Mounting the first prosecution against someone for carrying out FGM in England and Wales, the Crown alleged that Dr Dhanuson Dharmasena, a junior registrar in obstetrics and gynaecology at the Whittington hospital, had mutilated a 24-year-old mother by the manner in which he had sewn her up after childbirth.
The woman had undergone type 3 FGM – in which part of the labia are sewn together – as a child in Africa, and during labour the doctor had made two cuts to her vaginal opening to ensure the safe delivery of her baby. When Dharmasena sewed her up, a midwife warned him that what he had done was illegal. He asked a consultant for advice, and the more senior doctor said it would be “painful and humiliating” to remove the stitch he had made, and it remained in place, the court heard.
It’s the sewing up that’s being prosecuted.
The doctor, who qualified in 2005, and began specialising in obstetrics and gynaecology in 2008, had been at the Whittington for a month when the events took place in 2012.
Under the 2003 Female Genital Mutilation Act, a doctor does not commit an offence if his actions involve a surgical operation on a woman in any stage of labour, or immediately after birth, for purposes connected with the labour or birth.
Bex told the jury of seven women and five men: “It will be for you to decide if Dr Dharmasena’s admitted act of sewing [her] labia together was necessary for her physical health or was for purposes connected with the labour or birth.”
You know…I would hate to be on that jury. Given this account I would consider him guilty as charged, and I would feel horrible about it. I wish the first prosecution were of an actual cutter or a parent forcing the cutting on a child.
She said the case was not what might be expected of an FGM prosecution. “If you do know a little about FGM you may be expecting to hear that the offence took place in a back-street clinic by an unqualified and uncaring person on a young child. This trial is quite different but it nevertheless involves FGM.”
Yeah see that’s just it. It’s difficult.
Pregnant with her first child, the woman had been seen in antenatal appointments by midwives at the hospital, the jury was told. When asked standard questions about whether she had been subjected to FGM, she told the midwife, “It’s fine, it’s opened”, referring to a revision of her circumcision which had taken place in February 2011.
The midwife should have organised a birth plan for her which would have involved deinfibulation – reopening the vaginal opening – well in advance of going into labour. This was not done. Instead, AB arrived in labour at 8.55am, where her FGM was discovered.
Dharmasena arrived in the delivery room at 10.10am and saw the woman was progressing fast. Concerned about the baby, he made two cuts to facilitate the birth, one of which involved cutting through the scar tissue from the FGM.
In half an hour he delivered the baby. A senior house officer stitched up the mother, but at the insistence of Mohamed, Dharmasena followed up by sewing up the labia with a single continuous stitch around 1.5cm to 2cm long, the Crown said.
At the insistence of Mohamed – who is this Mohamed who gets to insist that a woman’s labia be sewn shut? Do they keep an Islamic chaplain hanging around the delivery room?
More likely of course is that he’s her husband – in which case – uggghhhhhhhh.
When she saw his stitch, the midwife, Aimma Ali, said it was illegal and spoke privately to Dharmasena. He consulted the on-call consultant, Vibha Ruparelia, and explained that he did not know the stitch was illegal.
The consultant said it would be too painful and humiliating to remove the stitch, and it was left in. In his notes, Dharmasena wrote: “Had discussion with consultant post delivery. In hindsight should not have closed stitches. Decision made not to reopen sutures.”
The doctor’s actions were against hospital policy which is written and available and Dharmasena was expected to be aware of it, said Bex.
Well there you go – he was expected to be aware of it. That’s what I said yesterday: there had to be a policy and he had to know it.
Still. I wish the defendant were a cutter rather than a doctor who screwed up.
Both. I’d like to prosecute both and Mohamed, whoever the hell he is. Gah! Now I have a desire to never uncross my legs again warring with the part of me that wants to hit cutter/doctor/Mohamed upside the head with a baseball bat.
There was really so much that went wrong here that you’d think several people would be in court sharing the responsibility – and yet again, it’s medical malpractice, but err, as you say, if that’s all the fgm they can find… Incidentally, what he was supposed to do according to that article was over-stitch the labia, – a sort of simple reconstructive surgery? It sounds as though he might not have known where to start.
Honestly, I don’t think any medical professional should need a policy to know that they should ignore a third party insisting that they perform a medically unnecessary procedure on their patient.
