Monday, August 18, 2014

From Pre-Natal to Manhood

We spent today shadowing the nurses and doctors at Maternal Child Health center (MCH).  Claire and I were placed in the Ante-Natal Care Clinic with Everlyne, the supervisor and head nurse at MCH, and wow, what an incredible job to have. Each pregnant woman brings a check-up book in which the nurses track important information such as HIV status, appointment reminders, and other information. These books are also used to monitor the newborns vaccines and weight changes after birth.  Everlyne uses these books to make sure all tests, records, and counseling sessions are done prior to delivery and that patients receive all necessary information.  Women are scheduled for four visits with the overall focus on birth preparedness and readiness to handle complications.  Below is a breakdown of what happens at each visit.

Many important conversations fall under the counseling and education portion of the visits.  During this time, Everlyne makes sure to teach the expecting mothers exactly what is happening inside of them, why certain things are and are not ok to do, and rid them of any false beliefs they may have.  Other topics include breastfeeding, malaria prevention, and the importance of having a skilled delivery attendant present for the birth. There are also many rumors and false stigmas that Everlyne tries to explain to the soon-to-be mothers.  One specific rumor Everlyne told us about is the rumor that some babies have white on them when they are born because their parents had sex while the mother was pregnant.  Everlyne explained however, that this white film is made by the mother’s body in order to keep the baby warm inside the womb.

The first patient Claire and I saw was 21; one year older than me, one year younger than Claire.  She had a section on her belly that was bubbled up, but not where the baby was, which concerned Everlyne.  For this reason, Everlyne suggested the mother go to the hospital in Kakamega to receive an ultra sound.  Unfortunately, Kakamega is about an hour bus ride away, and transportation costs may make this difficult for the patient.  This challenge is very common, and instances like this make it clear why WOPLAH’s income generation projects are so needed in order to improve health standards.  While this young lady had an unresolved issue, and highlighted a struggle in local healthcare, the rest of the appointments went smoothly and were very exciting to be a part of.  By the end of the morning, we had seen women at every stage of pregnancy and had felt the small heads of several babies in the womb!  Everlyne is unbelievable.  She is so knowledgeable and can find and identify every part of the baby within just a few seconds of touching the woman’s stomach.  One of the babies twitched when we touched its knee, which was very cool.  The best part though, was the heartbeat of the babies.  I almost started crying it was so beautiful. It took me a few tries before I finally heard it, but once I did I was overwhelmed with joy. The pitter-patter sound was so pure. I think I could do that for the rest of my life.

Following the Ante-Natal Care Clinic we stepped into a whole new portion of life.  Watching the beginnings of life changed to the beginnings of manhood as we each took turns watching a male circumcision at MCH.  Winter break just started here meaning it is time for circumcisions.  This is the case as USAID provides free circumcisions in health facilities during all holidays to ensure boys have time to recover before the school year starts again.  The little boy I watched was 11 and he was so brave!  Many of the boys were nervous after hearing stories from their friends who had been circumcised the traditional way, while others watched the entire thing (which was pretty crazy).  The traditional circumcisions are also taking place right now as evidenced by the many joyous parades we have seen marching down streets collecting funds for the boys’ recoveries.

In these practices, boys are usually taken into the countryside and numbed in cold rivers, after which they use knives to perform the act.  The boys then stay in the countryside for one month to recover.  However without sterile equipment or the knowledge of health facility employees, it can be a dangerous practice, which is why many people are now being encouraged to go to health facilities.  Not to mention that the health facilities use local anesthesia where as in the traditional practice they only have the coldness of the river to help numb before the procedure takes place.  I really appreciate and honor traditions in general, but seeing the caution used at MCH when performing the circumcisions, made it difficult for me to disregard my concern for the health and safety of the young boys going the traditional route.

- Libby Alvin '16 Molecular and Cellular Biology Major


  1. Would you say an 11-year-old girl was "brave" for her response to female genital surgery, or would you question why it was happening?

    The sooner this outdated tradition dies out, the better. It makes no sense to be promoting male circumcision to prevent HIV.

    From a USAID report:
    "There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher."

    It seems highly unrealistic to expect that there will be no risk compensation. 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".

    It is unclear if circumcised men are more likely to infect women. The only ever randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised:

    ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery seems likely to cost African lives rather than save them.

    Europeans don't circumcise, South Americans don't circumcise, Australians and New Zealanders used to circumcise but stopped, and less than half of North Americans circumcise. Why should Africans circumcise?

    Recent news from Botswana:
    "There is an upsurge of cases of people who got infected with HIV following circumcision."

    and from Zimbabwe:
    "SOME circumcised men are contracting HIV and Aids after ditching the use of condoms, under a misguided belief that male circumcision (MC) would prevent them from getting infected"

    and from Kenya:
    "Push for male circumcision in Nyanza fails to reduce infections"

    Google "ulwaluko" for horrific photos of what can go wrong with traditional circumcision btw.

  2. Was the eleven year old boy able to give informed consent? Was he told about the irreversible nerve damage? Was he told about the functions of the prepuce? Was he told how common it is for men to regret getting circumcised?