphilis, with an injection now. For the benefit of public health in Fitzroy, I was pleased the women all chose immediate treatment.

  My second patient presented an unexpected problem. She was an overweight woman in her late thirties, very good-humoured, and apparently unfazed by this mandatory visit to the ‘Government Clinic’.

  ‘Oh dear, I hope it’s not me with the syphilis, Doc,’ she said, as she heaved herself up onto our old-fashioned examination couch and slipped her feet into the stirrups provided. ‘It would upset my poor paraplegic husband so.’

  I said that I too hoped she didn’t have an infection.

  ‘Well, it’s unlikely, Doc, because I’m the sitter at Mrs Browne’s. I only have to lend a hand, so to speak, when it gets busy. But then you never know I suppose.’

  I was puzzled, so I asked, ‘Tell me – what does a sitter do?’

  ‘Oh, I just answer the phone and greet the gentlemen at the front desk and take their money. But like I said, sometimes I have to help out with the odd client, here and there, when it gets busy.’

  As I completed the internal vaginal examination and took the necessary swabs, I asked my patient, ‘Has your husband been paraplegic long? Is he managing OK?’

  ‘Only about six months, Doc, and he’s doing as well as can be expected. After he got shot, at first it was hard managing, for me and the two kids.’

  ‘He got shot?’

  ‘Yes, some bastard shot him in the back!’

  Perhaps appropriately, I decided not to pursue my line of questioning because I was distracted by the last step in the examination. At that time, it was routine practice to take swabs, not only from the cervix and urethra, but also from the anus, usi
ng a proctoscope. My patient, as I have said, was a large lady. With proctoscope poised in my right hand, while parting the folds of her ample buttocks with my left, I was having some difficulty finding the required anatomical spot.

  ‘Everything going all right down there, Doc?’ she inquired. ‘Well, um, no, I’m afraid not,’ I had to admit, somewhat shame-faced, ‘I can’t seem to find your anus.’

  ‘Oh, silly me. I should have told you. You won’t find it, Doctor, because I don’t have one. I’ve got a colostomy, haven’t I.’

  My patient amazed me. Her good humour appeared unassailable under the hardest of circumstances. She clearly bore me not a trace of ill-will.

  As the morning wore on, and the last two women from Mrs Browne’s establishment presented themselves for testing (presumably after they had been relieved from duty by the earliest two we had examined), I marvelled at my earlier patient’s misfortune. She was working in a brothel, living with a colostomy for some previous medical condition, bringing up two young children, and supporting a husband rendered paraplegic by a gunshot wound in the back. Yet, on an enforced visit to an STI clinic, she was still smiling. My encounter with her only increased the respect I felt for all my sex worker patients.

  The MCDC and the Gay Community

  When I took over as Director, another pressing problem was the clinic’s poor relations with the gay community. My predecessor was gentlemanly, white-haired and distinguished-looking. A staunch Catholic with conservative values, he had actively discouraged gay men from attending. On my first day, when I asked why there were no proctoscopes in the male clinic, he said to me, ‘Oh, we don’t want to encourage perverts, Dr Bradford.’21

  A news-sheet of the time, Gay Community News, had mounted an ongoing attack on the government STI clinic and its attitudes. The paper advised gay men not to attend, but rather to seek out the one or two gay-friendly private general practices in Melbourne.

  Ensuring that the Clinic provided a good service to gay men and encouraged their attendance was high on my agenda. That I was gay myself was not a factor. There was an excellent public health reason. Gay men were at high risk of STIs in Australia and syphilis was unfortunately making a comeback. There was in fact quite an epidemic of syphilis in sexually active gay men in Melbourne. I needed more factual information, so I looked around for a suitable site to undertake a survey.

  Sometime in 1980 a gay sauna, called Steamworks, had opened in the CBD. There were, and had been, other gay saunas for many years, but Steamworks was regarded as something special, a ‘state of the art’ steam bath. I had heard many good reports of the sauna – that it was modern and well-run. Gay men patronised it in good numbers, especially after the Hamer Liberal government decriminalised homosexuality in Victoria in December. I thought the new sauna might be an ideal place for my survey. In my official capacity, I went to meet the owner.

  Steamworks occupied a two-storey building near the corner of Latrobe and Elizabeth streets. I entered at street level and climbed a flight of plushly-carpeted stairs to the upper level. The ambient electronic music of Vangelis played softly from hidden speakers. Behind a window, a well-built man in a tank-top waited to collect an entrance fee and to issue towels and a locker key. Having an appointment, I gave my name and was allowed entry to a pleasant room furnished with comfortable armchairs and lounges. At one end of the room was an elevated stage, with a large television set, and at the other end a café and snack bar. I was most impressed how well-appointed the place seemed. Obviously a lot of money had been spent fitting it out. The owner came out of his office to greet me and took me on a tour of the building. We went through a large locker room, then down another flight of stairs to a tiled area complete with plunge pool, Jacuzzi, dry sauna and a large, dimly-lit steam room. Everything seemed clean and well maintained. Beyond, we entered a darkened maze of narrow corridors, with many cubicles opening off them. We returned upstairs and the owner ushered me into his office. I discussed my proposal with him and he proved most obliging. He said he was anxious to assist any way he could to safeguard the health of his gay clientele. He would provide private space on Wednesday evenings for me to take blood tests for syphilis from any volunteer clients. Receptionist staff would assist by making regular announcements throughout the evening, letting people know I was in attendance.

