Monday, December 29, 2014

RWANDA: Boy dies, another has fistula after cutting

Inyenyeri News (Rwanda)
December 18, 2014

Rwanda: Families blame Circumcision for [Sickness and] Death of Children

by Venuste Mfitmana
Two families in Burera District whose children developed medical complications after undergoing circumcision recently have expressed their concerns over the safety of the procedure.

The parents of a six-year-old boy claim their son is suffering from urethrocutaneous fistula, an unusual developmental anomaly in children who present with an abnormal opening on the ventral aspect of the penis with a normal foreskin. [Obviously cut-and-pasted from a medical textbook. Urethrocutaneous fistula is also a known complication of circumcision.]

The medical complication came after the boy underwent circumcision during a campaign by the military that was held at Bungwe Health Centre in Burera in October.

This is likely to undermine government efforts to promote circumcision as one way of preventing HIV transmission.

The Ministry of Health launched free male circumcision programme in October 2011. However, last year, the ministry launched a national drive to “non-surgically” circumcise 700,000 boys and men aged 15 to 49 by the end of 2016.

The procedure involves using a plastic device called PrePex that comprises two rings and an elastic band that cuts off blood supply to the foreskin, which shrivels and is removed with the band after a week. [This may be knifeless, but it is still surgical.]

The boy’s parents have however alleged that the child received inadequate medical attention and poor treatment while he was suffering.

“After a few days of circumcision, our child started having complications every time he urinated, with pus coming from the wound where he was operated” the boy’s father said. “He also felt pain in his bladder, then urine started dripping through two small holes from his penis since his urinal valve (urethra) was damaged during surgery.

“When we realised that the problem was worsening and Bungwe Health Centre was no longer able to treat him, we were transferred to Butaro Hospital but they also failed to handle the problem.”

The case was later referred to Rwanda Military Hospital in Kanombe, Kigali. However, the aggrieved family claims the boy did not receive treatment at the hospital. Instead, they were advised to return to the hospital after six months.

“We believe there was carelessness in circumcising our child,” the mother added. “We are worried that our son’s condition may deteriorate in the absence of medicines and develop more complications.”

However, Dr Africa Gasana, a urological surgeon at the military hospital, who received the patient, explained to Rwanda Today why the child was not treated then.

“We gave the child six months to allow the wound to heal because we cannot operate on him when it is still fresh,” Dr Gasana said. “It is not the first time we have treated such ailment.”

On the parents’ fears of the boy developing other complications, the doctor said: “We gave them our phone number so that they can call us in case of another serious problem.

Aggrieved family
However, another aggrieved family claimed that their son died a few weeks after undergoing similar circumcision.

The boy’s father told Rwanda Today that the 19-year-old, who was circumcised using PrePex on October 13 during the same Army Week campaign at the health centre, died suddenly in unclear circumstances.

When he returned to hospital for check-up after a week, he developed medical complications on his way back home.

“On his way home, he felt tired and very sick,” the father said. “That night we took him to Manyagiro Health Centre but he was eventually transferred to Byumba Hospital where he died in the morning.
“When I asked the doctor what killed him, I was told that it was blood pressure.”

He said the boy had not suffered such an ailment before.

Cecile Mujawayezu, the nurse at Bungwe who did the pre-surgery screening on the boy, said he had no pre-existing medical condition.

“I screened the boy but I didn’t find any problem” Ms Mujawayezu said. “A medical autopsy showed he died of blood pressure; maybe he had it before, with low tension, which rose after he was circumcised for unknown reasons.” ["Blood pressure" is only a symptom. Could the boy have died of septic shock?]

However, the Ministry of Health maintains that, going by the procedures and medical examination, the cause of the death is not linked to circumcision.

“All the male procedures that have been undertaken, including outreach and campaigns, have been a success,” said Nathan Mugume, the head of Rwanda Health Communication Centre Division at the Ministry of Health. “They are done by experienced professionals.”

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