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A traditional birth attendant cut my son’s penis into two, doctors couldn’t reattach it — Mom

Aishatu Usman’s modest apartment in a busy neighbourhood at
Abattoir, Agege, Lagos was full of sympathisers last week. It was also
filled with cries of anguish. The apartment, a shack, was constructed
with zinc and a few planks of cheap wood. The sun was out and the heat
in the shack was thick and unbearable. But the sympathisers, most of
them women worked tirelessly, begging Usman to stop wailing.

But the tall, thin woman would not be easily dissuaded. She wailed: “That woman killed my son.”

Her neighbours said Usman had started crying around 10am. It
was now 3pm. Five hours after she started crying, she was still holding
on tightly to the lifeless body of her nine-year-old son. She would not
stop crying and she refused to let go.

The cut of death

As she cried, our correspondent noticed that her pink top
was wet with drops of milk seeping out of her engorged breast. By this
time, the skin of the little boy, who will never suckle, had grown pale.
The woman whom Usman blamed for the death of her son was a traditional
birth attendant. She had provided two services for Usman: she helped to
deliver her of her son and she also helped to circumcise the little
baby. It was the second service that turned out to be fatal.

According to the United States National Library of Medicine,
circumcision is one of the world’s most widely-performed procedures by
health workers. It is a religious or cultural ritual for many Jewish and
Islamic families, as well as some tribes in Africa and other parts of
the world.

The word ‘circumcision’ is derived from the Latin word, circumcidere, meaning “to cut around.”

A medical website, WebMD, defines male circumcision
as the surgical removal of the foreskin by a qualified health
professional in a sanitary environment. However, many Nigerian parents
who circumcise their male children do not seek out qualified health
professional.

One of Usman’s neighbours, who spoke on condition of anonymity, said the ill-fated boy must have died from prolonged bleeding.

She said, “After her son was circumcised, he began to bleed.
Usman noticed the bleeding and then called the traditional birth
attendant who circumcised him, but she kept giving excuses that she was
busy at the time. They spoke on the phone. The TBA later said she would
come to her house a bit late. As each hour passed, the bleeding became
worse. I guess her son lost a lot of blood.”

Usman, while narrating what happened to her son, put the
blame on the birth attendant. Speaking to the small crowd of
sympathisers who were in the room, she said the TBA didn’t circumcise
her son properly.

“That woman (the TBA) killed my son. She no do am well. That woman killed my son; wetin I go do now. Ah! My child don die. My baby, God! Why me?” she said.

The cut of injury

Eudora Michael’s son is also a victim of a botched
circumcision. The 35-year-old mother regrets the day she chose a TBA to
circumcise her son. Her son’s penis was cut off during circumcision. She
told SUNDAY PUNCH that her life wouldn’t ever be the same because of her son’s condition.

Michael said she regretted allowing her step-father, who is a traditional doctor, circumcise her son when he was one-month-old.

She said, “After my son’s penis was cut off, my step-father
said it would grow afresh within three weeks. He then rubbed all sorts
of concoctions on my son’s private part. Till today, my son’s penis has
not grown back. I am heart-broken.

“I regret my action; every day I wish I had taken him to a
proper health clinic for circumcision. There are days when I cry for
hours. I know my son’s life would never remain the same. We travelled to
India with the hope that his penis would be reformed by the doctors
there, but they said nothing can be done until he is 14 years old. I
broke down into tears when I heard them say that.”

Traditional birth attendants

In Nigeria, TBAs are recognised for the critical position
they occupy in the health care chain. They play a vital role in health
care delivery in developing countries where many people, because of
poverty and substandard facilities, are unable to afford or access
quality health care. They are licensed to provide specific services by
government.  During the 2016 presentation of certificates to traditional
birth attendants by the Lagos State Governor, Akinwunmi Ambode, the
services of TBAs were spelt out by the governor.  Circumcision was
however not listed among the services.

The services provided by TBAs include:  the protection of
the health of mother and baby; the care of women during pregnancy and
child birth; the treatment of complications due to miscarriage and or
unsafe abortion; pre-pregnancy advice and health education; the care of
new born; recognising and addressing problem in women and newborns
before and during pregnancy; offering general health information
including reproductive health care and family planning; assisting women
to successfully breastfeed; referring women and newborn to higher care
when conditions arise beyond their scope of practice and capabilities;
and to foster a dialogue with formal community leaders about the needs
of pregnant women.

