Token 'circumcision' is too painful Ritual: Seattle doctors hoped their procedure would spare young women from returning to Africa for female circumcision. But even their symbolic alternative provoked a public outcry.

THE BALTIMORE SUN

SEATTLE -- The idea causes instant indignation among Americans -- the practice known as female circumcision, or female genital mutilation. But in many African countries, it is **TC cultural tradition intended to ensure that women remain virgins until marriage and remain faithful to their husbands.

In Seattle, a group of physicians recently tried to develop a surgical procedure that might meet the cultural needs of some of their immigrant African patients as well as standards of U.S. medicine.

Those physicians at Harborview Medical Center, a public hospital, asked this question: Could they perform a symbolic blood-letting on the girls brought to them as patients and thereby discourage some African parents from sending their daughters back to Africa for a damaging, far more dangerous procedure?

To the disappointment of the doctors, the answer to their question is apparently "no." Harborview announced last month that it would not perform any kind of female circumcision, symbolic or otherwise.

The doctors wanted to draw a drop of blood in a procedure that would leave no scarring and leave all genital tissue intact.

In some cultures, the usual operation involves cutting away the clitoris and the labia, and sewing up the vagina to leave only a small opening that must be torn open for intercourse and opened further for childbirth.

For the woman, the procedure guarantees considerable scarring and, often, serious health problems.

When the Harborview proposal became public, doctors received letters of complaint, in some cases with copies sent to their supervisors and state officials. The letters condemned what the writers perceived as the doctors' advocacy of female circumcision.

"We weren't talking about doing circumcisions [but] a symbolic procedure that does nothing more than draw blood," says Dr. Elinor Graham, a pediatrician at Harborview. The doctors, she says, were looking for a safe procedure that would prevent mutilation. But hospital officials concluded that the issue was too controversial for Harborview.

Congress has barred circumcision of females under age 18, but the ban doesn't go into effect until March. But hospital officials understood the law to define circumcision as the removal of tissue, which they did not propose to do.

Most of the potential patients Harborview had in mind belong to the city's community of about 3,000 recent immigrants from Somalia. But the larger community reaction was mixed.

Khadra Abdulle is an accountant who emigrated from Somalia and the mother of two young girls. They "will never be circumcised," she says.

She welcomed Harborview's announcement that it would not perform even a symbolic circumcision: "They did the right thing. They should not have started this to begin with. Incision, in my opinion, it's just an assault, and no one should use it."

And Abdulle questions why physicians thought it necessary to consider offering such a procedure.

"They probably talked to very few people, who probably came from the [Somalian] countryside," she says. "In an urban environment, that has been eradicated many, many years ago. There are 20-year-old [women] who were not circumcised any way. Those women are doing great. Harborview was just talking to a few that haven't even been educated."

Ahmed Scego, an activist within the Somalian community, says about 40 women came forward saying they wanted the modified circumcision for their daughters. Most of them have had little formal education and believe in their cultural practices very strongly.

"It's very frustrating for them," Scego says. "People very strongly believe that if you can't get it from here, if ever we get the chance, we'll fly back to Africa, do the circumcision and get back.

"Somalis say, 'Oh, a woman is not a complete woman if she has not been circumcised.' "

He believes it is wrong to circumcise girls, especially after talking with a young Somalian man who had tried for five days, unsuccessfully and painfully, to have intercourse with his bride. But Scego believes it was right to raise the issue of the modified procedure.

"In my opinion, instead of going all the way down [to Africa], where there are no good hospitals or anesthesia, why can't we do it here, the moderate way?"

Scego worries that Somalis preparing to move to the United States will hear about the decision and get their daughters circumcised in Africa without anesthesia and in unsterile conditions.

And African immigrants in the United States have asked why Americans circumcise boys, in a procedure that removes skin and is more involved than the proposed modified circumcision.

Sandra Paxson, a supervisor at Seattle's Columbia Health Center, which has many East African patients, says some have inquired about getting their daughters circumcised. "It's just explained to them that it's not done here, and why it's not done," she says.

"At first they don't understand why we don't do it, why it's not legal here, and why we believe that's not necessary," Paxson says. "They usually don't pursue it after that, if they trust the people who are telling them."

Dr. Asha Mohamud works in Washington, D.C., with the Program for Appropriate Technology in Health, a private, nonprofit group opposed to female circumcision of any kind, because the procedures are not medically necessary and involve nonconsenting adolescents.

In Africa, modified circumcisions have been impossible to monitor, Mohamud says. "People tell you, 'I'm doing the modified form,' but health providers do whatever the parents ask them to.

"It became an incentive for health providers. Once they're making money out of it, it's very difficult to ask them to stop. It's their livelihood."

Mohamud says Harborview is the only medical center in the United States to address the issue. "The hospital is good-intentioned and reputable," she says. "The people who work there have been advocates of children's health."

She knows that Harborview provides interpreters and culturally sensitive health care through its refugee clinics and understands that Americans can feel uncomfortable telling newcomers that their traditions are wrong.

"Cultures are good and to be respected," says Mohamud, who is Somalian. "But they are not to be respected when they are harmful to the health of individuals."

The solution, she says, is education.

"Doctors have a role to play in educating women when they're pregnant, asking them to consider their own bodies, the problems female genital mutilation has caused them -- and asking them not to subject their daughters to the same thing."

Pub Date: 1/06/97

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