Date: 28/06/2004
Source: Eastern Cape Provincial Government
Title: Goqwana: Health service interventions
PRESENTATION BY MEC FOR HEALTH, DR BEVAN GOQWANA ON HEALTH SERVICE INTERVENTIONS AIMED IN MEETING THE CHALLENGES ASSOCIATED WITH MALE CIRCUMCISION, 28 June 2004
Programme Director,
Madame Premier,
Members of the Executive Council,
Distinguished Guests,
Ladies and Gentlemen
Introduction
I have been asked to present, a topic that is currently a focus of public scrutiny, as it continues to make headlines for all the wrong reasons.
As I tackle the issue of male circumcision from the Department's perspective, I hope at the end of my presentation, to have succeeded in raising consciousness, around some of the contentious issues, surrounding circumcision, thereby adding my voice to the ongoing debate, in seeking suitable and acceptable solutions, to some of the challenges facing this custom.
I shall touch on the meaning, the challenges, the context of the practice of circumcision, with a particular emphasis on this province, and the impact the tradition has on our everyday life. I shall then focus on the intervention strategies, devised by the Eastern Cape Department of Health, together with other stakeholders, in an effort to curb the mortality rate of initiates and botched circumcisions, that we see documented almost daily in the media.
Programme Director, I intend to demonstrate that despite the mounting challenges faced by the custom and the initiates themselves, the Provincial Department of Health has made tremendous inroads to bring down the loss of life and limb, now associated with the practice of this custom.
Origins of the Custom just to give a broad overview, young men in many African communities traditionally undergo training, involving rituals and circumcision to mark the transition to Manhood. This is an old age tradition passed on from generation to generation.
In the ceremony, which can last anywhere from weeks to several months, the elders teach boys, typically around the age of 18, about manhood and responsibility, in a rite of passage that includes the cutting off, of the foreskin and this is called Circumcision.
As part of this ritual, the young men who have undergone circumcision go with little food and water, live in a hut in a remote area in the bush, far removed from the modern comforts of the cities and spends much of the time covered with a blanket. In the olden days, experienced elders would oversee the ceremony, and carefully observe the boys, to make sure they were fit to undergo the custom. At this juncture, Programme Director it is important to mention that Circumcision is not exclusive to the African communities, but it is practiced widely as Jews and some of the Moslems also perform the ritual, though the manner, the stage, and the fashion in which it is performed, obviously differs from one group to the other. For an example, the Jews perform Circumcision at any early age, whilst Xhosas and other groups, undergo initiation when they are in their teens. Rites of Passage Initiation into manhood is but one of the rites of passage that a young African boy is expected go through in life. Imbeleko, (this is performed soon after a child is born), the naming of a child, marriage, becoming a father for the first time, are some of the other rites of passage.
Role of Women Contrary to public perception, women play a very significant role in the initiation process. A would be initiate, will in most cases, communicate his wishes to be circumcised to his mother, who will then pass the message on to the father.
The mother would then be involved in the planning stages of the ritual until such time the boy is taken to see the traditional surgeon, then the mother is no longer involved but kept informed of the developments.
The huts used by initiates, are actually put together by women, as well as brewing of traditional beer for initiation ceremonies. It is forbidden though, for sexually active women especially, to visit the initiates' hut, as this would stimulate the young men aggravating their situation.
Today's environment, in which the custom is practiced, is not static and is forever changing, and as such we need to be responsive to these changes. I am mentioning this deliberately whilst on the role of women, as it is regarded taboo, to even inform the mother of an initiate who has passed away, until a time that is considered appropriate by men to inform her.
We need to constantly evaluate some aspects of the custom's relevance and rationale, in today's environment.
Advantages of Initiation Ladies and gentlemen it is not all gloom and doom, as there are of course positives for those undergoing circumcision.
A young man who has undergone this custom, graduates to another status, enjoys respect amongst his peers and the community at large.
Recent studies undertaken on initiation, suggest that it is advantageous to undergo the ritual, as it promotes cleanliness and amongst other things, diminishes the chances of being infected with the Aids virus.
Dr Alan Brody, national director of the United Nation's Children's Fund, who supports male circumcision as one precaution against HIV infection, asserts that studies on the effectiveness of the procedure, have produced differing statistics. Brody goes on to say, "depending on the report you read, the possibility of infection is reduced by 25 percent to 50 percent in the circumcised male".
Analysis be that as it may, a snapshot of the initiation practice today, produces a bleak picture. There are a number of factors, that contribute to the degeneration of standards in the practice of Initiation which include the following; Opportunists motivated by greed, looking to make a quick buck, pose as traditional surgeons, and in the process mutilate our children, exposing them to death and permanent injury.
