Photo : Messenger
The heart-wrenching news of the sudden death of Ayaan, a vibrant and ever-smiling five-year-old boy studying at a private school, on December 31, 2023, sent shockwaves throughout Bangladesh. The country was plunged into deep grief upon learning that the circumcision procedure being performed on Ayaan at a private hospital in Dhaka had ended in tragedy. While the nation was still grappling with this horrific incident, another tear-jerking event occurred on February 21, 2024. Ahnaf, a ten-year-old boy, lost his life due to complications arising from his circumcision procedure at a different private hospital in the capital city of Bangladesh. According to news published in national dailies on February 21, 2024, Ahnaf's death was attributed to the administration of general anaesthesia instead of the appropriate local anesthetic. These two young lives, full of potential and dreams, were unexpectedly cut short as a result unsafe and inappropriate procedure during circumcision surgery.
In Bangladesh, circumcision has traditionally been performed by individuals known as "Hazam." These individuals, often considered experienced in performing the procedure, have been relied upon by many families seeking circumcision for their male children. However, there has been a recent shift as people have become more aware of the potential risks associated with circumcision, particularly the risk of post-operative infections. As a result, parents are now opting to have the procedure performed by surgeons in controlled medical settings such as hospitals or clinics. This change in preference is driven by the desire to minimize the chances of complications and ensure a safer and more hygienic circumcision experience for their children.
It is important to note that while complications from circumcision are generally minimal, they can still occur. These complications, such as bleeding, oozing, or local infections, are usually manageable and can be addressed with appropriate medical care. However, the growing awareness of potential risks has prompted parents to seek the expertise of trained surgeons who can provide a higher level of medical care and ensure a safer environment for the procedure.
By choosing to have circumcision performed by surgeons in medical facilities, parents aim to minimize any potential complications and provide their children with the best possible care during the procedure. This shift reflects a growing emphasis on prioritising the safety and well-being of children undergoing circumcision, aligning with the increasing awareness and understanding of healthcare practices among the general population in Bangladesh.
Unfortunately, what was once considered a routine surgery has now turned into a tragic issue, resulting in the loss of two promising lives. It is disheartening to note that these surgeries took place in hospitals under the care of doctors. Many of these doctors lack proper training and medical knowledge of circumcision, and they are performing the procedures without following the protocols for administering anaesthesia, primarily in unauthorised private clinics. This rampant practice is leading to fatalities that are increasing the child mortality rate in the country. In both cases, the use of complete or general anaesthesia instead of the appropriate local anaesthetic led to disastrous outcomes. The absence of thorough monitoring and management of vital signs by qualified professionals such as anaesthesiologists or licensed nurse anaesthetists may have played a significant role in these instances of medical negligence. Such incidents raise serious concerns regarding the improper use of anaesthesia from a public health standpoint.
The occurrence of these two tragic events within a short span of two months has created an atmosphere of immense anguish and apprehension among parents who have plans for their male children to undergo circumcision. They find themselves grappling with a profound lack of courage and confidence when it comes to subjecting their children to the circumcision procedure. Simultaneously, the children themselves experience overwhelming fear and anxiety surrounding the surgery. To illustrate the impact of these incidents, consider the case of a mother who had intended to have her six-year-old son circumcised in January 2024. However, upon witnessing the unprecedented news of Ayaan's tragedy, she now finds herself in a state of tension and indecision.
She is uncertain whether she should proceed with the circumcision at a hospital or opt for a traditional procedure performed by a Hazam. This unpleasant and uncertain scenario has become a matter of significant concern for both parents and the future generation that will require circumcision. Consequently, it has acquired a heightened level of relevance and urgency in terms of public health. While the government of Bangladesh has achieved remarkable success in reducing infant and child mortality through targeted policies and interventions such as early immunisation and providing vitamin supplements to infants and children, there is a risk of undermining this success if the issue of child mortality related to circumcision is not addressed.
In light of these tragic circumstances, two important concerns demand immediate attention: who will be the next victim, and what steps can be taken to prevent further deaths resulting from seemingly minor surgical procedures? In light of these considerations, I humbly request that the appropriate government authorities acknowledge the seriousness of this situation and begin formulating comprehensive policies and action plans to prevent future deaths resulting from circumcision surgical procedures.
Circumcision holds a strong religious significance for Muslims in Bangladesh and continues to be a commonly performed religious and cultural practice. Therefore, the government should prioritise the safety and well-being of children above all else. It is crucial to implement stricter regulations and guidelines for administering general anaesthesia during circumcision procedures, particularly in private hospitals and clinics.
This includes ensuring that only qualified and trained certified medical professionals, such as surgeons and anaesthesiologists, are allowed to perform the procedures of circumcision and anaesthesia, respectively. Additionally, proper monitoring and management of vital signs during the circumcision surgery should be mandatory to prevent complications and address any emergencies that may arise.
The government should also consider providing training and support to healthcare professionals, particularly those involved in approved private hospitals and clinics, to ensure they have the necessary skills and knowledge to perform circumcision procedures safely. This may involve developing standardised training programmes, conducting regular assessments, and implementing a certification process to ensure compliance with best practices and safety standards.
As two of the incidents took place in private clinics, it is of the utmost importance and has become an urgent requirement to immediately establish a specialist child circumcision unit in each and every government health institution, including the Upazila Health Complex. This dedicated unit should be manned by physicians and nurses who are qualified and talented in circumcision.
Public awareness campaigns should be initiated to educate parents about the potential risks associated with circumcision and the importance of choosing a safe and reputable healthcare setting for the procedure. Parents should be encouraged to ask questions about the qualifications and experience of the healthcare professionals involved, as well as the protocols followed during the surgery. This will empower them to make informed decisions and prioritise the safety of their children.
In conclusion, the tragic deaths of Ayaan and Ahnaf during circumcision procedures in private hospitals highlight the urgent need for comprehensive measures to ensure the safety of children undergoing such surgeries. Stricter regulations, enhanced public awareness, improved training for healthcare professionals, and available safe circumcision units in govt. hospitals are crucial steps that should be taken to prevent further fatalities and protect the well-being of children in Bangladesh. The government, medical community, and society as a whole must come together to address this issue and prioritise child safety in all healthcare practices.
The writer is an associate professor of development Studies Discipline, at Khulna University, and PhD fellow, at Lingnan University, Hong Kong. He could be reached at [email protected].
Messenger/Fameema
