The death of a baby after a home circumcision highlights new problems, writes Nuala Haughey, Social Affairs Correspondent
Ebong Obot brought his only son from Ireland to have him circumcised at a private clinic in London when he was three months old. For the Nigerian-born father of five it was a matter of both tradition and pride. His heir should be circumcised just as he had been, and his father and grandfather before him.
Faced with a lengthy wait to have the procedure performed at Temple Street Children's University Hospital, in Dublin, Obot voted with his feet three years ago. He did not explore the option of having a backstreet operation, a choice tragically made by the parents of Callis Osaghae, the month-old boy who died in Waterford this week.
"We sought to have him circumcised in Temple Street, but they said the waiting list was one year, and from our tradition it's more painful the older the kid becomes," says Obot, who has worked in Ireland for four years and now runs Global Sourcing recruitment company.
In most parts of Nigeria cultural tradition dictates that young boys be circumcised in the first few weeks of life. "It's like bringing the boy into manhood immediately, initiating him into society. It's our tradition, and there's no way you can stop that."
In his native Akwa Ibom, a state in the south of the country, it would be "a shame to the family and a shame to our culture" not to have the procedure performed. "It's a taboo. They would look at you as an inferior person for not being circumcised. The girls would run away from you."
With hindsight it is easy to say that Callis Osaghae's death from blood loss following a botched home circumcision was an accident waiting to happen. Doctors in the South Eastern Health Board region expressed concerns earlier this year about the lack of a service at Waterford Regional Hospital for parents requiring male circumcisions on religious or cultural grounds. The hospital, where little Callis died in the early hours of last Monday, circumcises males only on medical grounds.
Africans began arriving in Ireland in significant numbers in the late 1990s; it was inevitable that they would import their cultural practices.
An estimated 30,000 Africans live in Ireland, up to 20,000 of them Nigerian. Nigerians have accounted for more than a third of asylum-seekers in recent years, with some evidence of "chain migration" from parts of the country. Nigerians and other Africans have formed churches and opened food and hairdressing shops to cater for the communities' demands for goods and services.
It is natural for immigrant communities to cling strongly to their traditions, including, for Nigerians, circumcision of their infant sons. Circumcision of males on cultural grounds is widespread in many African states, although the age at which it is traditionally practised varies.
It has been known for years that Ireland's African communities have occasionally resorted to a self-help approach to ensure their young male children have access to the procedure. As far back as 1999 there were reports that a man from England held impromptu clinics in a rented room in a Dublin hotel.
"It came up in discussion with a women's group that other women were bringing their children in to get them circumcised and he was charging £50," recalls Sister Breege Keenan of Vincentian Refugee Centre in Dublin. "At the time I was encouraging pregnant women to go to Temple Street or check it out with the maternity hospitals."
P. J. Boyle is a community nurse and member of the health and development group of Comhlámh, an organisation of returned development workers that lobbies on transcultural health issues.
"A number of women from Nigeria and other African countries have said to me that they thought circumcision was illegal in Ireland, that it wasn't possible to have it done," he says.
"They wouldn't be familiar with how to access a safe circumcision. It's something they didn't have a chance to discuss or were fearful of discussing with healthcare professionals, who they see as part of officialdom."
In the parts of north inner Dublin where many Africans live, community nurses visiting mothers and babies had noticed that sons had been circumcised and that the parents were nervous when questioned about it, according to Boyle.
The nurses have responded by establishing clear procedures to refer parents to Temple Street, one of three hospitals in Dublin that perform increasing numbers of circumcisions on religious or cultural grounds.
The nurses have also produced a leaflet informing parents that male circumcision is legal and warning that having it done by a non-medical person outside a hospital or clinic could endanger a baby's life. The brochure emphasises that a safe circumcision is more important than one performed soon after birth and that it is not more painful for older children.
The Health Information Programme is a Dublin-based peer-led service aimed at bridging cultural gaps and offering a sort of orientation to asylum-seekers about health services in Ireland. Its three outreach workers visit asylum-seekers in Dublin reception centres to give information about medical provision through adult-education material such as colourful laminated story cards.
The co-ordinator of the pilot project, Lisa Mauro-Bracken, says the multilingual information officers started including material about male circumcision after receiving queries from expectant mothers and fathers. "It's important for the medical services to understand that people have different practices and come up with solutions about how do you maintain some of the traditional ritual but ensure that it is done safely by medical practitioners rather than somebody just out to make a quick buck," she says.
Little Callis's death has been a wake-up call for health services around the country, highlighting inconsistencies in provision.
The Department of Health and Children yesterday announced that the chief medical officer is to chair a national group on "matters regarding circumcision". The group will include representatives from health boards, the Department of Justice, Equality and Law Reform and ethnic-minority communities.
"They will look at things like the need to have a standardised service, when it is best to carry it out and best practice in the area. They will look at international practice and try to come up with standardised guidelines on it," says a department spokesman.
Immigrant groups welcome this effort, but they warn that young females are at risk of circumcision in some African groups. Boyle says the Comhlámh group has had inquiries from public health nurses who have been approached by mothers who want to know where their young daughters can have the procedure, also known as female genital mutilation. "Hopefully we are not looking at a situation down the road where it is a little girl who dies," he says.
Akina Dada wa Africa, or Akidwa, an African women's network, has united with Comhlámh in lobbying for the outlawing of female genital mutilation in Ireland. "We have heard of people who travelled from Ireland to England to have it done because it's being practised there," says Salome Mbugua of Akidwa. "If they are travelling and it's kept quiet and there's no legislation, then it could end up happening here in Ireland and be very hidden."
Ebong Obot would also like change. "I would be very happy if something could be done so that this thing doesn't happen again and people don't have to go underground. If people know that they can go and get it done here, they wouldn't go through that stress."