Gambian gynecologist Dr. Babanding Daffeh last Wednesday presented evidence to lawmakers in Banjul showing Female Genital Mutilation/Cutting (FGM/C) is harmful.
Dr. Daffeh who works at Kanifing General Hospital (KGH) was among guests invited for a consultative meeting with the National Assembly Joint Committee of Health and Gender on the Women's (Amendment) Bill 2024.
In a power point presentation, Dr. Daffeh took the members through the female anatomy and shown them pictures of survivors of FGM/C in The Gambia who needed operations as a result of complications of the practice. Some lawmakers weren't at ease with the visuals portrayed.
Daffeh said he attends to pregnant women and he has conducted over three thousand surgeries in this country, both caesarean sections and other surgeries--75% of these cases are women.
Sharing his opinion on the subject matter, Dr. Daffeh said people tend to compare Type 1 of FGM/C to male circumcision, but they are not the same. He said what is cut on men is the hood that covers the glans penis and not the gland itself which is compared to the clitoris of women.
"The function of the glans penis is for what? It's a sensitive area. It gives feelings to men. It is compared to the clitoris. And there is something that we call the prepuce, we call the hood that covers it. That hood is the one compared to the prepuce of that of man. So what you cut in a man and what you cut in a woman's clitoris is not the same.
"It is compared to the hood that you cut. In fact, there is a medical indication for that. Some women will have an overgrowth of their hood, we call the prepuce. And they do what we call the hoodectomy, the clitoral hood reduction. Because it covers the clitoris so the woman may not have the sexual desire that she's supposed to get. So you expose it. Also, it can harbor some dirt under. To avoid that, then you can trim it so that the dirt does not go under. If you look at that, it's more compared to that of the male. Because male also, what is harbored under can cause infection. So these are the comparisons.
"So what you cut in a woman's clitoris is a sensitive part equal to that of the glans penis. So it means that if we cut the clitoris, we can cut the glans penis of men also. For us to understand what is being cut in a woman. So this is the comparison. So that's why they said type 1 is compared to. No. If it is only attached to the hood or the prepuce of a female, then you can compare, but otherwise not," he explained.
Explaining further, Dr. Daffeh said Type 2 is the partial or entire accession of the labia minora with clitoris, while Type 3 is the infibulation.
"That is when you cut the prepuce; the clitoris. You also cut the labia minora and even the major. And what happened during this process? I have interacted with so many women. Sometimes when they cut, people think that they stitch. No, they don't stitch. All they do [was to] allow the blood to clot there. And they will allow the woman to bind her legs so that there is no wound drainage.
"And in fact, not only the herbal substance, I've interacted with some women who said tomato paste, sometimes it's been used. A girl confessed to me. A lady also confessed to me at the clinic. Tomato paste that is used for cooking, cannot be used to stop bleeding, cannot be used to seal somebody. But this is how it is," he said.
Dr. Daffeh also explained that Type 4 is the unclassified types of FGM--that all other procedures to the female external genitalia for non-medical purpose. He said this includes pricking, piercing, stitching, cauterization, scraping, introduction of corrosive or acidic substances, and "Taba". Taba is called snuff in English, which is a type of smokeless tobacco that is made of finely ground or shredded tobacco leaves. There are reports that some women use it on their private parts.
"I've interacted with women. They use "Taba" to make them tight. But according to this definition, even the use of "Taba" in this country is classified as the type 4 FGM/C because it's a substance. And with the aim of narrowing that orifice, that's the vaginal orifice, then it's a type 4 FGM/C," he said.
FGM/C Type Total Deliveries in Kanifing Hospital (January-April 2024)
Dr. Daffeh said they have a central register where they record all deliveries. He said the total delivery they have seen from January to end of April amounted to two thousand and seventeen (2017).
"Type 1 FGM/C accounts for 392. That's 19.40% of what we registered. So FGM/C type 2 accounts for 1,163, that's 57.70% and FGM/C type 3 accounts for 101, that's 5%. And non-FGM/C accounts for 361, that's 17%. So this is the picture for this short duration," he revealed.
