But the tall, thin woman would not be easily dissuaded. She wailed: “That woman killed my son.”
Her neighbours said Usman had started crying around 10am. It was now 3pm. Five hours after she started crying, she was still holding on tightly to the lifeless body of her nine-year-old son. She would not stop crying and she refused to let go.
The cut of death
As she cried, our correspondent noticed that her pink top was wet with drops of milk seeping out of her engorged breast. By this time, the skin of the little boy, who will never suckle, had grown pale. The woman whom Usman blamed for the death of her son was a traditional birth attendant. She had provided two services for Usman: she helped to deliver her of her son and she also helped to circumcise the little baby. It was the second service that turned out to be fatal.
According to the United States National Library of Medicine, circumcision is one of the world’s most widely-performed procedures by health workers. It is a religious or cultural ritual for many Jewish and Islamic families, as well as some tribes in Africa and other parts of the world.
The word ‘circumcision’ is derived from the Latin word, circumcidere, meaning “to cut around.”
A medical website, WebMD, defines male circumcision as the surgical removal of the foreskin by a qualified health professional in a sanitary environment. However, many Nigerian parents who circumcise their male children do not seek out qualified health professional.
One of Usman’s neighbours, who spoke on condition of anonymity, said the ill-fated boy must have died from prolonged bleeding.
She said, “After her son was circumcised, he began to bleed. Usman noticed the bleeding and then called the traditional birth attendant who circumcised him, but she kept giving excuses that she was busy at the time. They spoke on the phone. The TBA later said she would come to her house a bit late. As each hour passed, the bleeding became worse. I guess her son lost a lot of blood.”
Usman, while narrating what happened to her son, put the blame on the birth attendant. Speaking to the small crowd of sympathisers who were in the room, she said the TBA didn’t circumcise her son properly.
“That woman (the TBA) killed my son. She no do am well. That woman killed my son; wetin I go do now. Ah! My child don die. My baby, God! Why me?” she said.
The cut of injury
Eudora Michael’s son is also a victim of a botched circumcision. The 35-year-old mother regrets the day she chose a TBA to circumcise her son. Her son’s penis was cut off during circumcision. She told SUNDAY PUNCH that her life wouldn’t ever be the same because of her son’s condition.
Michael said she regretted allowing her step-father, who is a traditional doctor, circumcise her son when he was one-month-old.
She said, “After my son’s penis was cut off, my step-father said it would grow afresh within three weeks. He then rubbed all sorts of concoctions on my son’s private part. Till today, my son’s penis has not grown back. I am heart-broken.
“I regret my action; every day I wish I had taken him to a proper health clinic for circumcision. There are days when I cry for hours. I know my son’s life would never remain the same. We travelled to India with the hope that his penis would be reformed by the doctors there, but they said nothing can be done until he is 14 years old. I broke down into tears when I heard them say that.”
Traditional birth attendants
In Nigeria, TBAs are recognised for the critical position they occupy in the health care chain. They play a vital role in health care delivery in developing countries where many people, because of poverty and substandard facilities, are unable to afford or access quality health care. They are licensed to provide specific services by government. During the 2016 presentation of certificates to traditional birth attendants by the Lagos State Governor, Akinwunmi Ambode, the services of TBAs were spelt out by the governor. Circumcision was however not listed among the services.
The services provided by TBAs include: the protection of the health of mother and baby; the care of women during pregnancy and child birth; the treatment of complications due to miscarriage and or unsafe abortion; pre-pregnancy advice and health education; the care of new born; recognising and addressing problem in women and newborns before and during pregnancy; offering general health information including reproductive health care and family planning; assisting women to successfully breastfeed; referring women and newborn to higher care when conditions arise beyond their scope of practice and capabilities; and to foster a dialogue with formal community leaders about the needs of pregnant women.
