Female Genital Mutilation. To the minds of thousands of human rights activists all around the world, it is, indeed a barbaric act in its most vicious way. Some say it is based on custom, while some shouts violation of human rights. The existence of a rather indistinct border between religion and custom makes confusion inevitable. Tolerance in Islam, agrees on restriction to severity, mentioning the mildest form and miniscule act of removing a segment of the skin from the female prepuce without harming or ceasing the female's rights to her daily life (sexual pleasures). It is mentioned, in one of Prophet Muhammad SAW hadeeth, who have passed by a women performing circumsicion on a young girl, that:

"Cut off only the foreskin (outer fold of skin over the clitoris; the prepuce) but do not cut off deeply (i.e. the clitoris itself), for this is brighter for the face (of the girl) and more favorable with the husband." [8] 

while some cultures, quite understandably,

carry out the ritual in its most extreme form as a must, to fulfill some of the intense traditional requirements in their culture (mostly africa and some parts of asia & middle east),

clitorodectomy and infibulation.

It is indeed, a difficult task to solve.

Customs and traditions are not merely beliefs one can choose to ignore over sudden NGO mind-attacks and protests. Thousands of years in the making are radiating and screaming superstitious beliefs. So it is best to get into their minds and try to decipher the hidden meanings. We should ask ourselves, who are we to deny what is believed to be right to others? One of the stories goes like this: 

A female bomoh, performs female circumsicion (or in some countries, who obviously oppose it, calls it FGM or female genital mutilation) out of fear. Fear of death and fear of breaching the sacred tradition. The belief is that, when a child is born from an uncircumcised women's (those who haven't got their clitoris removed) vagina, her clitoris will 'travel' to her head, from her body, to her nose, up to her head. And she will die. So does her child. And family members.

So you see, while we agitate on the harshest and cruelest things that one can do to others, certain rituals that they perform in their culture, are in fact, the essence of their living. The reason of their existance.  A protective shield towards all sorts of evil they can possibly imagine. No force needed, just their pure surrender to what they believe in, discarding the possibilities of serious health problems (infection, infertility and even death)

So as medical doctors, or activist, what is the best solution we can offer?

Just this morning we had a lecture/panel discussion with dr Mahar on the role of environment, socio-economic background and beliefs in ones well being -- not just, medicine and drugs. It was an interesting topic, as these aspects of daily living can intimately affect the health, and heck, the life of a person.

Our first and foremost responsibility, is to treat and DO NO HARM to others-- the first pillar of bioethics, while taking into consideration the culture and background of the patient. Which contradicts with the next aspect of bioethics in some instances--autonomy. So dilemma occurs when there is a clash between beneficience to the patient and autonomy. Some religion prohibits blood transfusion, though how deadly the consequences are from not agreeing to the procedure. So how do we deal with this problem?

And it doesn't stop there,
A doctor should also consider the legislative law and acts relating to the required procedure. A quote from my lecturer: 

"apa yang baik tidak semestinya benar, dan apa yang benar, tidak semestinya legal."
.dr edy mulyono.

So friends, be prepared for the challenges ahead and expect the unexpected.
It might just not measure up to something we'd signed up for.

she left.

:'(