Saturday, November 21, 2015

TORONTO: Cutting unwanted, baby dies, doctor cautioned

National Post (Canada)
October 25, 2015

Ontario newborn bleeds to death after family doctor persuades parents to get him circumcised

by Tom Blackwell
TORONTO — An Ontario doctor has been cautioned after a 22-day-old baby bled to death from a circumcision gone horribly wrong, underscoring the heated debate over a simple yet contentious procedure.

Another physician involved in the case was urged by a medical governing body to be “mindful” of the operation’s dangers.

But Ryan Heydari’s parents say the regulators who handled their complaints have shed little light on what led to Ryan’s death – or how to prevent similar tragedies in future.

Ryan Heydari - dead from genital cutting
Ryan Heydari

They say they did not even want the newborn circumcised — a view in line with longstanding recommendations from the Canadian Pediatric Society — but were persuaded to do so by a family physician.

In fact, the case only became public because the couple appealed the original Ontario College of Physician and Surgeons rulings, which were rendered in secret.

An appeal tribunal upheld this month a decision by the College to caution the doctor who saw Ryan in the emergency department hours after his circumcision, his diaper stained red with blood.

The Health Professions Appeal and Review Board also confirmed the college’s separate advice to the pediatrician who conducted the procedure to be aware of its potential hazards, and document his efforts to get informed consent.

The pediatric society said in a recent report that death from bleeding caused by circumcision is “extremely rare,” though it’s not completely unheard of. A five-week-old B.C. baby bled to death after being circumcised in 2003.

Ahmadi gave birth on Jan. 3, 2013 to a boy who loved attention, cried relatively little and seemed to actually smile. “He gave us the most amazing moments of our life,” says Ryan’s mother.

She and husband John Heydari, who immigrated from Iran about 12 years ago, opposed having him circumcised, convinced that “mother nature created us the way she intended us to be.”

But their family physician persuaded them it was a good idea for medical reasons, despite contrary advice from pediatric specialists.

Once carried out on most Canadian boys and still common as a religious rite for Jews and Muslims, circumcision has generally fallen in popularity, rates hovering around 32 per cent.

The pediatric society has long held that its risks – including pain to a small baby, bleeding and the chance of disfigurement of the penis – outweigh its benefits.

The group revisited the issue with a report just last month that addressed growing evidence circumcision helps prevent sexually transmitted disease, acting almost like a vaccine in countries with high rates of HIV. ["Almost like a vaccine"? Only one person says that.

Circumcised boys [who survive] are also less likely to suffer urinary-tract infections and to develop rare penile cancer later in life, the society says.

But its report still recommended against routine circumcision of every newborn male, saying that it may make sense in certain cases. For those who have the procedure, “close follow-up in the early post-circumcision time period is critical,” the society warns.

One urologist says he has encountered a few cases where circumcised babies had to undergo transfusions because of dangerous bleeding, and sees less-serious complications routinely.

Dr. Jorge DeMaria of Hamilton’s McMaster University believes regulators should require doctors to prove they have undergone proper training before doing circumcisions. He also questions circumcising newborns for preventive-health reasons, in a country with low levels of HIV and wide availability of condoms.

Ahmadi says she and her husband knew almost immediately after their son’s procedure that something was seriously wrong.

The previously unfussy baby “was crying so much, so hard, and he wouldn’t stop,” she recalled in written answers to questions. “He was bleeding, and it only got worse over just hours … It was so obvious from the blood his tiny body had lost that he was in danger.”

The pediatrician who did the circumcision told the College he conducts many of them, that Ryan’s was uneventful and there was no bleeding when he checked the dressing before the family left.

The parents called about bleeding later that day, though, and he advised them to take Ryan to Toronto’s North York General Hospital, which they did.

“We … waited for care that could have saved his life, but that level of care never came,” says Ahmadi.

A sparse outline in the board’s decision says Ryan was eventually transferred to Sick Kids hospital, but died there seven days later. Pathologists said he succumbed to “hypovolemic shock” caused by bleeding from the circumcision, which emptied his body of 35 to 40 per cent of its blood.

The doctor at North York General — whose name has been withheld according to College policy — was cautioned for failing to recognize the seriousness of the boy’s condition or treating “compensated shock” – the first stage of the condition.

But the process left the family little further ahead in fathoming how Ryan could have died, said Brian Moher, their lawyer.

“My clients felt that there was a big gap in what the College had done with the investigations, essentially missing the point around the infant’s death.”

The devastated parents, meanwhile, have not had other children.

“The loss of Ryan, our only child, has made us realize that we can’t possess anything, even our hopes and dreams,” Ahmadi says. “We hope that this never happens to any other baby.”

SYDNEY: Father lied to police about daughter's cutting

The Guardian
October 15, 2015

Father in FGM trial tells court he lied to police about what he knew of ceremony

Father and mother were interviewed by police and then placed in a room with a listening device, the New South Wales supreme court hears

The mother of two girls who allegedly underwent female genital mutilation told her husband “just a little bit” when her husband asked if the ceremony involved cutting their clitorises, a court has heard.

The first trial of FGM in Australia is being heard in the New South Wales supreme court with the mother of the two alleged victims charged along with an older woman known as KM, who is accused of carrying out the FGM, and Shabbir Mohammedbhai Vaziri, a leader in the Dawoodi Bohra Shia Muslim community.

When the parents were initially interviewed by police in 2012 a listening device was placed in the waiting room and after he had talked to police, their father, known in court as A1 met his wife in the room.

“It took a long time, they asked many things, they ask me do you have any idea what they do in circumcision, I tell them I don’t know anything, if they ask you say you do not know … in us do they cut skin?” he asked her.

The mother responded: “No they just do little bit, just little.”

The father admitted in court he had not told police the truth when he said he did not know what khatna, the ceremony the girls took part in, involved.

“She explained to me it involved placing forceps in genitalia, and saying Qur’anic verses,” he told the court of what his wife told him khatna involved.

In previous evidence the father had said it involved “some sort of metal on on the private parts” and when asked by crown prosecutor Nanette Williams why he had changed evidence from “in” genitalia, to “on”, A1 said “I’m not sure where the forceps are placed, but it’s on the private parts somewhere”.

A1 also admitted he had not told the truth to the police when he said in 2012 he did not know what khatna involved.

“I knew what khatna was, I knew what my girls went through, I didn’t tell the truth to the police,” he said.

Asked by Williams if khatna involved an injury to genitalia, he responded: “not in my girls.”
The alleged FGM was allegedly carried out on the girls, known as C1 and C2, when they were each seven years old, between 2010 and 2012.

A conversation between A1 and C1 was recorded in 2012 in which C1 talked about being cut.
“You have no cut, we do not do cut, no we do not cut, we cannot cut, nothing was cut of yours, we cannot do the cut here,” her father responded.

When C1 said she had seen scissors during her khatna, her father said it was forceps that she saw, not scissors.

“Forceps used for cleaning purposes, for a check up,” he said.

The court has previously heard about the “Africa story”, a lie the mother and others had agreed to tell that part of the khatna that took place in Australia was a “check up” and if the girls had been cut it was in Africa.

The trial continues.

BRUSSELS: No, Europe's cutting concern undiminished

The Jewish Daily Forward
October 9, 2015

Europe Council Reiterates Opposition to Circumcision

he Council of Europe refuted reports in Israeli media that it had canceled a resolution from 2013 that called nonmedical circumcision of boys a harmful violation of children’s rights.

The clarification Thursday on the position of the Council, a body for pan-European dialog that has no executive powers and is not part of the European Union, came following statements by Israeli politicians, Jewish activists and media suggesting the Council had reversed its position on the practice.

According to those statements, the change came in the passing on Sept. 30 by the Council’s Parliamentary Assembly of Resolution 2076 on “Freedom of religion and living together in a democratic society.”

Milah UK, a leading Jewish advocacy group supporting the practice, on Tuesday said in a statement that Resolution 2076 “cancels a previous motion that had cast into doubt the legality of religious circumcision.” Milah is the Hebrew-language name for the ritual circumcision of eight-day-old males. Muslims also circumcise their children.

The previous resolution referenced by Milah UK is Resolution 1952, which the assembly passed in 2013 and which lists milah along with female genital mutilation and calls both practices a harmful “violation of the physical integrity of children.”

But Nathalie Bargellini, a spokesperson for the Council’s Parliamentary Assembly, on Thursday told JTA that Resolution 2076 “does not cancel nor replace Resolution 1952.” She noted the more recent resolution references the older one.

Bargellini also said that Resolution 2076 “calls for strict conditions governing the exercise of this practice.” According to the new resolution, “circumcision should not be allowed ‘unless practiced by a person with the requisite training and skill, in appropriate medical and health conditions,’” Bargellini said.

Resolution 1952 carried no such recommendation for outlawing certain types of circumcision — a divisive issue in Europe for its relevance to immigration by Muslims and to children’s rights.

Though it is nonbinding, the 2013 resolution was controversial and was seen as significant because it was the first time that a prominent pan-European institution weighed in on the circumcision debate.