Removing stitches is not painful, so I don’t know what the consultant is talking about. And it is only humiliating to the doctor because he has to go back and admit to a mistake.
SC – yeah, true. What Mr Mohamed has to do with it, even (or perhaps especially) assuming he’s her husband, is beyond me. What, was he all “Make it nice and tight for me, Doc. Tighter than that! Really TIGHT”?
What about this midwife? I mean, in 9 months of pregnancy did NO ONE do an exam on this woman?
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STOP KHITAN AL-INATH (sunat perempuan), STOP ISLAMIC FGM!
Germany (Ringel / Meyer; Tatjana Hörnle), bad enough, and unfortunately now even Great Britain are paving the way towards the so called “mild Sunnah” type, towards a legal FGM. We should stop this, any form of FGM or MGM should be banned everywhere.
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Female genital mutilation comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons (WHO, UNICEF, UNFPA, 1997). The WHO/UNICEF/UNFPA Joint Statement classified female genital mutilation into four types (FGM Type I, II, III, IV).
Now UK judge James Munby compares male circumcision with FGM – without demanding a ban on ritual circumcision of minors. Are fears of legalisation of female genital mutilation (FGM Type IV and maybe also Type Ia) in the UK unfounded?
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In the matter of B and G (Children) (No 2)
Sir James Munby, President of the Family Division
http://www.judiciary.gov.uk/wp-content/uploads/2015/01/BandG_2_.pdf
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Judge Sir James Munby can know that the circumcision of girls is religion, part of several hadith and many fatwa. The Fiqh (Islamic Jurisprudence) of Shafii madhhab and many Ulama of Hanbali madhhab regard FGM as wajib, i. e. as a religious duty. So khitan al-inath (sunat perempuan; FGM) is part of authentic Islam.
Hadith. Muhammad said to the muqaṭṭiʿa al-buẓūr (cutter of clitorises) Umm ʿAṭiyya:
أشمِّي ولا تنهكي
ašimmī wa-lā tanhakī
[Cut] slightly and do not overdo it
اختفضن ولا تنهكن
iḫtafiḍna wa-lā tanhikna
Cut [slightly] without exaggeration
Today several Muslim clerics promote a “mild sunnah” circumcision; who tells Judge Munby about this fatwa: What is the Ruling on Circumcision for Women?
Circumcision is obligatory upon men and women according to us (i.e. the Shafi’is). (Majmu’ of Imam An-Nawawi 1:164) The circumcision is wajib upon men and women according to the rājih qawl of Shāfi’ī madhhab. Answered by: Sidi Abdullah Muḥammad al-Marbūqī al-Shāfi’ī. Checked by: Al-Ustāż Fauzi ibn Abd Rahman
My real concern is that Europe will soon legalise some “mild” forms of the Classification of FGM.
And again: every form of FGM or MGM should be banned everywhere.
s o u r c e s
A Cutting Tradition. By Sara Corbett. The New York Times, published: 20.01.2008
http://www.nytimes.com/2008/01/20/magazine/20circumcision-t.html
Inside a Female-Circumcision Ceremony. Photo: Stephanie Sinclair
http://www.nytimes.com/slideshow/2008/01/20/magazine/20080120_CIRCUMCISION_SLIDESHOW_index.html
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I call shenanigans. Quite a few things sound off:
1) [Pt.] seen in antenatal appointments by midwives at the hospital … asked … questions about … [having] been subjected to FGM,[tells] the midwife, “It’s fine, it’s opened”, referring to a revision of her circumcision [done] in February 2011 … [then pt. presents] in labour at 8.55am, where her FGM was discovered. (emphasis mine)
History of FGM elicited and noted in her prenatal record but no vaginal exam, not once during first visit or any of the f/u prenatal visits, and no records obtained for her past [revision] surgery. How is that possible?
2) [Dharmasena] made two cuts to facilitate the birth, one of which involved cutting through the scar tissue from the FGM. In half an hour he delivered the baby. A senior house officer stitched up the mother, but at the insistence of Mohamed, Dharmasena followed up by sewing up the labia with a single continuous stitch around 1.5cm to 2cm long, the Crown said.
