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Harmful practices to the female body; part 1 Female Genital Mutilation

“Mama tied a blindfold over my eyes. The next thing I felt my flesh was being cut away. I heard the blade sawing back and forth through my skin. The pain between my legs was so intense I wished I would die.” –Waris Dirie, UNFPA Goodwill Ambassador and spokesperson on FGM

1. What is FGM?

Female Genital Mutilation (FGM) has been defined by the World Health Organization (WHO) as “all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons.” Most of the victims live in African countries, some in the Middle East and Asian countries and it is increasing in Europe, Australia, New Zealand, USA and Canada.

FGM is usually performed by an older experienced woman with no medical training. In primitive areas, anaesthetics and antiseptic treatment is not used and the tools consist of knives, scissors, scalpels, pieces of glass and razor blades. A mixture of herbs is placed on the wound to tighten the vagina and stop the bleeding. The age of the girls varies from infants to girls to the age of 10 depending on the community and family.

It is extreme form of discrimination against women and performed on innocent children that are not able to defend themselves. It is nearly always carried out on minors and is a violation of the rights of children. The practice violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.

2. 4 types of FGM

According to WHO;

a)     Excision (removal) of the clitoral hood with or without removal of part or all of the clitoris. Occurs in 85% of the FGM.

b)     Removal of the clitoris together with part or all of the labia minora. Occurs in 85% of the FGM.

c)      Removal of part or all of the external genitalia (clitoris, labia minora, and labia majora) and stitching and/or narrowing of the vaginal opening leaving a small hole for urine and menstrual flow. Occurs in Djibouti, Somalia, Sudan, parts of Egypt, Ethiopia, Kenya, Mali, Niger, Nigeria and Senegal.

d)     All other operations of the female genitalia.

3. History of Female Circumcision

Female circumcision, also known as Female Genital Mutilation (FGM) is not a recent phenomenon as it has been dated back as far as to 2nd century BC when a geographer, Agatharchides of Cridus wrote about the subject that occurred among tribes residing on the western coast of the Red Sea (today’s Egypt). Based on the current areas practicing FGM, it seems as the tradition has originated from Egypt and spread. Others believe that the custom was rooted in the kingdom of the Pharaohs.

As Islam rose throughout the region, Egyptians raided territories in the south and exported Sudanic slaves. Female slaves were sold at a higher price if they were “sewn up” as they became unable to give birth. After many converting to Islam, this practice was abolished as Islam prohibits Muslims from harming their body and enslaving others.

Today this primitive tradition has reached the coasts of America, Europe, Australia and Canada. Numbers from Amnesty International estimates that 135 million women have experienced FGM and that between 2-3 million girls and infants undergoes this practice every year.  In Africa alone it is about 92 million girls who has undergone FGM.

4. Medical consequence of FGM

FGM have absolutely no health benefits for the girls except doing harm and causing extreme pain. As the healthy genital tissue is being removed, the body cannot function in a natural way. Since this procedure is being practiced by people who have no medical training and without using any necessary anesthetic or sterilization, the FGM can lead to death by shock from bleeding or infections by the unsterilized tools. The first sexual intercourse will be extremely painful who will be needed to be opened and this is being performed by the partner with a knife. Besides bleeding there are several short and long term complications that these girls have to deal with and I have listed them shortly.

Depending on the degree of mutilation, short term health problems caused by FGM;

  1. Severe pain and shock
  2. Bacterial infection
  3. Urine retention
  4. Open sores injury to adjacent tissues
  5. Immediate fatal haemorrhaging (bleeding)
  6. Extreme pain as girls are cut without being numbed and the worst pain occurs the next day when the girls have to urinate
  7. Trauma as girls are forced and held down by several women

Long-term implications;

  1. Extensive damage of the external reproductive system
  2. Uterus, vaginal and pelvic infections
  3. Cysts and neuromas
  4. Increased risk of Vesico Vaginal Fistula
  5. Complications in pregnancy and child birth
  6. Psychological damage
  7. Sexual dysfunction
  8. Difficulties in menstruation
  9. Recurrent bladder and urinary tract infections
  10. Infertility
  11. The need for later surgeries such as to be cut open to allow childbirth and sexual intercourse after marriage. Sometimes it is also stitched again several times after childbirth.
  12. Problems urinating as girls are left with a small opening. This can slow or strain the normal flow of urine and lead to infections
  13. Gynecological health problems as they are not able to pass all of their menstrual blood out and have infections over and over again.
  14. Increased risk of Sexually Transmitted Diseases/Infections (STD/STI) including HIV as the procedure is being performed in unclean conditions
  15. Psychological and emotional stress. A study by Pharos, a Dutch group that gathered health care information of refugees and migrants revealed in February 2010 that majority of these women suffered from stress, anxiety and was aggressive. They were also most likely to have relational problems or fear for relations. According to the study, it is believed that an estimate of 50 girls is being genitally mutilated every year in the Netherlands.

