Dr Charmaine Gauci

Whether it is about the lethal tar of nicotine accumulating in your lungs or the silent HIV virus working its way up to your immune system after a night of unprotected sex, Dr Charmaine Gauci will be the new face and voice reminding you of the terrible effects of life’s little pleasures.
Minutes after she got to know about her appointment, the news was already spreading unofficially as her predecessor on the health promotion front, Mario Spiteri, was quick to point at the “invisible hand of the Curia” behind his demotion.
The public health crusader could not be more direct in his accusation: “I had a serious clash with the church’s commission for youth (Kummissjoni Djocesana Zghazagh – KDZ) when they asked for our department’s funding to finance their campaign promoting sexual abstinence,” Spiteri said last week.
“I was under pressure to give in to the KDZ’s insistent requests for funds but I stuck to my position. My first allegiance is towards the public, and promoting abstinence is something from another era. Who’s going to buy that? I couldn’t do that and sleep comfortably when the World Health Organisation clearly lists abstinence alongside sexual loyalty and condoms as the best ways to avoid STDs.”
KDZ denied the allegation immediately, although Spiteri is sticking to his guns and insisting that the pressure he faced against his campaigns promoting the use of condoms as one way of avoiding AIDs and other illnesses was the reason behind his demotion. Faced with all this, the 40-year-old doctor who is now the director of the new department says she is prepared for the challenge that this directorate entails.
“Mario is a colleague and a friend of mine, we worked a lot together and I wish we could keep working together. I am not replacing Mario, this is a totally new directorate, merging health promotion with prevention for both communicable and non-communicable diseases. Mario is more than welcome to continue working with me. I knew the reform would be carried out although I didn’t know how it would happen. There was a call for applications for a number of directorates last March and I felt I could apply specifically for this post because I have experience and qualifications in all sectors, including health promotion. Last week I was surprised with the news that I got the post, as was everyone else. I had long been planning what I could do if I became director, and I’m ready for this challenge.”
Whether the Curia lobbied for Spiteri’s removal or not cannot be verified, but definitely he was under pressure from all sides throughout his career at the helm of the department, and sexual education was a veritable minefield.
Dr Gauci treads carefully in this department. She says it is useless being militant about one message while ignoring the social context of Maltese society.
“I was not involved on HIV and AIDs campaigns. I think one has to look at the culture in Malta and promote health accordingly. As the minister said, total abstinence on its own does not work, but you have to look at the health promotion measures that can work in your country and which the people are ready to take up. It is useless preaching a message when it would go against their beliefs. We have to keep in mind this is Malta, with its culture and the ideas of the Maltese, including religious ideas, because that is a substantial part of the person. Yet we have to base our messages on scientific evidence.”
I ask her if she would nevertheless take Spiteri’s stand on abstinence-only programmes, but Dr Gauci is noncommittal.
“We have to see what are the best measures to take in the situation, what is most applicable to this country.”
I tell her there is not much to say about the condom, really. It’s a question of putting it on.
“I think it is very important to work in dialogue with all stakeholders. I’ve just started in this position so I have yet to meet a lot of people but it is important that our campaigns involve as many people as possible, because otherwise our campaigns will backfire.”
Yet STDs are on the increase and, clearly, whatever the Church’s position, people are having sex, and a lot of it is unsafe.
Besides, statistics abroad show abstinence is not working. According to the latest study coming out of Columbia University and Yale, virginity “pledgers” are much less likely to use condoms and their rate of STDs remain the same as others.
The study found that the STD rates for whites who pledged virginity was 2.8 per cent compared with 3.5 per cent for those who didn’t pledge. For blacks, it was 18.1 per cent and 20.3 per cent. For Asians, 10.5 per cent of virginity pledgers had STDs compared with 5.6 percent of non-pledgers. For Hispanics, it was 6.7 per cent and 8.6 per cent. Let’s say you need to take a stand on the use of condoms even though you might make an enemy out of the Curia…
“You have to analyse the situation and what is there to gain and what is there to lose. You have to strike a balance, however our aim is to protect the health of the Maltese population."
Another source of immense pressure for Spiteri was the smoking lobby. Although he was not responsible for its implementation, Spiteri was at the forefront of the crusade against smoking in public places attracting all sorts of adjectives and attacks from Vince Farrugia of GRTU.
“I’m used to working under pressure,” Dr Gauci says. “Besides this job I am also a lecturer at university and I have a family, but I believe in dialogue a lot. Before coming up with a campaign I think one should consider which stakeholders are involved and affected and find ways how this campaign becomes a success.”
Her background in disease surveillance has put her on the ground wherever infectious diseases break out, from classrooms to work places and immigrants’ centres – always constantly on the lookout for an outbreak of tuberculosis or meningitis or other communicable diseases that are potentially a source of massive panic and health scares.
Yet where migrants are concerned, Dr Gauci dispels a lot of myths surrounding foreigners’ health and their potential threat to the wellbeing of the Maltese.
“We screen all immigrants for TB, which is transmittable by close prolonged contact with an infectious person. In fact there has been no evidence of any acute cases of TB contracted the disease from immigrants. Now we have just applied for EU funds to improve the screening process.”
Now, after the department’s restructuring, Dr Gauci will also be responsible for non-communicable diseases, such as cardiovascular disease, although the priority areas have yet to be mapped out.
As regards the campaigns’ effectiveness, Dr Gauci admits there is a problem in quantifying their effects as there is not enough data available.
“For example on obesity, the data we have goes back to the 1990s. At present what we have is self-reported surveys, which are not that reliable given the Maltese people’s tendency to lessen their weight when they speak about it. So we may be having a larger problem than recent figures are telling us. We need to incorporate campaign evaluations within the very campaigns so that we would know whether they are being effective or not. To do that you would need a snapshot before, during and after the campaigns.” Prevention, as the saying goes, remains better than cure. General annual checkups and improved primary health care will go a long way towards saving thousands of liri on the national health service, which along with adapting health information material in a way that will be eventually taken up by the people at large to modify their lifestyle will be one of Dr Gauci's approaches in her task to minimise the burden of illnesses.
“Information on its own is not enough, our message has to be flexible enough to be taken up by our audience and incorporated into their life; it’s a behavioural question, like convincing people about the need to be physically active. It is important that we invest in prevention, because it will pay off in the long term. Whatever you invest in prevention will be saved from the health services.”