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Published: Monday 19th January 2015 by The News Editor
A British doctor performed female genital mutilation on a young mother after she gave birth in hospital, a court has heard.
Dhanuson Dharmasena, 32, is standing trial accused of carrying out the illegal procedure at the Whittington Hospital in north London in the first prosecution of its kind in the UK.
A second man, Hasan Mohamed, 41, denies encouraging and abetting the offence.
The woman, 24 at the time, first underwent female genital mutilation (FGM) aged six in Somalia, London’s Southwark Crown Court heard.
The highly dangerous procedure left her at risk of infection, haemorrhage and even death.
The mother of two, who cannot be named and was only referred to as AB in court, lives in Britain and went to hospital in November 2012 in labour with her first child.
During labour, her FGM stitches were torn. Dharmasena, the junior registrar in obstetrics and gynaecology, sewed her back up in a procedure that amounted to FGM, the court heard.
Kate Bex, prosecuting, told jurors: “The prosecution is the result of an alleged offence under the Female Genital Mutilation Act 2003.
“Female genital mutilation is often abbreviated to FGM, it is also known as female circumcision. It may be that it is not a law that you have heard much about, or that you are unsure exactly what FGM means.
“You may be expecting to hear that the offence took place in a back-street clinic, by an unqualified and uncaring person, on a young child.
“This trial is quite different, but nonetheless involves FGM.”
She said the woman, now 27, had been subjected to FGM as a child in Africa.
And after the birth and “at Mr Mohamed’s insistence, or with his encouragement” Dharmasena “stitched” her back up.
She added: “It is that stitching back together by Dr Dharmasena, and Mr Mohamed’s insistence or encouragement, which the prosecution says is an offence under the Act.
“What Dr Dharmasena did, by stitching back together the labia, was against the policy of his employer, the Whittington Hospital.
“That policy is written and available to all midwives, nurses, obstetricians and students at the Whittington and Dr Dharmasena was expected to be aware of it.”
Jurors heard that FGM is a highly dangerous procedure which risks the health of tens of millions of women worldwide.
Ms Bex said: “The World Health Organisation estimates that 130 million women worldwide have undergone genital mutilation and approximately two million women undergo some form of genital mutilation each year.”
She said the procedure in this case, known as type 3 FGM, accounts for around 10% of FGMs globally and can be deadly.
She added: “FGM can be very dangerous for a woman’s health and psychological well-being.
“It can lead to severe health problems and, in some cases, to death. FGM causes gynaecological, urological and obstetric problems in women, chronic pain and sexual dysfunction.
“It increases the risk of death in childbirth to both mother and baby.”
Jurors heard the woman would have been most exposed to these side-effects when the surgery was first performed when she was six. Dharmasena’s stitches would not have carried the same risks, but should not have been sewn at all “unless medically necessary”.
Dharmasena, of Ilford, Essex, denies carrying out FGM on November 24 2012.
Mohamed denies one count of aiding or abetting the procedure, and one count of intentionally encouraging or assisting the commission of an offence.
The pair both wore smart suits as they sat in the glass-fronted dock.
The court heard that a doctor spotted the woman’s childhood FGM and surgery was performed in February 2011 at Kingston Hospital in south London to undo the procedure.
The woman told a community midwife about this but, against hospital policy, she was not referred to a specialist FGM midwife.
Dharmasena, who took up his post at the Whittington a month before the events took place, was in charge of delivering the baby on the morning of November 24.
He said the woman “was initially very reluctant” to allow him to perform incisions necessary for the birth, but was persuaded.
The court heard that doctors thought the woman found it difficult to understand what they were saying and Mohamed translated.
The senior house doctor, Kate Duhig, helped with the delivery.
Afterwards, while she was stitching AB, she spotted Mohamed looking at what she was doing “which she found unusual”.
Ms Bex said: “Mr Mohamed asked her to repair the FGM and although she naturally cannot remember exactly how he phrased it, Dr Duhig was left in no doubt that he wanted her to re-stitch (the woman).
“Dr Duhig found the experience unpleasant and ignored Mohamed’s request.”
But she was called away and, under encouragement from Mohamed, Dharmasena performed FGM, the court heard.
A midwife, Aimma Ali, realised what was happening “was illegal”, jurors heard.
She took Dharmasena to one side and told him.
As a result he told the on-call consultant Vibha Ruparelia and explained “he did not know that he was not allowed to do it until the midwife had told him”.
Ms Bex said: “Dr Ruparelia took the view that it would be painful and humiliating for (AB) for the suture to be removed” so it was left and the incident recorded in medical notes.
The hospital trust launched an investigation into the incident within a few weeks.
In a statement Dharmasena said he carried out the procedure because he thought the woman, AB, wanted him to. He also said Mohamed urged him to.
He said: “At no point in time did I intentionally or deliberately want to cause any harm to the patient. I had obeyed all of the patient’s wishes.”
But jurors heard he changed his justification when he was interviewed by police on August 20 2013.
Ms Bex said: “It would seem that Dr Dharmasena had familiarised himself with the law and you may feel that he changed tack as a result.”
She said that it was at this interview, ten months after the operation, he raised the possibility it was “medically justified”.
Mohamed was later arrested and answered “no comment” in police interviews.
Dharmasena denies one count of female genital mutilation.
Linked to this, Mohamed is facing one count of abetting Dharmasena in committing the offence.
He faces an alternative count of encouraging or assisting the commission of an offence. He denies both counts.
Carrying out female genital mutilation carries a maximum sentence of 14 years in prison.
The case was adjourned until 2pm tomorrow.
Published: Monday 19th January 2015 by The News Editor