1. There is great enthusiasm amongst young men, brought on at times by peer pressure, to undergo the ritual, and as a result, unbeknown to their parents, they undergo circumcision in secret, with frightening consequences.
2. Earlier I mentioned that, the elders oversaw this Custom, but now, in our modern society there has been an increase in a number of female - headed households; boys who have no father figures or uncles to broach the subject with, turn to strangers, and become exposed to dangers in the process.
Economic impact of the botched circumcisions the price of botched circumcision is high, not only psychologically but also materially. For example it costs R700-00 a day, for an initiate to be treated in a hospital, those injured spent on average 30 days in hospital, in order to heal properly.
In the province, we have had, 4 749 admissions since the Introduction of the Traditional Circumcision Act of 2001. When you multiply R700 rands x 30 days and the number of admissions to date (4 749); You will then realise, that it has cost the Department R99 729 000 to date, to treat and rehabilitate victims of botched circumcisions.
Psychological Impact of Botched Circumcision The psychological impact of botched circumcisions is far-reaching, and can have dire consequences; * For one, the victims of such, if they survive, can no longer enjoy a normal life, as they have been robbed of their manhood
* In the event that the child concerned is an only son; as he can no longer be able to have children of his own, the family name, down the line, may cease to exist.
Leading causes of death and injuries
Coming to the main causes of deaths and injuries, especially in summer, the wounds easily become septic due to infections caused by non- sterilisation of instruments. Lack of proper training and capacity from the traditional surgeons. As, there is a period when consumption of water is prohibited; dehydration is also a major contributing factor to these statistics. Conversely in winter, the exposure to cold leads to pneumonia.
Other factors include the use of the initiation huts as haven for criminals; they store drugs and other stolen goods, as these places are not likely to be searched by police.
Then the easy access to illegal substances, more often than not, leads to unprovoked fights resulting in fatal injuries amongst the initiates themselves.
Intervention by the Health Department
Now the question you may ask is, what are we doing as Government? First of all, I would like to make it crystal clear that the Department of Health are not the custodians of the custom and have no such ambitions. In fact the custodians of the practice are the traditional leaders. But, at the end of the day, the Government is the guarantor of the basic right to life, and as such we could not sit back and watch as the mortality rate rose day by day.
The Department then took the initiative, and made a call to all role players and stakeholders, to get involved, in an effort to curb the death rate and the number of botched circumcisions. So far three South African provinces have approved legislation, which bear on the issue of circumcision. In the Northern Province, Eastern Cape and Free State, provincial laws deal with the observation of health standards, in traditional initiation schools, the granting of permission for the operation of circumcision schools, and generally, with the granting of permission to conduct circumcision.
Parental consent is also provided for, if the boy is below a prescribed age. The Eastern Cape has seen a 70 percent decline in incidences of unlawful initiations from 2001 to date, more than 42 traditional surgeons and nurses have been arrested since the province's Traditional Circumcision Act was introduced.
As part of this Act, just over 300 Medical Officers, drawn from various Health practitioners, have been designated to amongst other things;
1. Oversee the practice of this custom
2. Issue permits and assess application standards
3. Provide surgical training and equipment
4. Monitor the practice on the ground and intervene where necessary.
The Act itself is currently being reviewed, to scrutinise it for loopholes, and possibly incorporate initiates themselves, as would be offenders, in order to stem the tide of illegal circumcisions. National Minister for Provincial and Local Government Sydney Mufamadi, whilst addressing a Conference on Circumcision in Johannesburg recently, said a national law to regulate traditional initiation schools, would be considered by parliament later this year.
In addition to numerous raids being undertaken by the Department all over the province, 30 vehicles have been dispatched to various places to monitor the practice during this season.
Conclusion in conclusion ladies and gentlemen circumcision is just One aspect of the whole initiation cycle, that symbolises in this case, the graduation of a young man from one passage of life to another. This practice holds a pride of place in our communities as Africans, and reinforces our cultural identity and instils a positive value system in our young men.
Having said that, we need to be sensitive to the dynamics of society and our modern environment, therefore we need to constantly interrogate the Management, modus operandi, and the prevention of Criminal element in the initiation custom thereby preserving it.
Maybe food for thought is the contention of having this ritual performed in winter only, when it is more than likely that infections, dehydration, will be at a minimum and the possibilities of lightning bolts are remote thereby reducing deaths.
As a Department we therefore call upon all organs of society, Traditional leaders and other role players to form and united front to fight this scourge, chart a way forward, and stop the unnecessary loss of life and Restore dignity to a custom that is proudly African.
