Sunday, October 9, 2011

FGM Female Genital Mutilation

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I am a physician outraged by the continuing genital mutilation of children in the US. Children born in the US are citizens of the US whether their parents are or not. Those children like it or not are protected by our laws and our customs not those of the immigrant. If the immigrant family obtains US citizenship, then that family has pledged allegiance to our flag and our laws. If citizenship is not the case, then such an illegal act of child abuse/assault justifies and demands immediate deportation.
I encountered only one of these cases of genital mutilation in my practice and that was enough. An adolescent Egyptian girl with dysuria had a large distended blader. I could not examine her without her aunt in the room. What we saw was unimaginable. Fortunately, the aunt was supportive. The patient had multiple urethroplasties with a fair outcome.  

We have a heavy burden of African and Middle East immigrants, most of who came here to escape violence in their own country. Committing more violence while here, is unacceptable. Some immigrants seek citizenship others not. In either case, justice prevails. The problem is the secretive nature of the act and the immigrants’ commitment to their own cultural tradition.

Eventually a physician will examine these children. The clear duty is to the child, not the family. The law demands that the physician report the crime to the police and child welfare.
 
Excuses given:
·         Custom and tradition: Communities that practice FGM maintain their customs and preserve their cultural identity by continuing the practice.
·         Women’s sexuality: In some societies, FGM espiers to control womens sexuality by reducing their sexual fulfillment.
·         Religion: While religious duty is commonly cited as a justification for the practice of FGM, it is important to note that FGM is a cultural, not religious, practice. In fact, while Jews, Christians, Muslims, and other indigenous religions in Africa, practice FGM, none of these religions requires it.

There is no room for dancing around some concept of other cultures or political correctness. The life altering and life threatening complications for these girls who have yet not a voice in the matter are far too great.

 At the request of HHS, the Centers for Disease Control and Prevention (CDC) undertook a study to determine the prevalence of FGM in the United States. Using data from the 1990 U.S. Census, along with country-specific prevalence data on FGM, the CDC estimated that in 1990, there were approximately 168,000 girls and women living in the United States with or at risk for FGM. This estimate has to be a gross under-estimate given that every female infant born to some of these communities is at risk. The United Kingdom estimated 200,000 in their country alone.
In my view, immigration has gotten too far ahead of cultural evolution.


    

Thursday, October 6, 2011

Microscope

ZEISS
I cannot imagine what it is  like to practice medicine without a microscope. Boy does that date me. Our clinic ran a lab, that is before small clinical labs were virtually eliminated by regulation. From my experience with hospital labs, it is a good idea to look over your urine, gram stains and blood smears. OK, things are more efficient now. You don't have time to stick your nose in the lab. The computer-screen images everything you need including x-rays. Sure, if you are in the Mayo Clinic. What about rural health. Wherever you go for an outdoor lifestyle there won't be that kind of support.

Enter super-microscopy, a field not yet adapted for small office use but what potential. With a small library of fluorescent dyes, one could diagnose a wide array of infectious and parasitic diseases. Who knows, with weather change, we could be looking for malaria.  Some fluoroscopy techniques yield super-microscopy imaging with traditional light microscopes and filters. This is not a costly thing.

Traditional light microscopes with wave lengths of between 350 and 750 nm become blurry right at the cell wall or edge of microbes, 200 nm. With fluorescent dyes that respond to a much narrower range of wavelength the image sharpens up to a resolution around 20 nm. That tenfold improvement in resolution is a real big deal for clinical use.

Commercial interests will work away from that goal of clinical use, however, because large scale clinic use of fluro-microscopy would threaten the high profit margins of hospital and commercial laboratories' revenue stream.

I wouldn't hang my shingle without one.