SOUTH AFRICA: 33 die from circumcision

May 22, 2013

33 men 'die in South African circumcision ceremonies'

by Aislinn Laing


As many as 33 young men are now thought to have died over two weeks in one province of South Africa as they took part in traditional initiation ceremonies that included circumcision and extreme survival tests.

Police have confirmed that they have opened murder investigations into all but one of the deaths in northern Mpumalanga province, which President Jacob Zuma described as a "massive and unnecessary loss of young life".

Tens of thousands of young South Africans take part in traditional initiation ceremonies each year where circumcision is normally performed by traditional healers.

Although fatalities during the winter ceremony season are not uncommon, the high toll has prompted calls for a public inquiry into the policing of the traditional schools and their care of initiates.

Just over half of South African men undergo circumcision, which has been promoted by the government as key in the fight against HIV/Aids.

Around half of those do so aged 10 to 15 as part of traditional initiation ceremonies, which generally last around three weeks and former president Nelson Mandela described in his autobiography as "a kind of spiritual preparation for the trials of manhood."

What exactly goes on during the ceremonies is shrouded in mystery, but initiates are often painted with red clay and spend long periods of living in the bush, often with little or no clothes. Some are given herbal concoctions to drink.

In the past, deaths during initiation have been caused by botched circumcisions, infection and loss of blood, or by dehydration and hypothermia.

The highest previous death toll from initiations in Mpumalanga province was reported to be eight.

Lt Col Leonard Hlathi, a police spokesman, said autopsies were still being conducted on the Mpumalanga fatalities but added that the one initiate for whom an inquest had been opened had complained of stomach pains and vomiting.

Despite suggestions that the initiates might have died at rogue schools set up by unlicensed operators seeking to make money, he said that they all occurred at officially-recognised sites where doctors were normally present.

He confirmed that police had never previously investigated initiates' deaths, but added: "We are talking about lives here that we have lost in a space of two weeks. It's too many."

Dr Wilson Makgalancheche, head of the country's National House of Traditional Leaders, said some schools failed to conduct health checks on initiates when they arrived, and some brought along younger siblings who were not ready to take part.

He said there was no question of initiations being banned. "It's a cultural practice embedded in people's lives and they feel that without these practices, they might cease to exist," he said. "The important thing is for them to be better policed and updated to fit with modern life."

Mr Zuma, a Zulu traditionalist who has spoken openly about his own circumcision for health reasons, called for "swift justice" for those responsible for the deaths.

"It cannot be acceptable that every time young men reach this crucial time in their development, their lives are culled in the most painful of ways, in the care of circumcision schools," he said.

Earlier story

SOUTH AFRICA: 29 die: ANC wants faster inquiry

Bloomberg
May 23, 2013

S. Africa's ANC Criticizes Circumcision Investigation

by Franz Wild

South Africa’s ruling African National Congress criticized the slow pace of a police investigation into the death of 35 young men during traditional initiation ceremonies.

Twenty-nine boys and young men 13 years to 21 years old died in the eastern Mpumalanga province during this year’s rituals that involve circumcisions, police spokesman Colonel Leonard Hlati said in a phone interview today. Another six died in the northern Limpopo province, according to the ANC.

“While we are fully supportive of the practice of initiation, we believe it should not be a death sentence to so many young people,” the ANC said in an e-mailed statement today. [So how many should it be a death sentence for?]

Every year, thousands of boys participate in initiation ceremonies in South Africa, where they undergo a series of trials as a rite of passage into manhood.

In 2009 and 2010, 145 boys died because of complications related to their circumcision, and another 1,200 were hospitalized, according to a 2010 report by the Johannesburg-based Commission for the Promotion and Protection of the Rights of Cultural, Religious and Linguistic Communities, a government group.

Poorly carried out circumcisions can lead to infection and penile amputation, the report said.

The police are taking witness statements before turning the case over to the National Prosecution Authority, Hlati said.

Parliament’s health committee said the deaths were unnecessary and questioned whether correct procedures were taken during the circumcisions.

“Initiates are supposed to undergo tests to establish whether or not they are in good condition to be circumcised,” the lawmakers said in a statement this week. “There must also be provision of medical support in case of emergencies at the initiation schools.”

Earlier story

SOUTH AFRICA: 27 die from circumcision

No, circumcision is to blame.


AFP
May 21, 2013

Local leader blames negligence in S. Africa circumcision deaths

JOHANNESBURG — Negligence is to blame for some of the 27 deaths of young males who died while undergoing ritual circumcision, a local traditional leader said Tuesday.

The death toll during the procedures -- part of traditional rites of passage into manhood -- on Friday climbed to 27, police said.

South African police last week said they had launched a series of murder inquiries into the matter and President Jacob Zuma has called on them to move faster in their investigation and arrest the culprits.

The latest four deaths occurred on Friday in the northeastern Mpumalanga province.

