PENERAPAN LAYANAN KHITAN INKLUSIF DAN RAMAH ANAK DISABILITAS DI RSI SITI RAHMAH

Abstract

Circumcision is one of the most frequently performed minor surgical procedures globally, carried out for medical indications, hygiene standards, and socio-religious considerations. Clinically, circumcision has been proven to effectively minimize the risk of urinary tract infections (UTIs), prevent local pathological conditions such as phimosis and balanoposthitis, and reduce the transmission of sexually transmitted pathogens. Despite being a fundamental medical procedure, the accessibility and success rate of circumcision are heavily influenced by the readiness of healthcare facilities and the adoption of technical approaches tailored to the patient's physiological and psychological conditions. In the pediatric population with disabilities—including individuals with Autism Spectrum Disorder (ASD), Cerebral Palsy, Down Syndrome, and other intellectual disabilities—the execution of circumcision presents significant clinical complexities. Neurodivergent characteristics and functional limitations in this group often trigger sensory hypersensitivity, expressive communication barriers, and high levels of pre-procedural anxiety. These conditions have the potential to evoke resistance responses, such as physical agitation or meltdowns during the procedure. Without specialized management, this dynamics not only increases the risk of long-term psychological trauma but also heightens intraoperative complications—such as tissue trauma and bleeding—as well as postoperative complications due to wound hygiene challenges. On the other hand, the majority of healthcare facilities still apply conventional circumcision protocols that are not yet integrated with disability-inclusive care principles. The lack of sensory-friendly infrastructure, limited pre-procedure preparation modules for caregivers, and insufficient competency among healthcare professionals in disability-friendly interactive approaches constitute major systemic barriers to fulfilling the healthcare rights of children with special needs. RSI Siti Rahmah holds a strategic position to intervene in this issue through the formulation and implementation of an Inclusive and Disability-Friendly Circumcision Service model. This approach integrates behavioral management strategies, adjustments to a sensory-friendly clinical environment, and active caregiver involvement based on the concept of Family-Centered Care (FCC). Based on this urgency, this community service program was conducted to implement and evaluate an integrated, safe, minimally traumatic, and standardized circumcision service model for children with disabilities at RSI Siti Rahmah