'Make home circumcision illegal'
Following the death of a baby in Manchester after a home circumcision a mother has called for mobile circumcision services to be banned.
The trial of nurse Grace Adeleye who carried out the circumcision on Goodluck Caubergs heard that up to three children a month are admitted to the Royal Manchester Children's Hospital because of bleeding after home-based circumcisions.
Adeleye was found guilty of the manslaughter of Goodluck by gross negligence by a jury at Manchester Crown Court on 14 December.
Manchester-based solicitors JMW are currently investigating a separate case of a family from West Sussex who claim their son was left in "excruciating pain" after a home circumcision.
The doctor involved in the case said the redness and swelling her son experienced was a normal part of the healing process.
The mother said she had arranged for her son to be circumcised at home because she did not live near to a clinic that offered the procedure.Trusted the doctor
Explaining why she wanted her son circumcised, she said: "I found a mobile circumcision doctor on our local mosque's website.
"My husband is Muslim and proud to be Muslim and our children are Muslim too.
"We put our trust in the doctor, going to a clinic would have involved a lot of travelling but it was because he is a doctor that swung it."
She said the doctor visited their home in September when her son was aged 22 months.
Circumcision in the UK
- Most circumcisions in the UK are done for non-therapeutic reasons (religious). The operation is usually done under local anaesthetic or without anaesthetic soon after birth
- Medical circumcision is more commonly done on older children and adults
- The Scottish government has agreed that religious circumcision can be carried out under general anaesthesia by trained paediatric surgeons at one of four paediatric centres under the NHS
- Currently no formal qualifications are required to perform the operation
- Jewish boys are circumcised when they are eight-days-old by a Mohel - a Jewish person trained in the practice of brit milah, the covenant of circumcision. Mohel's are often, but not always, qualified doctors. Most Muslim boys and some Christians are also circumcised as babies. There is no equivalent of a Jewish Mohel in Islam or Christianity with procedures usually carried out by doctors
- Religious circumcision is largely unregulated in the UK - but medical professionals who have botched private operations have faced sanctions from the GMC
- Some medical experts have called for religious circumcision to be offered on the NHS to minimise the risk of post-operative complications
About five days after the circumcision she said the swelling on her son's penis started increasing and he was in "excruciating pain".
She said she took him to her GP who prescribed antibiotics for an infection.
The mother said she contacted the doctor who performed the circumcision who said she should wait three weeks for the skin to heal.
Her doctor said: "In my leaflet and at the time I went to do the circumcision I did explain redness and swelling is normal in healing, that it will go away in two weeks but it can happen."
He said he did not think there were any complications arising from the procedure.
The mother said she took her son to a paediatric urologist who she said told her not enough skin had been removed and her son would require surgery to remove some skin and a granuloma which had formed to prevent deformity as he grew up.
"I've been left with a child who refuses to have his nappy changed, who screams if you go to touch it [his penis] and he needs surgery to fix it," she said.
She said she would like mobile circumcisions to be made illegal and better signposting from GPs to private clinics for parents who want the procedure.
But her doctor said a clinic is no more sterile than a home environment.
He said: "It's not illegal or unethical to do it at home.
"I use a one-use pack of sterile instruments. An operating theatre has special ventilation to make it sterile but a clinic doesn't."
Melissa Gardner, a specialist medical negligence solicitor at JMW, said: "Given the impact on their child, the family has significant concerns about the way the procedure was conducted.
"While it is too soon to know what the long-term effects will be, this case highlights the need for extreme care when performing circumcisions."
The mother said she has also referred her case to the General Medical Council.
While circumcision is available on the NHS in England for medical reasons different primary care trusts take different stances on whether or not to commission the service for their communities.
In Chadderton, where the family of Goodluck Caubergs lived, NHS Oldham only funds circumcisions for medical reasons.
But the trust recommends an accredited private provider based at Glodwick Primary Care Centre in Oldham, where people can pay £100 for male circumcision for religious reason on infants aged between one and six months.
One trust which does offer the procedure is NHS Tower Hamlets.
The London trust charges a fee from £120 depending on the borough of residence and that the baby is "fit and well" and aged from six weeks to five months.
In general the Department of Health maintains that NHS circumcision should be carried out only for medical reasons, not for ritual or cultural beliefs.
But a department spokesman added: "However, PCTs are responsible for commissioning services to meet the health needs of local communities.
"In some areas, particularly where they feel children are at risk from unsafe procedures, PCTs do work with local providers and communities to ensure that a safe service is available."'No record'
In 2010 senior doctors urged the NHS to offer circumcisions to avoid botched operations.
A study into circumcisions performed at an Islamic school in Oxford found that 13 out of 32 boys who had the procedure suffered medical problems.
Paediatric surgeon Simon Huddart said the British Association of Paediatric Surgeons (BAPS) and the British Medical Association have issued guidance on circumcision.
He said: "It shouldn't happen in a home. BAPS guidance says it should be in an operating theatre or an appropriate environment for a child.
"An appropriate environment should be clean with good lighting and sterile instruments - I can't believe you could achieve a sterile environment in a home.
"A range of complications can occur outside hospital but that's not to say you don't have complications in hospital as well."
Glen Poole, strategic director of The Men's Network, a charity which aims to improve men's health and education in Brighton and Hove, writes a blog about the issues raised by male circumcision.
He said people need to talk about male circumcision to help inform the debate about when it might be deemed "unnecessary".
"Some people think it should only be done in a medical setting, others think it should not be done at all without a strong medical reason or the child's consent," he said.
"Our first concern is that there is no record of how many are performed in the community and the level of complications," he added.
"We only know if they turn up in hospital so at the very least I would like to see a register and a ban on the procedure being carried out by non-medical people."