Earlier story

JERUSALEM: Jews, Muslims unite to undo Europe's cutting caution

The Jerusalem Post
October 1, 2015

Council of Europe cancels anti-circumcision measure after joint Jewish-Muslim effort

Jewish and Muslim MKs united over past two years to advocate for reversal of Parliamentary Assembly of the Council of Europe resolution calling to ban ritual circumcision of children.
by Lahav Harkov

Two years of efforts by the Knesset to combat a resolution by the Parliamentary Assembly of the Council of Europe recommending that countries ban [no, age-restrict] ritual circumcision bore fruit Thursday, when it was reversed via a resolution on religious freedoms. Passed with 73 in favor and six opposed, the resolution recommends that PACE member states “seek reasonable accommodations with a view to guaranteeing equality that is effective, and not merely formal, in the right to freedom of religion.”

It gives general guidelines to promote coexistence and fight hate speech, allowing religious communities to practice their faith, manage welfare institutions and express their opinions.
The resolution refers specifically to Islamophobia, but not to anti-Semitism.

The council recommended that states require circumcisions to be performed by people trained to do so, in appropriate medical and health conditions, and that parents be informed of any medical risk to their child.

The resolution also addresses ritual slaughter, stating that PACE is not convinced it should be banned, and recommends following the French or German model of protecting animals from unnecessary suffering while respecting religious freedom.

MK Esawi Frej (Meretz), who represented the Knesset at the vote, called the decision a victory for common sense.

“The argument about whether to circumcise is legitimate, but opponents of the ancient ritual should fight through education and public relations and not try to force their opinions through legislation,” Frej said. [While those who cut children force their opinions with a knife.]

In October 2013, PACE’s Social Affairs, Health and Sustainable Development Committee approved a resolution by German rapporteur Marlene Rupperecht stating that ritual circumcision, in addition to piercings, tattoos, plastic surgery, medical intervention in cases of possibly transgender children and female genital mutilation, violates children’s right to protect their physical integrity. [The words "protect their" are not in the resolution. Obviously small children can not protect their own integrity.]

It also recommended that laws be passed “to ensure that certain operations and practices will not be carried out before a child is old enough to be consulted.” Jews perform ritual circumcision on boys when they are eight days old, and Muslims do so at the age of 13.
PACE resolutions are non-binding, but are taken seriously by member states.

Since the resolution passed, the Knesset, under Speaker Yuli Edelstein’s leadership and the guidance of Knesset Diplomatic Advisor Oded Ben-Hur, has sent delegations of MKs, Jewish and Muslim, to PACE and to countries from Azerbaijan in the East to Paris in the West, to enlist their European colleagues from other countries in the battle against the decision and other initiatives to ban ritual circumcision. MKs advocated for ritual circumcision to be dealt with as a matter of religious freedom, as opposed to children’s rights, moving it to PACE’s Culture, Science Education and Media Committee, which discusses religious issues, among others.

NEW YORK: Metzitzah: City not telling doctors about herpes cases

The Jewish Daily Forward
September 25, 2015

New Controversial Circumcision Rite Rules: Don't Ask, Don't Tell

by Paul Berger
New York City has not only stopped requiring mohels to obtain written consent before performing a controversial circumcision rite — the city has also stopped alerting doctors and the public when it suspects that a mohel has infected a baby with herpes following the ritual, known as metzitzah b’peh or MBP.

Between January 2013 and December 2014 — when the city enforced its short-lived attempt to regulate MBP through a consent form — each time health officials identified a neonatal herpes infection linked to the practice, they reminded doctors of the care and sampling procedures to follow if infants displayed symptoms.

The alerts also brought media and public attention to the ongoing health issues related to the practice.
During that period, there were six cases in which city health officials believed that the ritual — in which the mohel uses his mouth to suction blood from the circumcision wound — infected a baby with herpes.

Since 2000 MBP has been blamed for 18 cases of neonatal herpes in New York City. Two of those babies died, and two others suffered brain damage.

But at the beginning of 2015, under pressure from the ultra-Orthodox community, the administration of New York City’s mayor, Bill de Blasio, announced the city’s intention to revoke the consent form regulation.

At a meeting of the city’s board of health September 9, when the consent form regulation was officially revoked, health commissioner Dr. Mary Bassett revealed that there had been a case of neonatal herpes infection linked to MBP this past April.

... the department’s press secretary, Christopher Miller, ...<1--gave no explanation. He later--> told the Forward in an email that the department did not issue a health alert for the April case because “we believed that awareness at the provider level was sufficiently high given all the press in recent months.”

...<1--But media attention surrounding MBP, which is practiced exclusively by a subset of ultra-Orthodox mohels, has been no greater this year than in previous years.

According to a search of news articles and transcripts on LexisNexis during 2013 and 2014, when the health department issued five health alerts — one for each month in which it became aware of a case or multiple cases — there were some 200 media stories about MBP and neonatal herpes.

>What has changed this year is the city’s approach toward MBP. During his 2013 election campaign, de Blasio pledged to replace a city regulation of MBP enacted in 2012 under former mayor Michael Bloomberg.

The regulation, which enraged the ultra-Orthodox community, required mohels to get written consent from parents before performing MBP.

The consent form, drafted by the city’s health department, warned parents that MBP poses a risk of infecting their child with herpes, which could result in brain damage or death.

Many leading ultra-Orthodox rabbis and mohels do not believe that MBP causes herpes infection in infants.

The virus, which commonly causes cold sores, is prevalent in more than two-thirds of adults in New York City.

Mohels say that by using the correct infection control practices, such as gargling with mouthwash, they can prevent the spread of the disease.

They believe that many neonatal herpes cases the city attributes to mohels were caused by a family member or a caregiver touching the circumcision wound with a finger or hand.

Yerachmiel Simins, a lawyer who represents the ultra-Orthodox community ...said that the ultra-Orthodox community has still not come to an agreement with the health department over the terms of the DNA protocol. He said that the ultra-Orthodox community has been keen to conduct DNA testing on mohels for years, but the city has “steadfastly and consistently” refused.

...Jonathan Zenilman, chief of the infectious diseases division at Johns Hopkins University, said that by allowing the ultra-Orthodox community to continue performing MBP as it did before the consent form regulation was brought into force, the city’s health department was being cowardly by acting in a “pusillanimous” fashion.

Earlier story

FLORIDA: Secret agreement reached over visits to cut-dispute boy

Sun-Sentinel (Palm Beach, Florida)
September 16, 2015

Parents in circumcision fight appear to settle visitation dispute after judge, attorneys meet privately

by Marc J. Freeman
Heather Hironimus may soon be allowed supervised visits with the son she hid for months this year during her highly publicized battle against his circumcision. But the terms negotiated by attorneys Wednesday were not publicly disclosed after a judge abruptly halted a court hearing and convened private talks.

Palm Beach County Circuit Judge Jessica Ticktin printed copies of the agreement from her computer and distributed them to the attorneys through a courthouse deputy, more than two hours after she began meeting in her chambers with attorneys for the West Boynton mother and Dennis Nebus, father of the nearly 5-year-old boy.

The dialogue continued sometimes with and without the judge, who did not return to the bench to adjourn court after Hironimus and Nebus signed the pact. Hironimus has been seeking a reunion with her child for the first time since mid-May. The Boca Raton father has had temporary full custody.

Judge Ticktin did not return a call to the Sun Sentinel from a message left with her assistant, and the attorneys hurried past a reporter without commenting on what happened in place of an advertised, three-hour public court hearing. The official online court docket for the case did not show the agreement had been posted Wednesday night.

It was the latest twist in a battle that generated international headlines after Hironimus violated family court orders and fled with the boy to a Broward domestic violence shelter for about three months, until she was arrested and jailed for nine days.

She became the champion of circumcision opposition groups, after she decided to fight the procedure she agreed to in a 2012 parenting plan.

Wednesday's hearing began as expected, with Hironimus watching her attorney, Brian M. Moskowitz, arguing for her to visit with her son at a neutral site, a Delray Beach family center, with an off-duty cop watching at her expense.

"A mom has the absolute right to see her child as long as she abides by the law," the attorney said. He promised she will behave, because a violation could void a deal resolving her separate criminal case concerning an interference with custody charge and land her back in Palm Beach County Jail.

Hironimus, who signed a consent to the circumcision in May, "has no idea if her son has been circumcised," Moskowitz said of the procedure.

May L. Cain, attorney for Nebus, only said her client has been stymied each time he has tried to schedule the medical procedure, because of threats and intimidation from "crazy groups." [The only threats have been of legal action. It's not a medical procedure. The boy has no symptoms and no diagnosis.]
"Some of them call themselves intactivists," she told the judge.

Still, Nebus is agreeable to Hironimus being a part of her son's life if security precautions — including at least one deputy in the room along with a "parenting coordinator" — are put in place, Cain said.

"We're still afraid these groups are going to abduct this child," she said. "My client's main concern is to keep the parties' son safe."

His ground rules: The mother doesn't say a word about circumcision to the boy; she gets one, one-hour visit per week; and no photography will be allowed during the visits.