A member of the Board of Trustees, National Association of
Nigeria Traditional Medicine, Mr. Idowu Olawale, said there was no exact
figure of the number of TBAs in the country. He, however, added the TBA
to population ratio is estimated to be 1:200, indicating there is one
TBA to 200 persons. Given this ratio, there should about 910,000 TBs in
Nigeria. Many of these TBAs are unlicensed. Most of these unlicensed
TBAs operate in the shadows. In a recent report, the UNICEF stated that
Nigeria loses about 2,300 children under five and 145 women of
childbearing age daily to unskilled birth attendants.  It added that
only 35 per cent of deliveries were handled by skilled birth attendants.

Speaking with SUNDAY PUNCH, the President of
National Association of Nigeria Traditional Medicine, Thomas Oleabhiele,
admitted that TBAs are not licensed by the government to circumcise
babies.

He said,” The government does not give licence to TBAs to
circumcise male babies, but any traditional doctor who is registered
under NANTMP receives a right and licence to do whatever he knows. He or
she can do whatever he has expertise in, as long as he doesn’t bring
problem to anyone.

“Circumcision, prior to new innovation, is a thing of
parental decision. Parents decide who to take their male babies to for
circumcision.”

A not-so-simple surgery

According to the United States National Library of Medicine,
circumcision is one of the world’s most widely-performed procedures by
health workers. Its popularity is driven by religious and cultural
factors. It is most commonly done by adherents of Judaism, Christianity
and Islam, as well as some tribes in Africa and other parts of the
world.

A paediatrician surgeon, Dr. Sebastian Ekenze, said a
variety of problems or complications could arise from improperly
performed circumcision.

“Fortunately, most of these are mild and easy to correct,
while some are moderate and might require major operations for
correction. In some instances, a few of these severe complications may
lead to death,” he said.

Ekenze noted that infertility could occur in cases where the glans or the head of the penis was accidentally cut off.

“I frequently see, attend to, and operate on boys with
problems/complications from improperly performed circumcision. The
challenge is that most of the cases come to us late. Probably the
parents did not recognise the problems early, or they feel ashamed to
bring this to the notice of a doctor, or they are afraid of the cost of
treatment. If the head of a penis is accidentally cut off, infertility
can occur,” he said.

Cost, conceit and ignorance

TBAs, unlike medical doctors, nurses and midwives, often
learn their trade through apprenticeship. Others boast that they are
self- taught. Many TBAs are also herbalists, traditional healers, while
others are older women and men with no training but who are
well-respected in their communities for their experience in successfully
handling births.

Some mothers told our correspondent that they patronise TBAs because of their low fees.

A petty trader, Mrs. Funke Adeyemo, said TBAs assisted her in giving birth to all her children.

She said, “I couldn’t afford to go to a hospital to put to
bed. Delivering in a hospital is too expensive. Why would I spend N50,
000 in a hospital when I can pay a TBA N10,000? TBAs are also
experienced.”

A boutique owner, Mrs. Helen Ololade, also described TBAs as birth experts.

“You would hardly find a TBA who is young. TBAs are always
in the late fifties, sixties and so on. These persons are trained in
their craft,” she said.

A traditional doctor, Nwogu Nwachukwu, said TBAs are as
good, if not better than doctors and nurses in the circumcision of
newborns.

She said, “TBAs are very effective in their work. Before
medical doctors became known in African society, TBAs were in existence.
Babies with ailments were treated at home with traditional medicine.
Even in the area of circumcision, I personally believe there is no big
deal in the procedure. We performed circumcision before the arrival of
orthodox doctors. It is a practice done all over the world.

“Is there any big deal in circumcision? All you need to do
before the procedure is to sterilise your instrument. For mothers who
had a bad experience with TBAs in the area of circumcision, they must
have visited a quack TBA. There are quack TBAs among us.”

Oblivious of the fact that their activities in this regard
are not licensed by government, the TBAs dismissed the doctors’
warnings.