5. Where is FGM practiced?

Southeast Asia; Indonesia, Malaysia,

Central Asia; Tajikistan

Eastern Europe; Chechnya, Dagestan, Ingushetia

Middle East; Yemen, UAE, turkey, Syria, Saudi Arabia, Palestinian territories, Pakistan, Oman, Jordan, Iraq and Kurdistan, Iran,

Africa; Zimbabwe, Zaire, Uganda, Togo, Tanzania, South Africa, Somalia, Sierra Leone, Senegal, republic of Congo, Nigeria, Niger, Mozambique, Mauritania, Mali, Malawi, Libya, Liberia, Kenya, guinea-Bissau, guinea, Ghana, Gambia, Ethiopia, Eritrea, Egypt, Djibouti, democratic republic of the Congo, cote d’ivoire, Comoros, Chad, central African republic, Cameroon, Burkina Faso, Benin, Algeria

The majority of cases of FGM are carried out in 28 African countries. In some countries, (e.g. Egypt, Ethiopia, Somalia and Sudan), prevalence rates can be as high as 98 per cent. In other countries, such as Nigeria, Kenya, Togo and Senegal, the prevalence rates vary between 20 and 50 per cent. It is more accurate however, to view FGM as being practised by specific ethnic groups, rather than by a whole country, as communities practising FGM straddle national boundaries. FGM takes place in parts of the Middle East, i.e. in Yemen, Oman, Iraqi Kurdistan, amongst some Bedouin women in Israel, and was also practised by the Ethiopian Jews, and it is unclear whether they continue with the practice now that they are settled in Israel. FGM is also practised among Bohra Muslim populations in parts of India and Pakistan, and amongst Muslim populations in Malaysia and Indonesia.

6. Religion or culture?

Although FGM happens in countries with Muslim majority, and people think that it is associated with Islam, FGM is not supported by any religion and condemned by many religious leaders.

In fact FGM is a pre-Islamic tradition and since Islam prohibits humans from harming and mutilating their body, therefore FGM is forbidden in Islam. In Ethiopia, Cote d’Ivoire, Kenya, Senegal, Benin, and Ghana, Muslim population groups are more likely to practice FGC than Christian groups but in Nigeria, Tanzania, and Niger, the prevalence is greater among Christian groups.

Today FGM is a mixture of cultural, religious and social factors. For instance, the social pressure to perform FGM because others in the same community do it keeps the practice strong. As from the religious view, the parents thinks that FGM is necessary to raise the daughter properly and make sure that she is a virgin until she is married even though no religious scripture supports this. It is motivated by the thought of proper sexual behavior.

7. Reasons and justification

  1. custom and tradition
  2. religion; in the mistaken belief that it is a religious requirement
  3. preservation of virginity/chastity
  4. social acceptance, especially for marriage
  5. hygiene and cleanliness
  6. increasing sexual pleasure for the male
  7. family honour
  8. a sense of belonging to the group and conversely the fear of social exclusion
  9. enhancing fertility

8. What can be done to prevent and abolish FGM?

Each community should arrange meetings where they discuss, talk and consider opinions about FGM. Here it would be important to allow the elder generation to speak with the young. It is important to spread out and explain about the harsh health problems FGM causes.

Next important thing is education. Education is the key to everything. As we can see, this is happening in areas where most people is illiterate or doesn’t have the possibility to go to school. The generations repeat themselves and the circle is hard to break. Another important thing would be that Islamic scholars and other religious leaders should change the perception about FGM as people listen to them.

Every country and community should work towards changing the attitude as women feels they are being disloyal to their culture for not choosing FGM. This pressure can change if doctors and other health care workers would talk with women about the dangers of FGC and offer other options that don’t involve cutting. Some human rights advocates also suggest that men could help reduce the practice of FGC by openly marrying uncut women. Many human rights organizations are also calling on religious leaders to openly confirm that their religions do not require women to have FGC.