"We have proven that there was some negligence," Kgoshi Mathibela Mokoena, head of the traditional leaders in the provincial parliament told AFP.

He said preliminary findings showed that some of the 30,000 males currently undergoing the circumcision rites, had developed complications but were not administered proper after-care after they were left in the hands of inexperienced young men.

After conducting the procedures, some of the circumcisers left and returned to the secluded bushy sites, hours later, some of them drunk.

Other people suffered from dehydration as it was established some of the 200 odd sites dotted across the province lacked clean drinking water.

Despite the escalating death toll, police are yet to make arrests almost two weeks after the first death occurred on May 8.

"There is a huge amount of investigation, it's not a question of arresting but doing the right things during the investigation," said police spokesman Leonard Hlathi, dismissing fears some of the perpetrators may flee.

Police have so far launched series of murder inquests into the deaths of the boys and young men aged between 13 and 20 years, but Zuma said they were not acting fast enough.

"While we welcome action taken by police so far in opening murder dockets, we wish to urge them to ensure swift justice for the families and that those responsible for the deaths are brought to book without delay", he said in a statement.

The country is "outraged at this massive and unnecessary loss of young life at the hands of those who are supposed to nurture and protect them," said the president.

Ritual circumcision is common among South Africa's ethnic Xhosa, Sotho and Ndebele ethnic groups.

Deaths at the so-called initiation schools in South Africa are common, with several hundred cases recorded in recent years due to bleeding and infections.

Boys spend around a month in secluded bush or mountains sites for the sessions that also include lessons on the virtues of masculine courage and discipline.

SOUTH AFRICA: Woman who won't challenge fatal tradition "should be sacked"

ENCA (South Africa)
May 18, 2013

MEC in hot water for circumcision comments

MPUMALANGA - The Mpumalanga Health MEC should be fired over her circumcision comments, according to the National Education Health and Allied Workers Union.

Candith Mashedo-Dlamini last week said tradition forbids her (as a woman) to get involved in the deaths of 23 young men who lost their lives at the start of the circumcision season in Mpumalanga.

Nehawu says the MEC's reluctance to take action amounts to a dereliction of duty.

It's the second organisation to condemn the MEC’s comments.

The Public Service Accountability Monitor on Friday lashed out at the lack of adequate safety measures at circumcision schools.

“This is a tradition... this is a tradition... so in other traditions whether there are deaths or what - but a woman can't come closer to that. But because there are police now, we're relying on the police so that they can give us reports," Mashedo-Dlamini said.

Nehawu commented that it was proof that Mashego-Dlamini was completely out of her depth - and did not deserve the responsibility of running health issues in the province.

Sizwe Palma, Nehawu spokesperson, said: "23 people have died, lives have been lost, families have lost their loved ones, and yet the only thing that the MEC could offer was that there's nothing she could do because of tradition and culture! It's unacceptable... The laws and the human rights in this country are more important than any other religion, any other culture or any other tradition for that matter. So the MEC has failed in her responsibilities, she needs to go."

Pamla said the ruling party’s silence on this matter was also concerning.

"The people of South Africa deserve better... the ANC-led government has to [be accountable for] the people of South Africa. So we expect the national Cabinet to act, we expect the ANC itself to condemn this and then take steps to show that it really cares about the people of this country," Palma said.

However, traditional authorities in Mpumalanga said that only God knew who was going to die and when.

"It is recklessness, it is irresponsible of anyone to be using God... when man-made actions and man-made methods have resulted in the deaths of these young people," Palma reacted.

The Public Service Accountability Monitor demanded that the custodian of tradition in Mpumalanga, king Mabhoko, apologise to parents who lost their sons.

Earlier story

SOUTH AFRICA: 23 die from circumcision

Herald Sun
May 17, 2013

Ritual circumcision kills 23 in S Africa

SOUTH African police said they had launched a series of murder inquiries after 23 males died while undergoing circumcision during traditional rites of passage into manhood.

The 23 - aged between 13 and 21 - died in various places across the country's northeastern Mpumalanga province over the course of a week.

"We have opened 22 cases of murder and one of inquest," regional police spokesman Leonard Hlathi told AFP.

One of the deaths was labelled an inquest because the boy reportedly had an existing health condition.

There have been no arrests yet as police compile statements and await post-mortem results.

Ritual circumcision is common among South Africa's ethnic Xhosa, Sotho and Ndebele ethnic groups.

Deaths at so-called initiation schools in South Africa are common, with several hundred cases recorded in recent years due to bleeding and infections.

Boys spend around a month in secluded bush or mountains areas for the sessions that also include lessons on the virtues of masculine courage and discipline.

There are usually two circumcision seasons - in winter during the months of May through July and in summer between November and December.

Government and the ruling African National Congress Party have expressed concern at the deaths which have nonetheless sparked little public outrage.