Dr. D makes one cut to release the labia (FGM) and a second, routine, one (episiotomy). Then Dr. X, a senior resident, stitches up the episiotomy, marking the end point. Pt. is stable, episiotomy repaired, all done, medically. Then Mohamed, the patient*, insists Dr. D repair the infibulation and he does, by throwing a stitch.
A competent Ob/Gyn doesn’t know it’s unnecessary surgery? He also doesn’t know that suturing up scar tissue is malpractice? (Just for the sake of discussion, the way to go about it is to call a plastic surgery/very experienced gyn surgeon consult, debride, reconstruct, and only then suture the area.) Also, what happened to Dr. X?
*I’m assuming Mohamed = pt. since she’s the only one who can consent to treatment.
3) When she saw his stitch, the midwife, Aimma Ali, said it was illegal and spoke privately to Dharmasena. He consulted the on-call consultant, Vibha Ruparelia, and explained that he did not know the stitch was illegal.
There is no question that Dr. D knew that the stitch was not medically indicated. Yet he does not consult the on-call attending on the procedure, only its legality?
4) The consultant said it would be too painful and humiliating to remove the stitch, and it was left in.
Even if we assume that the original incisions, delivery, and suturing were done without local, the attending is unaware that analgesics are available in the hospital? As to “too humiliating” I’m assuming it means against the pt’s wishes. In which case is the attending unaware of the physician’s responsibility to explain the risks and advise and guide the pt. to a medically beneficial decision?
Ugh, my bad:
Dharmasena, 32, is charged alongside another man, Hasan Mohamed [not a medical professional], 41, who is accused of aiding and abetting the doctor. Both men deny the charges.
OK, consider me gobsmacked that Dr. D allowed Mohamed to direct treatment.
Also, this:
In a statement as part of an internal hospital investigation, Dharmasena said: “I was not entirely sure how to repair the anterior midline incision. The cut edges were very small containing scar tissue and had minimal bleeding.”
To orient you, this paper (pdf and possibly NSFW) has a very good illustration of the various types of episiotomy incisions, including a brief discussion of deinfibulation (anterior incision).
My guess
Hasan Mohammed is the patients husband although I doubt that the marriage has been registered in the UK as that would not suit the husband , also the patient probably speaks very little English so it was left to Mohammed to translate her wishes.
and from the Guardian
“The woman refused to provide a witness statement to the police”
Why is it that when vunerable women are trafficked from Eastern Europe for sex its considered a crime but when they are from Africa we are expected to tolerate it?
Like ema above, I’m finding myself distracted by the claim that they “discovered” the FGM when she went into labor. Huh? Hadn’t they done a physical exam? Didn’t they have her records in the system? I’ve given birth twice and in both cases, my OB/GYN had sent my records to the hospital well in advance.
Nobody should have been assuring the midwife it was fine, there should have been numerous physical exams in advance of the birth, along with a written plan for how to handle the mutilation, if it wasn’t surgically opened beforehand. (Which it should have been!)
It sounds to me like there was enough medical malpractice to go around. Unbelievable.
However, yes, I’d much prefer to see a cutter prosecuted. This dude screwed up but it’s going to be difficult to tell how much was malice and how much was stupidity.
It’s got to start somewhere. Setting a precedent and making it known there’s zero tolerance might make the next one hesitate to do it. And the publicity might make women at risk more aware of their rights, more aware that they have the right to demand protection from their families and from religion.
Just regarding the physical exam – I’m not sure what standard practice is in the UK, but I’ve had midwives for two pregnancies (in Canada) and it isn’t unusual for no vaginal/internal exam to be performed until the patient is actually in labour.
Really??? That seems extremely…surprising.
According to several sources Hasan Mohamed is the husband. But why is there absolutely no mention or concern expressed anywhere about what the woman actually wanted? or about what she wants now with regard to the prosecution?
I shuddered a the line: ‘concerned about the baby, he made two cuts…’
Well, yes, the delivery was obstructed by scar tissue left from previous mutilation, and only partly cleared by some sort of slashing in 2011. But where the hell was his concern for the primary patient?
And was the whole medical situation ‘kaffir-rein?’ Was anyone who wasn’t an Initiate, like, just a real doctor without an ideological investment, anywhere in sight?