Dr Darren Russell is Director of Sexual Health at Cairns Base Hospital, Adjunct Associate Professor at James Cook University School of Medicine and Clinical Associate Professor in population health at the University of Melbourne. He is also past-president of the Australasian Chapter of Sexual Health Medicine and the Australian Federation of AIDS Organisations.
In 1990 I wanted more experience in palliative care and HIV medicine because they were two areas I hadn’t covered well in my medical training. I called Dr David Bradford — who was chief venereologist in Victoria and probably had the biggest HIV clinic in Melbourne — to ask if he could suggest a course. He didn’t know but asked if I wanted a job in his HIV clinic (Lygon Medical Service in Carlton). He’d been advertising for 18 months but no one wanted it. I asked why and he explained that it was an HIV clinic, clients were injecting drug users, sex workers, marginalised people with a terminal illness or at risk of getting one and, at that stage, they were nearly all going to die. The condition is infectious and we take all our own bloods as well as doing minor surgery and it doesn’t pay very well. How could I resist? I started work there in November 1990.
HIV is my main focus. I try to get the best outcome for people with the least side effects. I also work in screening and treatment for sexually transmitted infections, hepatitis C, sexual dysfunction, reproductive health and medical abortion.
I love the patient group and the academic challenge of HIV. Often, finding the best drug regimen is a challenge. It’s a cerebral discipline and I like that. We have to think about what medications patients have been on, drug resistance, side effects, new therapeutic drug monitoring and genetic resistance assays. If you stop for six months, you’re out of date, so I like the pressure of having to keep up with cutting-edge stuff.
When I first started in the field, everyone died. It was awful. These were young, wonderful, delightful men about my age who could have been my peers, and they were dying of something we couldn’t stop. In 1996 highly active antivirals started to become available. Now, even though people are committed to a lifetime of medication, they will have a lifetime of medication. It’s just a wonderful thing to see people get on with their lives, work, have relationships, have kids and do normal things everyone else can do.
The stuff we can cure is really rewarding. There’s nothing better than a good case of gonorrhoea, because the bloke comes in with pus and stinging when he pees and a horrible, dramatic presentation, and you just give him an injection or some tablets and within hours it’s gone. There’s not much in medicine that you can treat that way. We can cure so many people with hepatitis C now, even though the treatments are still pretty awful. The long-term benefits for those individuals, both physically and mentally, are phenomenal.
I have four main mentors. Dr Bradford, who I mentioned before, is a delightful individual and also very knowledgeable. He taught me a lot about working with the affected community — not just being a doctor from a distance but being involved in the community to prevent and treat HIV. I worked at the Victorian Infectious Diseases Service at The Royal Melbourne Hospital and three outstanding clinicians there were: Dr Allen Yung, an old-style fever doctor who taught me about taking a good history, listening to the patient and doing a good examination; Dr Alan Street, an infectious diseases doctor with a top-notch intellect and knowledge about HIV and infectious diseases; and Professor Graham Brown who, as head of the unit at the time, showed me what a great medical leader can do.
I felt privileged to have been president of the Australian Federation of AIDS Organisations. It’s a community-based organisation and I felt very honoured as a doctor to be involved. Also, a couple of years ago the Royal College of Physicians in London gave me a Fellowship as a sexual health physician here in Australia and that was a great honour.
Sexual health medicine is a vital discipline that’s not well recognised. We often do the sort of stuff that other doctors don’t like doing. It is a great career if you are comfortable working with people at the fringes of society and if you’re not afraid to talk about taboo topics. We can’t be judgemental about things, even if we disapprove of people’s behaviour — that’s not our call. Not every doctor is able to do that and that’s fair enough. If you can and you are interested in doing work on behalf of your patients, it’s an absolutely wonderful career.