A member of the Board of Trustees, National Association of Nigeria Traditional Medicine, Mr. Idowu Olawale, said there was no exact figure of the number of TBAs in the country. He, however, added the TBA to population ratio is estimated to be 1:200, indicating there is one TBA to 200 persons. Given this ratio, there should about 910,000 TBs in Nigeria. Many of these TBAs are unlicensed. Most of these unlicensed TBAs operate in the shadows. In a recent report, the UNICEF stated that Nigeria loses about 2,300 children under five and 145 women of childbearing age daily to unskilled birth attendants. It added that only 35 per cent of deliveries were handled by skilled birth attendants.
Speaking with SUNDAY PUNCH, the President of National Association of Nigeria Traditional Medicine, Thomas Oleabhiele, admitted that TBAs are not licensed by the government to circumcise babies.
He said,” The government does not give licence to TBAs to circumcise male babies, but any traditional doctor who is registered under NANTMP receives a right and licence to do whatever he knows. He or she can do whatever he has expertise in, as long as he doesn’t bring problem to anyone.
“Circumcision, prior to new innovation, is a thing of parental decision. Parents decide who to take their male babies to for circumcision.”
A not-so-simple surgery
According to the United States National Library of Medicine, circumcision is one of the world’s most widely-performed procedures by health workers. Its popularity is driven by religious and cultural factors. It is most commonly done by adherents of Judaism, Christianity and Islam, as well as some tribes in Africa and other parts of the world.
A paediatrician surgeon, Dr. Sebastian Ekenze, said a variety of problems or complications could arise from improperly performed circumcision.
“Fortunately, most of these are mild and easy to correct, while some are moderate and might require major operations for correction. In some instances, a few of these severe complications may lead to death,” he said.
Ekenze noted that infertility could occur in cases where the glans or the head of the penis was accidentally cut off.
“I frequently see, attend to, and operate on boys with problems/complications from improperly performed circumcision. The challenge is that most of the cases come to us late. Probably the parents did not recognise the problems early, or they feel ashamed to bring this to the notice of a doctor, or they are afraid of the cost of treatment. If the head of a penis is accidentally cut off, infertility can occur,” he said.
Cost, conceit and ignorance
TBAs, unlike medical doctors, nurses and midwives, often learn their trade through apprenticeship. Others boast that they are self- taught. Many TBAs are also herbalists, traditional healers, while others are older women and men with no training but who are well-respected in their communities for their experience in successfully handling births.
Some mothers told our correspondent that they patronise TBAs because of their low fees.
A petty trader, Mrs. Funke Adeyemo, said TBAs assisted her in giving birth to all her children.
She said, “I couldn’t afford to go to a hospital to put to bed. Delivering in a hospital is too expensive. Why would I spend N50, 000 in a hospital when I can pay a TBA N10,000? TBAs are also experienced.”
A boutique owner, Mrs. Helen Ololade, also described TBAs as birth experts.
“You would hardly find a TBA who is young. TBAs are always in the late fifties, sixties and so on. These persons are trained in their craft,” she said.
A traditional doctor, Nwogu Nwachukwu, said TBAs are as good, if not better than doctors and nurses in the circumcision of newborns.
She said, “TBAs are very effective in their work. Before medical doctors became known in African society, TBAs were in existence. Babies with ailments were treated at home with traditional medicine. Even in the area of circumcision, I personally believe there is no big deal in the procedure. We performed circumcision before the arrival of orthodox doctors. It is a practice done all over the world.
“Is there any big deal in circumcision? All you need to do before the procedure is to sterilise your instrument. For mothers who had a bad experience with TBAs in the area of circumcision, they must have visited a quack TBA. There are quack TBAs among us.”
Oblivious of the fact that their activities in this regard are not licensed by government, the TBAs dismissed the doctors’ warnings.
Oleabhiele said, “Doctors don’t know what they are talking about when they say people shouldn’t patronise TBAs. Prior to the arrival of the white men, women were delivered of their babies by traditional attendants and not by medical doctors. There were no hospitals at the time. I was born at home.”