Last, if the countries establish strict laws and investigate cases regarding FGM, then it will have some effect but it will not be enough to abolish it as 18 African countries has laws or decrees against FGM. Even countries with the highest rates of FGM have recently openly noted the need for banning this practice. Fines and jail sentences are typically minor, but most view any sanctions against FGC as a good start.

It is important that everyone is aware of this heinous practice that mutilates the female body. It is hard to understand how parents can perform this on their infant babies who are not able to defend themselves. Every country should implement various strategies to eliminate FGM and it starts with education and communication.

International World Tuberculosis Day, 24th March

24th March every year is the World Tuberculosis day designed to spread awareness about the global epidemic of tuberculosis and efforts to eliminate the disease. Today, this disease causes the deaths of about 1,6 million people each year, mostly in the third world.

The reason that it is on 24th March is because the day commemorates the day in 1882 when Dr. Robert Koch announced that he had discovered the cause of tuberculosis, the TB Bacillus. By the time of the announcement in Berlin, Europe and Americas was already being raged by the TB-virus causing the death of every one out of seven people.

In 1982, on the 100th anniversary of Robert Koch’s presentation, the International Union Against Tuberculosis and Lung Disease (IUATLD) proposed that March 24th would be proclaimed as an official World TB Day.

Signs and symptoms

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When the disease becomes active in the human body, 75% of the cases are pulmonary TB, that is, TB in the lungs. The symptoms include; chest pain, coughing up blood, and a productive, prolonged cough for more than three weeks. Systemic symptoms include fever, chills, night sweats, appetite loss, weight loss, pallor, and fatigue. Tuberculosis also has a specific odour attached to it; this has led to trained animals being used to vet samples as a method of early detection.

In the other 25% of active cases, the infection moves from the lungs, causing other kinds of TB, collectively denoted extra pulmonary tuberculosis. This occurs more commonly in immunosuppressed persons and young children. Extra pulmonary infection sites include the pleura in tuberculosis pleurisy, the central nervous system in meningitis, the lymphatic system in scrofula of the neck, the genitourinary system in urogenital tuberculosis, and bones and joints in Pott’s disease of the spine.

Causes

The cause of TB, Mycobacterium tuberculosis (MTB), is a small aerobic non-motile bacillus. High lipid content of this pathogen accounts for many of its unique clinical characteristics. It divides every 16 to 20 hours, an extremely slow rate compared with other bacteria, which usually divide in less than an hour.

Epidemiology

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A third of the world’s population has been infected with M. tuberculosis, and new infections occur at a rate of one per second. However, not all infections with M. tuberculosis cause TB disease and many infections are asymptomatic. In 2007, an estimated 13.7 million people had active TB disease, with 9.3 million new cases and 1.8 million deaths; the annual incidence rate varied from 363 per 100,000 in Africa to 32 per 100,000 in the Americas. Tuberculosis is the world’s greatest infectious killer of women of reproductive age and the leading cause of death among people with HIV/AIDS.

In 2007, the country with the highest estimated incidence rate of TB was Swaziland, with 1200 cases per 100,000 people. India had the largest total incidence, with an estimated 2.0 million new cases. The Philippines ranks fourth in the world for the number of cases of tuberculosis and has the highest number of cases per head in Southeast Asia. Almost two thirds of Filipinos have tuberculosis, and up to an additional five million people are infected yearly. In developed countries, tuberculosis is less common and is mainly an urban disease. In the United Kingdom, the national average was 15 per 100,000 in 2007, and the highest incidence rates in Western Europe were 30 per 100,000 in Portugal and Spain. These rates compared with 98 per 100,000 in China and 48 per 100,000 in Brazil. In the United States, the overall tuberculosis case rate was 4 per 100,000 persons in 2007. In Canada tuberculosis is still endemic in some rural areas. The incidence of TB varies with age. In Africa, TB primarily affects adolescents and young adults, however, in countries where TB has gone from high to low incidence, such as the United States, it is mainly a disease of elder people, or of the immunocopromised.

What are the main causes of TB?

There are a number of known factors that make people more susceptible to TB infection such as HIV. Co-infection with HIV is a particular problem in Sub-Saharan Africa, due to the high incidence of HIV in these countries. Smoking more than 20 cigarettes a day also increases the risk of TB by two to four times. Diabetes mellitus is also an important risk factor that is growing in importance in developing countries. Other disease states that increase the risk of developing tuberculosis are Hodgkin lymphoma, end-stage renal disease, chronic lung disease, malnutrition, and alcoholism.