Oleabhiele said, “Doctors don’t know what they are talking
about when they say people shouldn’t patronise TBAs. Prior to the
arrival of the white men, women were delivered of their babies by
traditional attendants and not by medical doctors. There were no
hospitals at the time. I was born at home.”

Oleabhiele added that TBAs now attend courses to increase their knowledge and are also hygiene-conscious.

He said, “The World Health Organisation even recognises
TBAs. We also regularly teach our members the importance of hygiene. I
believe there is reason to form a synergy between western and
traditional practice. There are numerous problems that western medicine
is not focusing one which traditional medicine takes note of.”

A traditional birth attendant, identified only as Mrs.
Elijah, stressed that the role of traditional doctors in society cannot
be ignored.

She said, “I have circumcised numerous male children. I
learnt the practice from a midwife. I have become experienced. We TBAs
are good at our job. Because we are not working in a hospital or wearing
a white robe doesn’t mean we don’t know what we are doing. We are
better than some doctors.”

Traditional time bombs

A family physician/primary care paediatrician, Dr. Rotimi
Adesanya, disagreed with these mothers and the traditional healer. He
argued that mothers who patronised TBAs expose their children to
infections such as hepatitis and tetanus.

He added that circumcision is a long procedure involving blood and should be done by trained medical practitioners.

“Any mistake done during the procedure can lead to
infection. It should be done by a qualified person, in a sterile and
clean environment.  Unlike medical practitioners, TBAs usually carry out
circumcision in unclean environments and the newborn gets exposed to
infections such as hepatitis, tetanus — infections transmitted through
blood. A TBA can use an equipment on several persons without sterilising
it,” he said.

Adesanya stressed that TBAs who carried out circumcision lacked the formal training needed for successful circumcision.

He said, “They don’t have any form of medical qualification.
Most of them are uneducated. Most times, they use traditional
concoctions. The reason why many women patronise TBAs is because their
services are cheap. The cost of circumcision in a hospital is between
N3,500 and N20,000. While TBAs charge as low as N1,500.”

A senior lecturer at the College of Medicine, University of
Lagos, Mrs. Bolanle Balogun, also warned against TBAs carrying out
newborn circumcision. She added that they should also not be allowed to
take first-time deliveries.

“Newborn circumcision is not primarily the source of
livelihood for TBAs. They should not engage in circumcision. Mothers
should visit primary health centres for newborn circumcision. They
should patronise persons trained in midwifery skills. They should
patronise skilled birth attendants,” she said.

In the same vein, a consultant paediatrician, Dr. Temilola
Sam-Amoye, said circumcision has become a relatively simple procedure
and that most modern techniques have reduced the risk of complications
based on the procedure.

She stated, “Circumcision just like any other medical
procedure is best done in a registered health facility in order to
achieve a good outcome and minimise risk of injury.”

Adesanya added that hospitals now use a modern method of
circumcision — the plastibell method.  Plastibell is a clear plastic
ring with handle and has a deep groove running circumferentially.

“The plastibell method is stress free. TBAs still use the
old method of cutting the skin of the penis, and go as far as pouring
engine oil on the penis,” he said.

Deafening silence…

In Lagos State, where the victims referenced in the story
reside, the ministry of health is in charge of the regulation of the
activities of TBAs. This is also true for other states. However, the
Director of Public Relations, Ministry of Health, Lagos Sate, Adeola
Salako, said only the Special Adviser to the Lagos State Government on
Health Care, Dr. Femi Onanuga, could comment on TBAs. Onanuga neither
picked his calls nor responded to a text message sent by our
correspondent.

Meanwhile, experts say that more babies are likely to suffer
the fate of Usman’s and Michael’s babies except government intervenes
to restrict the activities of TBAs. One thing that is sure is that
whatever government does, it would be too little and too late to assuage
Taiwo Samuel’s pain. Samuel’s world was turned upside down after a TBA
botched her son’s circumcision and damaged his urinary tract.

Ireti, Samuel’s sister, who spoke about the experience,
said, “My sister and I thought the TBA was experienced. Little did we
know that she had wrongly circumcised my nephew. We both began to panic
when we noticed how he urinated. It was also glaring, on his face that
he was in pain. I can’t forget that period. My sister was so
heart-broken. She felt like a bad mother, as if she had murdered her
son.”

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