  I obtained the necessary approval from the HCV; from then on, my partner Michael and I spent our Wednesday evenings at Steamworks. I did the blood tests and Michael kept the records. At the end of twelve months, I had tested enough men to start making a positive impact. As expected, a significant proportion were infected with syphilis without being aware of it, and I had been able to arrange treatment for them. The results were analysed and I submitted an article to the Medical Journal of Australia.22 With the sauna owner’s continued support, Michael and I, with occasional help from other MCDC staff, continued regular Wednesday evening blood testing. We saw this as a great opportunity to build links between the clinic and the gay community.

  In the years when homosexual behaviour around the world was either illegal or frowned upon, saunas (or bath-houses as they were called in the United States) were important meeting places for gay men. Some had become famous, like the ‘Continental’ (1968–1974) and the ‘Everard’ (1888–1986) in New York City. The ‘Continental’, around 1970 or so, provided regular entertainment for clients, including performances by such celebrities as Bette Midler and Barry Manilow. After Steamworks came on the scene, a couple of other saunas continued operation in Melbourne but these were smaller and less luxurious concerns. It’s important to point out that gay saunas were not brothels. Men merely paid an entrance fee that allowed them to use the facilities for several hours, but prostitution was never tolerated.

  It became clear to us that for many gay men, Steamworks was a ‘home-away-from-home’. On weekends there were evening shows held in the lounge – mostly ‘drag’, but sometimes live gay comedy. Several times over the years that followed, the owner asked me to arrange talks on gay sexual health, which he advertised well in advance. They were always well attended. For those who didn’t like the bar or disco scene, Steamworks provided a safe, friendly environment, ideal for meeting people and, of course, for having sex if someone took your fancy and the feeling was reciprocated. Michael and I inevitably met a large number of Melbourne’s gay male community through our work at the sauna. The clientele were varied: all ages from eighteen onwards, and all physical shapes and sizes. There were timid young men not knowing what to expect on their first visit to a gay venue, and closeted older men who had been looking for years for just such a sheltered retreat where they could find an outlet for their same-sex desires. There were many regular characters like the kindly old chap in his seventies whom everyone called ‘Queen Victoria’. Queen Victoria had a full set of dentures, upper and lower. When he took them out, it was rumoured, that he gave ‘the best head job in Melbourne’. He made it well known that he was happy to oblige anyone who felt the need for this unique service.

  Steamworks continued for almost thirty years before closing its doors in 2008, and Peter Hayes, a nurse from the MCDC, continued blood tests every Wednesday evening right through to the last week. This job that Peter undertook over the years was nothing less than amazing. Fashions change, and although gay saunas in many capital cities remain, demand for them has declined. The same is true of gay clubs, discos and bars. Young gay men tend to meet each other for sex and companionship through the internet these days. For the purposes of health promotion and targeted intervention activities, like blood testing, the decline of gay venues has come at a cost.

  Non-Gay Patients at the MCDC

  In those pre-AIDS days of the early eighties, sexually active people rarely attended a doctor’s office or clinic for a sexual health check-up like they might do today. There was little public awareness or education about STIs. To rectify this, I decided I should write a book for the general public about STIs. One of the main issues of the day was that
young people never thought of prevention. If they thought about STIs at all, most people believed they were not a serious threat because they were so easily treated. As well there was a strong feeling in the community that ‘nice people never got VD’, and if you talked too much about prevention of STIs, it would simply give encouragement to young people to be more promiscuous. Using condoms for anything other than avoidance of pregnancy was almost unheard of, and widespread use of the contraceptive pill had largely removed the worry about unwanted pregnancy. Consequently, almost everyone attended the MCDC because they had developed symptoms. We found most of them had an infection. Gonorrhoea, syphilis, non-specific urethritis (NSU), genital herpes, genital warts and vaginitis were all common. Sometimes though, we were able to tell a patient she or he had been worrying unnecessarily.

  Mario was seventeen when he first attended the MCDC. He was worried and anxious. It had taken him a month to summon up courage to come along. His only sexual encounter had been five weeks before with a new girlfriend. It had been quick and unsatisfactory. Imagine his horror then to discover warty looking spots all around the head of his penis a week later. I examined him carefully:

  ‘Mario, I’m happy to tell you these spots aren’t warts.’

  ‘They’re not, Doc? Well, what are they then?’

  ‘They’re PPPs; that’s pearly penile papules. You’ve had them all your life.’

  ‘Not possible, Doc. I’d have noticed them.’

  ‘Well, they only become obvious around puberty. You see how regular in size they are, and how they are arranged in a nice, neat line? Warts are never neat like that. That’s one of the ways we can tell the difference.’