Operation Libreng Tule

"Quaint, primitive, and beautiful. Earlier this year, the now-famous town served as a set location where about a quarter of the forthcoming movie "The Bourne Legacy" was filmed." retirednoway

Quaint, primitive, and beautiful. Earlier this year, the now-famous town served as a set location where about a quarter of the forthcoming movie “The Bourne Legacy” was filmed.

"The heart of the town of El Nido is surrounded by spectacular karst limestone cliffs." retirednoway

The heart of the town of El Nido is surrounded by spectacular karst limestone cliffs.

"The cliff behind the Municipal Hall. Note the two large caves (dark areas) on the wall's face." retirednoway

The cliff behind the Municipal Hall. Note the two large caves (dark areas) on the wall’s face.

"The area around El Nido is marked by large karst limestone formations. Here's one at the southern end of town" retirednoway

The area around El Nido is marked by large karst limestone formations. Here’s one at the southern end of town

A boy’s rite of passage

Supot!

Among young boys (up to about age 12), this was the defining taunt. You’re either one of us (the majority, who, in this case, are circumcised – tuli or tule – pronounced as two syllables: tu-le) or not (the minority, who, in this case, are uncircumcised – supot)!

Circumcision is practiced widely in the Philippines.

High rates of circumcision are unsurprising in the far south of the country, on account of its Islamic culture. The near-universal circumcision of males in the Christian areas further north takes rather more explanation. It would be tempting to attribute this to the influence of American rule in the early decades of the twentieth century, but there is a problem — style. Traditional circumcisions in the Philippines are most commonly a dorsal slit rather than full removal of the prepuce, definitely not something learned from the Americans. More likely is that the routine is a hang-over from the pre-colonial era, the whole island chain having been Muslim before the arrival of the Spanish and the consequent forced conversion of the population to Roman Catholicism.

[I don't agree with that statement. It seems more likely that most of the northern 2/3 of the archipelago was pagan when the Catholic Spaniards arrived.]

The final possibility is that circumcision in the Philippines pre-dates Islam, perhaps even being a distant echo of the culture that gave rise to circumcision in Aboriginal Australia and amongst the earliest inhabitants of Hawaii.

Due to the impoverished lifestyle of many Philippino [sic: "Filipino" is the correct form of the adjective] families and the absence of a free healthcare system, many boys are at risk of botched circumcisions performed by unqualified operators. To minimise this risk, various organisations within the country together organise what is known as Operation Tule — a free circumcision service provided on a charitable basis. Such circumcisions are very public affairs, the whole village sometimes turning out to watch and photograph the proceedings. Typical age at circumcision is 7 to 12 years, but the free service is available to all.

Circlist.com (a website)

Backdrop

Two weeks ago, one of the alumni groups of my college fraternity, Alpha Phi Omega, conducted a one-day free circumcision clinic.

"Alpha Phi Omega's banner announcing its first circumcision service clinic" retirednoway

Alpha Phi Omega’s banner announcing its first circumcision service clinic. “Libreng Tule” literally means “free circumcision.”

"Circumcision normally costs 500 pesos per child and would have been performed at the government clinic shown in the background, the "rural health clinic." It has been the habit of politicians to plaster their name on their projects. I can tell, therefore, that the ambulance was procured under the administration of the former disgraced governor. (Joel T. Reyes is currently a fugitive. He chose not to surrender to authorities to answer charges that he is responsible for ordering the assassination of one of his critics. Read more below for this digression. The advantage, and disadvantage, of affixing one's name to public property--even if it was that person's project--is laid bare here!)" retirednoway

Circumcision normally costs 500 pesos per child and would have been performed at the government clinic shown in the background, the “rural health clinic.” It has been the habit of politicians to plaster their name on their projects. I can tell, therefore, that the ambulance was procured under the administration of the former disgraced governor. (Joel T. Reyes is currently a fugitive. He chose not to surrender to authorities to answer charges that he is responsible for ordering the assassination of one of his critics. Read more below for this digression. The advantage, and disadvantage, of affixing one’s name to public property–even if it was that person’s project–is laid bare here!)

Reward for Palawan’s fugitive politicians in Ortega killing reaches P1.55M
May 3, 2012

The reward money for the arrest of former Palawan Gov. Joel Reyes and his brother, both wanted for the killing of broadcaster and environmentalist Gerry Ortega, is now P1.55 million, the Ortega family and their supporters said Thursday.

The “Justice for Doc Gerry Ortega Movement” in a statement said it was able to raise an additional P350,000 from concerned individuals and groups.

