Sunday, September 27, 2020

Foreskins lie at the heart of a storm

It was, in the end, much more than the classic tempest in a teapot. Recent media reports had cast the spotlight on an issue that was unsettling Ministry of Health officials. As the story broke, the matter provoked labels ranging from “unethical” to “questionable motives”.

After it emerged that the drive to keep safe male circumcision ticking over had gone awry over the issue of disposal of foreskins, there was an expected rush to pinpoint the scapegoats. Ministry of Health officials met the issue with studied denial, shrugging off knowledge of “any allegations of malpractice concerning circumcision in particular concerning foreskins”.

Some unscrupulous officials in the ministry have allegedly been selling the foreskins to traditional doctors. It is an allegation that has been denied by both the ministry and the Botswana Police. But according to media reports, some traditional doctors confirmed buying foreskins from officials in the ministry.

The tap dancing over male circumcision and foreskins goes to the heart of a lucrative international trade in foreskins, which presumably have traditional medicinal benefits. Those involved in selling them do brisk business in peddling these body parts that have found use in bio engineering, cosmetic engineering, among others.

Male circumcision has been going on for many years and involves the removal of the foreskin which is primarily used to cover the tip of the penis. It is encouraged that infants be circumcised during the first two days after birth. It is an extremely painful surgical procedure requiring local anaesthetic to curb this pain. Usually the prerogative of the parents in cases of minors and that of individuals once they are adults, circumcision is a voluntary procedure.

It is not significant enough to be recommended as a routine procedure therefore not particularly medically necessary. However the Ministry of Health has embarked on a nationwide campaign in a bid to promote safe male circumcision in aide of reducing transmission and infection rates of HIV and Aids in an already hard hit Botswana.

Cosmetic technology has come up with peculiar innovations like the usage of fish scales in manufacturing lipstick, cow placenta in anti ageing creams and crushed cochineal (scaly) insects in the manufacturing of hair shampoo. The emergence of the utilisation of the foreskin for the restoration of youth in the ageing population when used to manufacture high end anti ageing ointments therefore did not come as a shock.    

After circumcision process, scientists are then able to harvest cells known as the fibro blasts which are then nurtured and are given months to grow and multiply in laboratories. These cells can either be put on the skin in the form of ointments or injected as part of a concoction. The cells will then either produce collagen, hyaluronic acid and elastin (which build and reinforce it) or they make enzymes called metalloproteinase which ultimately break down excessive tissue which causes the skin to wrinkle.

This procedure has raised a number of ethical issues which have so far been blind sighted by monetary benefits since one infant’s foreskin can generate up to $100┬á000 USD.

In a less controversial medicinal use, after circumcision, the foreskin can also be used in the skin grafting process for victims of burn, diabetic ulcers and large area open wounds. The Fibroblast cells in this instance are used for the creation of “Bio- skin” which acts as a real skin band aid. This usage has been extremely successful since it reduces recovery time and prohibits re infection of the wounds by preventing entry of external infections which could delay the healing process.┬á It is ideal to use the foreskins of infants in this process because they are extremely flexible and are less likely to be rejected by the patients.

“It is easier to transplant internal organs like the heart and kidneys from one person another,” says local dermatologist, Dr Stasoje Radovanoich. “Skin on the other hand, is extremely sensitive and it would require a lot of tests and drugs to ensure that the recipient does not reject it.”

Radovanoich says that it is much wiser and easier to use one’s own skin when performing grafts rather than from another person.

The other use for foreskins which may get the approval from the Society of the Prevention against Cruelty to Animals (SPCA) is when pharmaceutical and cosmetic companies part with a lot of money to purchase foreskins to use them for testing whether products are safe for human use and or consumption. A number of protests around the world have occurred condemning the use of animas with similar properties as human beings for testing of beauty and medicinal products. Foreskins are said to be the better testers since they are human skin and therefore will provide more accurate results unlike animals which are merely similar to human beings.

Foreskins are generally classified as pathological waste which includes body parts, organs and blood from surgeries and blood banks and are supposed to be disposed of through either cremation in furnaces or burying the waste.

Although in Botswana the scare surrounding the sale of the foreskins is still confined to the belief that they are used by traditional healers, there is a whole multibillion dollar industry out there which also requires the purchasing and reconstruction of the foreskins.

However the Ministry of health remains adamant that the public should remain calm and continue with the safe male circumcision campaign.┬á “The ministry urges the public not to be discouraged but see circumcision as Governments effort to reducing the spread of HIV and AIDS. In light of the above, all eligible males are encouraged to come forward and undergo circumcision with knowledge that high standards of practice and ethics are maintained at all times,”┬áa statement from the ministry read.

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Sunday Standard September 27 – 3 October

Digital copy of Sunday Standard issue of September 27 - 3 October, 2020.