Government spokeswoman Phumla Williams called on the initiation schools "to ensure that precautionary health measures are exercised during this period to minimise illnesses and death".

Minister in The Presidency for Performance Monitoring and Evaluation, Collins Chabane said he was saddened by the loss of young lives.

The "loss of several young lives in Mpumalanga and elsewhere in the country is regrettable," Chabane said this week.

Earlier story

SOUTH AFRICA: More than 20 die from circumcision

Reuters
May 16, 2013

Over 20 South African boys die in circumcision rituals: police

by Jon Herskovitz, ed. Pascal Fletcher

JOHANNESBURG (Reuters) - More than 20 South African boys have died over the past week during coming of age rituals, police said on Thursday, and they blamed botched circumcisions as the likely cause of death.

Northern Mpumalanga province's police department has opened 22 murder cases but no arrests have been made so far, spokesman Colonel Leonard Hlathi said.

Every year in South Africa, boys aged 10 to 15 years from several of the country's tribal groups are circumcised in traditional "initiation rituals". The ceremonies usually take place over a number of weeks in remote rural areas.

Deaths are often caused by blood loss or infection when circumcisions are poorly performed by traditional practitioners. [The "poor performance" is a post-hoc judgement. Nobody checks how "well" the circumcisions were performed on the boys who didn't die.]

Minister in the Presidency Collins Chabane this week called the recent deaths "regrettable".

"This has happened to young people who were still at their prime, looking forward to a brighter future where they could still reach their potential," he said in a statement.

SOUTH AFRICA: More than 15 die from circumcision

The New Age (South Africa)
May 12, 2013

More than 15 die at initiation school

by Sphiwe Masilela

WITH just a week spent at the bush, at least over 15 boys have died at this year’s winter school and various police departments have launched investigations following the death of young boys who wanted to be men.

KwaZulu-Natal police spokesperson, Colonel Jay Naicker said Marian hill police were investigating a case of assault with intent to cause grievous bodily harm after more than eight boys between underwent circumcision.

“We can confirm an incident that occurred where more than eight boys between the ages of 13 and 15 were allegedly circumcised without their parent’s consent in Milkyway Road, Dassenhoek,”

Colonel Leonard Hlathi, Mpumalanga police spokesperson said they were also investigating cases of inquest following the death of eight boys aged between 15 and 21, who died at the initiation schools around KwaMhlanga and Verena areas respectively.

“The incidents occurred on the 08th and 09th of May 2013, where four of the victims were admitted at the local hospital and died later. Two were certified dead on arrival whilst two at one of the initiation schools,” said Hlathi.

He said a probe has been launched in regard to this incidents and the post-mortem will be conducted to determine the cause of death.

“Police are also in the process of verifying whether the initiation schools were registered or not,” he added.

An 18-year-old boy from Dennilton also died at the initiation last Tuesday in Bronkhorstspruit.

It is alleged that the boy bled a lot and resulted in the death.

Police spokesperson, Constable Zanele Vilakazi said: “An Inquest docket has been opened at the Bronkhorstspruit Police station and further investigations conducted to determine the cause of death. It is alleged that the young man was circumcised on Monday night and his body recovered in the early hours of Tuesday morning,” added Vilakazi.

No arrests have been made.

SACRAMENTO: Hospital denies death was circumcision-related

March 13, 2013

Hospital denies circumcision caused death

by Hugh Young

UC Davis Children's Hospital has posted on its Facebook page:

The comments being posted regarding a patient who allegedly died because of circumcision at UC Davis are entirely false and misleading. The patient was not circumcised at UC Davis and the cause of the patient’s death was not circumcision, nor was it hemophilia or a clotting disorder. UC Davis did all it could to save the patient’s life, and we are deeply sorry for this family’s loss. UC Davis has a deep respect for the privacy of its patients and does not use patient names in social media without their express consent and does not permit posting of patient names by third parties.

The baby was circumcised at Lodi, two days before he died. The coronor's report into his death has not yet been released. The hospital is pre-empting the court in determining the cause of death.

Earlier story

SACRAMENTO: Another circumcision death

March 8, 2013

Another circumcision death

An 11-day-old boy has died died at UC Davis Children's Hospital in Sacramento, California, two days after being circumcised in the nearby town of Lodi.

According to his grandfather, Brayden Tyler Frazier had been taken to the doctor when he was a week old because he had been sleeping constantly and not eating. His parents had also noticed that his neonatal sticks and pricks had not healed quickly, and had to stay bandaged for two days or more.

The doctor in Lodi sent them home with instructions to monitor his condition and after two days, he was circumcised. It was later discovered that the wound had continued to bleed. He was taken back to the doctor, then to Urgent Care, then to the ER, and then transferred to UC Davis Medical.
He had "generalized bleeding" and an unidentified infection.

Over the two days after his circumcision, he went into seizures and a coma, and died.

