The thing about ‘tuli’

Imagine the scene: Around 20 boys are cramped into a poorly ventilated room. They’ve been instructed to cooperate, to take off their underthings, to cover their eyes, and to be quiet. A lot of them are sobbing. Some are being held down while multiple voices tell them to shut up, to grin and bear it.

It sounds like the opening scene of a harrowing movie about child victims but in reality, scenes like this are a dime a dozen during summer in the Philippines. Medical and surgical missions flourish during vacation months, and it’s the time of year that boys—probably with a median age of 11, as young as 7 and as old as 18—are pushed to line up for the rite of passage called “tuli.”

As young medical practitioners, we welcome the opportunity to participate in missions like this. We’re able to practice surgical skills in a setting outside of the hospital, and there’s a thrill to being the primary surgeon rather than the last in a long line of assists in the operating room. Also, if you’re lucky, sometimes you get patients who are willing, even excited, to undergo the procedure, and they walk away from their circumcisions proud and grateful. Still, there’s something truly disturbing about how en masse circumcisions are held in our country. It isn’t just that many of the things patients should be able to take for granted—confidentiality, understanding, privacy—are compromised from the get-go. It’s that the basic right of a child to say no is assumed as optional.

The topic of coercion is a sketchy one at best when it comes to parents and child health. After all, children object to injections and vaccines just as much as they do to minor surgery. Still, circumcision isn’t as necessary or as life-and-death as Filipinos frequently make it out to be—at least compared to vaccines, which any sound scientific inquiry will prove to be beneficial. Even the most well-meaning parents are unable to provide any solid scientific explanation for the need for circumcision to their wailing sons, probably because there isn’t a real one. Different institutions offer different clinical guidelines: Some say circumcision offers a benefit by a reduction in viral infection and penile cancer later in life. Some say the risk of complications—ranging from decreased sensation to rare but frightening penile necrosis, not to mention the psychological trauma of being screamed at while naked in a room full of strangers—outweigh the benefits. Some say that, in a culture such as ours where a child will be stigmatized for being “supot,” the risk of social trauma alone should recommend circumcision.

So while there isn’t any one answer to the question of should-we-or-shouldn’t-we-circumcise, it’s clear that the pressure boys face to undergo tuli isn’t going away any time soon. It’s a shame that circumcision—an entirely elective procedure—should be carried out in such an environment, fraught with anxiety and the undercurrent of coercion.

The stink of sexism and homophobia makes the whole thing even more distasteful. It’s nearly impossible to go into a tuli mission without hearing things suggesting that the patient is a pansy (“Bakla ka ba?”) and should take it like a man (“Magpakalalaki ka naman!”). As though the standard of manhood is decided by how well someone tolerates local anesthesia and a few stitches of Chromic. It’s one way to scare a boy into going under the knife. But to what end, and at what cost?

Tuli missions are just one more pocket of society where tradition trumps necessity, and the tiny traces of sexism and unwarranted social pressure go unchallenged. And while I’m not about to back out of any circumcision missions—I could use the experience, and can only be grateful to the young patients who put themselves in my hands—maybe it’s about time we changed that. Maybe it’s time to start paying attention to what we tell kids about circumcisions. A little less “Tiisin mo yan” (Endure it) and a little more “You don’t have to if you don’t want to.”

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