Relief for men with fatal bleeding disorder

Kenya: Martin Munene is a happy young man. For years, the Form Four student at Kibumbu Secondary School in Meru has been subjected to ridicule. Not any more.

His peers who underwent circumcision in their teens thought he was not a man enough. What they didn’t realise was that if Martin underwent the cut without close monitoring by a medical expert, the consequences would have been disastrous, probably fatal.

“I have shifted school twice because of threats to circumcise me forcefully yet the cost of having the necessary medication to enable my blood clot, are quite expensive, thus I was waiting for my family to afford the Sh 50,000 to buy the clotting factors,” he told The Standard on Saturday.

Munene is hemophiliac. This is a hereditary bleeding disorder, where this is a partial or total lack of an essential blood clotting factor that could lead to massive blood loss resulting to anaemia or death.

And with the most common complications associated with circumcision being bleeding and infection, a team of doctors this week operated eight young men mostly hemophiliac patients. The families waited for a Good Samaritan to donate the clotting factors, and that opportunity came last week.

For decades discussions have been advanced on circumcision benefits on religious, medical and cultural grounds.

For most people, this is considered a religious ritual whereas some families view it as a cultural tradition and others believe it is a preventive healthcare measure.

Complications

Amongst Christians, circumcision is spelt out in a decree recorded in Genesis Chapter 17, where Prophet Abraham and his successors were to be circumcised. In Islam, it is performed to conform to the practice of Prophet Mohammad but is not a religious requirement.

Closer home, African communities set aside seasons for initiation especially for age sets and each tribe had a prescribed way of circumcising, mostly done by community-appointed circumcises.

Medically, the infection of sexually transmitted diseases, including HIV, the risk of developing cancer of the penis and urinary tract infections has been found to be is significantly lower in circumcised males.

For whichever premise that a decision to circumcise is made, male reproductive health specialist David Kimani agrees that the health profile of the individual should be taken into consideration to guard against complications.

“In some cases, the foreskin can be difficult or impossible to retract in what we call phimosis, leading to inflammation of the foreskin or head of the penis,” says Dr Kimani, a urologist at the Kenyatta National Hospital.

 

Martin’s elder brother James Mwangi,31, also has haemophilia and benefited in 1998 from a hospital-based initiative at the KNH.

“I encouraged Martin to educate his peers and the wider community that he cannot be circumcised without the clotting factors otherwise he would have uncontrolled bleeding,” says James who was the first of two boys in the family to be diagnosed with the condition when he was one year.

The disease is common in males than females. Coordinator of the Kenya Haemophilia Association Peter Shikuku, says the aim of bringing the young men together for circumcision in the hospital was to integrate them socially and culturally into the society despite having the bleeding disorder.

Mary Wanjiku also brought her 14-year-old son, Michael Njenga to undergo circumcision.

“I learnt my second born child had the complication when he was five months old after he bled excessively when his tonsils were cut,” Mary said in an interview at the hospital.

Ms Wanjiku recalled how her brother John bled to death after a tooth was extracted. Her son who has the condition is a Standard Six pupil at Uthiru Primary School. He came position nine out of 42 pupils at the close of third term last month.

“I am careful not to play dangerous games that will lead to injuries and cause bleeding so most times, I sit with my books and watch my friends play,” Michael said.

Wanjiku warns against public condemnation of individuals who aren’t circumcised. “I usually see them frog-match some men for forceful circumcision yet the individual could have a bleeding disorder that would require him to be ‘cut’ in a hospital setting,” she added.

Very expensive

According to Dr Shikuku, the condition occurs in one in every 5,000 males globally and in Kenya there are 450 people diagnosed with hemophilia out of an estimated 4,000 men who have been tested.

Currently, Kenya relies on donations from the World Federation of Hemophilia. However, the national hospital insurer, NHIF, does not pay for the admission of patients with haemophilia for circumcision.

“To replace 20 per cent of the factor in the body, we give children at least one vial of 500 international units while adults are given four vials every 12 hours,” he says adding that a vial costs Sh 50,000 and thus makes treatment very expensive and out of reach by the ordinary Kenyan.

Once the clotting factor has been given half an hour before the surgery, urologist David Kimani explains circumcision is done in theatre and the patient monitored to ensure proper recovery.

“It’s a 30-minute procedure carried out in a controlled environment to ensure minimal blood loss, if any,” Dr Kimani says. “After three days of assessment, we discharge them to go home if they have shown no indications of signs and symptoms that may complicate their recovery.”

 

A November 2013 study carried out in Sudan on 87 men with haemophilia at the Khartoum Teaching Hospital, corroborated these families’ concerns.

The study shows that before circumcision, the men faced prejudice from their peers and they preferred to stay indoors and not participate in any social activities while the fathers’ of some of them abandoned them because circumcision in this country is viewed as mandatory.