A paediatric haematologist/oncologist comments:

Coagulation studies are not routinely done before many types of surgeries, including circumcisions. ... Also coagulation studies are not a part of routine newborn screening tests. Coagulation is complex, and involves the platelet cell and a couple dozen chemicals / proteins, to clot when needed but also not to clot in inappropriate locations, or excessively, and to additionally reabsorb clots after they have done their jobs. Plus hemophilia isn't a single disorder; there are two main types of "hemophilia" (deficiency of Factor 8 or Factor 9 ). But there are many other reasons to bleed excessively. However, a combination of several functional tests can narrow down the list of specific aspects of the coagulation system that need testing, in a given individual whose screening functional tests are abnormal, in order to identify what needs to be done to treat that individual's bleeding/risk. However it is more complicated in newborns: 1) Of the couple dozen chemicals, many are in different levels in newborns. For several reasons, some aspects of the newborn's system are hypo-coagulable [blood won't clot] while others are hyper-coagulable [blood clots very easily] and it generally balances out. So there are different normal ranges for results in infants. 2) Most tests of the coagulation system involve drawing blood from a vein or artery and simultaneously mixing it with anticoagulants (different anticoagulants for different tests). These tests also involve a relatively large amount of blood. Additionally the tissue factors, that trigger the initiation of the clotting system in injuries, are released from a heel stick and affect clotting studies. 3) It is however easy to do extensive or specific coagulation tests in newborns. When planned, the blood is correctly drawn at delivery from the umbilical cord, taking the blood otherwise left in the placenta... This can be planned when a family history [of haemophila] is present or there are other reasons to test. Surgeries / procedures that have no medical necessity, [such as] circumcision, should not be done.

JAKARTA: Boy with haemophilia bleeds after circumcision (!)

Jakarta Post
February 21, 2013

Toddler with hemophilia bleeds after circumcision

by Panca Nugraha

Haikal Syafi’i, a three-year-old with hemophilia, has been receiving repeated treatment in hospital for severe bleeding from a circumcision wound.

Haikal from Lombok, West Nusa Tenggara (NTB), was taken to Gerung Hospital in Lombok Barat after a mass circumcision event last month . He continued to suffer constant bleeding so his parents took him to Bhayangkara Hospital in Mataram, NTB.

“After receiving treatment in those two hospitals, his bleeding continued; so, he was brought to NTB General Hospital (RSUP) on Monday. We found that Haikal is suffering from hemophilia, a disorder in the blood clotting process,” the hospital’s Lalu Ahmadijaya, told The Jakarta Post, on Thursday.

Hemophilia is a genetic disorder that affects mainly boys, famously prevalent in the royal families of Europe.

“This should be a lesson for our people that they should check the health conditions of their children before circumcision.” said Ahmadijaya.

Speaking to the Post, Haikal’s mother, Sanemah, said that her boy attended a mass circumcision with seven other boys from their kampung on Jan.27 to commemorate the Prophet Muhammad’s birthday.

“After being circumcised, he had no complaints. But four days after the procedure, he began bleeding from his circumcision wound,” she said.

“Hemophilia treatment can be costly. Koate, for example, costs around Rp 10 million (US$1,030) per injection and Haikal needs three injections to stop his bleeding,” Ahmadijaya said, adding that Haikal’s treatment would be covered by the government-fund health coverage scheme Jamkesmas. (ebf)

BRAZIL: Circumcision kills one in 7700 (=156 deaths/p.a. in the USA)

Einstein (Sao Paulo) 2012 Sep;10(3):342-346.

Circumcisions for medical reasons in the Brazilian public health system: epidemiology and trends.

Korkes F, Silva Ii JL Pompeo AC

Abstract
OBJECTIVE:
To evaluate the epidemiological factors associated to medical circumcision, based on data from the Brazilian public health system.

METHODS: Using the Unified Health System public database between 1984 and 2010, hospital admissions associated with surgical treatment of phimosis were searched. A total of 668,818 men admitted to public hospitals who underwent circumcision were identified and included in the present study.

RESULTS:
A mean±standard deviation of 47.8±13.4 circumcisions/100,000 men/year was performed through the Unified Health System for medical reasons. During the 27-year period evaluated, 1.3% of the male population required circumcision for medical reasons. [So 98.7% of routine circumcisions are wasted on boys and men who will never need it.] Total number of circumcisions and circumcision rate increased in childhood, declined progressively after 5 years of age and rose again progressively after the sixth decade of life. In the regions of the country with better access to healthcare, 5.8% of boys aged 1 to 9 years old required circumcisions. [Or were circumcised whether they needed it or not.] From 1992 to 2010 there were 63 deaths associated with circumcisions (mortality rate of 0.013%).

[That's one death in 7692 circumcisions. In this USA, that would amount to 156 circumcision deaths per year.]

