4 May 2013

Tanzania: Medics Warn Against 'Kimeo' Cutting

MEDICAL doctors have expressed concern over the increasing habit of cutting off of uvula (uvulectomy) among infants and are calling upon the government to start a nationwide campaign to stop the practice.

Uvula (kimeo) is a small fleshy finger- like flap of tissue (epiglottis) that hangs in the back of the throat and is an extension of the soft palate. Muhimbili National Hospital (MNH) Senior Paediatrician, Dr Sulende Kubhoja, has told the 'Daily News on Saturday' that lack of knowledge about public health, especially in rural areas, was the reason behind continued practice (uvulectomy), which is dangerous to the children.

"Unfortunately this practice is not limited to rural areas but it is also practised in the urban centres. When children have prolonged coughs, fail to gain weight and have frequent diarrhoea, uninformed people attribute the symptoms to uvula. They believe that once the 'fleshy finger' is clipped off it ends the problem," he explained.

Another MNH Paediatrician, Dr Namala Mkopi told this paper in an exclusive interview that the task of conducting education, specifically for public awareness against the habit, should be carried out in a multifaceted approach involving medical experts, the media and policy makers for enactment of laws when necessary. He gave an example of Female Genital Mutilation (FGM), saying the practice had somewhat declined in the country after putting in place a legislation and serious advocacy.

"As for uvulas, the campaign should be conducted under similar zeal. Medical reports indicate that the problem is implacable," he observed. "The major challenge we face is lack of statistics due to limited number of research work done on the subject. However, a simple survey in hospitals under the assistance of medical experts can easily reveal the magnitude of the problem," he said.

The paediatrician said that uvulas were just like any other organ of the human body and like the last finger or toe; they had their importance in the functioning of the human system. He explained that the fleshy fingerlike tissue has glands that assist in swallowing of food and in the pronunciation of certain words. For example, the difference between singers whose uvula had been cut off and those who are not is so pronounced that one can notice the difference.

"As doctors, however, our concern lies more on the dangers involved in the actual cutting off of the 'finger' because from experience, I have personally witnessed children being brought in with diseases connected to the practice, heavy loss of blood and infections," he said. Dr Mkopi cited a case where a child was suspected to have contracted HIV after the cutting off but medical evidence showed that both parents didn't have the virus and no blood transfusion was carried out on the child.

However, he was explicit that doctors weren't 100 per cent certain that the cut caused the virus. The doctor said that it was sad that there were some people in the medical profession who thought that the practice of cutting uvula was not a serious concern, adding that unlike what many people believed, the practice wasn't only limited to rural areas but it was also rife in Dar es Salaam in areas like Kariakoo, Ukonga and Mbagala and people who conducted them were known.

Dr Kubhoja said that the three enemies of the nation that the late Father of the Nation, Mwalimu Julius Nyerere pointed out including ignorance, poverty and diseases are still the nation's enemies that the society should overcome to solve problems of the day. He said that when a child's uvula is cut off, the baby bleeds profusely and the blood goes down the throat often causing more complications or even death.

The child specialist said that the cutting off of the uvula was very common in African societies particularly in Somalia and Eastern Africa including Tanzania and that it was once practised in Asia but had declined significantly. According to the paediatrician the removed uvula piece is either discarded or used for traditional rituals as is the case with the umbilical cord depending on traditions and custom of a particular society or country.

"Evidence shows that in Tanzania, the regions where pastoralists exist tend to lead in this practice and I think it should be given the national attention like that of albino killings," he said. He said that he considered himself lucky to have escaped and attributed the escape to knowing doctors at MNH and later working there. Ear, Nose and Throat expert at Muhimbili National Hospital, Dr Menrad Kahumba said that there was a need for the government to raise greater awareness and strongly condemn the practice.

Dr Kahumba said that some societies attributed impotence and infertility to the presence of uvula and many traditional healers prescribed the cutting of the tissue as medication."I concur with other doctors on the need to raise awareness. The government and other stakeholders should work together to stop this as unsterilised instruments used for clipping off the ovula risk other people's lives," he lamented.

According to the Pan African Medical Journal, an article published on the subject in 2012 pointed out that about 96 per cent of children in Mkuranga District, Coast Region had undergone uvulectomy, a bad practice of cutting the child's uvula (epiglottis), when a child has prolonged fever and cough, thus leading to severe anaemia due to excessive bleeding and consequently death.

The study, entitled "integrated community based child survival, reproductive health and water and sanitation programme in Mkuranga District, Tanzania: A replicable model of good practices in community based health care," was conducted by the African Medical and Research Foundation (AMREF).

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