HEADLINE:   rites of passage

PUBLICATION: Cape Argus

PAGE NUMBER: 16

AUTHOR:     Zubeida Jaffer

DATE:       2001-02-27 20:30:28

Rite of passage need not be the unkindest cut

A woman doctor in a Port Elizabeth township, Mamisa Chabula,  is making waves in the all-male world of circumcision rituals by campaigning for the use of a clamp developed in Malaysia and planning to establish a village to teach safe techniques. She also sees circumcision school as the ideal forum for HIV/Aids education. Special Writer Zubeida Jaffer met her

Zubeida Jaffer

Special writer

health

The fathers wait until nightfall. Then, with their sons by their side, they knock on her door, desperate for help.

At first, Mamisa Chabula does not know what to do. It is 1989 and she has just set up her medical practice in Motherwell, a township in Port Elizabeth. The fathers are bringing their sons from the bush where the traditional circumcision rites have gone horribly wrong.

"Oh - the septic wounds," says Chabula. "I cannot forget the expressions of these young men."

She decided to ask her brother to help remove the bandages and dressings around the genitals. A penis completely caked in yellow pus. Another shrivelled up, black, charcoal-like as a result of infection. Then the complete absence of genitalia.

"Nothing. Dead. I tried to give them some sense of dignity but it was too terrible," she said. "Fear, anxiety, horror. Torn between loyalty to custom and excruciating pain."

Every six months, young boys throughout the country attend circumcision or initiation school. In Port Elizabeth alone, about 15 000 boys are annually involved in this age-old rite of passage from boyhood to manhood.

It is an affirmation of identity, an assertion that the African mind has not been colonised. The trend in Soweto, where children are increasingly undergoing surgical circumcisions in hospital, is rare in the Eastern Cape and most other provinces.

In December last year, 11 initiates are known to have died in the Eastern Cape. Forty more were admitted to hospitals and one had his penis amputated at the local provincial hospital just days before Christmas.

In Cape Town, 12 initiates were admitted to Groote Schuur Hospital between the beginning of December and the end of January. One, who was circumcised in the Eastern Cape, had his penis amputated, while the second, who went "into the bush" here, had 4cm of his penis removed. The infection had spread to his knees, and he was battling to walk.

At GF Jooste in Manenberg in the same period, 21 initiates were admitted.

Back to Motherwell. Chabula said in most cases the practitioners were not dressing the wounds properly. They were not using herbs and were not nursing the initiates. Dehydration and septicaemia were the main causes of death.

She believes that some traditional practitioners know what they are doing is wrong. Some were motivated by commercial interest.

But as the patients piled up, she decided something had to be done.

She started talking to the traditional practitioners and encountered resistance.

"I could see they were wondering whether I wanted to make money, to take their jobs away from them," she said. "Although they did not publicly agree with me, something told them that it was not right. But they did not want to listen to me. I was a woman interfering in a man's world."

After more than a year of talking, they slowly came round. "We could then together decide that the boys must be medically examined before the circumcision and that an association had to be formed," she said.

The Motherwell Traditional Surgeons and Attendants Association became the backbone of a campaign, which continues to grow.

It set up a register for all practitioners (iingcibi). Chabula trained them in wound management and insisted on pre-medical examinations of all young boys. The iingcibi agreed to carry a registration card to prove their credentials.

But then fathers and sons started arriving from other areas. She tried knocking on official doors in the city for help but had no luck.

The breakthrough eventually came in 1999. Govan Mbeki, former deputy chairman of the Senate, advised her to take the local mayor to see the boys in hospital.

"When the mayor saw the botched circumcisions, he said to me: 'Mama, is this the struggle we are letting you go through alone?' He was shocked."

He immediately established an intervention committee, which included Chabula and local councillors.

Chabula was appointed as the Director of the Western District Council serving a large section of the Port Elizabeth community. This gave her the official platform to drive the campaign for controlled circumcision across several residential areas. "We have so far registered and trained 200 practitioners and plan to do more," she said.

She and her colleagues also went on an aggressive radio drive to make people aware of the dangers.

But she generally found that while she privately enjoyed the support of most of her colleagues and the people she spoke to, there was little public defence of her controversial position. After all, she had entered an area traditionally reserved for men and intimately bound up with tradition and custom.

She unleashed further controversy when she discovered that Malaysian doctors had invented an instrument called the Tara Klamp, which guaranteed safe circumcision.

"I read about it on the internet, contacted Dr Singh who invented the instrument who then invited me to visit Malaysia," she said. The Western District Council sent Chabula and a group of traditional surgeons to visit Malaysia.

Once there Muslim doctors allowed Chabula to perform 40 circumcisions on boys between the ages of eight and 10 using the clamp. The device, pre-sterilised and disposable, clamps over the penis, separating the foreskin from the flesh of the penis proper. The foreskin is cut with minimal or no bleeding and the clamp remains on for a few days.

Chabula is convinced that the R100 clamp is the answer to surgical problems. It can be used in the veld and people can be easily trained to use it, she said. But so far, she has not been able to win enough support for it to be used here.

Her work has won the support of the Eastern Cape provincial health department. MEC Bevan Gowanda has issued stern warnings to parents not to take their children to iingcibi not known to them.

He has drafted a proclamation aimed at clamping down on unregistered iingcibi. "The Malaysians eliminated the problem. We can too," said Chabula.

"Unfortunately, the problem is only being spoken about in the Eastern Cape. It has to be on the national agenda. It's happening in other provinces too, but not spoken about." 

Her long-term goal is to pilot a circumcision village to provide a model for best practice.

If properly handled, Chabula believes that circumcision schools provide a golden opportunity to pass on HIV/Aids education. "The young boys are at their most receptive," she said. "It is not only about the removal of a piece of flesh but about teaching values and spirituality.

"At the moment we are stuck on the sepsis and not the erosion of a very important custom where boys are taught to be men."

With the pain-filled faces etched in her mind, she drives herself to win more and more to her cause.

"When I think of their expressions, especially those whose organs we have had to remove, then I somehow get the strength to stand up and say: 'It is about time that this thing is stopped'.

"One death and one botched circumcision is one too many."