"We feel those photos will end up online somehow," Cain said, noting that in the past the child's maternal grandmother was responsible for leaking the "most private details of the child's life" on the Internet.

Nebus' hesitation is a result of the protracted circumcision battle and a lack of trust when it comes to Hironimus considering how she first tried to get state courts to block the surgery and then fled with the boy.

"The mother told the child the father was dead," Cain told the judge. "This is not," the attorney explained, "your normal run-of-the-mill case."

Both attorneys had announced they were calling several witnesses, including Hironimus and Nebus.
Judge Ticktin then said, "Counsel, why don't we take five minutes?" and called Cain and Moskowitz back to her chambers.

That left Nebus, 48, and Hironimus, 31, sitting in awkward silence, alone at opposing tables, for more than 45 minutes until their attorneys emerged without the judge.

The back-and-forth negotiations in the judge's chambers continued without explanation. Hironimus' criminal defense attorney, Richard Tendler, also joined some of the talks.

Hironimus appeared to be pleased upon signing the agreement, totally different from the scene that played out at the same table on May 23, when she cried and shook while signing a circumcision consent form.

On July 16, her criminal case was resolved as well, with a pretrial intervention agreement. Hironimus was not required to plead guilty, but she admitted "responsibility for interfering with a lawful custody order."

She's required to undergo a mental health evaluation and finish all recommended treatment; submit to random drug testing; and check in with a probation officer once a month. [Shouldn't Nebus, who has repeatedly and at length tried to force unnecessary surgery on the boy, be undergoing a mental health evaluation?]
The State Attorney's Office will drop the felony count in one year if Hironimus successfully meets the requirements, including the completion of a four-hour parenting course. If she fails, she could once again face prosecution and a maximum punishment of five years in prison for a conviction.


VICTORIA B.C.: Human Rights group criticises CPS policy

Children's Health and Human Rights Partnership (CHHRP)
September 9, 2015

Canadian Children's Rights Group Questions New Circumcision Policy

VICTORIA, BRITISH COLUMBIA-- A just released policy on infant male circumcision by the Canadian Paediatric Society (CPS) was judged today by the Children's Health & Human Rights Partnership (CHHRP) to be a step in the right direction, but was "nevertheless 'predictably inadequate' with respect to several specific issues."

CHHRP Medical Director Dr. Christopher Guest, MD, FRCPC, said the new policy is consistent with international paediatric associations that affirm infant boys should not have their healthy foreskins routinely removed.

Citing the position of the CPS that recognizes the unique sensory functions of the male foreskin, Dr. Guest asserted that, "A growing number of medical associations now recognize that an intact penis with a foreskin contributes to sexual pleasure for the male and his partner." According to Guest, in 2010 the Royal Dutch Medical Association concluded, "the foreskin is a complex erotogenic structure that plays an important role in the mechanical function of the penis during sexual acts."

"Circumcision alters the structure of the penis, which inevitably alters function. Long term harm to men from infant circumcision has never been studied" Guest said. Despite this, Guest says men are reporting long-term adverse consequences at the Canadian-based online Global Survey of Circumcision Harm. Although the CPS failed to include it, Guest says scientific evidence has emerged that supports these men's claims. In 2011, Dr. Morton Frisch published findings in the International Journal of Epidemiology showing that in Denmark, where circumcision is rare, 'circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in their female partners, notably orgasm difficulties, dyspareunia [difficult or painful sexual intercourse] and a sense of incomplete needs fulfilment.'

Guest faulted the CPS for inclusion of  "convenient untruths, "most notably a discussion of HIV being lower in circumcised men. He says such claims are based on methodologically weak African trials, which contradict global HIV trends, for example the United States, which has a high circumcision rate, yet a significantly higher rate of HIV infection than Sweden and Japan where circumcision is rare. "Even if the African trials were scientifically valid, they cannot be used to justify infant circumcision because infants are not sexually active persons," he said. "Soap and water and safer sex practices, including condoms, can prevent disease."

According to Guest, the CPS failed to include crucial information from a 2012 report by the International NGO Council on Violence Against Children, which CHHRP sent to the CPS in 2014. The report stated that "non-consensual, non-therapeutic circumcision of boys, whatever the circumstances, constitutes a gross violation of their rights, including the right to physical integrity, to freedom of thought and religion and to protection from physical and mental violence."

"Medical associations in the Netherlands, Finland, Sweden, Norway, Denmark, Germany, and others confirm that there is no justification for circumcising infants in the absence of medical urgency," Guest stated. "The CPS is out of step with those medical associations, who also urge an end to the practice due to ethical and human rights concerns."

Although the CPS concluded that routine infant circumcision is not recommended, and that the benefits of the surgery do not outweigh the risks (contrary to a 2012 claim by the American Academy of Pediatrics), Guest contends that the position statement is still insufficient due to its ambiguity in leaving the decision up to parents. "Parents are not physicians. They do not have the medical knowledge to decide if surgery is medically indicated for their child," Guest asserted. He went on to say that, "Leaving a decision about medically unnecessary surgery up to parents is an ethical failure on the CPS' part. Where else in medicine do physicians place this burden on parents, in order to obviate their own professional responsibility?"

"Preservation of bodily integrity is a basic and universal human right that the CPS must articulate clearly in future statements," Guest said. "We Canadians, as well as our institutions and government, have an obligation to protect that right for all citizens, regardless of gender or age."

The Children's Health & Human Rights Partnership was established in 2012 as a partnership of professionals in the fields of medicine, ethics, and law to further public education regarding non-therapeutic genital surgery on Canadian children.

Earlier story

NEW YORK: Metzitzah now virtually unregulated

the Washington Post
September 9, 2015

NYC ends consent requirement for circumcision suction ritual

by Jennifer Peltz 
NEW YORK — People who perform an ultra-Orthodox Jewish circumcision suction ritual will no longer have to get parents to sign acknowledgements of potential health risks, the city Board of Health decided Wednesday, reversing a policy that pitted health officials against religious leaders over a practice that dates to biblical times.

The vote formalized a tentative policy shift Mayor Bill de Blasio’s administration made in February. The city now distributes information about what officials see as possible risks of oral suction circumcision, but signed consent forms are no longer required.

“The Board of Health, from the start, aimed to ensure that parents had information so that they could make informed decisions,” Health Commissioner Dr. Mary Bassett said Wednesday, adding that the consent requirement “hadn’t been that effective.”

The practice is performed each year on an estimated 3,000 New York City babies, a fraction of the city’s Jewish population. The ritual, formally called metzitzah b’peh in Hebrew, entails a rabbi or another circumciser sucking blood from an infant’s circumcision wounds.

City health officials believe the practice was linked to at least 18 cases of infant herpes since 2000, though DNA testing to pinpoint the source of the infection was not done in all cases. Two babies died, and two others suffered brain damage.

In 2012, the health board passed a requirement for signed consent from infants’ parents or guardians, including acknowledgement that they understood that health officials recommended against the practice.

Some rabbis objected, seeing the requirement as an imposition on religious rights, and they urged their faithful not to comply. Those who performed the ceremony questioned any link between the practice and spreading herpes, saying they deployed herpes testing, hand-scrubbing and mouthwash to ensure it didn’t.

Rabbi Romi Cohn of Brooklyn, who says he has safely performed about 35,000 such rituals, commended the city’s change of direction.

“Oral circumcision is part of our tradition,” he said by phone after Wednesday’s vote. “I think New York will be blessed for doing the right thing.”

The matter put the health board in a difficult position, members noted.

“It is our core responsibility to protect the health of New Yorkers,” member Dr. Deepthiman K. Gowda said. “At the same time, we have to institute educational policy that actually works. ... The rollout of our previous policy actually eroded the relationship we wanted.”

But some weren’t convinced the problems merited ending the requirement.

“A very significant public health concern is served,” said Dr. Lynne Richardson, who abstained from the vote.

The city has distributed 20,000 printed copies and 22,000 email copies of a new informational brochure in English and Yiddish, Bassett said.

Earlier story

OTTAWA: Canadian Paediatric Society does not recommend "routine circumcision"

CTV News
September 8, 2015

Canadian Paediatric Society re-affirms position against routine circumcision

The Canadian Paediatric Society has released an updated statement re-affirming its position against routine circumcision for newborn males.

The society said recent evidence about the potential health benefits associated with circumcision prompted them to undergo a review of the current medical research. Its last position statement on the matter was published in 1996.

While medical literature has pointed to potential health benefits of circumcision, including the prevention of urinary tract infections and some sexually transmitted infections, the benefits generally don't outweigh the risks, the society said.

"While there may be a benefit for some boys in high risk populations and the procedure could be considered as a treatment or to reduce disease, in most cases, the benefits of circumcision do not outweigh the risks," Dr. Thierry Lacaze, chair of the CPS Fetus and Newborn Committee, said in a separate statement released Tuesday.