Two businessmen, who asked not to be named, donated P250,000 to the cause, they said.

An initial P1.2 million was offered for capture of the former governor and his brother Coron Mayor Mario Reyes, the Ortega family said.

– GMA news (online article)

Preparation

An all-volunteer medical team consisting of two medical doctors, several registered nurses, and specially-trained laymen brought their instruments, medicines, and expertise to El Nido.

"Sterilization: Boiling water kills microbes, right?" retirednoway

Sterilization: Boiling water kills microbes, right?

"Cidex: a disinfectant familiar to all clinicians (Introduced over 30 years ago, Cidex® Activated Dialdehyde solution is a fast and effective way to disinfect and sterilize a wide variety of medical devices and instruments. http://www.civco.com/mmi/ultrasound_products/accessories/disinfectant_cleaners/cidex/)" retirednoway

Cidex: a disinfectant familiar to all clinicians (Introduced over 30 years ago, Cidex®  solution is a fast and effective way to disinfect and sterilize a wide variety of medical devices and instruments.)

"Soaking in Cidex" retirednoway

Soaking in Cidex

"Toothbrushes ready." retirednoway

Toothbrushes ready.

"Operating Platforms. Makeshift. Make do with available materials. Just like the Boy Scouts." retirednoway

Makeshift operating platforms. Make do with available materials just like they teach in the Boy Scouts.

"The post-operative care kit: pain-killers, antibiotics, and advice." retirednoway

The post-operative care kit: pain-killers, antibiotics, and advice.

"Post-operative care kits: packed and ready for distribution!" retirednoway

Post-operative care kits: packed and ready for distribution!

"Post-operative leaflet: first item: make sure your hands are clean!" retirednoway

Post-operative leaflet: first item: make sure your hands are clean!

"Medical Supplies were at the ready." retirednoway

Medical Supplies were at the ready.

"An experienced medical team " retirednoway

An experienced medical team

"Dr. Zabala of Bulacan was one of the two MDs in the medical team." retirednoway

Dr. Zabala of Bulacan was one of two MDs in the medical team.

"Dr. Quan from Bataan was the other MD. Here he is working on the most difficult circumcision of the day! The patient was deathly afraid of being pricked, cut, and sewn. While the typical circumcision took between 20 and 30 minutes, his took nearly an hour!" retirednoway

Dr. Quan from Bataan was the other MD. Here he is working on the most difficult circumcision of the day! The patient was deathly afraid of being pricked, cut, and sewn. While the typical circumcision took between 20 and 30 minutes, his took nearly an hour!

"The team included specially-trained laymen." retirednoway

The team included specially-trained laymen.

Stats and Images

Nearly 100 boys were circumcised by the end of the day. There were six trained and experienced persons (four registered nurses and two medical doctors) working on six boys at a time. They were backed up by specially-trained laymen. Each volunteer paid for his or her own passage to and from El Nido (this ranged between 4,000 and 6,000 pesos for volunteers coming from the main island of Luzon).

"In this batch of 20, the boys are as young as 7 and as old as 15. Note the presence of brothers (lines 9 and 10, for instance, are twin brothers)." retirednoway

In this batch of 20, the boys are as young as 7 and as old as 15. Note the presence of brothers (lines 9 and 10, for instance, are twin brothers).

"Pre-tule. This was one of the first batches to be circumcised." retirednoway

Pre-tule. This was the first batch to be circumcised.

"Mothers were there to help. Here, a mom makes like a pillar for her son who's removing his shorts." retirednoway

Mothers were there to help. Here, a mom makes like a pillar for her son who’s removing his shorts.

"Saying a silent prayer." retirednoway

Saying a silent prayer.

"Stoic; he doesn't want to see what's going on." retirednoway

Stoic; this one prefers not to see what’s going on.

"On the other hand, this kid is (literally!) laid back." retirednoway

On the other hand, this kid is (literally!) laid back.

"Another batch of 20; the youngest is 8 and the oldest, 13." retirednoway

Another batch of 20; the youngest is 8 and the oldest, 13.

"Expert eyes promote relaxed patients. Note the boy's hands." retirednoway

Expert eyes promote relaxed patients. Note the boy’s hands.

"The view from the rear." retirednoway

The view from the rear.

"Hey, that wasn't so bad!" retirednoway

Hey, that wasn’t so bad!

"Dr. Zabala showing us how it's done. After sterilizing the crotch and surrounding thighs, she numbs the penis with an injection of ouch!" retirednoway

Dr. Zabala showing us how it’s done. After sterilizing the crotch and thighs, she numbs the penis with an injection of ouch!

