by Nadia Ahmed

LoveGUM – yes I do! I feel very fortunate to work in a speciality that over ten years from starting, I (still) find intellectually stimulating, challenging (in a good way!) and above all enjoy. I really cannot see my enthusiasm and passion for HIV, sexual and reproductive health ever tiring when the speciality offers so much variety and there is still so much to achieve both in the UK and internationally.

My journey into GUM has some echoes of the FAQ on this site! I might not have known about GUM as a speciality and therefore made it as a consultant, but am a strong believer that you will be drawn to your intended path by the right means along the way to get you there! When people ask why I chose the speciality, similar to my answer about why I chose medicine as a career, I can give specific reasons, but I think the strongest reason for me is not knowing but just knowing it is what I wanted to do. I think I was drawn to the speciality because of part of my South African and Indian heritage, and seeing and knowing about the impact HIV particularly had and still has, but also the health inequalities from a local to societal level.

However, to be specific, it really does encompass the breadth of medicine from prevention to cure, and managing acute and chronic conditions. Sexual health gives you a unique opportunity to manage symptoms people are often quite nervous about seeing a doctor for, reassuring them, testing and even seeing the causative agent moving around under a microscope, and treating them. There is also so much more including chronic genital issues spanning gynaecology, dermatology and sexual function. HIV brings out everything in medicine in a specialised but also general way in both outpatients and inpatients, with the potential complexity of antiretroviral treatment from patient choice, drug interactions and resistance. I have looked after some people with HIV for over a decade, seeing them through important milestones as well as their healthcare. Communication in the speciality is a key pillar that I appreciate, particularly when it comes to discussing very personal issues and being able to alleviate the anxiety they made have had and help through to better health, but also navigating psychological and social challenges with HIV but also sexual and reproductive health. Finally, the international scene is what further propels my passion; given the history particularly of HIV from the 1980s to date, but also sadly the health inequity still seen including access, service and frontline healthcare of not only HIV but sexual and reproductive health.

Early on as a medical student at University College London I did a special study module in the origins of HIV, an intercalated BSc in Infection with a project developing a HIV test based on the original ones developed. After qualifying I did not know GUM existed as a speciality, despite recalling fondly the medical student rotation with doctors who went on to be my educational and clinical supervisors, mentors and then consultant colleagues. I had started to accept I would have to develop my interest via infectious diseases but during my CMT1 rotation I heard about GUM at a grand round (also done by a now consultant colleague!). At the same time I saw an advert for a GUM taster. The taster did not need to do any selling, it only confirmed this is what I wanted to do. A rotation in my CMT2 year in HIV medicine at the Royal Free Hospital just continued to confirm this. I applied and chose Mortimer Market Centre for my training. I was fortunate at the time to have applied and allowed to take a year out (a lot of post general medicine and MRCP downtime needed!), going to South Africa where I spent the year working in the HIV clinic in Mitchell’s Plain, Cape Town.

My training years at Mortimer Market Centre, Archway Centre, St. Ann’s clinic, the North Middlesex and University College London hospitals were great. My fellow trainees were nurturing, supportive and fun, many continuing to be close friends. My supervisors and mentors were more than I could have asked for, really shaping the doctor I am today. I took quite the usual path with one or two deviations. Firstly, I took time out to develop my interest in adolescent health, spending over a year in our adolescent HIV clinic as well as outreach adolescent sexual reproductive health clinic. I then took a few months out and worked in a paediatric HIV department and with a charity implementing adolescent youth services, in Durban, South Africa (again!). Secondly, I spent longer than my trainee colleagues in our sexual function service, which really shaped my interest within sexual health and the work I currently do. Thirdly, I took time out to train as a forensic physician (sexual offences examiner) at The Havens, in Camberwell, London, where I continued to work out-of-hours for a few years. A particular highlight throughout those years, however, was beginning to develop (and little did I know, strengthen) my interest in international health with an exchange trip with a doctor in Iran via the charity, Justri.

Fast forward to where I am at now, a consultant in GUM. Having gained my Certificate of Completion of Training in November 2015, I initially had a locum consultant post at Mortimer Market Centre, but then spent just under three years in Cape Town, South Africa (yes again!) following an opportunity that came up. I worked at the Desmond Tutu HIV (now Health) Foundation Centre with the University of Cape Town, and within the township Gugulethu. I was appointed as the adolescent clinical lead, which involved clinics with adolescents and youth living with HIV (and the occasional adult), being course conveyor for a course on adolescent health with the London School of Hygiene and Tropical Medicine leading on the implementation of adolescent youth health service, PrEP and school health services with the National Department of Health and dipping into research in various ways. During this period, I also got involved with Doctors Worldwide, doing educational and service attachments in very rural Malawi (think consultations under a tree!) and then education and training of doctors (often newly qualified) working with the Rohingya population in Cox’s Bazaar, Bangladesh. I returned mainly for personal reasons to the UK to take up a permanent consultant post in HIV medicine at the end of 2019, at Mortimer Market Centre. My role has evolved from HIV outpatient clinics and one of the consultants supporting inpatient HIV liaison (and everything else that comes with a consultant role including service development, audit/quality improvement, education and training – I’ve never really got tickled by research which is ok but dip my fingers in occasionally), to HIV outpatient clinics, lead for inpatient HIV liaison supporting a local renal MDT and national neurology MDT, and sexual function clinics including taking over as medical lead for the service last year. My specific interests have continued in adolescent health, inpatient care, and continue to develop in sexual function and bringing that more so in the healthcare people with HIV. Education and training has always been a theme, and I have recently been appointed the undergraduate lead for sexual health and HIV.

I have also managed to continue marrying my day to day work with my passion in international work on a voluntary basis, with the organisations mentioned and also recent initiatives including the Inter-Agency Working Group. So far I have been fortunate to have done work in and continued to foster working relationships with colleagues in-person in Romania, Turkey, and most recently Sudan, and virtually with teams in Pakistan and Nepal, along with the countries already mentioned. Being able to enjoy what I do is the most important part, while also making a difference to patients, staff, students and services, and GUM definitely gives me that and a little more. If I was to do this over, I would definitely still choose GUM.