CONCLUSION:
In conclusion, yearly circumcision rates could be estimated in Brazil, and a very low mortality rate was associated with this procedures. Circumcision is mostly performed in children in the first decade of life and a second peak of incidence of penile foreskin diseases occurs after the sixth decade of life, when circumcision is progressively performed again.

[This study was circulated by Prof. Brian Morris, who presumably thinks this is an "acceptable" death rate.]

MANCHESTER: Nurse escapes gaol for circumcision death

BBC
February 8, 2013

Nurse spared jail for killing baby in botched circumcision

A nurse who caused the death of a baby in a botched home circumcision has been spared jail.

Grace Adeleye, 67, carried out the procedure using scissors, forceps and olive oil and without anaesthetic in Chadderton, Oldham, in April 2010.

Four-week-old Goodluck Caubergs bled to death before he could reach hospital the following day.

Adeleye, who was found guilty of manslaughter by gross negligence, was given a suspended jail sentence.

A judge at Manchester Crown Court ordered her to serve 21 months in jail, suspended for 24 months.

'No problem'
She was also given a six-month overnight curfew [apparently her only "penalty"] and a 12-month supervision order.

...

Goodluck's parents said after sentencing "not for one minute" did they think the procedure would cause him harm.

In a statement they described his death as "having a nightmare that we could not wake up from".

"The sadness we feel does not seem to ease. We have now just grown to live with the pain of our son's death rather than it subsiding."

Det Insp Darren Meeks from Greater Manchester Police said the case in which a young baby lost his life in such a "tragic and unnecessary manner" was "heartbreaking".

"Although Adeleye was a registered nurse, she carried out the surgery at the parents' home, using a historic, crude and dangerous method, with inappropriate instruments."

[If it had been any other operation, would she have escaped imprisonment?]

Earlier story

EASTERN CAPE: Circumcision deaths resume: 15 this season

TimesLive (South Africa)
December 21, 2012

Eastern Cape officials to meet on circumcision deaths

by

Officials from the national department of health will meet with local leaders and officials on Friday to discuss the deaths of young boys after circumcision.

The department will meet with the Eastern Cape MEC for health Sicelo Gqobana, the Eastern Cape House of Traditional Leaders and local government departments in Bhisho, said provincial health spokesman Sizwe Kupelo.

This meeting follows the death of a boy in Mzimvubu this week.

He was the 15th boy to die as a result of a botched circumcision this season. [Apart from his death, how was his circumcision different from one that wasn't "botched"?]

In June, a total of 49 boys died while undergoing initiation in the mountains.

"The national department of health is expected to present a plan to the province and then there will be discussions that will seek to bring an end to the problem," Kupelo said.

MANCHESTER: Nurse guilty of manslaughter after circumcision death

BBC
December 14, 2012

Grace Adeleye guilty of killing baby in botched circumcision

A nurse has been found guilty of manslaughter after causing a baby's death by botching his circumcision.

Grace Adeleye, 67, carried out the procedure on four-week-old Goodluck Caubergs at an address in Chadderton, Oldham, in April 2010.

The boy bled to death before he could reach hospital the following day.

Adeleye was found guilty of manslaughter by gross negligence at Manchester Crown Court.

The nurse, who denied the charge, had told the jury she had done "more than 1,000" circumcision operations without incident. [So much for "Make sure the doctor who does it is experienced"!]

The court heard that Adeleye and Goodluck's parents were from Nigeria, where the circumcision of newborns is the tradition for Christian families.

Adeleye, of Sarnia Court, Salford, was paid £100 to do the operation.

The jury was told that she carried out the procedure using a pair of scissors, forceps and olive oil and without anaesthetic.

She had claimed there had been "no problem" when she left the infant and that his parents had been pleased with the operation.

However, the court heard that when Goodluck's parents had changed his nappy several hours later, they had found a large amount of blood and phoned Adeleye, who had told them to re-dress the wound.

Goodluck's parents called an ambulance the following morning and he was taken to the Royal Oldham Hospital, where he died a short time later.

A spokesman for NHS Oldham said had the family gone to the hospital and asked for a circumcision, "they would have been advised to go to an approved practitioner who would have charged £100, the same as Grace Adeleye".

Following the guilty verdict, Adeleye was bailed while pre-sentencing reports are prepared.

The Crown Prosecution Service's Jane Wragg said the case "was not about the rights or wrongs of circumcision [yet if he hadn't been circumcised, he would still be alive], but the grossly negligent way in which the procedure was undertaken".

"Goodluck Caubergs was a healthy little boy whose tragic death was wholly unnecessary," she said.

"Goodluck died because the standard of care taken by Grace Adeleye in carrying out the circumcision fell far below the standard that should be applied.

Earlier story

MANCHESTER: "Discredited" method used to circumcise baby who died

Mancunian Matters
December 7, 2012

Nurse accused of killing Oldham baby in botched circumcision used 'discredited' procedure, court hears

by Lucy Kenderdine

A nurse accused of killing a four-week-old Oldham baby in a botched circumcision used a ‘relatively dangerous’ and ‘discredited’ procedure, a court heard today.