The updated statement also included the following recommendations:
Parents of newborn males must receive the most up-to-date, unbiased and personalized medical information about circumcision, so they can weigh the risks and benefits in the context of their own familial, religious and cultural beliefs;
Parents who opt for circumcision should be referred to a practitioner who is trained in the procedure, and whose skills are up to date;
Newborns who are circumcised should be followed-up in the early post-surgery time period;
At the time of discharge from the hospital, parents should understand how to properly care for their son's penis, and be aware of possible complications.
Circumcision has become a contentious issue in Canada, as it raises ethical and legal considerations, in part "because it has lifelong consequences and is performed on a child who cannot give consent," the statement said.

However, waiting until a child is old enough to give consent can increase risks, as doctors [which doctors?]  recommend the surgery be performed within the first week of life. [When he can afford to lose only 35ml of blood, and will not alert anyone that he is bleeding out.]

While circumcision used to be quite popular in Canada starting in the 1950s, rates have declined over the past decades to the current average of 32 per cent, CPS said.

To the original press release
Excerpts from the
Canadian Pediatric Society

Newborn male circumcision
Posted: Sep 8 2015
The circumcision of newborn males in Canada has become a less frequent practice over the past few decades. This change has been significantly influenced by past recommendations from the Canadian Paediatric Society and the American Academy of Pediatrics, who both affirmed that the procedure was not medically indicated. Recent evidence suggesting the potential benefit of circumcision in preventing urinary tract infection and some sexually transmitted infections, including HIV, has prompted the Canadian Paediatric Society to review the current medical literature in this regard. While there may be a benefit for some boys in high-risk populations and circumstances where the procedure could be considered for disease reduction or treatment, the Canadian Paediatric Society does not recommend the routine circumcision of every newborn male.
The foreskin ...
In the male newborn, the mucosal surfaces of the inner foreskin and glans penis adhere to one another; the foreskin is not redundant skin. The foreskin gradually separates from the glans during childhood. By six years of age, 50% of boys can retract their foreskins, although the process of separation may not be complete until puberty: 95% of boys have retractile foreskin by 17 years of age. Parents may be reassured by their observation of an unimpaired urinary stream in a boy with a nonretracted foreskin. Until this developmental process is complete, the best descriptor to use is ‘nonretractile foreskin’ rather than the confusing and perhaps erroneous term ‘physiologic phimosis’.
Appropriate care for the uncircumcised penis has been well reviewed and should include anticipatory guidance on hygiene and an understanding of the normal nonretractile foreskin. ...
Ethics and legalities of circumcision
Neonatal circumcision is a contentious issue in Canada. The procedure often raises ethical and legal considerations, in part because it has lifelong consequences and is performed on a child who cannot give consent. [This is new.] Infants need a substitute decision maker – usually their parents – to act in their best interests. [But only when a decision needs to be made. In most of the developed world, genital cutting is not even considered.] Yet the authority of substitute decision makers is not absolute. In most jurisdictions, authority is limited only to interventions deemed to be medically necessary. In cases in which medical necessity is not established or a proposed treatment is based on personal preference, interventions should be deferred until the individual concerned is able to make their own choices.

[This is a very wishywashy policy:
  • It nowhere actually recommends against cutting healthy babies, and sets a very low bar for "medical necessity", barely higher than parental whim.
  • The summary seems to have been written by cutting advocates, with the benefits played up and the risks and harms played down.
  • One of the  three "selected resources" is by cutting fanatic Professor Brian Morris.
  • The table of risks and benefits mentions "unsatisfactory cosmetic results" but offers no figure for their frequency.
  • The cited articles seem largely cherrypicked from the  works of other cutting advocates.
A plus is the emphasis on the normality of infant non-retractility, and the suggested expression " ‘nonretractile foreskin’ rather than the confusing and perhaps erroneous term ‘physiologic phimosis’." But a warning against premature retraction is only hinted at, when it should be explicit and strong, since that is a major cause of the "infections" which commonly make genital cutting "necessary". ]

MALAWI: Genital cutting is undermining condom use

The Maravi Post (Malawi)
August 30, 2015

Is voluntary male medical circumcision de-campaigning Condom use?

by da Kazembe
Blantyre, August 29, 2015: Seventeen-year-old Homic Muluwani of Bangwe Township is excited that at last he has had the most taunted voluntary male medical circumcision (VMMC) which to him certifies him to having unprotected sex now that he presumes he will be safe.

He is one of the more than 2000 males circumcised in the recent VMMC campaign which according to the Blantyre district VMMC coordinator, Jean Mhango was a success.

Much as the figures indicate the campaign as being successful, it is the mindset of the VMMC clients which seem to defeat the intended purpose for VMMC which is 60 percent risk reduction of HIV infection in HIV negative males who undergo the procedure.

Homic Muluwani and his friends tell the dangerous story as they wait for their turn to get circumcised at South Lunzu VMMC camp.

“I have had a girlfriend for the past two years and we have been having protected sex for fear of the HIV virus but this time I am going to enjoy unprotected sex since I am sure of my safety following the medical circumcision,” says Muluwani.

The 60 percent HIV risk reduction that follows after VMMC is surely misconceived in most males who are flocking for the procedure for they take it as a guarantee to having unprotected sex.

This leads to the query as to whether condom use is not being de-campaigned by VMMC promotion.

The Ministry of Health spokesperson, Adrian Chirumba says much as the opinion may arise from such sentiments, a study has not been carried out to validate this.

“Our implementing partners in VMMC such as Banja La Mstogolo (BLM), Population Services International (PSI) also have no records to validate the opinion,” says Chikumbe.

According to PSI one of the Ministry of Health’s implementing partners in VMMC, Malawi is working to scale up 605 coverage of male circumcision among negative males ages 10-34.

PSI national communications coordinator for VMMC, Lionel Chipeta points out that Malawi is working to scale up to 60 percent coverage of male circumcision among HIV-negative males aged from 10 to 34.

“VMMC is recognized as a high priority intervention in the Malawi National HIV and Aids Strategic Plan 2015-2020 and the National HIV Prevention Strategy 2015-2020,” explains Chipeta.

Martha Kamela of Mbayani Township finds her husband is better off uncircumcised due to the same misconception of the 60 percent risk reduction for she thinks once he is circumcised he will be at liberty to have unprotected sex with other females.

“Since my husband will know that he is safe from contracting the virus, chances are he will be cheating more as compared to now where he is afraid of contracting the virus,” says Kamela.

Kamela states that most men want to go under the knife as a guarantee to go and have unprotected sex without fear.

According to the VMMC South Lunzu site supervisor, Joseph Mdzinga, males aged between 10 and 19 patronized the services.

Looking at the age group, one can easily conclude that those accessing VMMC are still in the youthful exploring age hence the danger in the misconception.

The World Health Organisation HIV prevention package includes Abstinence Being faithful and Condomise (ABC), Post Mother to Child Transmission (PMTCT) as well as VMMC and if the later seems to be defeating the condom use as per the perception, one wonders whether VMMC will yield the intended results, come 2020.

Wednesday, August 19, 2015

ISRAEL: Baby's Penis Reattached after Mohel Botches Circumcision

Israel Hayom
August 7, 2015

Baby's penis reattached in hospital after brit goes wrong

After circumcision is botched, family members keep severed tissue on ice until baby arrives at hospital • "We are optimistic about the baby's chances of recovery," surgeon says after operation • Unclear what led mohel to remove part of baby's urethra [glans].
by Danny Brenner and Israel Hayom Staff 

An 8-day-old boy from northern Israel was rushed to the Pediatric Emergency Unit at the Rambam Healthcare Campus this week after a botched circumcision in which the mohel severed part of the baby's urethra [glans]. The infant underwent penis reattachment surgery, which doctors later pronounced successful.

The medical team praised the family for placing the severed tissue on ice until they arrived at the hospital, increasing the chances for a successful operation.

The reattachment surgery was performed by senior pediatric urologist Benjamin Hardak.

"These kind of procedures are relatively rare," Hardak said. "The operation was a success and we are optimistic about the baby's chances of recovery, but it is still too soon to know what the ramifications will be for the baby. We are monitoring his condition closely."

Following the surgery the infant was admitted to the Intensive Care Unit at the Ruth Rappaport Children's Hospital, part of the Rambam Campus.

Mohels (ritual circumcisers) undergo special training before being allowed to perform the delicate medical procedure.

According to the Health Ministry's statistics, complications following circumcisions occur in less than 1% of cases, with the most common complication being excessive bleeding. Details of what went wrong in the brit in question were not immediately available.

MALAWI: HIV rising despite cutting, says Medecins Sans Frontiers

August 4, 2015

Malawi: Circumcision Disaster - Malawi HIV Infection Rate Doubles

Following up the reports that Malawi24 released on 25 July that circumcision does not help in the reduction of HIV but exacerbates it, reports have emerged that have agreed with the facts that we had earlier established. 

Medecins Sans Frontieres (MSF), one of the world's renowned NGOs working on public health, has released statistics showing that HIV infection rate in Malawi has doubled in recent years despite a range of interventions put in place to tackle the spread of the virus that have included relentless campaign on condomisation and circumcision. 

According to the statistics by MSF, HIV rates have doubled in Malawi moving from 10% to 20% in 1 year. Strangely, this has been the same period that Malawians have been manipulative forced to go through circumcision in masses with the promise that it reduces the contraction of HIV. 

