Circumcision Rituals Cause Illness, Death

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Circumcision Rituals Cause Illness, Death
Traditionalists disregard pleas to sterilize knives

EAST LONDON, South Africa - Gusha didn't want to come to the hospital in the first place. But now, he dreads leaving. The shy 19-year-old high-school student is being treated because his penis became infected during a Xhosa circumcision ceremony.

Each year at this time, hundreds - perhaps thousands - of teenage males in South Africa suffer the same fate. The infections arise when traditional surgeons wash their knives or axes with polluted water, or when they use the same unsterilized instrument on more than one initiate in the ancient coming-of-age ritual. In extreme cases, the infections can lead to amputations or death.

Gusha escaped with a relatively minor infection. His problem will come when he returns to his circumcision school for the feast marking the end of his three-week manhood rite. Because he sought modern medical treatment, he worries he will be seen as being weak.

Gusha's dilemma is South African medicine's as well: How does it operate in the awkward intersections between tradition and modernity in a changing society?

"Very cautiously." said Walter Makhonjwa, a public-health official who has been trying for years to teach ingcibi (traditional surgeons) to sterilize their knives and to use a different knife for each initiate. "Modern medicine has a role to play in circumcision, but it's a back-seat role. We don't want to dilute anybody's custom.''

Circumcision - the surgical removal of the foreskin of the penis is one of the oldest surgical procedures in the world. It is widely practiced, among Asians, Africans, Middle Easterners and Westerners, for reasons ranging from religious to ethnic to medical.

In the West, the operation typically is performed just after birth. Among Africans, it is ordinarily done after puberty. About half of South Africa's 10 black tribes practice teenage circumcision, and Xhosas attach great significance to the ceremony. An uncircumcised Xhosa male cannot inherit his father's possessions, establish a family or officiate at tribal events. He is not considered a man.

The modern Xhosa circumcision ritual calls for teenage males to live for up to three weeks in temporary huts, isolated from their community. The circumcision is done typically with an assegai - a traditional spear - and without anesthetic. It is meant as a test of bravery.

Last year Makhonjwa organized a conference of 150 nurses and traditional leaders. He offered free knives and sterilization solution and urged that initiates be pre-tested for AIDS and venereal diseases. And he implored communities to stop ostracizing initiates who have to be treated.

The education campaign seems to have had some effect. In December - summer here and the busiest month for circumcision schools - 10 hospitals in this Xhosa-dominated region around East London admitted 89 boys with infected penises, compared with 129 in December 1993. Six died, down from 12 last year.

But the problem continues to intensify in other regions. In one Northern Transvaal village, home of the Pedi tribe, five initiates died last year when polluted water was used to stop the bleeding. And in townships around Johannesburg, gangs of young men have begun abducting uncircumcised teenagers and operating on them on the spot. Some speculate the abductions are being arranged by tradition al surgeons who fear they are losing business to modern circumcisions practiced in hospitals. This has led to calls in some areas for the ritual to be discontinued, but here in the heart of the Xhosa region, community groups will hear none of it.

"If anything, the practice has grown more popular," said Joe Jordan, a spokesman for a civic group. "What we need is more public education about the health risks. The old white government paid no attention to this issue. They regarded at as a black problem."