Grace Adeleye, 67, of Sarnia Court, Salford, denies manslaughter by gross negligence where 27-day-old Goodluck Caubergs died following the operation at his home.

The jury in Manchester Crown Court heard evidence from expert circumcision consultant Nigel Zoltie on the Nigerian religious ‘clamp and cut’ procedure used by Adeleye in the circumcision.

He said: “Bleeding is such a significant risk that it must be explained to the parents, particularly for the method used on Goodluck.”

Mr Zoltie added that the traditional method carries risks greater than others currently used and the procedure has largely been discredited by medical circles.

But he did argue that it whilst the instruments used by the defendant, artery forceps and surgical scissors, were not the ideal tools, if ‘used with skill’ they could do the job effectively and safely.

The prosecution also argued that the high risks and complications that can arise as a result of the procedure were not properly explained to the parents.

This could mean that full consent for the circumcision was not given as the parents did not fully understand what it entailed and how it would be done, the court were told.

Adeleye also did not get written consent from the parents to carry out the procedure as it is not customary to do so for community and religious circumcisions, the jury heard.

However she defended herself by saying that she discussed the risks with the parents before the procedure through a series of phone calls with the father on the day of the circumcision.

She said: “I explained everything to him and he told me he understood.”

Adeleye added that the fact that they had asked her to perform the circumcision was enough consent for community circumcisions and written consent was never given.

The court also heard evidence surrounding the aftercare of baby Goodluck and what information the parents were given regarding his safety.

Neither parent received written information on what to look out for in terms of complications after the procedure.

Adeleye said: “I told them they should watch out for bleeding and infection.”

The trial continues next week.

Earlier story

MANCHESTER: Nurse circumcised baby who died "culturally"

Manchester Evening News
December 5, 2012

Salford nurse accused of Oldham baby's manslaughter after 'botched' circumcision defends method

A nurse accused of the manslaughter of a four-week-old baby after a home circumcision said today she had carried out "more than a thousand" such procedures without a single problem.

Grace Adeleye, 67, performed the procedure on Goodluck Caubergs without anaesthetic and using only a pair of scissors, forceps and olive oil, Manchester Crown Court heard.

Goodluck was born on March 22, 2010, in Rochdale Infirmary and died on April 17, after bleeding to death the day after the circumcision, aged 27 days old.

The defendant is originally from Nigeria, where she qualified as a nurse and midwife, as [are] the youngster's parents, where the circumcision of newborns is the tradition for Christian families, the jury heard.

Mrs Adeleye said after praying before the operation, as is her custom, she used the traditional, Nigerian "clamp and cut" method, which she had used hundreds of times, without any pain-killers for the child.

And she told the jury when she left the boy with his parents, Sylvia Attiko and Olajunti Fatunla, there [were] no problems but [she] warned them to monitor closely any bleeding from the wound.

...

But today Mrs Adeleye, a mother-of-six told the jury she herself performed circumcisions on her two grandsons and carried out more than a thousand such ops while practising in Nigeria.

She said it was custom to have a naming ceremony for the child on the eighth day after birth then she would travel from church to church performing the operation.

And since coming to the UK in 2004, working as a state registered nurse in Litchfield, she had performed a further 20 home circumcisions.

None had required hospital treatment or suffered excessive bleeding.

Mrs Adeleye said she performed the same circumcision technique on Goodluck like the others.

"It's the cultural one in Nigeria. It's clamp and cut," she said.

Peter Wright QC, defending asked her: "Is there anaesthetic administered to the child before the procedure?"

"We don't usually, no," she replied.

"The culture, why we don't need anaesthetic, that's why we do it early in life. We believe if it's done early the pain is not as well as in an older child."

The prosecution claim Adeleye also failed in her duty of care to the child because the boy's parents knew nothing about the procedure or medical matters.

But the witness said she had discussed the procedure and what needed to be done with firstly the father then the mother separately,

"Mr Fatunla asked me , he told me about the procedure he wanted to do," the defendant told the jury.

"He said he has inquired amongst the Nigerians. That he wanted to do the cultural one."

She added: "He said he's scared of blood. He said he doesn't want to see blood."

Mrs Adeleye said she did not want to use "big medical words" so spoke to the father in their own Yoruba dialect from Nigeria - and stressed the boy must be monitored for bleeding from the wound.

The defendant said she questioned the parents about the health of mother and baby, sterilised the instruments she used and cleaned the boy's groin with TCP before the op began.

She used artery forceps to clamp the excess skin for one minute then used surgical scissors to "trim" the foreskin which only took a "few seconds," before gauze, vaseline and bandages were applied.

The skin was given to the boy's father, because Nigerian custom has it, that if it is discarded carelessly the boy will grow into a "promiscuous" man, the jury were told.

