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More than 36 boys and infants have lost their manhood in the ongoing HIV-prevention male circumcision programme.
Most of the injuries are due to the use of inappropriate forceps that have been banned since, 2014, but known to be quicker than recommended alternatives. A quicker method means more cuts and hence more funding.
An assessment of the programme in 15 countries published last week, shows Kenya and South Africa to have by far the highest number of injuries.
“These boys have suffered injuries that may cause permanent disfigurement, functional impairments, and lifelong psychological impact,” said the report by the Ministry of Health and several US State agencies.
For more than a decade the US President’s Emergency Plan for AIDS Relief (PEPFAR) has been funding anti-HIV male circumcision in 15 Eastern and Southern African countries including Kenya.
Over the period, the programme has gained some notoriety in Kenya, with several donor reports documenting data manipulation, unethical practices and serious injuries especially to young boys.
Most of these have been blamed on ambitious money-based targets set by the donor. The more cuts local implementers make the more money they get.
Unethical cutting
Last year a report by Kenya Medical Research Institute accused implementers of recruiting underage children, bribing them, cutting them without parental consent, engaging unqualified circumcisers and even inadequate stitching of the boys.
Earlier in 2018, a report by the US Centers for Disease Control and Prevention-Kenya reported 25 serious genital injuries between 2014 and 2017.
A quarter of them had been caused by health providers who did not comply with technical procedures with five boys suffering permanent penile deformities. Due to the many injuries, the World Health Organization (WHO) had investigated the matter and in 2014 warned against the use of the forceps-guided (FG) method.
Deformation of the penis from forceps guided method
Shortly after, PEPFAR prohibited the use of the FG method in infants and children under 15 years and recommended the gentler dorsal-slit (DS) method.
An assessment found evidence indicating the FG method is still being used.
It describes what the boys went through as a huge physical and psychological trauma especially because most of the injuries could have been easily avoided.
“Complete glans amputations are preventable through proper use of a circumcision method,” says the assessment appearing in the journal BMC Urology.
The glans is the rounded head or tip of the penis and most vulnerable to injury during circumcision especially in infants and boys under 15 years.
The study shows 69 per cent of the injuries happened in South Africa and Kenya in that order with five countries reporting no injury.
Uganda, for example, with the biggest male circumcision programme in the group recorded no injury.
“In Uganda …. the FG method has never been practiced and no glans injury has ever been reported,” says the report.
The FG method had been used in 29 of the 36 (81 per cent) injury cases recorded with most of the victims aged 10 years.
A few injuries, seven cases, involving infants aged under two months were recorded where the dorsal-slit (DS) and Mogen clamp devices had been used.
“The continued use of the FG method is the likely immediate cause of the majority of these injuries,” suggests the study involving the National AIDS and STI Control Program, Ministry of Health, Kenya.
The FG method may have been preferred because it is considered faster and technically easier than other methods. Most of the injuries were found to happen in the afternoon when most of the circumcisers were likely to be tired. “For example, one record documented that a single provider completed over 140 circumcisions in a day, not finishing until after midnight,” says the report.
Can the damage be reversed?
Even when a serious injury happened, the patients were not being attended to quickly enough in a way that could allow for the successful reattachment of the dismembered tissue.
Most patients were transferred to two or more facilities, spending as long as six hours before they could be treated. The report shows less than a quarter of reattachment attempts were successful.
The investigating team found only in five out of 23 amputations was the severed tissue handled properly. “This dismal rate of reattachment success speaks to the importance of prevention.” To save more boys falling on the FG method, wants the government to adopt a policy which would restrict the purchase of some parts used in the device.
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