Queuing to save lives

2013-08-30 00:00

THE waiting room at the Southern African Clothing and Textile Workers’ Union (Sactwu) Worker Health Programme (SWHP) clinic is filled with young teenage schoolboys holding their pink authorisation forms. It is Friday and it is usually the day that schoolboys get permission to come in for the circumcision procedure.

There is comfort in numbers, and the sterile and efficient atmosphere of the offices gives them confidence as they move forward in the queue. They have been encouraged to come here as a result of massive outreach programmes in the townships in and around Durban.

The principals and teachers at their schools have allowed the Sactwu outreach workers to address the boys and their parents, and explain how being circumcised can prevent the transmission of HIV by up to 60%.

It also reduces the transmission of other sexually transmitted diseases and reduces the risk of cervical cancer in their partners.

In KZN, HIV infection is the highest in the country, and many of these boys have experienced the effects first hand. Some have lost one or both parents to the epidemic, and others have relatives who have died.

Although the practice of circumcision died out in the Zulu culture over a century ago, there is renewed interest in the procedure.

These boys would like to prevent themselves from getting infected in future. They would also like to say they are no longer “boys” but have become men.

While other cultures do the circumcision procedure when the boys are in their late teens, the Sactwu circumcision programme follows the Department of Health’s guidelines and targets sexually active males aged between 15 and 49 years.

Nikki Soboil, executive director of Sactwu Worker Health, said: “Sactwu has been proactive in addressing the HIV/Aids epidemic among its members and the circumcision programme is the latest in its effort to help stop the spread of HIV.

“Through negotiated bargaining, Sactwu has ensured that in certain sectors, employers contribute between 30 cents to R1 per employee per week, towards a centralised HIV fund. The Sactwu Worker Health Programme also accesses international donor funding.”

Its Durban clinic is situated in an old refurbished warehouse and the design is clean and modern. The programme has a strong emphasis on taking health-care facilities to where members work.

This means they have a few mobile clinics that go to the premises of the clothing factories to offer HIV and TB-related services, as well as screening for chronic diseases of lifestyle.

Soboil explained: “Workers are reluctant to take time off to visit clinics due to a loss in wages, or use their hours off to go to the clinics. In addition to this, the government clinics are usually not open after hours when they have their free time, or the queues are very long, so Sactwu is making the health services available to them at the work place.”

Soboil said that anybody who arrives for circumcision, whether he is a member or not, does not have to pay and he is treated with care and compassion. The clinical teams are made up of a doctor, urologist and a nurse.

The medical team is supported by trained counsellors and administrative staff. The patients get counselling before and after the procedure. Soboil said that the post-operative counselling ensures that the boys are educated on wound care and personal hygiene, and the message that routine condom usage is essential for the prevention of HIV and STIs is re-enforced.

Clients are urged to attend check-ups at 48 hours, seven days and 21 days post-op, to ensure that the wounds are fine and early clinical intervention can occur if necessary.

Parents must give their consent if the boys are younger than 18.

“There is such a lot of misinformation and we need to take this opportunity to give men and women as much information as possible. We are not only targeting young boys.We would like to get older men to undergo the procedure but there is more reluctance. The wives tend to think that if their husbands are faithful there is no need for them to be circumcised. It must be emphasised that this benefits them too, by reducing their risk of developing cervical cancer.”

As the boys move up closer to the surgical door, their nerves become more apparent. Fingers fiddle with the form and there is a lot of joking and some swopping of places in the queue. But there are no terrifying yells from the surgery. It’s quiet, except for the gentle chatter of the staff.

The operation is done under local anaesthetic and Sactwu’s clinical teams use the surgical forceps-guided method.

Those who emerge put on a brave face and give a thumbs-up. They swagger off to the recovery area and receive a sandwich and a cup of sweet tea or a cool drink.

Jonathan Cockburn, who is in charge of monitoring and evaluation, said: “The medical science is categorical and supports the circumcision argument fully. Men who are circumcised have a much lower risk of being infected by HIV and, in turn, of spreading the virus. Research shows that those countries where circumcision is widely practised have lower HIV rates. The advantage to women is that there is less incidence of cervical cancer among women who have a partner who is circumcised.

Cockburn said that the practice of circumcision was done in Zulu culture in the 1800s. The practice was stopped by Shaka Zulu, who stopped the initiation because it took time away from his warriors who had to train. In those years, circumcision was done in winter to minimise the chances of infection because there was less body sweat. Ironically, today, clinics are swamped in winter when boys decide to go for “the snip”.

But medical circumcision can be done at any time, throughout the year, as infection rates do not fluctuate according to season.

Zulu King Goodwill Zwelithini has backed the Health Department’s circumcision efforts and advised young Zulu men to have it done at medical facilities and clinics.

Sactwu’s first national organising secretary, Chris Gina, said the health programme has made a huge difference to the quality of health care for Sactwu members.

“We are saving lives and we are also taking health care to the members so they can access the health care they need. It is impacting on the broader society and we are happy if we are serving our members and their communities.”

• trish.beaver@witness.co.za

YOUNG human-resources student Simphiwe Kunene was one of the young men in the queue at the Sactwu clinic. He told The Witness why he chose to be circumcised.

“We are very aware of the whole HIV problem and my friends and I talk about it all the time. I decided to get tested for HIV a few months ago and I was very nervous. But when I knew the result was negative, I felt that I was able to take control of my life. I think it is a big thing to get tested because once you have the answer, your life changes. For me, the next step was to decide what to do about circumcision. I heard that it helps you to be safer and I believe it also helps you to feel more like a man.

“I heard about the Sactwu clinic and when I arrived, I was pleasantly surprised by the conditions. It is clean and they are very professional. They counselled me and I had my HIV-status confirmed. Then they explained exactly how the circumcision was to be done. Of course, I was a bit nervous, but they give you confidence. The worst part was the injection to make it all numb. That was a bit painful, but then it was all fine. “Then they spoke to me about how to keep everything clean and how to avoid exercise for a while.

“I like this place because they phone you and keep in touch by SMS, and they make you feel like they care. It is as if they are welcoming and you are not a stranger here. I play soccer and I am a dancer, and I will definitely tell my friends to come and have this thing as it is about being responsible and looking after your future.”

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