Tuesday, February 2, 2010

Medical-Surgical Mission

Friday, January 29, 2010

St. Paul’s University went the extra mile to provide allow us to experience a clinic focusing on prenatal care and pediatric circumcisions. This was a medical mission established for the school, providing an opportunity for male community members between the ages of 9 and 14 to receive free circumcisions. Circumcisions are recommended for all males in the Philippines in order to prevent infections from swimming in contaminated water supplies, improve hygiene, and decrease the prevalence of sexually transmitted infections.


1. The surgical room where circumcisions were performed.
2. Kirsten ready to assist with a circumcision.
3. Our team with the medical doctor who performed the circumcisions.


  1. "in order to prevent infections from swimming in contaminated water supplies, improve hygiene, and decrease the prevalence of sexually transmitted infections."

    Surely circumcising children is more likely to cause infections from swimming in contaminated water supplies. We certainly don't cut parts off baby girls to prevent such infections.

    Canadian Paediatric Society
    "Recommendation: Circumcision of newborns should not be routinely performed."

    College of Physicians & Surgeons of Saskatchewan 2002
    "It is difficult to identify any other domain of medicine in which practice patterns stand in such contrast to research evidence"

    Shame on you.

  2. This comment has been removed by the author.

  3. Mr. Lyndon,
    Thank you for your comment. We looked at your source, which comes from an article printed in 1996 and is now being revised. With that said, what was stated in our Blog is the reasoning behind doing circumcisions in the Philippines, not in Canada, which is where your source is from. For the reasons stated in our Blog, plus religious and cultural traditions, male circumcisions are routinely practiced in the Philippines (World Health Organization). It is true that in Canada routine circumcision is not currently recommended. However, the Canadian Pediatric Society (2004) states that for every 1,000 boys who are not circumcised, “10 will have a circumcision later in life for medical reasons, such as a condition called phimosis. Phimosis is when the opening of the foreskin is scarred and narrow because of infections in the area that keep coming back,” (Canadian Pediatric Society). In the Philippines, members of society do not have universal health care, and the health system itself runs on a limited budget with scarce resources. Thus, many members of society are unable to afford proper health care and therefore can suffer from numerous complications that are not typically seen in Canada.

    You are correct in saying that male circumcision does not 100% protect against the transmission of sexually transmitted infections (STI’s), but it has been found to decrease transmission rates in two specific studies by the World Health Organization (WHO): HPV and HIV. Regarding HPV, male circumcision and condom use, along with administration of the HPV vaccine and routine cervical cancer screening has been found to decrease transmission of the Human Papillomavirus (WHO, 2010). Furthermore, male circumcision can decrease the transmission of HIV (Weniger and Brown, 1996). Weniger and Brown (1996) state:
    “An enigma in the Asian pandemic is that rapid sexual transmission has not occurred in some places...for example, in Bangladesh, Indonesia, and the Philippines. One contributing reason may be the high proportion of men in these Muslim and Catholic societies who are circumcised, a factor that has been shown elsewhere to reduce the rate of female-to-male transmission,” (p. 344).
    With that said, there are additional precautions members of society should practice in order to prevent the transmission of STI’s.
    Last, the question of whether circumcision is “right” or “wrong” is not strictly biomedical. It is also a cultural and religious one, which is one of the main reasons circumcision is routinely practiced in the Philippines. Lee (2006) writes, “...ritual male circumcision is not an arbitrary act but a highly valued practice intimately tied to the social organization of Filipino society,” (p. 232). As nursing students partaking in an immersion into community health care, we can see the value in respecting traditions, values, and norms of the Filipino culture.

    For more information, please visit:
    Canadian Pediatric Society (2004). Circumcision information for parents. Retrieved February 5,
    2010, from the Canadian Pediatric Society’s website,

    Lee, R. B. (2006). Filipino experience of ritual male circumcision: Knowledge and insights for
    anti-circumcision advocacy. Culture, Health & Sexuality, 8(3): 225-234.

    Weniger, B. G. and Brown, T. (1996). The march of AIDS through Asia (editorial). New
    England Journal of Medicine: 335, 343–345.

