Tuli de Pokpok

I just got home from work. A lot of things happened. From vomiting, abdominal pains, and the worst gunshot wounds.

But what made the night so bloody is this one patient who have just been circumsized later that day.

Yes. You read it right. Circumcision.

I intentionally used patient x to not disclose any information on the person who is involved on this event.

So this is what had happened.

Patient X, a 11 year old male was brought to the hospital with a complaint of penile bleeding. Upon taking up his history, we have found out the reason behind why his male organ is bleeding. He got circumsized by a native way that we called "tuli de pokpok".

So what is this tuli de pokpok?

Tuli de pokpok is a native or cultural way of circumsicion in the Philippines. It is said that it was a ceremony or rite of passage from being a young boy to becoming an adult.

How it is done?

Tuli de pokpok is usually done along the riverside because before the circumcision, the person who wanted to be circumsized will soaked himself on the river to let his penile fore skin to be soft. While the person is soaking, the "magtutuli" will prepare the following:

1. Putpot - a small rectangular piece of cloth with a hole on the center

2. Guava leaves

3. Luwal - a pointed wood that is strucked down on soil at the other end

4. Razor

5. Another wood to be used as hammer

When the person is ready for the circumcision, he will be instructed to chew the guave leaves while his knees on the ground in fornt of the "luwal". Then the "magtutuli" will insert the fore skin of the male organ on the "luwal".

The magtutuli will then put the razor abive the foreskin then will hit the razor with the other wood. After the fore skin was cut, the chewed guava leaves will be put into it then it will be put into the hole of "putpot" and tied it up.

The circumsized person will now be instructed to wash his male organ everyday with the extract of boiled guave leaves. The wound usually heals for about 1-2 weeks.

They say that the payment of this kind of circumsicion is a pack of cigarettes.

How safe is tuli de pokpok?

Tulo de pokpok is not recommended by the health department in our country because it isn't aseptic. You can get infection or even worse than that like of Patient X.

But even if the health department don't recommend this way of circumcision, it is still practiced by many. Why?

Others say because it does not cost too much and it is in their culture to get circumsized that way.

Back to Patient X

Patient X was given an intravenous line and given tranexamic acid to control the bleeding. He was also given anti tetanus injection and iv antibiotics because his wound is considered as dirty.

The surgeon has done ligation of the bleeder and repaired the circumcision in a proper way.

Patient X was instructed to drink antibacterial medication for a week and to wash his wound with antibacterial agent.

Good morning everyone!