Circumcision: An old tradition that claims lives

EAST LONDON, South Africa - Pride fills the young men wearing rough blankets and sheepskin headbands as they near the end of their ritual initiation. A month ago, a traditional surgeon used a blade to circumcise them and mark their passage into manhood.

"I am more than proud. I am a man," declares one of the "abakhwetha," the Xhosa word for initiates.

"No one can speak for me. No one can tell me where to go," says the youth, his face painted a ghostly white with clay as a symbol of purity.

Meanwhile, in Ward 14 at the nearby Cecelia Makawane Hospital lie a dozen recent initiates who have nothing to celebrate. They are the victims of botched circumcisions.

Complications from ritual circumcisions killed at least 14 boys in Eastern Cape Province last year. More than 100 initiates ended up at Cecelia Makawane alone, suffering from infection, pneumonia and other ill effects - including amputation.

For years, the centuries-old Xhosa custom has injured and killed youths. But Dr. Michael Zanewczyk, head of the hospital's urology department, says the problem is getting worse.

He contends more and more traditional surgeons have no idea what they are doing. "They just cut. If there is bleeding they put a cord around the penis and pull it tight," Zanewczyk says.

The increasing presence of AIDS, tuberculosis and sexually transmitted diseases among South Africans make initiates even more vulnerable to infections and other complications, he said.

No anesthetic

About 17 percent of South Africa's 41 million people are Xhosas. Among them are former President Nelson Mandela and his successor, Thabo Mbeki.

The vast majority of Xhosa males undergo ritual circumcision after age 16, although no record is kept of exactly how many. Only a handful of urbanized Xhosas will admit to abandoning traditional ways.

Circumcisions are performed without anesthetic by traditional surgeons for a fee of 80 rand, about $13. Initiates are not supposed to drink any liquids for a week after the procedure and attendants are paid $20 to help treat their wounds - usually with traditional herbs. During the period, the youths sleep on the ground in straw huts covered by plastic sheeting.

Doctors say the injury and death toll is increased because there is a widespread stigma for initiates who seek hospital treatment, so many with complications wait until they are seriously ill. Some even die in the bush.

Mandela himself, in a vividly detailed description of the ritual in his autobiography "Long Walk to Freedom," describes the shame of feeling disabled by the pain and of failing to pronounce a ritual phrase with the same robustness as the other boys. "A boy may cry; a man conceals his pain," he wrote.

Modern methods

"The number of boys going to hospital is just the tip of the iceberg," says Dr. Mamisa Chabula, a local health official and crusader for safer circumcision methods.

She has managed to persuade some traditional surgeons to use sterilized surgical blades and conduct pre-circumcision medical examinations.

Chabula's newest weapon against infection is a disposable plastic device known as a Tara Klamp, developed by Dr. Gurcharan Singh of Malaysia.

It consists of an inner ring into which the penis is inserted, and an outer ring into which the foreskin is pulled and then clamped into position for circumcision. It stays on until the wound is healed and is designed to prevent bleeding, infection and possible exposure to the AIDS virus.

The idea of using the clamp draws a chorus of protest from the youths undergoing their initiation in a field near Mdantsane, a black township outside East London, a port on the Indian Ocean.

"They are undermining the dignity of our culture," one indignant initiate says.

"If it comes from another nation, maybe it works for them. But that doesn't mean it works for us," says another. "We must do it the way our forefathers used to do it."

The initiates are dismissive of those who end up in hospital. "They are weak. They didn't do what they were taught to do," says one.

Circumcision school

They are also outraged that a women doctor is involving herself in a matter regarded as the exclusive domain of men.

Chabula, whose five sons went through initiation, is unapologetic.

"I got involved in this 10 years ago because people were bringing in botched circumcisions to my rooms. Who should die or be mutilated before we rise up and do something?" she says.

Chabula's campaign has backing at the highest level. King Sandile, regent of the Rharhabe Xhosas, one the two main Xhosa groupings, has endorsed the clamp in principle. However, he says he will not impose it and is leaving it to lower-level traditional leaders to discuss the matter.

"This is a noble custom which we can never abandon, (but) the problem of fatalities, amputations and mutilations has led to a degeneration of the dignity in the custom itself," says the king's spokesman, Prince Zolile Burns-Ncamache. "The challenge we are facing now as the nation is how we restore that dignity."

In a separate initiative, King Sigcau, regent of the Gcaleka Xhosa, is setting up a circumcision school that will accommodate between 3,000 and 4,000 initiates and train traditional surgeons.