Indexing Title:
HTURINGAN’s Medical Anecdotal Report [05-03]

MAR Title:  A Horrendous Rite of Passage

Date of Medical Observation: April 1999

 Narration:

 Prior to the “no to circumcision” campaign of the department, I was  reminded of an incident when I was a first year resident, back then we were part of the nationwide fad of providing services like circumcision during the semestral breaks occurring in the months of April to May.  Circumcision, like dental and medical missions were also part of the community services provided by politicians in the country to strengthen their campaign. Local government officials used the government hospitals and the doctors training therein to take part of these so called programs.  The public in turn huddle to take advantage of these free services. 

 One night while on duty, a kid about 9 years of age was brought to the emergency room carried by several adult male companions and a crying mother.  The kid had blood running from his thighs, he was paper white, his lips bluish grey and obviously in shock.  A medical clerk then informed me that the blood pressure was 60-70 palpatory, pulse was faint.  Fluid resuscitation was immediately started while taking the history from the agitated relatives.  It seemed that earlier during the day the patient along with several kids were brought to a medical mission for circumcision. When I examined the kid’s genitalia, the prepuce was swollen from hematoma with continuous trickling of blood from the incised foreskin.  According to one of the companions it had been bleeding even before they went home after the procedure but thought it would stop eventually.  It took them twelve hours to decide to seek medical attention.  The dorsal vein was not ligated although there were several ligatures along its vicinity.  The vein was ligated, and that was that.

 Insights (physical, PSYCOSOCIAL, ETHICAL) ,Discovery, Stimulus, REINFORCEMENT:

 I imagined that it was one night the kid would remember grimly for the rest of his life, that he almost died to mark his rite of passage to manhood.  Its ridiculous but it seems anyone can perform circumcision nowadays, whether they are qualified or not is another matter.  Whether they understood the medical indications for doing the procedure and the lack of merit of using tradition as an excuse seems to have been lost in the puddle.  I knew one senior nurse asking me for absorbable sutures I can spare and when I asked what he needed it for, he told me that he will be going home to the province to perform circumcision on several neighbors for a small fee.  Medical clerks, interns, and licensed physicians in different fields perform this procedure left and right without being conscious of the basic principles of surgery such as hemostasis. 

It is our duty as surgeons to consciously and actively educate not only the public but also fellow members of the medical and paramedical personnel of the few medical conditions that warrant circumcision, and if this procedure should be performed, the basic principles of surgery must be adhered to.  Primum non nocere.