Government Actions in the Initiation Community

On November 3, 2000, the Department of Health of the provincial government in the Eastern Cape made the first significant effort to unite stakeholders and “curb the mortality rate and the number of botched circumcisions” (Minutes of the City of Cape Town Inaugural Initiation Indaba held at fountain hotel 2009).

In the Eastern Cape, the Circumcision Act required that surgeons and nurses be approved by the initiate’s family and school, and their equipment, procedures, and cleaning solutions must be approved by a medical officer before they can practice (Karl Peltzer, 2008).

While the Western Cape does not have such policies, the provincial government is keen to take steps to ensure the provision of a place of safe treatment for the youth. The provincial government has begun to visit and evaluate formal initiation sites.  One more heavily publicized visit occurred fairly recently on Aug. 12, 2010, when The Department of Cultural Affairs and Sport Minister, Sakkie Jenner, travelled to the established Langa Site (Barnes, C. 16 August, 2010).  His time was spent evaluating the sites’ facilities and discussing the site with the amaXhosa Initiation Council.  This cooperation between initiation sites and government is a symbol of the change that is taking place in Cape Town.

While the negative reactions to the legislation were discussed briefly earlier, there were a number of positives that have come from the 2001 Circumcision Act in the Eastern Cape.  A crackdown on illegal initiation sites commenced, and workshops to properly train surgeons and nurses were offered, to ensure a sterile and safe procedure (Kepe, 2010).  International aid programs such as the United States Agency for International Development (USAID) took the initiative to help improve the safety of South Africa’s rituals, and began to sponsor these clinics to teach valuable skills.

To understand the impact of clinics that train surgeons and nurses, such as those by the USAID, many case studies have followed.  A case study with 34 traditional surgeons and 49 traditional nurses was conducted in the Eastern Cape to determine the level of knowledge of surgeons and nurses and how they care for their patients (Karl Peltzer, 2008).  It was found that there is large inconsistency in the type of tool used, the way it is stored (anything from animal skin to plastic wrap), and the way it is washed (from solutions to simply warm water).  Approximately 50% of the surgeons reported that they had never had surgical complications while performing surgeries, but this must be taken with a grain of salt, given the nature of self-reported data gathering. Out of the 40% of surgeons who had handled an abnormal penis, approximately 38% had not felt confident while performing the circumcision (Karl Peltzer, 2008).  Facts like these indicate that these clinics are needed, and in a pre-post assessment, results showed that these clinics made a considerable impact on the surgeons’ and nurses’ knowledge of circumcision (see table below).

(Karl Peltzer, 2008)

Following this information though, Peltzer conducted a similar case study with the help of a couple other researchers in 2008.  Despite these positive results shown above, out of 192 initiates examined after being circumcised by surgeons who had received the training previous to performing the circumcision, the following data was found:

40 (20.8%) had mild delayed wound healing

31 (16.2%) had a mild wound infection

22 (10.5%) mild pain

20 (10.4%) had insufficient skin removed (Peltzer et al., 2008).

This data is from the same source, so that must be taken into consideration.  With that said, it does indicate that while surgeons are able to apply the information they have been taught, some are still unable to put this knowledge into practice.