Contact: Sizwe Kupelo
Cell: 082 773 0973
Issued by: Department of Health, Eastern Cape Provincial Government
28 June 2004
Source: Eastern Cape Provincial Government (http://www.ecprov.gov.za)
Source: Eastern Cape Provincial Government
Title: Goqwana: Health service interventions
PRESENTATION BY MEC FOR HEALTH, DR BEVAN GOQWANA ON HEALTH SERVICE INTERVENTIONS AIMED IN MEETING THE CHALLENGES ASSOCIATED WITH MALE CIRCUMCISION, 28 June 2004
Programme Director,
Madame Premier,
Members of the Executive Council,
Distinguished Guests,
Ladies and Gentlemen
Introduction
I have been asked to present, a topic that is currently a focus of public scrutiny, as it continues to make headlines for all the wrong reasons.
As I tackle the issue of male circumcision from the Department's perspective, I hope at the end of my presentation, to have succeeded in raising consciousness, around some of the contentious issues, surrounding circumcision, thereby adding my voice to the ongoing debate, in seeking suitable and acceptable solutions, to some of the challenges facing this custom.
I shall touch on the meaning, the challenges, the context of the practice of circumcision, with a particular emphasis on this province, and the impact the tradition has on our everyday life. I shall then focus on the intervention strategies, devised by the Eastern Cape Department of Health, together with other stakeholders, in an effort to curb the mortality rate of initiates and botched circumcisions, that we see documented almost daily in the media.
Programme Director, I intend to demonstrate that despite the mounting challenges faced by the custom and the initiates themselves, the Provincial Department of Health has made tremendous inroads to bring down the loss of life and limb, now associated with the practice of this custom.
Origins of the Custom just to give a broad overview, young men in many African communities traditionally undergo training, involving rituals and circumcision to mark the transition to Manhood. This is an old age tradition passed on from generation to generation.
In the ceremony, which can last anywhere from weeks to several months, the elders teach boys, typically around the age of 18, about manhood and responsibility, in a rite of passage that includes the cutting off, of the foreskin and this is called Circumcision.
As part of this ritual, the young men who have undergone circumcision go with little food and water, live in a hut in a remote area in the bush, far removed from the modern comforts of the cities and spends much of the time covered with a blanket. In the olden days, experienced elders would oversee the ceremony, and carefully observe the boys, to make sure they were fit to undergo the custom. At this juncture, Programme Director it is important to mention that Circumcision is not exclusive to the African communities, but it is practiced widely as Jews and some of the Moslems also perform the ritual, though the manner, the stage, and the fashion in which it is performed, obviously differs from one group to the other. For an example, the Jews perform Circumcision at any early age, whilst Xhosas and other groups, undergo initiation when they are in their teens. Rites of Passage Initiation into manhood is but one of the rites of passage that a young African boy is expected go through in life. Imbeleko, (this is performed soon after a child is born), the naming of a child, marriage, becoming a father for the first time, are some of the other rites of passage.
Role of Women Contrary to public perception, women play a very significant role in the initiation process. A would be initiate, will in most cases, communicate his wishes to be circumcised to his mother, who will then pass the message on to the father.
The mother would then be involved in the planning stages of the ritual until such time the boy is taken to see the traditional surgeon, then the mother is no longer involved but kept informed of the developments.
The huts used by initiates, are actually put together by women, as well as brewing of traditional beer for initiation ceremonies. It is forbidden though, for sexually active women especially, to visit the initiates' hut, as this would stimulate the young men aggravating their situation.
Today's environment, in which the custom is practiced, is not static and is forever changing, and as such we need to be responsive to these changes. I am mentioning this deliberately whilst on the role of women, as it is regarded taboo, to even inform the mother of an initiate who has passed away, until a time that is considered appropriate by men to inform her.
We need to constantly evaluate some aspects of the custom's relevance and rationale, in today's environment.
Advantages of Initiation Ladies and gentlemen it is not all gloom and doom, as there are of course positives for those undergoing circumcision.
A young man who has undergone this custom, graduates to another status, enjoys respect amongst his peers and the community at large.
Recent studies undertaken on initiation, suggest that it is advantageous to undergo the ritual, as it promotes cleanliness and amongst other things, diminishes the chances of being infected with the Aids virus.
Dr Alan Brody, national director of the United Nation's Children's Fund, who supports male circumcision as one precaution against HIV infection, asserts that studies on the effectiveness of the procedure, have produced differing statistics. Brody goes on to say, "depending on the report you read, the possibility of infection is reduced by 25 percent to 50 percent in the circumcised male".
Analysis be that as it may, a snapshot of the initiation practice today, produces a bleak picture. There are a number of factors, that contribute to the degeneration of standards in the practice of Initiation which include the following; Opportunists motivated by greed, looking to make a quick buck, pose as traditional surgeons, and in the process mutilate our children, exposing them to death and permanent injury.
