Tag: medicine

THE CUTTING, THE VIRUS, THE FISTULA

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Joyce Sunday
Staff Writer

I can never forget the girl, how the women held her down with the sharp blade ready to cut off her female genitalia, and her innocence. As the blade started coming towards her direction, she began to struggle, cry, and scream. All those tears fell on the deaf ears of the women strongly holding her down, spreading her legs wide open. I couldn’t watch, so I left the room, though her shouting pain echoed in the silence. After a few minutes, she was taken out of the room by her mother, her legs tied. She had been abused, but now was rewarded with gifts because the experience had made her a woman. This was the first time I ever experienced the female genital cutting, or rather what my society will call the “womanhood initiation ritual” of a five-year old Nigerian girl.

Female genital cutting is the “partial or complete removal of the clitoris”, or inflicting of other injuries to the female genitalia. Girls are often subjected to cutting before they reach the age of puberty, though cutting still may occur anytime between puberty and marriage as well. There are three major types of female circumcision: type I is the clitoridectomy, type II is the excision, and type III is the infibulation. The clitoridectomy involves either the partial or whole removal of the clitoris organ. The excision type is the partial or whole removal the clitoris organ, as well as the inner labia, which may be accomplished with or without removing the labia majora. The infibulation, which narrows the vaginal opening by creating a seal, is the most severe type of female circumcision and is performed by cutting and repositioning the labia. After this procedure the two sides of the vulva are stitched together to cover the urethra and prevent continuous bleeding.

In most countries circumcision practices are performed by untrained operators who have limited understanding of the female anatomy, and also often lack surgical skills. The clitoris has about eight thousand sensory nerve endings, and it is located at a very sensitive neurovascular area of the female genitalia. Any attempt to remove or alter a tiny amount of tissue can cause serious medical and physical problems. Certain medical complications like severe pain, prolonged bleeding, and hemorrhage can cause death or immense shock for the victims of female circumcision. In some cases, while the victims are still alive, prolonged bleeding can cause severe anemia which can affect the development of the girls. Some infections such as tetanus, ulcers, septicemia and gangrene have been encountered after the circumcision procedures as well. In third world countries especially, unexperienced operators perform surgery with unsterilized instruments, leading to the spread of the human immunodeficiency virus, Hepatitis B and other blood transmitted infections. The infibulation is the most severe type of circumcision, and can cause long-term health complications because it affects urine drainage, as well the flow of the menstrual blood through the vagina. Pelvic inflammatory diseases that arise from infibulation can lead to infertility, pelvic pain and painful periods (dysmenorrhea). Yet another medical condition that can arise from circumcision is keloid formation, which may cause pain, itching and disfigurement of the female genitalia.

Intercourse, pregnancy, and childbirth can be more difficult for circumcised women. Female genital cutting reduces the size of the vagina, making it difficult for its victims to have sex, or give birth, without being in pain or having their genitalia skin ripped apart. During birth, the head of the fetus may be impeded by the stitched up area of the genitalia, resulting in intense contractions that can cause perineal tears. When the woman has a weak contraction and the delivery of the baby’s head is detained, the fetus may die. This may additionally result in necrosis of the genital septum, which is the separating of the bladder and the vagina, ultimately leading to vesicovaginal fistula (VVF). Vesicovaginal fistula, also known as a type of female urogenital fistula (UGF), is a condition which allows the continuous discharge of urine without any control.

Female genital mutilation affects millions of women worldwide, and thankfully, a known reversible surgery exits. One by one, female genital circumcision survivors are being cut for a second time, but now to reclaim what they lost. The “defibulation” procedure, also known as female circumcision reversal operation, is not performed by many surgeons. Luckily, a select few doctors, such as Dr. Marci Lee Bowers of the San Mateo Surgery Center in California, is an American gynecologic surgeon that has performed this rare surgery on over one hundred patients. Most of her patients are women born in Africa, but now living in the United States. She was the first surgeon in the United States to ever carry out this reverse surgery. According to Dr. Bowers, after the reverse surgery, the clitoris is still found even in the worst cases of female circumcision. When the scar tissue is opened and the mutilation is reversed, the female genitalia can be restored, which will bring back the sensuality of the clitoris. Despite these efforts, there is still a need for more research and investment to provide additional surgical techniques that would be accessible to the victims of female genital mutilation.