    World Health Organization (2010). Human Papillomavirus and related cancers: Summary report
    update January 29, 2010 Philippines. Retrieved February 5, 2010 from the World Health
    Organization’s website,

  4. Thanks for your reply, which is considerably more detailed than what you said before. Can you actually find a source for this though: "Circumcisions are recommended for all males in the Philippines", or anything which mentions "infections from swimming in contaminated water supplies". I suspect this is hearsay, but if there's something official, I'd be very interested to see it.

    The rates of medically required circumcision are going down, but even by your figures, 99 boys would have to be circumcised to prevent one circumcision later. I can't think of any other operation where a body part would be routinely performed to prevent the possibility of the same operation later in life. For instance, about 1 in 15 people get appendicitis which is far more dangerous than phimosis, but we don't routinely remove anyone's appendix to prevent an appendectomy later.

    The CPS link you quoted:
    also says the following:

    "After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions."
    "Of every 1,000 boys who are circumcised:
    20 to 30 will have a surgical complication, such as too much bleeding or infection in the area.
    2 to 3 will have a more serious complication that needs more treatment. Examples include having too much skin removed or more serious bleeding."

    I quoted the current position on male circumcision of the CPA, which is consistent with other such statements eg:
    RACP Policy Statement on Circumcision
    "After extensive review of the literature, the Paediatrics & Child Health Division of the Royal Australasian College of Physicians has concluded that there is no medical reason for routine newborn male circumcision."
    (almost all the men responsible for this statement will be circumcised themselves, as the male circumcision rate in Australia in 1950 was about 90%. "Routine" circumcision is now *banned* in public hospitals in Australia in all states except one.)

    British Medical Association: The law and ethics of male circumcision - guidance for doctors
    "to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate."

    Are you aware of meatal stenosis which is a very common complication of circumcision?

    (to be continued as I've hit the limit of 4096 characters)

  5. Circumcision is a particularly dangerous distraction in the fight against AIDS. There are six African countries where men are more likely to be HIV+ if they've been circumcised: Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Rwanda, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn't happen.

    Cameroon: http://www.measuredhs.com/pubs/pdf/FR163/16chapitre16.pdf table 16.9, p17 (4.1% v 1.1%)
    Ghana: http://www.measuredhs.com/pubs/pdf/FR152/13Chapter13.pdf table 13.9 (1.6% v 1.4%)
    Lesotho: http://www.measuredhs.com/pubs/pdf/FR171/12Chapter12.pdf table 12.9 (22.8% v 15.2%)
    Malawi: http://www.measuredhs.com/pubs/pdf/FR175/FR-175-MW04.pdf table 12.6, p257 (13.2% v 9.5%)
    Rwanda: http://www.measuredhs.com/pubs/pdf/FR183/15Chapter15.pdf , table 15.11 (3.5% v 2.1%)
    Swaziland http://www.measuredhs.com/pubs/pdf/FR202/FR202.pdf table 14.10 (21.8% v 19.5%)

    See also http://www.iasociety.org/Default.aspx?pageId=11&abstractId=2197431
    "Conclusions: We find a protective effect of circumcision in only one of the eight countries for which there are nationally-representative HIV seroprevalence data. The results are important in considering the development of circumcision-focused interventions within AIDS prevention programs."

    "Results: … No consistent relationship between male circumcision and HIV risk was observed in most countries."

    We now have people calling circumcision a "vaccine" or "invisible condom", and viewing circumcision as an alternative to condoms. The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups "believe that circumcised men do not need to use condoms".

    The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw.

    ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.

    You seem keen to respect cultural "traditions, values, and norms" in relation to male circumcision, but I can't imagine you'd take part in any form of female circumcision, though there are several countries where the same arguments would apply. You might see a fundamental difference, but the people that cut girls don't, and many forms of female circumcision do considerably less damage than the usual form of male circumcision.

    I think it's great that you're out in the Philippines, but I believe you should ask yourselves whether it's right to be taking part in operations for cultural and cosmetic reasons, rather than medical concerns.

  6. It's very useful blog about cautious, and Extensive LPN training fresno offering certificate as a licensed practical nurse and in other healthcare training programs.

  7. This post could not be written any better. Male circumcision is not a condom. Anyway thanks for sharing.

    Check this out too:
    Medisoft Software