Government Actions and Health Initiatives

In the past, ingcibis, or traditional surgeons, did not sterilize their tools in between each cut. The lack of sterilization was known to cause infection and may contribute to the transmission of sexually transmitted diseases.  Today, cleaning of spears is not mandated by the government or initiation sites, nor is there an equipment check to ensure that a spear is in satisfactory condition.  However, this sterilization process is taking place today on a large scale because of the growing awareness of STD’s.  A traditional Western Cape ingcibi stated that on average he performs his duties with six spears for a group of fifteen boys, using a different spear on each of the first six boys whom he circumcises.  A cleaning solution is used to sterilize every blade after each use.  He then repeats the process until all the initiates are circumcised.

imagesIt is reported that ikhankathas and ingcibis can wear gloves, but most ingcibis will often choose not to because they believe the gloves compromise their grip.  There is no policy that states that an ingcibi or ikhankatha must protect himself in this way.  In the Western Cape today, the Health department does not provide gloves, cleaners, or blades.  In one discussion, a prominent traditional surgeon stated that he believed the provision of free gloves and cleaners may very well make an ingcibi and ikhankatha more inclined to protect themselves and the initiate from diseases. It is believed that courses that teach safe practices will help to create a safer environment for initiation and preserve the traditional initiation culture.  A pre-post assessment of a course teaching safety practices in initiation presented in a 2008 report by L.L. Vincent showed that initiation courses have had a considerable impact on the surgeons’ and nurses’ knowledge of circumcision (Vincent, 2008).

In the Eastern Cape, it was confirmed that workshops are offered to ingcibis and ikhankathas on how to protect themselves from disease, and on how to manage wounds.  A benefit of these clinics is that they take place before the season begins, and an ingcibi and ikhankatha may receive free blades, gloves, and antiseptic there if they attend.  Nonetheless, not all ingcibis take advantage of these offers.  Some ikhankathas are now using western bandages and techniques, but others continue to use traditional methods.  These clinics are not mandatory and it is not known whether all ingcibis practice the safe methods taught in these courses.  Such methods have been proven to be safer through trials, and may be associated with the reduction in hospital admissions, penile amputations, and deaths from 1995 to 2007 in the Eastern Cape that were reported in a study printed in the South African Medical Journal (Meissner, 2007).

There are policies in the 2001 Circumcision Act which have affected the Eastern Cape, and currently only exist in the Western Cape in the form of recommendations made by certain ingcibis and site managers. These policies are as follows: an initiate must undergo physical evaluation before he is to go through the ritual, an initiate must be at least 16 with a recommended age of 18, the ikhankatha and ingcibi must be registered, and the parents must give permission to both the ingcibi and the ikhankatha.  Despite these policies, the Eastern Cape still continues to have a higher rate of injury and death than the Western Cape.

According to a City of Cape Town Department of Health official, the provisions of proper training, clean water, and showers help to make the sites such as Langa safer.  The facilities present are designed to be simple and unobtrusive to avoid straying from the ideal of not having structures, help ensure a safe environment for the initiates, ingcibi, and the ikhankatha.