9 October 2008

Uganda: Circumcision Gone Wrong

When the blowing of horns and playing of kadodi started in January through May to August announcing the arrival of the ritual of circumcision amongst the Bamasaba, Rogers Wareba, like many other boys, declared his intentions to be circumcised. He never imagined that getting circumcised would cause serious health consequences by damaging his urethra to the point of having to use a catheter to pass urine.

"I was set for Imbalu this year to initiate me into manhood, so the talk about the knife was not an issue. What I wanted was to get circumcised traditionally and not shame my parents and ancestors or be declared a misfit in society," Wareba recalls.

He says that during the ordeal, he felt unusual pain in the urethra and bled but that traditionalists told him that he would heal with traditional care using herbs like it is done amongst all Bamasaba. "But after sometime, there was no change and my parents opted for hospital when I failed to pass urine. The doctors then inserted the catheter.

It is very painful but I don't have a choice because I need to heal and pass urine normally," says Wareba. He is not the only victim though. Records by doctors at Mbale Regional and Bududa Referral hospitals have registered and treated many such cases.

Although the tradition of circumcision (Imbalu) has come a long way, it is still disturbing to think of how these boys brave the crude knife even when there are hospitals that carry out circumcision in more hygienic and modern conditions.

Wareba however says that traditionalists don't regard medically done circumcision highly, saying it is for cowards and social misfits and that once circumcised that way, one would never be a leader in the clan nor preside over clan meetings.

Although medical experts have long recognised that circumcision has health benefits, they condemn traditional circumcision especially amongst the Bamasaba as an easy way of contracting diseases like HIV/Aids and that it is partly responsible for urethral complications amongst boys.

A surgeon at Mbale Regional Hospital, Dr Peter Wakalyembe says that on many occasions, the traditional surgeons use one unsterilised knife to circumcise many candidates besides not using of gloves and failure to wash hands that put the candidates at risk of not only septic wounds but also transmission of new infections.

"There are already three cases admitted at Mbale Regional Hospital due to this traditional careless crude circumcision. One of them has had his urethra destroyed and he can't urinate. There could be many others ignorantly rotting in the villages," said Dr Wakalyembe.

He said that although there are research findings that male circumcision can protect men from contracting HIV by about 60 per cent, use of unsterilised knives for circumcision exposes candidates to risks of wound contamination, infection and spread of HIV/Aids, adding that research done by Communication Partnership revealed that although actively involved in circumcising, about 80 per cent of the surgeons lack training in the basics of circumcision, hygiene and health risks involved in the crude practice which explains why many children like Wareba are suffering the consequences.

A senior consultant surgeon at Mbale Regional Hospital, Dr Jaffer Balyejjusa said whereas under medical circumcision which he has been doing for the last 16 years great emphasis is put on hygiene, treatment, management of bleeding and treatment of the wound, they are all lacking in traditional circumcision.

"Besides wound contamination, infection and spread of disease due to poor hygiene, traditional surgeons make many mistakes during circumcision which have left many boys bleeding, taking long to heal and getting deformed," he said.

The Ministry of Health is working with Makerere University School of Public Health and Health Communication Partnership and has already started education and sensitisation programmes in Bugisu through community meetings, debates and Signal Radio spots to address such problems.

A local radio station is putting emphasis on promoting safe medical male circumcision under good hygiene, but the traditionalists are yet to cooperate.

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