How govt foots the FGM bill

News  Nation Weekend Magazine (Nairobi, Kenya). Friday, 5 July 2002.

Kenya: Government health insurance pays for FGM

Just four months after Kenya made it illegal to circumcise girls, one can still take a daughter or sister for the operation and earn Sh1,000 from the government for it.

Female Genital Mutilation has moved from traditional circumcisers to the clean and sterile minor theatres in recognised Kisii hospitals, performed by trained nurses. The cost of the operation is almost uniform in all the hospitals and clinics, but working parents get the fairest deal as their children are admitted to the wards with pretentious illnesses, and the  External link National Hospital Insurance Fund foots the bill.

The operation costs Sh500 and admission per day ranges from Sh350 to Sh500. NHIF recognises these hospitals and gives a rebate of Sh800 per day. A parent who takes his or her daughter for the operation and lets her stay in a hospital bed for five days can collect a Sh1,000 gift on the child's discharge - the cost having been covered by the government.

During the school holidays, girls flood the hospitals and stay in the wards for two to five days, depending on the wishes of their parents.

On the day of discharge, a parent, usually the mother will pick up the child, explains an administrator at one of the hospitals.

Badly kept secret

Circumcision of girls in the hospitals of Kisii District is not a secret. A parent or guardian who wants a daughter circumcised will only need to inform the nurses in charge - and it is over and done within minutes.

When the NHIF officials visit the wards, we insist that the girls are unwell so that their stay here is paid for. We also ask the girls to say the same if asked by the officials, says a nurse at another hospital.

The Hospital Insurance Fund's area manager, Mr Mark Chepkweny, says NHIF does not sponsor FGM in hospitals. We are aware that circumcision of girls goes on in December and during that time, our inspectors, both male and female, are more vigilant.

But if the medical staff do not tell the truth about the ailments of their girl patients, it is difficult for officials to establish what they are paying for.

This, however, will not continue for long, says Chepkweny. NHIF is about to establish a quality control department to include paramedics, whose knowledge will be useful in studying patients' conditions and deciding whether it is necessary for one to be admitted for the number of days being claimed.

For now, once the bill is paid, the new initiate's mother buys the child a new dress and shoes, then takes her home to muted celebrations. There will be no song or dance like it used to be. Before, circumcision heralded celebrations in the village and there was plenty to eat and drink when a child crossed the biggest hurdle into adulthood.

Knowing it is illegal to have girls circumcised is forcing the celebrations underground. The parents probably just want to fulfil a cultural requirement, says a teacher in the area.

Campaigners against female genital mutilation have been arguing that the danger of HIV/Aids infection posed by circumcising girls using unsterilised equipment made the practice dangerous. Now, with qualified health professionals carrying out the operation in homes and hospitals, that argument is becoming null and void. It also takes the fight back to Square One.

Julie Maranya, one of the activists fighting FGM in the area, says it is difficult to eradicate the practice as it has been commercialised by medics.

Our work has seen traditional circumcisers down their tools but circumcision of girls goes on in hospitals. It is no longer culture that is influencing it but the greed for money by these medical practitioners, asserts Julie.

No harm seen

Some medical practitioners do not see anything wrong with circumcising girls. Apart from the increased revenue for their private hospitals and clinics, the practice ensures the health workers' continued acceptance from the larger community for upholding tradition.

The nurses who organise with parents to circumcise their daughters privately in homes are happy for the extra income.

It is the culture of the people and if that is what they want done to their daughters, we grant it, argues a nurse. Although she says she will not have her daughters circumcised, she sees nothing really wrong with the practice.

It's a minor incision and after they are bandaged, they quickly heal. In fact, a few hours after the operation, you see the girls jumping up and down, she confides.

They tell us that we will have long painful labour but I haven't met a person who said they delivered children without labouring. But I know many people around here who delivered on their own while doing shamba work, explains Mongina Onsase, a family planning field worker.

She will not allow any of her sons to marry a woman from the tribe who has not undergone the rite but can tolerate a daughter-in-law from the four communities that don't practice FGM in the country - Luo, Luhya, Turkana and Teso.

At the Kisii District General Hospital, circumcision of girls is carried out under the pretext of admitting them for malarial or other treatment.

All that one needs to do to have his or her daughter circumcised is to explain to a nurse or clinical officer in confidence about what ought to be done.

In many cases, FGM is carried out without the knowledge of the doctors and hospital administrators. The number of patients admitted to the hospital far outweighs that of doctors and nurses. Before a doctor does his rounds, he will consult with the sister on duty who advises him about the patients who need his attention. A doctor cannot see each patient - and the bulk are under the nurses and clinical officers.

With such a strain on personnel, it is easy for FGM to be carried out under their noses.

Hema Hospital response: Circumcision of girls in the hospital? Never. Boys we do, but girls never! In fact the sister-in- charge, who is my wife, gives lectures everywhere condemning circumcision of girls. And if you write that we do it here you must come with tangible evidence, we will take you to court! says the owner DrHezron Manduku.


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