A doctor accused of carrying out female genital mutilation on a young mother told a jury he performed a surgical procedure after her childbirth in order to stem bleeding and was acting in her best interests.
Giving evidence in his own defence, Dr Dhanuson Dharmasena, 32, told Southwark crown court that at no time was he told by anyone in the immediate aftermath of the delivery that what he had done was illegal.
The doctor is the first person to be prosecuted in England and Wales with carrying out FGM since it was outlawed in 1985.
The case against him centres on a single stitch measuring 1.5cm to 2cm, which he used to repair an incision he had made during the birth of the woman’s first baby.
The crown alleges his actions were a criminal act as they amounted to reinstitution of the FGM which had been carried out on the woman when she was six years old in Somalia.
The doctor, who qualified in 2005 and began specialising in obstetrics and gynaecology in 2008, had joined the Whittington hospital in London some six weeks before the incident in November 2012.
He said he had not had training in FGM during his undergraduate medical degree, or his postgraduate studies. He admitted he had not read the hospital’s policy on FGM, or guidelines on the subject from the Royal College of Obstetrics and Gynaecology.
Dharmasena said he had not met AB, the woman at the centre of the case, before she arrived in labour on a Saturday morning in November 2012. Called to the labour room, he said due to the distress of the baby, he realised he would have to carry out an instrumental delivery, either with forceps or a suction cap.
As a result of the woman’s FGM, he said he had to make an incision in order to catheterise her and carry out the delivery.
After the birth, he repaired the cut. Dharmasena told the court: “I decided to put in a suture to stop the bleeding.”
Using a plastic model designed to help the training of young doctors, he showed jurors the figure of eight stitch he had sewn and the exhibit was then handed to judge and jury to examine.
Explaining the brief procedure, which took around 30 seconds, Dharmasena said: “I didn’t contemplate any other suture technique. This figure of eight suture, the purpose of it is to stop bleeding. In one movement you close off and stop bleeding in the area.”
Asked what he would have done if the cut was not bleeding, he said: “I would have left it alone.”
Under the 2003 FGM Act a doctor is exempted from prosecution for a criminal offence if he carries out a procedure for medical reasons during or after labour. Immediately after the delivery of AB’s baby, Dharmasena was called to carry out an emergency caesarean, and as he was in the theatre he began to doubt the procedure he had carried out on AB.
To reassure himself he asked the consultant on duty for her advice.
“The conversation went along the lines of her saying the technique wasn’t correct,” he said. “I explained what had happened in the delivery room, I asked her whether this was the correct surgical technique, and she advised me regarding the correct surgical technique.”
After this conversation he looked up the Royal College’s guidelines on his mobile phone.
Asked by his lawyer whether the more senior doctor had suggested what he had done was unlawful or illegal, he replied: “No.”
Zoe Johnson QC for the doctor told the jury: “This case is not about sending a message to society that every right thinking man and woman condemns the practice of FGM. I am sure you would agree all reasonable people would consider it an abomination and an abuse of a woman’s human rights.”
She asked the jury to focus on the facts of the case. “At all times he [Dharmasena] acted in what he thought was AB’s best interest. Dr Dharmasena’s defence is that the incision and the repair, which he has acknowledged and accepted from the outset, were necessary for AB’s physical health and that the incision and repair were connected with childbirth.”
The doctor told court he was born in Sri Lanka and had moved to the UK in 1986 at the age of four. He was a Hindu, he said, and nothing in his religion or culture supported the practice of FGM. “I regard FGM as an abhorrent practice with no justification in our society,” he told the jury. The doctor appears in court alongside another man, Hasan Mohammed, who is charged with aiding and abetting the offence. Both men deny the charges.
The case continues.