Mrs Adeleye said she remained at the house for one hour to monitor any bleeding before leaving.

She told the jury there was "no problem" with the parents thanking her and about to cook a meal before she left.

She told the jury they would hardly have been "dining and wining" if there had been complications with their son's op.

Proceeding

Earlier Story

MANCHESTER: Midwife tried for circumcision death

BBC
November 27, 2012

Manchester baby boy 'bled to death after circumcision'

A four-week-old boy "bled to death" after a home circumcision carried out by a nurse, a court has heard.

Goodluck Caubergs died the day after nurse Grace Adeleye carried out the procedure without anaesthetic, Manchester Crown Court was told.

The jury heard the 66-year-old only used scissors, forceps and olive oil at an address in Chadderton, Greater Manchester in April 2010.

Mrs Adeleye denies manslaughter by gross negligence.

The court heard the medic and Goodluck's parents are originally from Nigeria, where the circumcision of newborns is the tradition for Christian families.

'Dangers ignored'

Mrs Adeleye, of Sarnia Court, Salford, was paid £100 to do the operation, the court was told.

It is alleged the defendant, who is also a midwife, left a "ragged" wound that bled and her post-operative care was inadequate.

The family home, where the procedure took place, is a mile and a half from Royal Oldham Hospital.

Adrian Darbishire QC, opening the case for the prosecution, told the jury: "The allegation essentially here is that the care she provided in the course of tha t procedure was so bad that not only did it cause the death of that young baby wholly unnecessarily, but it amounted to gross negligence and a crime."

The court heard up to three children a month are admitted to the Royal Manchester Children's Hospital because of bleeding after home-based circumcisions - a danger the nurse should have been aware of.

Mrs Adeleye went to Goodluck's home on 16 April 2010, telling his mother to fetch some olive oil and a bowl of warm water and stripping the baby to his vest, the jury was told.

'No pain relief'

The defendant brought her "instruments" out of her handbag and dipped a pair of scissors into the water in a kidney dish.

She carried out the procedure with no anaesthetic or local pain relief before cleaning the wound with cotton wool and applied a bandage, the court heard.

Between 30 and 40 minutes after surgery, Mrs Adeleye left without making any proper checks on the patient, Mr Darbishire said.

Later, the parents found the bandage had come off the wound and there was blood in Goodluck's nappy. [US: diaper]

Mr Darbishire said even a small amount of blood loss is dangerous and the loss of just one sixth of a pint of blood can be fatal for a newborn.

A post-mortem examination revealed Goodluck's death was caused by a loss of blood.

The trial continues.

SEATTLE: AAP ethicist misrepresents role of circumcision in death

September , 2012

AAP ethicist misrepresents circumcision's role in death

By Hugh Young
The ethicist for the American Academy of Pediatrics has mis-stated the role of circumcision in a baby's death.

On radio KQED, he said the family of a very sick baby had wanted him circumcised before he died.
Yet the baby's mother had blogged, while he was still struggling for life against a circumcision-caused haemorrage, "I almost killed my baby".

The baby was born in Indiana in August 2010 with a major heart defect, virtually half his heart missing. He underwent heart surgery three days later. In October, the hospital told his mother he was well enough to be circumcised, but they nicked an artery and he died the next day.

The doctor came in this morning and asked if we wanted to get it done today. I said yes.... I should have known better. I should have said no. I had hoped that he would do well and that it wouldn't be such a big deal. But instead, I almost killed my child by consenting. ... Why did I have to say yes?

Clearly, she was desperately hoping and praying her son would live (of course).

On Radio KQED on August 29 2012, the ethicist for the American Academy of Pediatrics, Dr Douglas Diekema, grossly misstated the case, portraying the mother as abandoning hope (starting at 12:40):

"There's at least, y'know, one of these cases that gets trotted out, involved a very sick baby that was likely to die anyway, and his parents wanted him circumcised before, ah, his death, and to attribute that to a circumcision is silly, um, that kind of a death."

His mother's blogs give the lie to that interpretation. [She has since removed all reference to circumcision from her blog.]

Intactivists were accused at the time of exploiting the baby's death, after several had urged her not to circumcise, and berated her afterwards. Dr Diekema seems to be exploiting it in a much more cynical way, attributing to the mother a callous disregard for the baby's life.

NEW YORK: Metzitzah: Mohelim will defy "evil plan" to warn of risks

New York Post
September 2, 2012

Despite baby dying after getting herpes, Orthodox rabbis say they'll defy law on ancient circumcision ritual

By Kate Briquelet
Two children are dead, more are injured — yet a group of ultra-Orthodox rabbis say they plan to defy a health order in the name of religious freedom.

Less than a year after a Brooklyn tot died following an ancient circumcision ritual, the rabbis say they will ignore a proposed law that would mandate parental-consent forms before performing the dangerous procedure.