1. There is great enthusiasm amongst young men, brought on at times by peer pressure, to undergo the ritual, and as a result, unbeknown to their parents, they undergo circumcision in secret, with frightening consequences.
2. Earlier I mentioned that, the elders oversaw this Custom, but now, in our modern society there has been an increase in a number of female - headed households; boys who have no father figures or uncles to broach the subject with, turn to strangers, and become exposed to dangers in the process.
Economic impact of the botched circumcisions the price of botched circumcision is high, not only psychologically but also materially. For example it costs R700-00 a day, for an initiate to be treated in a hospital, those injured spent on average 30 days in hospital, in order to heal properly.
In the province, we have had, 4 749 admissions since the Introduction of the Traditional Circumcision Act of 2001. When you multiply R700 rands x 30 days and the number of admissions to date (4 749); You will then realise, that it has cost the Department R99 729 000 to date, to treat and rehabilitate victims of botched circumcisions.
Psychological Impact of Botched Circumcision The psychological impact of botched circumcisions is far-reaching, and can have dire consequences; * For one, the victims of such, if they survive, can no longer enjoy a normal life, as they have been robbed of their manhood
* In the event that the child concerned is an only son; as he can no longer be able to have children of his own, the family name, down the line, may cease to exist.
Leading causes of death and injuries
Coming to the main causes of deaths and injuries, especially in summer, the wounds easily become septic due to infections caused by non- sterilisation of instruments. Lack of proper training and capacity from the traditional surgeons. As, there is a period when consumption of water is prohibited; dehydration is also a major contributing factor to these statistics. Conversely in winter, the exposure to cold leads to pneumonia.
Other factors include the use of the initiation huts as haven for criminals; they store drugs and other stolen goods, as these places are not likely to be searched by police.
Then the easy access to illegal substances, more often than not, leads to unprovoked fights resulting in fatal injuries amongst the initiates themselves.
Intervention by the Health Department
Now the question you may ask is, what are we doing as Government? First of all, I would like to make it crystal clear that the Department of Health are not the custodians of the custom and have no such ambitions. In fact the custodians of the practice are the traditional leaders. But, at the end of the day, the Government is the guarantor of the basic right to life, and as such we could not sit back and watch as the mortality rate rose day by day.
The Department then took the initiative, and made a call to all role players and stakeholders, to get involved, in an effort to curb the death rate and the number of botched circumcisions. So far three South African provinces have approved legislation, which bear on the issue of circumcision. In the Northern Province, Eastern Cape and Free State, provincial laws deal with the observation of health standards, in traditional initiation schools, the granting of permission for the operation of circumcision schools, and generally, with the granting of permission to conduct circumcision.
Parental consent is also provided for, if the boy is below a prescribed age. The Eastern Cape has seen a 70 percent decline in incidences of unlawful initiations from 2001 to date, more than 42 traditional surgeons and nurses have been arrested since the province's Traditional Circumcision Act was introduced.
As part of this Act, just over 300 Medical Officers, drawn from various Health practitioners, have been designated to amongst other things;
1. Oversee the practice of this custom
2. Issue permits and assess application standards
3. Provide surgical training and equipment
4. Monitor the practice on the ground and intervene where necessary.
The Act itself is currently being reviewed, to scrutinise it for loopholes, and possibly incorporate initiates themselves, as would be offenders, in order to stem the tide of illegal circumcisions. National Minister for Provincial and Local Government Sydney Mufamadi, whilst addressing a Conference on Circumcision in Johannesburg recently, said a national law to regulate traditional initiation schools, would be considered by parliament later this year.
In addition to numerous raids being undertaken by the Department all over the province, 30 vehicles have been dispatched to various places to monitor the practice during this season.
Conclusion in conclusion ladies and gentlemen circumcision is just One aspect of the whole initiation cycle, that symbolises in this case, the graduation of a young man from one passage of life to another. This practice holds a pride of place in our communities as Africans, and reinforces our cultural identity and instils a positive value system in our young men.
Having said that, we need to be sensitive to the dynamics of society and our modern environment, therefore we need to constantly interrogate the Management, modus operandi, and the prevention of Criminal element in the initiation custom thereby preserving it.
Maybe food for thought is the contention of having this ritual performed in winter only, when it is more than likely that infections, dehydration, will be at a minimum and the possibilities of lightning bolts are remote thereby reducing deaths.
As a Department we therefore call upon all organs of society, Traditional leaders and other role players to form and united front to fight this scourge, chart a way forward, and stop the unnecessary loss of life and Restore dignity to a custom that is proudly African.
Contact: Sizwe Kupelo
Cell: 082 773 0973
Issued by: Department of Health, Eastern Cape Provincial Government
28 June 2004
Source: Eastern Cape Provincial Government (http://www.ecprov.gov.za)
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