PUBLICATION: Star

PAGE NUMBER: 9

AUTHOR:     Zubeida Jaffer

DATE:        2001-03-08 13:18:40

A woman doctor is striving for the practice to be made safe, even in the bush

By Zubeida Jaffer

Port Elizabeth

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

At first, in 1989, Dr Mamisa Chabula, did not know what to do. She had set up practice in Motherwell, a Port Elizabeth township. Fathers were bringing their sons from the bush where the traditional circumcision rites had gone horribly wrong.

"Oh! The septic wounds," said Chabula. "I cannot forget the expressions of these young men."

She asked her brother to assist her with the removal of bandages from 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.

In Port Elizabeth alone, 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.

In Soweto, children increasingly undergo surgical circumcisions in hospital, but this is rare in the Eastern Cape and most other provinces. During December, 11 initiates are known to have died in the Eastern Cape. Forty more were admitted to hospitals and one  had his penis removed at the provincial hospital.

The practitioners doing the circumcisions were not dressing the wounds properly, said Chabula. They were not using herbs and were not nursing the initiates. Dehydration and septicaemia were the main reasons for the deaths.

She believes that traditional practitioners knew they were doing wrong but were circumcising more boys to make more money. And they were not taking the time taken in the past. Patients piled up. She decided something had to be done. She talked to traditional practitioners but encountered resistance.

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

After a year of talking they  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."

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 medical pre-examinations of all young boys. Iingcibi agreed to carry a registration card to prove their credentials to the public.

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

The breakthrough came in 1999. Govan Mbeki, former deputy chairman of the Senate, advised her to take the local mayor to see 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," said Chabula.

The mayor immediately established an intervention committee, which included Chabula and other 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," said Chabula. She and her colleagues also went on an aggressive radio drive to make the public aware of the dangers.

But she found that while she privately enjoyed the support of her colleagues and the public, there was little public defence of her controversial position. After all, she had entered into an area traditionally preserved for men.

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

"I read about it on the Internet and contacted Dr Singh who invented the instrument. He invited me to visit Malaysia."

The Western District Council sent Chabula and a group of traditional surgeons to visit Malaysia.

Local Muslim doctors allowed Chabula to perform 40 circumcisions on young boys between the ages of 8 and 10 using the Tara Klamp, a sterilised disposable plastic device that clamps over the penis separating the foreskin from the flesh. The foreskin is cut with minimal or no bleeding and the clamp remains on for a few days.

Chabula is convinced that the clamp, which costs R100, is the answer for those set against attending hospitals. It can be used in the veld and people can be trained to use it.

So far, she has not won enough support for the Tara Klamp to be brought to SA, but her work has won the support of the Eastern Cape Health Department. The Health 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 clamping down on unregistered iingcibi performing the operation which has to be signed soon by the president and the health minister to become law.

"The Malaysians eliminated the problem. We can too," said Chabula. "They had the same problems. It took them 20 years to develop the Tara Klamp.

"The problem is only being addressed in the Eastern Cape. It has to be on the national agenda. It is happening in other provinces but is not spoken about." Her goal is to pilot a circumcision village to provide a model for best practice.

She believes circumcision schools provide golden opportunities for HIV/Aids education. Young boys are at their most receptive. It's not only about the removal of a piece of flesh but about values and spirituality, she said.

"It is a rite of passage from boyhood to manhood which over the centuries has contributed to social order.

"At the moment we have  sepsis and the erosion of a very important custom where boys are taught to be men. When I think of their expressions, especially those whose organs we have had to remove, I somehow get the strength to stand up and say it is about time that this thing is stopped," she said.

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