28/08/2009 (The Irrawaddy.org), Mae Sot - Ko Daung cried out in agony as he lay on a makeshift operating table in a corridor of the Mae Tao Clinic. A friend squatted next to him, offering his hand for support and a vest to grasp as the pain increased.

Two surgeons, one on each side of his waist, worked as fast as they could to remove infected skin from his penis. Sweat glistened on their foreheads in the stifling heat, stirred lightly by one oscillating fan.

People walked by oblivious to the operating table. Four people sat on the floor playing a traditional Burmese board game, unfazed by what was going. A medic strutted in and made a joke with someone in the room.  

The patient’s friend, his eyes filled with tears, looked up at the medic, as he bore witness to Ko Daung’s cries of pain.

Eight years ago, Ko Daung sat around drinking with some friends who had returned to Myawaddy, opposite Mae Sot, after working as fishermen in Thailand. After a couple of drinks, one of the men showed off his penis and bragged about his prowess.

He told his story about discovering palm oil and how he had injected it into his penis. Ko Daung naively joined in with his friends and also injected palm. No one in the group knew of the risks that are associated with the practice.

“I wish I would have known about the dangers,” whimpered Ko Daung. “If  I would have known, I never would have done it and I’d never be here”.

The practice is believed to have started about 10 years ago and was introduced into this area by Burmese sailors and fisherman who learned of the practice in Thailand and in other ports. It has grown into somewhat of a fad amongst young uneducated Burmese males on the border.

Law Wah Say, a medic at the clinic, estimated that on average five patients a week come to the clinic with infections as a result of injecting palm oil.

Ko Daung was the fourth patient this week and the 122nd of the year.

“Their friends come back to Mae Sot with a larger penis bragging about how amazing and easy it is, and then they want to have the same fulfillment,” said Law Wah Say. “They don’t know about the risks because of their lack of education and end up in a dangerous condition.”

Among the dangers are the injection itself, which can create a blister that often becomes infected. The palm oil can cause complications because it decreases blood circulation. An increased level of blood will flow into the penis, but it is impeded and can lead to severe inflammation and infection. 

In the most severe cases, the infection can go into the blood stream and lead to cancer or blood poisoning. The Mae Tao Clinic has received reports of two men in Burma dying from infections. A patient earlier this year had had to have his penis amputated. The standard treatment requires two operations and a one month stay at the clinic. The first operation requires removing the infected skin from the penis. A second operation involves taking skin from the thigh and grafting it to the penis.

The Mae Tao clinic is trying to educate Burmese males on the risks involved in using palm oil. A pamphlet was published in March, “The Risk of Unnatural Sex Enhancements,” which details the dangers as well as the treatment. An NGO, the Migrant Assistance Program (MAP), has distributed the pamphlet among migrant workers.

“We hope that the pamphlet will circulate among the communities and inside Burma,” said Law Wah Say. “Our main aim is to stop men from injecting palm oil and if they already have, to come and have a check up immediately.”

Besides the clinic’s education campaign, there is little work being done to reverse the use of palm oil for penis enlargement. World Vision had previously worked with the problem as part of a health education campaign but has since abandoned its effort.

“There are currently no organizations working on this issue,” said a health coordinator with World Vision, based in Mae Sot. “Lack of education is a massive problem. If one organization would dedicate time to teaching people about the risks, this would be a big help.”

“Many organizations are not concerned.