Image by Jackson

BIOETHICS IN EBOLA CLINICAL TRIALS

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Mobile Ebola Lab in Guinea

By Alexandra Reich
Staff Writer

There are certain drugs that may successfully treat the Ebola virus that is currently epidemic in West Africa and has captured the world’s attention. Several experimental Ebola drugs are currently in production, with optimistic experimental success rates. One of them is ZMapp, created by Mapp Biopharmaceutical. It takes months to make a small dose, so this is not viable as a long-term Ebola treatment. A few other Ebola treatments are currently being researched by other pharmaceutical companies.

Now that several Ebola drugs may soon become approved for use in treating people in West Africa, world health powers are expressing conflicting views on how these are to be implemented. The World Health Organization (WHO) has approved the use of experimental drugs in the treatment of Ebola, with the patient’s informed consent. The long-term side effects of the under-tested drugs are not closely scrutinized when the short-term result may be a cure for Ebola. However, epidemiologists estimate that the supply of these experimental drugs is insufficient for the number of people estimated to be infected. Widespread distribution of trial drugs isn’t a viable option due to the barriers of cost and availability.

There is another issue; the U.S. Food and Drug Administration (FDA) is supporting the standardized clinical trial process for the experimental Ebola drugs, where one group receives the potentially life-saving experimental drug, and the other group receives a placebo. The placebo groups acts as a control, so that the scientists can observe an experimental drug’s effect while monitoring the results under the exact same experimental conditions without the drug. This system of study is widely accepted in the scientific community under less urgent conditions. However, with the death rate of Ebola documented as high as 70 percent, one has to consider the social constructs and morality issues surrounding Ebola clinical trials in the field. A clinical trial participant who is placed in the placebo group has basically been handed a death sentence by the scientific community, for the purpose of advancing scientific knowledge. In epidemic conditions, the ethics of medicine must be considered, in addition to scientific advancement.

How can researchers, in good moral conscience, give only half of research participants a life-saving drug? The WHO expressed concerns about both the morality and safety of having randomized-placebo clinical trials. Global health scholar Trudie Lang argues that this form of clinical trial implementation is unethical, and potentially dangerous for healthcare workers who would deliver life-saving drugs to only some patients. A clinical trial participant, knowing the placebo group likely means death, could act out in order to access the lifesaving drug.

This brushes against the larger issue concerning trust of foreign healthcare products and workers in African nations. Violence against foreign healthcare workers is not unheard of. In February 2013, nine people working in Nigerian polio immunization clinics were shot and killed by armed men. The implementation of standardized clinical trials in Ebola-impacted nations could result in similar mistrust that could lead to violent actions. If pharmaceutical companies conduct randomized clinical trials that intentionally leave a placebo group to face Ebola without treatment of drugs in the name of scientific advancement, Ebola-infected nations have every right to be skeptical. Any scientific research on the Ebola epidemic needs to be done with the consideration of moral standards first, and scientific advancement second.

Bioethics is frequently debated during epidemic outbreaks, especially concerning the responsibilities of developed nations. Wealthier nations are depended upon to provide research into new, and potentially life-saving, drugs. However, this does not rationalize a paternalistic position towards the impacted countries. Scholars argue that to alleviate concerns of exploitation of Ebola-impacted communities for scientific advancement, research teams should make contributions to improving their host communities, such as working to improve the local healthcare facilities. Efforts made by clinical trial researchers toward truly improving the Ebola-impacted communities may help to lessen any distrust of the researchers.

If given access to the resources needed to save lives, pharmaceutical companies have a moral obligation to give people access to these drugs. As noted before, widespread distribution of experimental Ebola drugs is not feasible because there is not a large enough supply. Considering the smaller numbers of people in clinical trials, there is no morally sound reason to keep the placebo group. While the furthering of scientific knowledge of Ebola is important, it should not be collected by means of human experimentation.