Oleabhiele added that TBAs now attend courses to increase their knowledge and are also hygiene-conscious.
He said, “The World Health Organisation even recognises TBAs. We also regularly teach our members the importance of hygiene. I believe there is reason to form a synergy between western and traditional practice. There are numerous problems that western medicine is not focusing one which traditional medicine takes note of.”
A traditional birth attendant, identified only as Mrs. Elijah, stressed that the role of traditional doctors in society cannot be ignored.
She said, “I have circumcised numerous male children. I learnt the practice from a midwife. I have become experienced. We TBAs are good at our job. Because we are not working in a hospital or wearing a white robe doesn’t mean we don’t know what we are doing. We are better than some doctors.”
Traditional time bombs
A family physician/primary care paediatrician, Dr. Rotimi Adesanya, disagreed with these mothers and the traditional healer. He argued that mothers who patronised TBAs expose their children to infections such as hepatitis and tetanus.
He added that circumcision is a long procedure involving blood and should be done by trained medical practitioners.
“Any mistake done during the procedure can lead to infection. It should be done by a qualified person, in a sterile and clean environment. Unlike medical practitioners, TBAs usually carry out circumcision in unclean environments and the newborn gets exposed to infections such as hepatitis, tetanus — infections transmitted through blood. A TBA can use an equipment on several persons without sterilising it,” he said.
Adesanya stressed that TBAs who carried out circumcision lacked the formal training needed for successful circumcision.
He said, “They don’t have any form of medical qualification. Most of them are uneducated. Most times, they use traditional concoctions. The reason why many women patronise TBAs is because their services are cheap. The cost of circumcision in a hospital is between N3,500 and N20,000. While TBAs charge as low as N1,500.”
A senior lecturer at the College of Medicine, University of Lagos, Mrs. Bolanle Balogun, also warned against TBAs carrying out newborn circumcision. She added that they should also not be allowed to take first-time deliveries.
“Newborn circumcision is not primarily the source of livelihood for TBAs. They should not engage in circumcision. Mothers should visit primary health centres for newborn circumcision. They should patronise persons trained in midwifery skills. They should patronise skilled birth attendants,” she said.
In the same vein, a consultant paediatrician, Dr. Temilola Sam-Amoye, said circumcision has become a relatively simple procedure and that most modern techniques have reduced the risk of complications based on the procedure.
She stated, “Circumcision just like any other medical procedure is best done in a registered health facility in order to achieve a good outcome and minimise risk of injury.”
Adesanya added that hospitals now use a modern method of circumcision — the plastibell method. Plastibell is a clear plastic ring with handle and has a deep groove running circumferentially.
“The plastibell method is stress free. TBAs still use the old method of cutting the skin of the penis, and go as far as pouring engine oil on the penis,” he said.
In Lagos State, where the victims referenced in the story reside, the ministry of health is in charge of the regulation of the activities of TBAs. This is also true for other states. However, the Director of Public Relations, Ministry of Health, Lagos Sate, Adeola Salako, said only the Special Adviser to the Lagos State Government on Health Care, Dr. Femi Onanuga, could comment on TBAs. Onanuga neither picked his calls nor responded to a text message sent by our correspondent.
Meanwhile, experts say that more babies are likely to suffer the fate of Usman’s and Michael’s babies except government intervenes to restrict the activities of TBAs. One thing that is sure is that whatever government does, it would be too little and too late to assuage Taiwo Samuel’s pain. Samuel’s world was turned upside down after a TBA botched her son’s circumcision and damaged his urinary tract.
Ireti, Samuel’s sister, who spoke about the experience, said, “My sister and I thought the TBA was experienced. Little did we know that she had wrongly circumcised my nephew. We both began to panic when we noticed how he urinated. It was also glaring, on his face that he was in pain. I can’t forget that period. My sister was so heart-broken. She felt like a bad mother, as if she had murdered her son.”
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