The results which were published on BBC and revealed that of every 5 people, 1 person is HIV positive have pitted Malawi as the country worst hit by the HIV pandemic of all countries in the world. 

Commenting on the development some Malawians trashed the results claiming they were sensationalised and exaggerated for the sake of tarnishing the image of the country to the international world to achieve what they called MSF's own hidden agenda. 

Others faulted the BBC, saying it was one of the broadcasters' crusades against the African continent which they have tirelessly aimed to present in a negative light.

Medecins Sans Frontiers denies having had anything to do with this information. However,  these figures do bear the claim out:

Proportion of males  aged 15-54 with HIV cut intact
2010 10.3 7.9
2014 13.2 9.5

Source: Demographic and Health Surveys National Statistical Office,
Zomba, Malawi and ICF Macro, Calverton, Maryland, USA

NOTTINGHAM: Mother furious at baby cut without her consent

Daily Mail (UK)
August 2, 2015

Mother's fury after doctor circumcises three-month-old baby boy at request of Muslim father WITHOUT her consent

by Ross Slater
Father asked for his boy to stay the night and secretly took him to doctor
Dr Balvinder Mehat carried out the private procedure on request
Baby's mother said: 'I knew this was something my baby's father wanted, but I didn't agree with it at all'

A doctor faces a police inquiry after he performed a circumcision on a three-month-old baby without the mother's consent in Nottingham.

Dr Balvinder Mehat was asked by the child's father's family to carry out the private procedure in accordance with their Islamic faith, but the boy's mother was horrified when she found out.

The unmarried 26-year-old, who did not want to be named, said: 'I knew this was something my baby's father wanted, but I didn't agree with it at all.

'I spoke to my health worker and GP about it, and they said that if it was only my name on the birth certificate there was no way it could happen.'

The parents, who both live in Nottingham, were in a casual relationship when the baby was conceived. After the birth, the father visited his son every week.

When the boy was three months old, the father, whose family originate from Pakistan, asked if his son could stay the night to mark Eid, the end of Ramadan. 'I agreed because it seemed fair,' said the boy's mother.

'The next day I was woken up by a phone call from his grandmother asking me for his GP's details for the circumcision appointment.

'I didn't know what she was on about and gave them to her to avoid a row. I then started ringing and texting them to say that no way should they do anything to my son. I got no response. Then a couple of hours later I got a text saying, 'It's done.' I couldn't believe it.'

The child had been taken to the Bakersfield Medical Centre in Nottingham and given a 'Plastibell circumcision', which is a ten-minute surgical procedure. The mother was horrified by the sight of the wound when she went to collect her child.

She was given a post-operative care sheet warning her that 'common complications can be bleeding and infection'. The furious mother told her health visitor, who in turn informed social services.

'A social worker came to see me,' said the mother, 'but she was only interested in my emotional state and in arranging contact for the father's family as I wouldn't allow them access.

'I rang the medical centre and Dr Mehat later rang me back. He was very aggressive.'

According to General Medical Council guidance, doctors should 'get consent from all those with parental responsibility.

If you cannot get consent for a procedure, for example because the parents cannot agree, you should inform the child's parents that you cannot provide the service unless you have authorisation from the court'.

Dr Mehat qualified as a medic in 1984 and became a GP in 2006. When contacted by The Mail on Sunday, he issued a statement through the Medical Protection Society, saying:
'I am sorry to hear of the concerns that have been raised, but it would be inappropriate for me to comment further due to patient confidentiality. I would like to reassure my patients that I always strive to provide the best possible care.'

A spokesman for Nottingham Police said: 'We can confirm that the matter has been reported to us and that inquiries are ongoing.'

ESSEN, GERMANY: Hospital deters parents from cutting

The Jewish Post
July 21, 2015

German hospital working to deter parents from circumcising

Despite legislation enshrining the right to circumcision [or rather, to circumcise], the ritual still faces opposition in Germany, according to a local media outlet, which reported that a hospital in Essen is trying to convince parents to forgo the procedure for their sons.

The news website cited Dr. Peter Liedgens, the director of pediatric surgery at Elisabeth Hospital, saying that he has managed to persuade three quarters of parents at his hospital to rethink circumcision. As a result, only 11 circumcisions were performed in the first quarter of 2015, down from 70 during the corresponding period the previous year.

The website also claimed that now the hospital would cease to perform any childhood circumcisions. However, a hospital spokesman clarified to The Jerusalem Post that, while it still performs circumcisions and has no plans on stopping, it performs them only on children above the age of one and only under general anesthesia.

“Circumcisions are performed only by our pediatric surgeons and not by ritual circumcisers on hospital grounds. So the new policy doesn’t really change anything concerning this procedure,” explained spokesman Thomas Kalhöfer.

Asked if the hospital would actively try to deter religious families from circumcising their children, Kalhöfer said that, “We respect the religious grounds of families asking for circumcision, and we don’t actively want to persuade them to desist.

“Our surgeons are arguing from a medical standpoint according to the new medical guidelines of the German Society of Pediatric Surgeons, who recommend to perform circumcision only for medical reasons,” he said, adding that the hospital’s policy toward circumcision has been in place since the beginning of the year.

In 2012, a court in Cologne ruled circumcision a form of bodily harm subject to criminal penalties, causing an international furor and vehement protests from Jewish organizations and the State of Israel.

While the Bundestag moved swiftly to pass legislation enshrining the right of German citizens to undergo circumcisions [no, to genitally cut non-consenting minors - the right of adults to be cut was never restricted], several German medical associations came out strongly against the practice.

There is no reason from a medical point of view to remove an intact foreskin from underage boys or boys unable to give consent,” the German Pediatric Association asserted in a 2012 statement.

Jewish groups have expressed growing concern over circumcision in recent years, in the face of campaigns to ban the practice in several countries and a 2013 resolution by the Parliamentary Assembly of the Council of Europe, which described circumcision as a “violation of the physical integrity of children.”

According to the American Academy of Pediatrics, “The health benefits of newborn male circumcision outweigh the risks, but the benefits are not great enough to recommend universal newborn circumcision,” and “the final decision should still be left to parents to make in the context of their religious, ethical, and cultural beliefs.”

“The Simon Wiesenthal Center calls upon authorities to insist that the religious rights of Jews and Muslims be protected,” said Rabbi Abraham Cooper of the center.

While Rabbi Pinchas Goldschmidt of the Conference of European Rabbis mused that “the decision of the hospital is not based on questions of the legality of circumcision, which is guaranteed by German law, but on the fact that less and less Muslims are interested in this procedure, a fact showing the assimilation of Muslims into a post Judeo-Christian Europe.”

However, the hospital’s policy does show “a certain bias,” he said, adding that “for Jews the address for Brit Mila [circumcision] should be the synagogue and not the hospital.” 

LONDON: 50 girls "taken to Somalia for cutting"

BBC News
July 17, 2015

'Fifty girls' taken from UK to Somalia for FGM

Reports that at least 50 girls were taken from the UK to Somalia for female genital mutilation are being investigated by Scotland Yard.

Liberal Democrat peer Baroness Tonge contacted the Metropolitan Police after spotting a large group of girls on a flight from Heathrow last Saturday.

The girls were said to be aged 11 to 17 and with their mothers or grandmothers.

It comes as Bedfordshire Police secured the UK's first FGM protection order, preventing two girls from going abroad.

The Metropolitan Police said officers from the Specialist Crime and Operations Command were investigating Lady Tonge's report.

'Scattering of grannies'
Speaking to the BBC, Lady Tonge said the girls spoke English and were of Somali origin.

"It was just odd," she said. "They were young girls and mothers and a scattering of grannies."

They were on an Ethiopian Airlines flight to Addis Ababa on 11 July and according to the Lib Dem peer transferred onto a plane to Mogadishu, the capital of Somalia.

Lady Tonge, along with the Labour MP for Halifax, Holly Lynch, was on a trip to the Financial Development Conference in Addis Ababa.

FGM, also termed female circumcision, is illegal in the UK. It refers to any procedure that alters or injures the female genital organs for non-medical reasons.

It is a painful ritual carried out on women and young girls from certain communities from Africa, Asia and the Middle East.The Met says its Specialist Crime and Operations Command is probing the reports

Lady Tonge said that both she and Ms Lynch felt the presence of so many girls at the start of the summer holidays was "suspicious", given that it was the start of the so-called "cutting season" when FGM is carried out, and she decided to raise the alarm on her return to the UK.

Scotland Yard confirmed that police had been called by a "woman concerned about a large number of girls on a flight from Heathrow to Ethiopia on 11 July whom she believed were at risk of FGM".

That confirmation from the Met came after Bedfordshire Police said it secured a protection court order on the day new powers came into effect.

The civil legislation allows officials to seize passports from people they suspect are planning on taking girls overseas for FGM, and breaching an order is a criminal offence.

The move prevents two girls being taken to Africa, Bedfordshire Police said.

The force said it is estimated that more than 20,000 girls under the age of 15 in the UK are at risk of FGM each year, although very few cases are reported.