"I don't want to see, I just want to breathe." retirednoway

I don’t want to see, I just want to breathe.

"Another technique for injecting the ouch!" retirednoway

Another technique for injecting the ouch!

"This one showed no discomfort!" retirednoway

This one showed no discomfort!

"More ouch! The reddish stain on the boy's crotch is not blood but remnants of the antiseptic cleaning solution (like Betadine)." retirednoway

More ouch! The reddish stain on the boy’s crotch is not blood but remnants of the antiseptic cleaning solution (like Betadine).

"The full-face treatment" retirednoway

The full-face treatment

"Toes curled but not in too much pain." retirednoway

Toes curled but not in too much pain.

"After the penis has been numbed, the foreskin is sliced and some sewing gets done. These two have been sliced and are somewhere being sewed." retirednoway

After the penis has been numbed, the foreskin is sliced and some sewing gets done. These two have been sliced and are somewhere being sewed.

Why circumcise?

According to this article (written in 2003), the three reasons that justify circumcision are: (1) hygiene, (2) religious belief, and/or (3) preventive medical measures (like, to avoid foreskin problems in susceptible males).

The most convincing reason (for a Filipino) is based on religious belief — that Jesus was circumcised and that the Catholic Church supports the practice. But I think the real cause is based on a fourth reason that wasn’t discussed in that 2003 article. The fourth reason is societal pressure. Filipinos are conservative about adopting new ideas and a practice entrenched in multiple preceding generations is difficult to shake. I would describe it as societal inertia — a habit or practice that will continue because everyone does it, never mind why.

I remember snatches of conversation I had with my seventh grade classmates. I was 12 years old. I wasn’t sure what a circumcised dick was or why a dick should be circumcised. I just knew it was a “bad” thing not to be circumcised. I did not want to be “supot — uncircumcised.”

While researching for this blog post, I came across interesting information propounded by anti-circumcision advocates. The webpage is entitled “Anatomy of the Penis & Mechanics of Intercourse.” Among other things, it explains why an uncircumcised penis performs better than its counterpart (the way nature intended, apparently).

"Taking a breather. From 9am to 1pm, nearly 50 days had been circumcised." retirednoway

Taking a breather. From 9am to 1pm, nearly 50 boys had been circumcised.

"Waiting for instruments to finish being sterilized between patients..." retirednoway

Waiting for instruments to finish being sterilized between patients…

"Using the toothbrush to reach into the crevices." retirednoway

Using the toothbrush to reach into the crevices.

Traditionally, when a young Filipino boy reaches his adolescent years, he is forced to undergo circumcision. There are two versions of having a circumcision. One is through doctors and the other one, through a manunule. However, both have one purpose — to cut.

Prior to the procedure, all young boys are asked “Kapon ka na ba?” Kapon means that the boy has tried retracting his penis before. If the boy says “No,” then the doctor or manunule advises that he does so before going through the procedure. This makes the procedure easier since it would involve stretching the foreskin before cutting it. This would be extremely painful for a boy who has never retracted his penis.

When the boy is ready, using sterilized surgical knives, a medical practitioner (usually a doctor) creates a slit on the upper side of the foreskin surrounding the head of the penis. This is followed by the removal of the “sleeve of the foreskin.” After the procedure, medicines are given to the patient for the wound to heal.

However, in rural areas, there are “specialists” who do the “traditional pukpok under the tree, near the river” to perform the same procedure. Before the pukpok, the manunule or pukpok asks the one to be circumcised to chew guava tops. The manunule then uses a sharpened labaja or barber’s knife to cut the foreskin. The manunule then places the boy’s chewed guava tops on the genital as a way of medication. The “new man,” as they are usually called, then jumps into the river for cleansing. Jumping into the river would then constrict the blood vessels and stop the bleeding of the wound. Though it is unsanitary, the procedure is accepted and has been practiced for decades in rural areas.

Cirp.org (a website about circumcision)

"Pre-tule: more victims (patients, that is)" retirednoway

Pre-tule: more victims (patients, that is)

"Operation Libreng Tule in full stride: six boys at a time!" retirednoway

Operation Libreng Tule in full stride: six boys at a time!

"Sewing and stitching" retirednoway

Sewing and stitching

"Chatting with the patient and explaining the procedure helps the patient relax." retirednoway

Chatting with the patient and explaining the procedure helps the patient relax.

"Disinfect, numb, snip, peel back, sew, bandage. Nurse Brenda is still snipping here." retirednoway

Disinfect, numb, snip, peel back, sew, bandage. Nurse Brenda is still snipping here.

