Health Concerns during the Initiation Process

Health complications caused by improper surgical procedures and improper medical care present challenges during the initiation process. Poorly performed circumcisions, infections, and unhygienic environments are reasons that have caused the government to intervene on this traditional ritual (Meissner, 2007). Every year there are hospital admissions and deaths caused by initiations that are reported in the media all over South Africa. In one week during the 2004 initiation season, two males were admitted into the hospital in Western Cape due to botched circumcisions; twenty eight males were admitted into the hospital in the North Western Cape due to dehydration and acute sepsis; and three deaths were reported in the hospitals in the Northern Cape. Many of the admitted initiates have experienced delayed wound healing, swelling, mild wound infection, lacerations, and keloid scarring (Vincent, 2008). In order to regulate the initiation process and to reduce the incidence of medical complications the provincial authorities have been taking actions by providing initiation sites and training for nurses and surgeons.

The table below presents statistics for the hundreds of hospital admissions that resulted from initiation from 1995 to 2007 in the Eastern Cape.


Reported cases of hospital admissions, penile amputations and deaths of initiates in the Eastern Cape Province 1995 and 2007.

Sources: adapted from (Daily Dispatch, 2005) and (Daily Dispatch, 2006a)), ECDOH (2007), and Goqwana (2004a). No figures were available for hospital admissions and penile amputations for 2006. The 2007 figures only cover the period to the end of July. Please note that the authenticity of all these figures is not guaranteed, as there are possibilities of under-reporting due to the sensitivity of the matter; but they are used to illustrate the presence of a crisis.(Meissner, 2007)

There are many factors that contribute to complications during circumcisions:

  1. During the process, an unsterilized or unwashed blade can cause cross-transmission of blood-borne infections such as HIV and hepatitis B. In a documentary by the NationalGeographic, a circumcision is shown and the surgeon appears spraying his knife with a disinfectant after the procedure, before wiping it with a clean cloth. This use of a proper sterilization process is not always the case, but education about transmission of STDs and growing concerns for lack of sexual education has led to an increase in care by the surgeons.
  2. Occasionally, inexperienced surgeons remove excessive or insufficient amounts of the foreskin. This removal can cause serious issues, such as scarring of the distal foreskin and wound contraction (Meissner, 2007). Moreover, if severe mutilation of the skin or glands of a penis occurs, an initiate may be forced to go to the hospital to have his penis amputated; the initiate may still die due to a massive haemorrhage.
  3. Even if a circumcision is successfully conducted, in some cases, traditional nurses with insufficient medical knowledge may also offer poor health care and may bandage the wound too tightly, which leads to ischemia, a lack of blood supply (Kepe, 2010).
  4. Infection usually occurs when ikhankatha clean the wound improperly. Special training for traditional surgeons and nurses has been widespread in the Eastern Cape. This has the ability to greatly reduce the number of injuries due to malpractice (Vincent, 2008).