Aneeta Prem of Freedom Charity said "cutters" may also be entering the UK to carry out FGM
Det Ch Insp Nick Bellingham, from Bedfordshire Police's Public Protection Unit, said: "With schools breaking up for the summer holidays today, we will continue to use this legislation where needed to prevent young girls who we believe may be at risk from being taken out of the country.

"This is child abuse, and we will do everything in our power to ensure that children are kept safe and that those responsible are caught."

Aneeta Prem, founder of women's charity Freedom Charity, said the use of a protection order was a positive step.

But she warned that the authorities must also look out for "cutters" - people who carry out FGM "for as little as £200 a girl" - entering the UK.

"We can't be politically sensitive. Girls who are mutilated in this way suffer a lifetime of scarring and permanent damage," she said.

The Female Genital Mutilation Act 2003 in England, Wales and Northern Ireland, and the Prohibition of Female Genital Mutilation Act 2005 in Scotland states that FGM is illegal unless it is necessary for health reasons.

The law states that is also illegal to arrange for a UK national to be taken overseas to undergo FGM.
The order secured by Bedfordshire Police, which can be made by courts in England and Wales, was introduced under the Serious Crime Act 2015.

Equalities and Justice Minister Caroline Dinenage said the protection orders have been "fast-tracked... to make sure women and girls facing the awful threat of FGM can be kept safe".

"These orders mean girls and the communities around them now know they will have somewhere to turn, that the law is on their side and help is out there.

"The government is committed to ending FGM."

MEXICO: Students cut baby penis as "umbilical cord"

Stuff (New Zealand)
July 18, 2015

Medical students chop off baby's penis by accident

A newborn's penis has reportedly been mistaken for his umbilical cord.

Medical students have reportedly mistaken a newborn's penis for his umbilical cord and chopped it off.

The undergraduates made the shocking blunder in the delivery room in the City of Saltillo in the state of Coahuila, north-eastern Mexico, The Sun reported, and then tried to hide the boy from his parents.

The child's father Diego Rangel Izaguirre grew suspicious when he was denied access to his son for more than two hours after his birth. He was told that his son had suffered a minor injury and would need surgery.

"When my child was born and they cut his umbilical cord they injured his penis.

"And unfortunately when the surgeon started sewing it, he made other two new injuries, almost two centimetres deep."

The baby's mother, Zulem Contreras, said: "This shouldn't have happened, they should have assigned a gynaecologist to take care of him, not students."

The couple have made an official complaint but hospital officials claim the newborn is healthy and that the operation was both minor and the baby's parents gave their consent.

"According to the information available at the moment, during the labour, when cutting the umbilical cord, incidentally the foreskin was injured and was corrected with the usual procedure of circumcision to the minor," the Mexican Institute of Social Security said.

[Circumcision does not of course "correct" an injury to the foreskin, but causes one.]

FLORIDA: Mother cops plea to keep custody from spite-circumcision father

Associated Press
July 16, 2015

Woman in Son's Circumcision Fight Pleads in Custody Case

A Florida woman who was jailed in her fight against her son's circumcision can avoid additional jail time on a child-custody charge.

Thirty-year-old Heather Hironimus of Boynton Beach entered a plea Thursday allowing her to avoid prosecution for interfering with child custody if she doesn't land in trouble in the next year.

Hironimus had fled with her 4-year-old son to avoid the circumcision that the boy's father wanted and judges agreed should be performed.

She was jailed on a contempt charge, but freed after she agreed to the procedure. The child-custody charge was the last legal hurdle remaining for her.

Hironimus' attorney, Richard Tendler, tells The Palm Beach Post his client "is relieved the matter is behind her and looks forward to moving on with her life."


EASTERN CAPE: 22 circumcision deaths, custom questioned

July 10, 2015

Traditional circumcision questioned in the E Cape

The relevance of the tradition of circumcision is being questioned in the Eastern Cape. This as about 22 young boys have died since the start of winter in the Eastern Cape.

The Maphetshana family is grieving their 17 year old son was left for dead at an initiation school. His mother, Nomihlayethu Maphetshana, was denied access to him even after he was brought home.

Nomihlayethu says: "We are not allowed to see our children because we are women. My son was burnt with plastics, stabbed at his arms , beaten up all over the body and these people claim they did not see all that torture. My son was brought here and they denied me access in my own house and now I have lost my child."

An emotional Deputy Minister of Traditional Affairs Obed Bapela visited the bereaved families.

"I am a supporter of culture myself but if culture is going to kill our children I will say no it cannot be. I really send my condolences to the family and to all other families that have lost their children , here in the Eastern Cape and elsewhere." Bapela says.

Child rights organisations have also called for the arrest of those who abduct young boys and circumcise them.

At least 145 others are in hospital some in a critical condition from botched circumcisions.

Earlier story

EASTERN CAPE: 14 circumcision deaths
July 6, 2015

14 dead in S. African province after botched circumcisions

Traditional circumcision ceremonies in South Africa's Eastern Cape province, where the rite-of-passage practice is common, have left 14 boys dead and 141 injured this year, local authorities said Sunday.

Many of the injured teens suffered from "dehydration, wounds, pneumonia, aseptic penis and gangrene" Sizwe Kupelo, spokesman for the health ministry in the Eastern Cape province told AFP.
"Fourteen died and 141 are in various hospitals," he said.

Nine patients are waiting for a penis transplant -- a procedure requested more and more after the first successful transplant was performed in the country last year on another botched circumcision victim.

The rite of passage into adulthood, which usually follows a bush retreat of two to four weeks, is also a show of physical endurance.

For the ceremony, the teens gamble their lives. Each year teenaged boys die or are mutilated during the initiation.

"A death is always one too many," said Mamkeli Ngam, spokesman for the cooperative governance and traditional affairs minister in Eastern Cape, the home province of Nelson Mandela.

Ngam also said that several initiation schools had already been shut down.

According to media reports, 41,000 young men of the Eastern Cape -- one of the most affected provinces in South Africa -- completed the initiation last year.

Circumcision in the country can be lucrative, bringing in around 1,500 rand (110 euros, $120) per initiation, but the boys do not benefit from the profit. They are often treated harshly and receive little to no food.

In June, South African police rescued 11 teenage boys from forced circumcision after their parents reported that they had been taken from the street to participate in the initiation.

EASTERN CAPE: Hospitals swamped, 6 circumcision deaths
July 2, 2015

Eastern Cape hospital faces crisis due to initiate influx

by Adam Wakefield
Johannesburg - St Barnabas hospital in Libode in the Eastern Cape is facing a crisis due to an influx of initiates, the Eastern Cape health department said on Thursday.

Spokesperson Sizwe Kupelo said 36 initiates had been admitted to the hospital and it had run out of beds.

"Six ordinary medical cases could not be admitted last night [Wednesday] due to a shortage of beds as a result of initiate influx," he said.

"The provincial health department has had to intervene by moving some of the boys to Dr Malizo Mphehle Hospital to avert a crisis."

The boys were admitted due to a combination of ailments, from botched circumcisions leading to septic wounds, to dehydration and pneumonia.

Kupelo said the wounded boys had circumcisions performed on them by people who did not know how to perform them.

"Codefsa [Community Development Foundation for SA], an NGO assisting with circumcision rescue operations in the area, has agreed to erect a rescue centre behind the hospital."

Reputable traditional nurses
Chief Bokleni, a senior chief in the area, had given his permission for the land behind the hospital, which is not part of the property, to be used.

"All costs will come from Codefsa, [the] health [department] will need to support with medical kits and monitoring personnel," Kupelo said.

"Chief Bokleni will assign reputable traditional nurses for the duration of their stay, health nurses and doctors will monitor. Security guards will be assigned to secure the initiation village or rescue centre."

Other initiate admissions in the province had seen 14 boys admitted to Mthatha central hospital, seven to Dr Malizo Mpehle hospital in Tsolo, 15 to Canzibe hospital in Ngqeleni, and four boys to Holy Cross hospital in Flagstaff.

"The Co-operative Governance and Traditional Affairs MEC Fikile Xhasa, accompanied by senior health officials from Bhisho, is currently visiting St Barnabas Hospital and will also view the demarcated area for the rescue centre," Kupelo said.

Six people dead
On Sunday, Kupelo said a total of six people had died during the week in connection with the current initiation season.

Kupelo said five of the deaths happened in the OR Tambo district and one in the Chris Hani district. Libode is located in the OR Tambo district.

An 18-year-old boy from Ngqeleni was circumcised on June 13 and died on his way to hospital last Friday. The cause of death was still unknown, although he had presented with confusion and dyspnoea (laboured breathing). A forensic examination was underway.

A Tsolo man, 22, was circumcised on June 20 and died on Saturday. The cause of his death was still unknown.

PAPUA: Male cutting imposed

Jakarta Post
June 30, 2015

Painless circumcision method introduced to curb HIV spread

by Nethy Dharma Somba
The Papua AIDS Eradication Commission (KPAD) began to distribute 1,800 PrePex circumcision devices to residents on Monday in four regions in a bid to reduce the risk of HIV infections in the province.

