Trinity's director of health services has seen major changes in his 30 years there, mainly in the areas of alcohol abuse and sexual health. Muiris Houston, Medical Correspondent, reports
In more than three decades looking after Trinity students' health, the biggest change Dr David Thomas has noticed is the amount they drink.
As director of College Health Services at Trinity College Dublin (TCD), Thomas has taken care of thousands of students.
"Drinking patterns of students have changed enormously," he says, when asked what is the biggest change he has seen in more than three decades.
"I think people now feel they haven't enjoyed themselves unless they are drunk. About 30 per cent of students are drinking to excess."
Sexual health is another area of immense change, he says.
"Some 60-70 per cent of students are sexually active when they come into college. It is a much easier area to deal with," Thomas says.
"There is some unsafe sex among students, secondary to alcohol abuse, and we have noticed an increase in demand for the morning-after pill. But students are now prepared to consider sexual health from a preventative perspective."
Nor is sexual orientation an issue: "Students are comfortable and open about their orientation, that's a huge change."
A 2003 study of sexual health practices in TCD found that 94 per cent of Irish students were sexually active. Regarding sexual orientation, 96 per cent of females were heterosexual, as were 89 per cent of men.
"When we looked at condom use, the study showed 48 per cent of males and 38 per cent of females always used them, while some 25 per cent of the rest are using condoms some of the time," Thomas notes.
The rate of testing for sexually transmitted infections among students, at 20 per cent of females and 14 per cent of males, is an indication that a growing number of students now take a preventative attitude to sexual health.
The Trinity health service has noted an increase in the number of cases of chlamydia infection in the past two to three years.
"We offer free chlamydia screening instead of smear testing to women under 25."
Other changes include the greater number of male students who attend College Health Services, certainly compared with general practice. "Males do come to us in greater numbers. I think they see us as 'the anonymous doctor'.
"They perceive us as a friendly service," he says.
The role of nurses in the service has also changed. Team work means that nurses have a much broader role.
"We have very enthusiastic nurses who are prepared to push out the boundaries," he says.
When Thomas started his college job in 1974, house calls to students' rooms on the TCD campus were relatively common; now they are practically unheard of.
And, of course, the biggest change of all is how busy the service has become. "There has been a tripling of student numbers and with 1,800 staff on campus, August is now the only slack month," he notes.
In common with healthcare generally, students' expectations have changed. "Quite a few of them will have looked things up on the internet before they come in. And student travel has mushroomed out of all proportion.
"Students are much more mature than your generation or my generation," he says.
"They are more aware of political issues and conservation. There is an openness and a willingness to talk about everything."
Thomas says one of the attractions of becoming director of the College Health Service was "the opportunity to follow a liberal agenda. Being a liberal came from being a student in Trinity in the 1960s."
David Thomas has a palpable fondness for Trinity which has grown over the years. "It keeps you younger being around students. It makes me a little more aware of myself," he says.
And he sees his role as a doctor very much as one of "docare" (to teach). Following his retirement later this year he hopes to stay on "in an advisory and some clinical capacity".
The College Health Service has as its mission statement "the provision of ambulatory healthcare for the college community, to promote health education within the college and in so doing encourage healthier lifestyles, and a safe working environment for both staff and the student body".
According to its latest annual report,work is ongoing on the development of an integrated college mental health policy, health promotion programmes and the restructuring of occupational health.
And the reform of funding to allow for the expansion of services is a priority.
While student health services have traditionally been funded by third-level colleges, Thomas says: "It is increasingly difficult to do this for free. And we are saving the State a considerable amount of money by providing mental health services to students."
He would like to see a system like that in the US, where some funding for student health comes from the college, some from the students themselves and some from the state.
Trinity now has a health promotion officer, Dr Aileen McGloin, employed for two sessions a week. She was involved in the sexual health awareness guidance (Shag) week last term as well as contributing to TCD's alcohol policy.
Already the health service has succeeded in cutting down on the number of happy hours in college bars and restricted the amount of free beer made available on campus by drinks companies.
A health promotion week held every April works very well, Thomas says. The week focuses on stress management issues with t'ai chi, yoga and other stress-busting demonstrations.
There is also a healthy eating week and the health service provides information in the arts block on travel medicine, smoking cessation and sexual health.
Along with Sinead O'Brien, consultant psychiatrist and assistant director of the college health service, David Thomas is responsible for a highly impressive, multidisciplinary health unit that is clearly well set to meet the many challenges that lie ahead.
His achievements were formally recognised when Trinity College conferred an Honorary MD on him in December.