Image by European Commission DG ECHO

RHINO HORNS, GYPSIES, AND ASIAN MEDICINE: THE MEDICINAL BLACK MARKET

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By Rebecca Benest
Staff Writer

On April 18, Irish police found four rhino heads missing from a museum in Dublin. Although this may seem to be an obscure crime, the heads, when sold on the black market, are estimated to sell for $650,000 all together.

The rhino heads are not going to be used as a wall ornament. Instead, they will be harvested for their horns, which, in all likelihood, are going to be powdered-down and sold for their alleged healing properties. This type of crime has become increasing popular throughout the UK, with a large swell in robberies having occurred in 2011. Police have yet to make any arrests, but many link the crime back to a group of Irish travelers.

This incident is more than a museum robbery—rather, it is part of the reason for why rhinos are becoming endangered along with other commonly harvested animals, such as elephants. Beneath the surface of a successful museum heist lies a much larger-scale trade ring fueled by the large demand for illegal powdered horn destined for alternative Asian folk medicines markets.

The four missing heads are the most recent in a long line of similar robberies. In August 2011, “Rosie the Rhinoceros” was taken from Ipswich Museum in England. Rosie was only the most famous victim of the several similar incidents around that time, which, according to the European Police Office (Europol), all lead back to the same Irish traveller gang.

The robbery last week was different, however, which makes the situation all the more ironic. The National Museum of Ireland, which held the rhinos, were worried about the demand for the horns—and because of that, decided over a year ago to take the rhinos off of their original display and keep them in the less secure storage area. The lower levels of security in the storage spaces might have been a contributing factor to the success of the robbery.

The Irish travellers, also called the Pavee, or Gypsies, are largely accused for more than just taxidermist horn-napping. EUROPOL claims they are also heavily involved in drug trafficking, money laundering and other such crimes. They are also said to have a wide presence throughout South Africa, China, Australia, and much of the rest of the world . Nevertheless, nothing has been proven against them, and Martin Collins, a representative for the travellers at Pavee Point, insists there is no evidence. “I would suggest here that it’s downright irresponsible for Europol or anyone else to make these kinds of statements, unless they can be substantiated,” he said.

Collins’ statement is not unfounded, as police have previously jumped to conclusions in accusing the travellers of various crimes. They are subject to a wide array of prejudice and discrimination throughout Ireland and the rest of Europe, inciting further racial hatred of the group.

Personally, I am most intrigued by the question of the horns themselves: are their medical properties legitimate, or only an unfounded claim resulting in the potential extinction of an entire species? Although the powder is probably most often heard of for its use as an aphrodisiac, in reality, it is used for a variety of purposes. Meanwhile folk medicine very clearly does not include aphrodisiacal properties in that list. This list does, however, comprise of solutions to a wide array of troubles, including an antidote to poison, a sedative, a cure for typhoid, dysentery, smallpox, hemorrhages, drug overdoses and a charm to cure devil possession while warding away evil spirits.

Many of these properties are traced back to the fact that rhino horns are composed mainly of keratin, a protein with many sulfur-based amino acids, which can have a reaction to alkaline poison. This is probably what led to the claim that the horns can cure or detect poisons. In 1990, a study was done in Hong Kong, which found that the horn powder could alleviate fever in rats, but only in large doses, much larger than anything you would receive from a traditional medicinal specialist. Other than this, the claims are completely unproven, although they still pervade many Asian cultures.

Besides its medicinal uses, the rhino horns are hunted for other reasons. In Yemen, the horns are used to make the handles for Jambiya, knives coveted by Muslim men as a sign of manhood, honor, and devotion to their faith. The Jambiya handles are often intricately carved and studded with jewels as well.

More recently, a new use for the powder has been discovered and has gained popularity: a cure for hangovers. In Vietnam, the powder has become more expensive than cocaine, and is mixed with water to detoxify the body and prevent a hangover the following day.

Regardless of the potential or legitimate effects of the powder, rhinos are disappearing quickly and the killing needs to be stopped in order for them to remain as a species. A variety of measures, including bans and extensive security actions, are being enforced all over the globe to accomplish this goal.

One group, WildAid, uses familiar faces to spread their message. World-renowned basketball player, Yao Ming, is now seen among others on television screens and billboards all across China, hopefully making a change with this simple slogan: “When the buying stops, the killing will too.”

Photo by KitL Kat