The device, made of elastic rings and placed on male genitals for seven days before it is released, has been considered practical and easy to use and can provide a non-surgical, medical means to achieve adult male circumcision.

Papua KPAD secretary Constant Karma said that the 1,800 PrePex units, which were donated by the US-based Clinton Foundation through the Clinton Health Access Initiative (CHAI), would be distributed to Jayapura, Jayawijaya, Paniai and Manokwari, starting Monday.
[No mention of informed consent.  Papua is under military occupation by Indonesia and the rights of local people are severely curtailed. Is this just another example?]

“This is only the first stage. For the second phase, we will receive another 10 million PrePex units [from the foundation],” Karma said on Monday on the sidelines of a free circumcision service held to introduce PrePex use at the regional administration-run hospital RSUD Dok II Jayapura.
[The population of Papua is 3.5 million. Who are the other 8.25 million Prepexes for?]

The hospital, according to Karma, would open such a service until Friday.

In 2007, the World Health Organization and UNAIDS argued that circumcised men could reduce the risk of HIV infection by approximately 60 percent in high-risk areas.

The spread of HIV infections in Papua is alarming, according to the Papua KPAD. HIV in Papua is mainly transmitted through unsafe sexual intercourse. [And mainly from men to women, to whom male genital cutting offers no protection and may increase the risk.]
Unlike regular circumcision surgery, PrePex-assisted circumcision is much easier to perform. After the male genitalia is cleaned and measured, anesthesia cream is applied on the tip of it to get rid of a tingling sensation.

Then the PrePex, which is a set of two rings, one black and one white, is inserted onto the genitals according to the respective size.

The white ring is put inside the genital skin while the black one is put around the outer skin. The rings will clamp the skin, stopping the flow of blood, nerves and nutrition to the skin that will be cut off.

“As the flow of the blood, nerves and nutrition stops, the skin will automatically feel nothing so that no pain will be felt and no blood will come out,” said Suwardi, one of the hospital doctors who assisted in Monday’s circumcision service. [This is optimistic to say the least. The sensation caused by a tourniquet of any kind can be intensely painful. Pain and blood are far from the only downsides of genital cutting.]
After the rings are attached, patients could engage in normal activities and then return to the hospital a week later to have the dead skin cut off and the rings released, said Karma, who was also among the patients.


And so it begins again...

EyeWitness News
June 27, 2015

Three EC initiates die while undergoing rite of passage

by Xolani Koyana
CAPE TOWN - Just four days into the initiation season, three Eastern Cape boys have died while undergoing the rite of passage.

This follows the hospitalisation of nine other initiates in the province last week from complications following circumcision.

It’s believed the deceased are aged between 14 and 17 years old.

Eastern Cape Traditional Affairs spokesperson Mamnkeli Ngam says the department was alerted to the deaths after sending officials to the initiation school.

“While monitoring the schools they were informed that initiates had died in two different areas. At the moment we are unable to divulge the details around their deaths until we have received the post-mortem results.”

Earlier this month, the Department of Cooperative Governance and Traditional Affairs said new regulations proposed to govern initiation schools could see the use of modern medical practice to minimise injuries while women would also play a greater role.

Sixty thousand young boys undergo traditional circumcision across the country every season.
Over the past few years, interventions by the health department have seen the number of fatalities decrease.

Government said the proposal is aimed at streamlining standard medical practice with cultural norms.
(Edited by Winnie Theletsane)

EASTERN CAPE, SOUTH AFRICA: Nine boys in hospital after botched circumcisions

June 18, 2015

Nine boys in hospital after botched circumcisions

The teens apparently went to unregistered initiation schools without their parents' consent.
by Xolani Koyana / Tamsin Wort
CAPE TOWN – Nine Eastern Cape teenagers have been hospitalised due to complications from botched circumcisions.

It's understood the boys went to unregistered initiation schools without their parent's consent.

Eastern Cape health spokesperson Sizwe Kupelo said, “We admitted seven initiates at a state hospital and two were admitted in Umtata following circumcision-related complications. We heard reports of other boys being affected.”

FLORIDA: Spite-circumcision looming; doctor threatens to file complaint

the Broward Palm Beach New Times (Florida)
June 10, 2015

Hironimus Circumcision Case: Doctor Threatens to File Complaint Against Hospital

by Deirdra Funcheon
John Trainer, M.D., is a family doctor in Jacksonville. He has circumcised children and taught other doctors how to perform circumcisions. His own son is circumcised.

But during the past few months, as he's followed the case of 4-year-old Chase Hironimus — whose father won a highly publicized legal battle against his mother regarding whether the boy should be circumcised — Trainer reexamined his own position on the surgery and has come to believe that routine infant circumcision is a violation of medical ethics and that Chase's case is particularly egregious because the mother's consent was forced under duress.

Now, he is threatening Joe DiMaggio Children's Hospital, where a doctor is rumored to be circumcising Chase this week, saying that if the surgery proceeds, he will file a complaint with the state Department of Health, which would then have to consider the matter. So far, the matter has been treated in state court as a contract dispute, but this could force a different set of authorities — medical administrators — to look at it in a new light.

Hironimus, in a contract signed years ago, agreed to the circumcision but changed her mind as the boy aged and she learned more about the procedure. A judge ruled that the circumcision could proceed, and she fled with the child and was caught months later and jailed. She was forced to sign a consent form for the procedure or else remain in jail indefinitely. She signed it, crying hysterically in a courtroom.

From a physician's point of view, Trainer told New Times, "it's absolutely mind-boggling this would be considered as real consent." Of the doctor rumored to be scheduled to perform a circumcision on Chase — Gary Birken — Trainer said, "it is incumbent on him" to be "aware that this is a dramatic case, an unusual case.

"Where this this galls me the most," Trainer says, "is that if we are physicians and ethical and called on to police our profession," and the doctor here "either knew or should have known" — that's the phrasing commonly used in ethical standards — "that consent was tainted," and if he proceeds in this particular case, "at the very least his ethics need to be challenged."

Furthermore, he said, pediatric surgery ethics require that a doctor make the child aware of what is happening and consider the child's opinion in elective surgeries. Court documents asserted that Chase was scared of and does not want the procedure.

Trainer says he has no personal connection to the case, but as he followed it and engaged with anticircumcision activists, it was like the "allegorical scales falling off my eyes."

Circumcision in America was popularized by John Harvey Kellogg in the 1800s to prevent masturbation. Trainer says it's absurd that "the cereal magnate could still have impact on human anatomy 100 years later — I think it's barbaric and cruel." In a circumcision, he says, irrespective of the pain to the child, "you have an open wound in a soiled diaper with urine and feces. If we were asking any other surgeon to do this under these circumstances, it would be 'reductio ad absurdum.'"
It's also, he says, "the only procedure an obstetrician will do on a man — and with absolutely no follow-up. They'll never see that penis again — no follow-up. This is unheard-of with any other procedure."

Asked if he faced any career risks by preemptively speaking out against a doctor or hospital, Trainer said, "I am on the Board of Directors of Baptist Primary Care, a leader in a consortium of 150 providers — the largest and most trusted health-care system in Northeast Florida. If I suffer backlash for speaking out, I am OK with that. Actually, my Facebook page is blowing up with people commending me for being courageous. I don't really feel that brave."

Activists have launched a letter-writing and social media campaign to warn doctors not to circumcise Chase. Joe DiMaggio Children's Hospital has acknowledged on Facebook that it is aware of the objections, writing:
We have heard your concerns loud and clear. We recognize this is an emotionally charged topic and case, evident by the number of posts to this page from people in and outside our community. Joe DiMaggio Children's Hospital has been a pillar in the South Florida community and an advocate for many causes, always working for the benefit of its patients while providing quality service and care. We ask that you respect the confidentiality of all our patients as cases evolve. Please understand that we can't and will not discuss specifics in this forum due to HIPAA guidelines. A protest at the hospital was scheduled for today at 11 a.m.

[The story is progressing rapidly. A further statement from the hospital says -

...the child in question is not a patient at Joe DiMaggio Children’s Hospital or any Memorial Healthcare System facility or of Dr. Gary Birken. - yet leaked medical records show him as one. An emergency legal threat from another lawyer appears to have at least postponed the operation.]

Earlier story

NEW YORK: Metzitzah: De Blasio stacks Health Board to get rid of consent forms

NY Times
June 9, 2015

De Blasio Puts Allies on Panel Hearing Circumcision Plan

by Michael M. Grynbaum
Mayor Bill de Blasio has installed numerous allies on the New York City Board of Health as his administration prepares to present a controversial plan that would ease the rules on a circumcision ritual linked to herpes infections in infants.

The mayor has pointed to his proposal as a way to protect public health while respecting the ultra-Orthodox Jewish community that cherishes the ritual, known as metzitzah b’peh, or oral suction.

But a planned presentation to the board in March was abruptly delayed. Since then, Mr. de Blasio has moved to shake up the health panel, filling vacant spots and replacing members appointed by his predecessor, Michael R. Bloomberg.

