The Sunday News
Robin Muchetu, Senior Reporter
TWELVE-YEAR-OLD Thando Moyo* is no longer interested in school or playing with peers outside, she spends most of her time indoors far from others, hiding in her bedroom.
She has ambiguous genitalia, a rare congenital disorder condition in which an infant’s external genitals do not appear to be clearly either male or female.
In a baby with ambiguous genitalia, the genitals may be incompletely developed or the baby may have characteristics of both sexes. The external sex organs may not match the internal sex organs or genetic sex.
Mpilo Central Hospital doctors in Bulawayo recently dedicated themselves to offer corrective surgery but this has not been a walk in the park as pressure groups feel the children need to make a choice later in life when they are older on which sex they prefer.
The hospital’s clinical director who holds the “Mr” title in the medical field due to high studies, Mr Solwayo Ngwenya who spearheads the programme says the disorder causes serious challenges for the affected persons and requires early correction.
“An example is where you get a 12-year-old who is unable to mix with other girls because of the genitalia, there is no way she is going to be able to share a bath with other girls. The same applies for a grown woman, no man will be able to interact sexually with you if you have ambiguous genitalia.
“In some cases such people commit suicide because of their condition and sometimes relatives are faced with a dilemma of knowing the condition well but failing to explain to the child why they cannot bath with their peers.
“If we were to wait for this person to grow up we would not have many alive because most commit suicide as they grow older. We are not going to bend to the calls of pressure groups and human rights activists on how they see things. Most of them do not understand what is involved. They should know and believe that we do the right thing since we are professionals,” he said.
“In our teaching (medicine) we understand that there are human beings who are born like that and we know the appropriate treatment and in Zimbabwe nobody has ever tried to help people and that is where we are coming in as a hospital to assist,” he added.
Mr Ngwenya said pressure groups who are advocating for the operations not to take place must understand that ambiguous genitalia is a congenital condition so a person is born that way, but unfortunately there are mistakes or deletions in how the body functions in its biological form that manifests itself on the external features.
The Constitution of Zimbabwe states clearly under section 29 (i) that: “The state must take all practical measures to ensure provision of basic, accessible and adequate health services throughout Zimbabwe.
(ii) The state must take appropriate, fair and reasonable measures to ensure that no person is refused emergency medical treatment at any health institution.”
Mr Ngwenya said pressure groups that were against the surgeries were in a clear violation of the law as access to healthcare was a fundamental right adding that they were ignoring the untold suffering that affected people were going through.
“We have some who drop out of school because of this, we need these children to go back to school once this is normalised through surgery, and we have to act. Because the stigma is too much, how do pressure groups justify the pulling out of kids in school because they are insecure? It is denying them their Constitutional right to education,” said Mr Ngwenya.
There has been a lot of noise over the fact that children were going to be operated on without having agreed and made sound choices on what gender they want to assume following surgery and the Constitution in Section 60 (3) guarantees freedom of conscience and that parents have the rights to decide on behalf of their children.
“Parents and guardians of minor children have the right to determine, in accordance with their beliefs, the moral and religious upbringing of their children provided they do not prejudice the rights to which their children are entitled under this Constitution including their rights to education, health , safety and welfare.”
Mr Ngwenya however, said correcting this disorder was not genital mutilation as some were calling it, saying there were worldwide campaigns against genital mutilation and they were not doing that but correcting the abnormality only.
He said the challenge with pressure groups that were not for the idea was that they were advocating that people with ambitious genitalia remain untreated until they were older.
“The problem is that they have not spoken to the patient one-on-one to understand their plight and the challenges it comes with. I have spoken to these people, their relatives and examined them, and trust me, the suffering is too much. How do you justify someone having to drop out of school because of stigma, someone who has to wear a jacket throughout to hide breasts and that person does not interact with others, it will turn out to be a psychological problem.
“That person can be filled with anger and commit heinous crimes and you do not understand that person’s actions but its anger stemming from their condition. We offer psychological support to the patients and we are very careful about it especially looking at the ones that want immediate operations because they would have made up their minds that they want a change in their lives and want to mix with everyone else normally,” he said.
He said if the hospital was to tackle this condition properly; it would help a number of people in desperate situations.
Another area that Mr Ngwenya said was prevalent in some of the cases was that of cancer.
“We have come across a person who has both male and female organs including testicles that will be in the tummy. They become cancerous in many cases if not removed.
“We have seen people like this coming in at 28 years of age with widespread cancer. We are coming in to help with social stigma and to remove things like testicles which in turn lead to cancer,” he added.
Specialists concur that people with ambiguous genitalia can lead normal lives after they have had surgery to correct their condition.
“In some cases the person is essentially a woman who can later go on and have children but the major thing is this male like organ that she has which doctors can remove. Once removed the stigma goes away and she can get married and have children and lead a normal life,” added Mr Ngwenya.
Asked on the processes that take place when a child comes to the hospital to seek help, he explained.
“If it is indeed that you are found to have both male and female organs there is no rush to remove them so we can wait until they grow up and we see which organ is functional because what determines the operation is the functionality of that organ and the person is able to express themselves on the sort of pleasurable life they desire because we want a person to have a pleasurable life.
“The inappropriate organ of the person who is now a teenager can be removed as they have a choice to say I do not want to use this one. It is not the case that every child that we come across we immediately intervene. We do take steps to check them and give them time to think about it. We also inform them that the operation is permanent and cannot be reversed so they go and decide,” he said.
In May this year, Mpilo Hospital made a call to people with the condition to come forward and be screened following the successful operation of a boy from Tsholotsho who had ambiguous genitalia and they have registered 16 people from Mashonaland, Bulawayo, Plumtree and even Zambia.
