Circumcision: when tradition kills

Symbolically, winter is a transition from one stage of life to another. For scores of young South African males, this season also signals a move from being boys to becoming men.

Every year, at least 30 000 teenagers attend month-long rituals under harsh winter conditions in remote mountainside camps to ensure their place as men in their communities. This is done by means of circumcision – a procedure performed without anaesthetic by traditional “surgeons” who have no medical background.

As a result, what should be a celebration of manhood becomes a death sentence for many young initiates.

“One doesn’t want to generalise because, as in western medicine, there are good practitioners and bad practitioners. But when more than 30 young men die from a procedure, there’s a serious problem,” Cape Town-based GP, Dr Ryan Jankelowitz, told Health24.

Although there are other South African cultures that practice circumcision, such as the Muslim and Jewish communities, Jankelowitz says it’s without the horrible results of initiation schools.

“There’s no reason why those following these traditions should accept maiming and death as a part of this rite,” he says.

Dying in the name of tradition

With the number of deaths having more than doubled since last year, 2013 has been billed as the deadliest circumcision year on record:

•    50 boys died from botched circumcisions in the Limpopo and Mpumalanga provinces this May.
•    Another 30 young initiates also died in the Eastern Cape.
•    300 boys have already been rescued from illegal initiation schools, and hospitalised this winter.

As the winter ritual winds down, trained health professionals are left with a medical mess of gangrene, dehydration and genital amputations to clean up.

The Department of Health has set down regulations to govern initiation schools. One of the rules stipulates that an initiate must be 18 years old and have the full support of his parents or legal guardian to enroll. But these laws are often broken by greedy traditional surgeons with more regard for money than human life.

Speaking at the Tshwane University of Technology recently, Minister of Health Aaron Motsoaledi said: “They want the money. We know they’re charging a lot of money. It’s fast money and that’s what we’re observing here.”

Jankelowitz believes that while there are steps to regulate the process, they’re of little use if not well monitored. “Religious and traditional practices don’t mix well with politics, but there are diplomatic ways of handling these issues and it’s clear that we need to do more to protect our young men.”

Shrouded in secrecy

With initiates sworn to secrecy about the ceremonial process, often long after they’ve left the camps, there remains great mystery and media interest around traditional circumcision.

Earlier attempts by Health24 to get some clarity from an initiate were also cautiously met.

Aside from touching on the issues of societal pressures and possible rejection for those boys who did not keep with tradition, Mahap Msiza, a former employee of News24, kept his brief response well within the bounds of his secrecy oath.

It’s a well-known fact that, during these ceremonies, initiates are painted with red and white clay, after which they spend long periods in the bush – often with little or no clothes. But what to make of reports of deprivation, deliberate exposure to the elements, and blunt and unhygienic cutting instruments being used, usually on an entire group of initiates?

“Basic principles of hygiene generally aren’t implemented. As a result, these young men suffer from preventable infections, blood-borne diseases and pain. Many have paid with their manhood [penile amputations] and others with their lives,” says Jankelowitz.

Reacting to the ever-increasing spate of deaths, South Africa’s ruling party, the ANC, has called for the modernisation of this ancient, secret ritual. However, ANC spokesman Keith Khoza says the party doesn’t want to ban the ritual outright nor, he says, can they.

More than just tradition

Circumcision has recently received widespread scientific backing as a preventative measure against HIV, including from the World Health Organization and the United Nations.

Research shows that the “snip” helps to reduce the risk of men contracting HIV from an infected female partner by up 60%.

This has prompted the USA to further bolster circumcision programmes with a R100 million pledge just a month ago. This is in addition to the R360 million the US President’s Emergency Plan for AIDS Relief (Pepfar) committed to South Africa earlier this year.

“It [medical circumcision] is definitely of benefit in our struggle against HIV, but men must remember that the safest form of sex, although not 100%, is with a condom. Any other message is going to place even more people at risk,” concludes Jankelowitz.

For now though, whether for traditional purposes or for HIV prevention, the topic of circumcision has created more of a buzz than ever before.

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