"So I'm wondering, in the previous year, when we had about 6,917 deliveries in our labour ward and then 2,885 admissions. So if we can have this picture, that we have type 2 FGM/C. I'm not talking about the "deen" (Islamic religion) here. But I'm worried whether actually that is the Sunnah, the type 2, cutting that whole of that from our definition. That is too much from what we registered."
11 FGM/C Case Studies Dr. Daffeh Recorded
Dr. Daffeh had dealt with FGM/C cases before but didn't record them. He has since started recording the cases when the debate on the matter heats up this year and they sum up to 11.
"These cases are not from anywhere. They are from Gambia, and nobody attended to them. It's me personally. I don't rely on anybody's record," he affirmed to the lawmakers.
CASE STUDY 1
An eye witness death-related FGM/C registered in 2015, a young girl of 5 years old. She was brought to Kanifing General Hospital while I was on duty. According to the relatives, she was circumcised a day prior and bleeding could not stop. She bled the whole night and by the time they arrived at the hospital the girl was dead. She was paper white pale with no sign of life. She was confirmed dead. In this case, the girl went into shock as a result of the sudden loss of blood due to continuous bleeding which led to her death.
CASE STUDY 2
A young lady who was in labour. A primip gravida. On examination, she had type III FGM/C with pinhole vaginal opening which could not allow any vaginal assessment. She was taken to theater for C/Section and de-infibulation of the type III FGM/C.
CASE STUDY 3
In my clinical practice and in 2010, while I was on duty at EFSTH, a woman was brought from Basse. She had a urethral injury caused by a circumciser who allegedly performed a procedure on her genitalia due to recurrent infection. She developed iatrogenic fistula which made her incontinent. She later had to undergo medical surgery to repair the fistula.
CASE STUDY 4
17 years old who presented herself on 14th of March 2024 on account of (type II FGM/C). She got married but the husband could not penetrate her. De-infibulation was done on her under local anesthesia. She was prescribed some antibiotics, analgesic and vaginal gel for lubrication to ease subsequent penetration.
CASE STUDY 5
28 years old who was presented on the 23rd of March 2024. She got married but the husband could not penetrate her for 3 days. She was type III FGM/C. She consented and was taken to the theater for de-infibulation under general anesthesia. She was given antibiotics, analgesic and vaginal gel to ease further sexual engagement.
CASE STUDY 6
2 years/6 months baby who was brought by the mother on account of difficulty passing urine and pain during urination. On examination she has type III FGM/C. She was taken to the theater on the 2nd of April 2024 for de-infibulation under general anesthesia. She was given antibiotics and analgesics.
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CASE STUDY 7
6 years old girl, presented herself with a painful circumcision scar (clitoris neuroma), and some difficulty passing urine. She was type III FGM/C. She was taken to the theater on the 14th of April 2024 under general anesthesia for de- infibulation. She was given antibiotics and analgesics. She was seen on follow ups.
CASE STUDY 8
21 years old who presented on the 16th of April 2024 an account of difficult sexual penetration. She was type III FGM/C. She got married but the husband could not penetrate her. She was de- infibulated under local anesthesia. She was given some antibiotics, analgesics and vaginal gel for further sexual consummation.
CASE STUDY 9
23 years old lady presented herself with FGM/C TYPE III on the 20th of April 2024. She got married but had difficult sexual penetration. Under general anesthesia, she was de- infibulated. She was given some antibiotics, analgesic and vaginal gel.
CASE STUDY 10
31 years old lady presented herself with history of difficult penetration. She was TYPE II FGM/C. Under local anesthesia, she was opened on the 30th of April 2024. She was given antibiotics, analgesics and vaginal gel.
CASE STUDY 11
30 year old presented with one month history of difficult and painful sexual penetration. However on examination she has normal external genitalia with type 1A circumcision. She was counselled and was given assurance. Vaginal gel was prescribed for her.
Dr. Daffeh concluded that as far as FGM/C is concerned and based on his clinical experience, the harm far outweighs the benefit.
"So should we wait for every Gambian woman to have this and to say FGM is bad?" he quizzed.