Three of the new board members were contributors to Mr. de Blasio’s 2013 mayoral campaign; among those donors, one is married to an unpaid special adviser to the mayor. The fourth is the president of the city’s Health and Hospitals Corporation, a position he was placed in by Mr. de Blasio.

The mayor’s proposal, which requires approval by the board and will be presented on Wednesday, is supported by ultra-Orthodox rabbis who are among Mr. de Blasio’s most important political supporters. It would waive a requirement that parents sign a consent form before the ritual, which involves sucking blood from the incision on a baby’s penis.

Instead, the mayor’s plan would create an alternative system that would test a circumciser, or mohel, for herpes, although only after a baby is found to be infected. If the circumciser tests positive, penalties would be pursued if DNA tests can prove that the mohel and the baby were infected with the same strain.

The consent rule, introduced under Mayor Bloomberg, was assailed by Orthodox leaders as an infringement of their religious rights. Mr. de Blasio pledged to rescind the rule, and his aides later said the consent forms had been difficult to enforce, saying that herpes infections linked to the practice actually rose in 2014.

“This approach hasn’t been working in the past, and we need a new approach to truly reduce the health risk for infants,” Mr. de Blasio’s press secretary, Karen Hinton, said in a statement on Tuesday.

Ms. Hinton added that the mayor had an “obligation to ensure that the Board of Health is fully staffed with highly qualified health experts.”

Since 2000, the circumcision ritual has been linked to more than a dozen cases of herpes infection in infants and at least two deaths. Several health organizations, including the American Academy of Pediatrics, have warned that the ritual can significantly raise the risk of an infant’s being infected.

Aides to Mr. de Blasio have sought to characterize the mayor’s plan as sound science, and they dismiss the earlier Bloomberg approach as a mockery that was ineffective and strained ties with the Orthodox community. Ms. Hinton said that the city would distribute information about the ritual.

A simple majority of the 11-member Board of Health is required to adopt the new circumcision rules.
Dr. Mary T. Bassett, the city health commissioner, has a vote. So does Pamela S. Brier, a Bloomberg appointee who supports the mayor’s plan.

Ms. Brier, the chief executive of Maimonides Medical Center in Brooklyn, has her own ties to Mr. de Blasio. About a decade ago, she created a job at the medical center for his wife, Chirlane McCray.

Dr. Thomas A. Farley, who served as health commissioner under Mr. Bloomberg and spearheaded the consent rule, said on Tuesday that he was concerned about the board’s undoing the older policy.

“This is an inherently risky procedure,” Dr. Farley said. “Focusing on one or another specific mohel is not going to address that fundamental risk.”

Mr. de Blasio’s new appointees include Karen B. Redlener, who oversees several pediatric programs at the Children’s Hospital at Montefiore. Ms. Redlener and her husband, Irwin, the special adviser to the mayor, contributed $1,900 to Mr. de Blasio’s 2013 campaign. Two of the appointees, Rosa Gil and Gail Nayowith, gave $400 and $800.

Earlier story

ZIMBABWE: Man sentenced for cutting nephew

May 30, 2015

Man Circumcises Boy With Home-Made Knife

An elderly man from Mucheke Village under Chief Murinye in Masvingo District has been jailed for six-month after he tied and forcibly used a home-made knife to circumcise his nephew, a 16-year-old boy who has a mental problem.

82 year Kufakunesu Pagwaringira appeared before Regional Magistrate Judith Zuyu.

The court heard that on May 17, this year, around 1100 hours the accused called the complainant Gibson Hwekave into his house and asked him to get some nice clothes so that they could go to church, and the complainant complied.However Pagwaringira tied Hwekwave’s hands behind his back. The accused person force-marched the complainant to a mountain and ordered the complainant to lie down.He removed Hwekwave’s pair of trousers and produced a knife from his pocket and cut the foreskin of the complainant’s penis and applied some herbs.

It is suspected that Pagwaringira circumcised the boy because he has been sexually abused from time to time and Pagwaringira felt that he could protect him from sexually transmitted diseases by removing his foreskin.

Pagwaringira pleaded with the court to give him a non-custodial sentence since he was the only one looking after the mentally challenged boy.

Magistrate Zuyu slapped Pagwaringira with a 6 month imprisonment wholly suspended for 5 years.

An unknown caller tipped the Police who discovered that a home-made knife had been used to circumcise the boy. The accused was arrested and the knife was then recovered as an exhibit. The complainant was referred to hospital for medical examination by a medical doctor who compiled the medical report. 

SOUTH CAROLINA: Malpractice trial after intersexed infant castration

The Post and Courier (South Carolina)
May 25, 2015

Lawyers prepare for medical malpractice trial in rare ‘intersex’ lawsuit

by Lauren Sausser
A Richland County jury may decide later this year if the Medical University of South Carolina, Greenville Health System and the state child welfare agency are guilty of medical malpractice for removing a baby’s penis before he turned 2 years old.

Pam and Mark Crawford say surgeons in Charleston and Greenville performed unnecessary sex assignment surgery on their son — named M.C. in court records — when he was 16 months old. M.C. was born with both male and female reproductive organs [or rather, with reproductive organs that were not clearly male or female], but “there was no medical necessity to remove any of his genital tissue,” his adoptive parents said in their lawsuit.

Doctors should have let M.C. eventually choose a gender for himself, they contend.
“Our client’s penis was surgically removed for no medical reason. He’s going to have to live with that for the rest of his life,” said attorney Anne Tamar-Mattis, the legal director for Advocates for Informed Choice. “No surgery he can get can give him back what he lost.”

The Crawfords adopted M.C. from state custody after the S.C. Department of Social Services approved surgery that made him biologically female [no, only "ostensibly female"]. But it soon became clear, his mom said, that M.C. wanted to be a boy [or rather, felt himself to be a boy] — a decision his adoptive parents respected.

“He made the social transition with the name change at 7,” Pam Crawford said. “He’s just like any other boy. He’s been very well accepted in the community and the school and it’s really just not been an issue.”

The Crawfords, who live in Columbia, filed federal and state lawsuits two years ago against MUSC, Greenville Health System and DSS.

The court dismissed their federal lawsuit in Charleston earlier this year. Defense lawyers successfully argued that doctors weren’t aware when they operated that they may have violated M.C.’s civil rights.

... on January 26, 2015, the Court of Appeals for the Fourth Circuit reversed and remanded with instructions to dismiss the complaint.  The Fourth Circuit stated that it did not “mean to diminish the severe harm that M.C. claims to have suffered” but that a reasonable official in 2006 did not have fair warning from then-existing precedent that performing sex assignment surgery on sixteen-month-old M.C. violated a clearly established constitutional right.
Bill of Health, March 5, 2015

“It’s not clear if a different court in a different time in a different place would have decided it the same way,” Tamar-Mattis said. “The court did not rule if they did, in fact, violate his civil rights. They left that question open.”

MUSC attorneys would not comment on this case specifically, but a spokeswoman for the hospital said, “If at any time there is controversy or disagreement about a care plan, the case can be referred to that ethics committee for a decision.”

A spokeswoman for Greenville Hospital System declined to comment on the case.
Meanwhile, the state lawsuit in Richland County is moving forward. DSS denies the allegations, court records show. The case may be tried by a jury sometime after Nov. 15.

“We do feel that our case is strong,” Tamar-Mattis said. “A lot more will come out at trial.”
This may be the first public case of its kind, she said. Similar lawsuits have been settled privately out of court in other states.

“The reason we’re doing this is so some change is made. That’s really what we see as what’s important,” Pam Crawford said. “To make a settlement and make it a private thing, it’s not what we want to accomplish with this.”

They also want money to pay for treatment that M.C. will need during and after puberty, but the Crawfords have not named a specific amount in their lawsuit. They don’t yet know what his treatment will entail or how much it will cost.

“We monitor him in terms of hormone levels, maybe once a year,” Pam Crawford said. “I don’t think there’s a specific set date (for treatment) ... but it’s coming up in the next couple years.”

M.C., now 10 years old, may testify at the trial, but he’s not overly preoccupied with the lawsuit, his mom said.

“We’re certainly not hiding it from him, but it’s not a huge concern for him,” she said. “I don’t know how much he understands of it — not all.”

The specific intersex condition he was born with, called ovotesticular disorder of sexual development, is rare. It only affects one in 83,000 infants, but an estimated one in 2,000 children are born with genitals that are “visibly intersex,” the World Health Organization reports.

“It’s something like 5 percent every year are born with genetic bodies, sexual bodies that operate differently than we’re used to,” said Alison Piepmeier, director of women’s and gender studies at the College of Charleston. “Five percent, that’s significant.”

Gender is based on several complex variables, she said, and children should be allowed time and space to express who they really are. Luckily, she said, society is talking more openly about gender identity than ever before.

“I’m seeing college students, some that I know and many that I don’t know, who are beginning to recognize themselves in a different way,” Piepmeier said. “In the last 10 years ... it’s far more visible. We’re still perhaps a little uncomfortable by it, but I’m seeing that less and less, especially among people who are younger.”

Earlier story