Over the past decade, at least one other newborn died after contracting herpes from the rite, in which the rabbi draws blood from the penis with his mouth.

But ultra-Orthodox leaders are lashing out at the city’s “evil plans” ahead of the Board of Health’s vote next week.

About 200 rabbis signed a proclamation claiming the Health Department “printed and spread lies . . . in order to justify their evil decree.”

“It is clear to us, that there is not even an iota of blame or danger in this ancient and holy custom,” the letter states.

Neonatal Genital Herpes Simplex Virus Type 1 Infection After Jewish Ritual Circumcision: Modern Medicine and Religious Tradition by Benjamin Gesundheit, Galia Grisaru-Soen, David Greenberg, Osnat Levtzion-Korach, David Malkin, Martin Petric, Gideon Koren, Moshe D. Tendler, Bruria Ben-Zeev, Amir Vardi, Ron Dagan, and Dan Engelhard describes eight babies getting herpes 7.25 ± 2.5 days after being circumcised with Metzitzah b'peh. All four mohelim tested positive for HSV-1. - Pediarics (Vol. 114 No. 2 August 1, 2004 pp. e259 -e263)

Most modern mohels — men trained to perform religious circumcisions, who are usually rabbis or doctors — remove blood from the baby’s wound using a sterile pipette.
But some Orthodox Jewish parents insist on an ancient “suction by mouth” ritual called metzitzah b’peh.

The city’s law would require mohels to distribute consent waivers, detailing the herpes risk, before the ritual.

Rabbi David Niederman, executive director of the United Jewish Organization of Williamsburg, said no one will comply with the law, even if it’s passed.

“For the government to force a rabbi who’s practicing a religious act to tell his congregants it’s dangerous is totally unacceptable,” Niederman told The Post.

“You’re forcing the mohel and the parent to sign a piece of paper that contradicts their religious convictions.”

Niederman said there’s no substantive evidence linking herpes and the religious ritual.
Michael Tobman, a political consultant working with several large Hasidic communities, said the waiver is no minimal imposition.

“It warns parents that the city suggests a link between the practice and serious health worries, [and] it would undoubtedly have a chilling impact,” he said.

“City government shouldn’t be doing that.”

At least 11 babies in the city have contracted the herpes simplex virus since 2000 — and two developed brain damage and two died, according to a Health Department investigation.

In July, an Orange County infant was hospitalized after contracting a deadly strain of the virus.

Earlier this year, prosecutors were investigating the September 2011 death of a Brooklyn newborn at Maimonides Hospital from Type 1 herpes.

...

Earlier story

EASTERN CAPE: 42 Circumcision deaths in three weeks

the Sowetan
July 27, 2012

42 boys perish - but silence

By Mbuyiselo Botha and Nomonde Nyembe
THE figures of young boys dying at initiation schools are shocking. The death toll, as at July 11, was 42, in just three weeks.

According to reports, this is nearly double last years' figure of 26.

South Africa is now 18 years into democracy but the shame of young boys dying in Eastern Cape initiation schools continues unabated.

Why do we, as a caring, compassionate, democratic society, look the other way? Why do we allow certain cultural practices to rob young people of their future?

We are reminded of the work of gender activist and author Dr Gary Barker, whose comments in his book Dying to be Men describes the debilitating association of notions of manhood, issues of violence and HIV - that some young people will die for in their quest to become so-called "proper" or "real" men.

What it means to be a "proper" man and the fact that it has been reduced to the practice of circumcision is detrimental not only to the young men who go through the process but to society as a whole.

A society where manhood is ascribed only to individuals who have gone to initiation school is one that does not value men as whole beings with other aspects to their humanity. However, this does not affirm the notion that you can still be a man without being subjected to inhumane treatment.

Too often, not enough attention is paid when people's rights are trampled on with impunity. What message does the silence send to these young men who are expected to go through this route without any guarantee that they will come back alive?

It is our view that any other traditional law is subjected to our supreme law, the Constitution.

There are those who would argue that constitutional protection of culture gives them carte blanche to engage in practices that are not only harmful but may, in fact, lead to death. This is not so. Cultural and religious practices are protected to the extent that they are consistent with other rights in the Constitution (sections 15(3)(b) and 31(2)).

We are concerned that there is not a universal outcry from all of us to these statistics.

We wonder if this silence is a result of us fearing to be labelled as "Eurocentric" or "sell-outs" out there to please the white master.

The Children's Act prohibits the circumcision of young men and joins a number of other provincial [A]cts that regulate male circumcision in Free State, Limpopo and Eastern Cape.

Parents themselves are under an obligation to consent to the circumcision before it occurs.

There is a need for active citizenry in if we are to stop practices that not only harm but endanger people's lives.

We must hold our government to account and using the law to do so is our constitutional mandate. Doing otherwise would be betraying those who died for us to have those freedoms.

Earlier story