Diet may also modulate risk. For example, among immigrants in London from the Indian subcontinent, vegetarian Hindu Asians were found to have an 8.5 fold increased risk of tuberculosis, compared to Muslims who ate meat and fish daily. Although a causal link is not proved by this data, this increased risk could be caused by micronutrient deficiencies: possibly iron, vitamin B12 or vitamin D. Further studies have provided more evidence of a link between vitamin D deficiency and an increased risk of contracting tuberculosis. Globally, the severe malnutrition common in parts of the developing world causes a large increase in the risk of developing active tuberculosis, due to its damaging effects on the immune system. Along with overcrowding, poor nutrition may contribute to the strong link observed between tuberculosis and poverty.

Prisoners, especially in poor countries, are particularly vulnerable to infectious diseases such as HIV/AIDS and TB. Prisons provide conditions that allow TB to spread rapidly, due to overcrowding, poor nutrition and a lack of health services. Since the early 1990s, TB outbreaks have been reported in prisons in many countries in Eastern Europe. The prevalence of TB in prisons is much higher than among the general population, in some countries as much as 40 times higher.

Robert Koch

Heinrich Hermann Robert Koch (11 December 1843 – 27 May 1910) was a Prussian physician. He became famous for isolating Bacillus anthracis (1877), the Tuberculosis bacillus (1882) and the Vibrio cholerae (1883) and for his development of Koch’s postulates. He was awarded the Nobel Prize in Physiology or Medicine for his tuberculosis findings in 1905 and considered one of the founders of microbiology,

Heinrich Hermann Robert Koch was born in Clausthal, Prussia one of the German states as the son of a mining official. He studied medicine under Friedrich Gustav Jakob Henle at the University of Göttingen and graduated in 1866. He then served in the Franco-Prussian War and later became district medical officer, Wollstein (Wolsztyn), Prussian Poland. Working with very limited resources, he became one of the founders of bacteriology, the other major figure being Louis Pasteur. After Casimir Davaine showed the direct transmission of the anthrax bacillus between cows, Koch studied anthrax more closely. He invented methods to purify the bacillus from blood samples and grow pure cultures. He found that, while it could not survive outside a host for long, anthrax built persisting endospores that could last a long time. These endospores, embedded in soil, were the cause of unexplained “spontaneous” outbreaks of anthrax. Koch published his findings in 1876, and was rewarded with a job at the Imperial Health Office in Berlin in 1880. In 1881, he urged the sterilization of surgical instruments using heat.

In Berlin, he improved the methods he used in Wollstein, including staining and purification techniques, and bacterial growth media, including agar plates (thanks to the advice of Angelina and Walther Hesse) and the Petri dish, named after its inventor, his assistant Julius Richard Petri and these devices are still used today. With these techniques, he was able to discover the bacterium causing tuberculosis (Mycobacterium tuberculosis) in 1882 (he announced the discovery on 24 March). Tuberculosis was the cause of one in seven deaths in the mid-19th century.

In 1885, he became professor of hygiene at the University of Berlin, then in 1891 he was made Honorary Professor of the medical faculty and Director of the new Prussian Institute for Infectious Diseases (eventually renamed as the Robert Koch Institute), a position from which he resigned in 1904. He started traveling around the world, studying diseases in South Africa, India, and Java. He visited what is now called the Indian Veterinary Research Institute (IVRI), Mukteshwar on request of the then Government of India to investigate on cattle plague. The microscope used by him during that period was kept in the museum maintained by IVRI. Probably as important as his work on tuberculosis, for which he was awarded a Nobel Prize (1905), are Koch’s postulates, which say that to establish that an organism is the cause of a disease, it must be:

  • found in all cases of the disease examined
  • prepared and maintained in a pure culture
  • capable of producing the original infection, even after several generations in culture
  • Retrievable from an inoculated animal and cultured again.

Koch’s pupils found the organisms responsible for diphtheria, typhoid, pneumonia, gonorrhoea, cerebrospinal meningitis, leprosy, bubonic plague, tetanus, and syphilis, among others, by using his methods.

Robert Koch died on 27 May 1910 from a heart-attack in Baden-Baden, aged 66.

Source info; Wikipedia

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