My name is Susan, and I work as a sexual health adviser, which is a specialist nursing role, at the bSHaW sexual health clinic which is on the Wycombe Hospital site, behind the Breast Screening Unit and Maternity. We have a similar clinic in Aylesbury called Brookside which is next to the railway station.
My typical day involves speaking to a huge range of people, face to face or by telephone. Part of my role is to assess the risk of people who drop in to the clinic or telephone for advice. We see a lot of people who turn out to be fine but also those with symptoms of possible sexual infections, with contraception needs, or those in need of support and somebody to talk to, some of whom may be at risk of sexual exploitation.
Tuesdays are long days for me and require a lot of stamina – here is an outline of my last Tuesday at work
8.00am :I got to work at 8 am and had a cup of coffee. I then worked through a pile of patient clinic notes requiring action – usually results that need to be telephoned to patients, or notes that need review because of children’s safeguarding issues requiring calls to be made to other agencies such as Barnados R-U Safe, which is a service for missing young people and those being sexually exploited, or notes that need discussion with a clinic doctor because a result needs interpretation. And while I was doing of that –
8.15am : Telephone call from male, “very worried”. Last night a man told him (after unprotected sex) that he was HIV positive. Arranged to see him to give post-exposure prophylaxis (PEP) medication to reduce the risk of HIV infection. Talked to him about reducing risks in the future.
8.30am : Walk-in clinic. About six people have been waiting for clinic to start and others come in quickly until the waiting area is full. Girl of 17 was at a party and had sex with someone new. During discussion she explains she “tried to say no but he didn’t listen”. She starts to cry and thinks it was “her fault”. Work out with her what she wants to do about reporting this as a sexual assault.
9.30am :A “regular” attends, she has learning difficulties and we are part of her support structure. Try to explain appropriate use of services whilst checking out with her that she’s not being sexually exploited.
10.30am : Call from male aged 40 had sex with sex worker whilst away on business; he is desperate to be reassured that he is not going to infect his wife.
11.30am : Call from teenage pregnancy midwife. She has diagnosed chlamydia in a pregnant 16 year old. We work out the best way to get the girl and her partner treated.
12.30pm : Meet with lead nurse for safeguarding children to discuss concerns we have about under 18s attending the clinic from 12.30-1.30pm :This is all kept completely confidential and we only discuss if we have reason to believe the young person is unsafe. If we do need to discuss this, we always tell the young people first.
2.00pm : From 2-3pm I see a 15 year old who reported a sexual assault. She comes with her mother who is distressed and angry.
3.00pm : 3-5pm is the Under 21s clinic. Waiting room full of people wanting to be tested, needing contraception and also lots of their friends!
5.00pm : Mother attends with her 14 year old daughter. Mother wants her to have a contraceptive implant “to protect her”. The girl says she doesn’t want this. Work out a method that they are both comfortable with whilst asking about whether this is sex that the girl is happy with, is this a healthy relationship?
6.00pm : See a woman in her 20s, she’s had a recent termination but “can’t get on with” any method of contraception, look at all the possibilities with her whilst aware there are ten people in the waiting room.
On some days it seems possible to help people to make changes in their lives, maybe support a referral to drug or alcohol services, or for counselling, or that they are going to give up having casual sex. Sometimes people have already decided that they want to make a change. They may be fed up with taking risks with sex and just need to focus on a commitment to using condoms. The best days are when people leave with a plan and a decision that they want to look after themselves and their partner… that feels like a triumph!
At the end of a long day I hand over any outstanding concerns to colleagues and leave the clinic… until tomorrow…