"What stage is this in?" retirednoway

What stage is this in?

"Moms always help make the pain more bearable!" retirednoway

Moms always help make the pain more bearable!

Successful outcomes

One by one, the boys came out. A few felt faint but after some water to rehydrate, they walked away.

Most of them will remember this day. (All the fathers who came to pick up their kids do remember their own day.)

"Helped along by an older brother and trailed by his father, a newly-circumcised boy limps off." retirednoway

Helped along by an older brother and trailed by his father, a newly-circumcised boy limps off.

"Applying the finishing touches." retirednoway

Applying the finishing touches.

"dPost-tule: the older kids weren't picked up and so took their own post-operative care packs with them." retirednoway

Post-tule: the older kids weren’t picked up and so took their own post-operative care packs with them.

"Post-tule: careful not to let garment touch the fresh wound" retirednoway

Post-tule: careful not to let garment touch the fresh wound

"Post-tule: Relieved it's over!" retirednoway

Post-tule: Relieved it’s over!

"Post-tule: he's done!" retirednoway

Post-tule: he’s done!

"Post-tule: biting his lower lip, he's just glad it's over!" retirednoway

Post-tule: biting his lower lip, he’s just glad it’s over!

"Post-tule: the most difficult patient of the day walks off. His circumcision took nearly an hour and the attention of four adults!" retirednoway

Post-tule: the most difficult patient of the day walks off. His circumcision took nearly an hour and the attention of four adults!

"Post-tule: limping away." retirednoway

Post-tule: limping away.

"Post-tule: hands in his shorts prevent the garment from touching his bandaged organ." retirednoway

Post-tule: hands in his shorts prevent the garment from touching his bandaged organ.

"Post-tule: father picking up his son after the operation" retirednoway

Post-tule: father picking up his son after the operation

"Post-tule: one of my favorite photos. This dad was in better spirit than his son (understandably). Note that this is the only kid not shielding his freshly-bandaged dick from his shorts. His dad's doing it for him!" retirednoway

Post-tule: one of my favorite photos. This dad was in better spirit than his son (understandably). Note that this is the only kid not shielding his freshly-bandaged dick from his shorts. His dad’s doing it for him!

The team

"Glad we could help!" retirednoway

“Glad we could help!”

""It was our pleasure." retirednoway

“It was our pleasure.”

"Alpha Phi Omegans from Pampanga" retirednoway

Alpha Phi Omegans from Pampanga

10 responses to “Operation Libreng Tule

  1. Kaye Gonzales

    Thanks so much for this blog post, bro. Glad to be of service =)

  2. Anthony Decena

    Brothers and Sisters, another noble service rendered to the community of Palawan.

    From your APO ARME Family: MABROUK!

    Bro. EGG
    THETA DELTA 1989 A-1
    RD, ARME

  3. Thank you Bro Alex for this blog post.. very nice..

    • Brenda, I enjoy writing and when the topic is meaningful, as Operation Libreng Tule was for me, writing becomes a pleasure. I have to confess that it took longer than usual. This is one of my longer posts to begin with. It contains over 60 photos. I lost track na. Documenting the event of the circumcision clinic was interesting for me. I was spared from having to be circumcised because my parents decided to do it at birth. So when I was 12 and heard classmates and friends discuss it, I only had a vague idea about it. Hahaha.

  4. so privileged to read something as articulate and meaningful as this…great job sir Alex!

  5. I live in the USA. My question here is are any Filipino boys ever circumcised against their will?

    • That’s an interesting question that I’ll ask other Filipinos.

      I’ve never heard of one. In fact, the thought never crossed my mind. That’s because it’s so much a part of the culture. Recall one of the last images in the post, the one with the dad pretending to cover his genitals, while his son isn’t but is grimacing? That’s a display across two generations.

      I’ll ask around and see if anyone has stories.

  6. Circumcision benefits outweigh risks, but parents should choose, pediatricians say

    Click on title above to read source.

    “Circumcising baby boys has clear health benefits and parents should feel free to have it done, but they shouldn’t feel pressured to do so, the top U.S. pediatricians group said on Monday.”

    “Circumcision lowers the risk of a range of diseases, from AIDS to herpes, and doesn’t hurt sexual performance or pleasure in adulthood, the American Academy of Pediatrics said. While the Academy doesn’t go so far as to recommend circumcision as routine, it’s the group’s strongest endorsement yet of the sometimes controversial procedure.”

  7. Great experience for the young nurses., they will be required to perform this service many times during their career. Many thanks to all the ladies who helped the boys!

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