Circumcision season usually starts from May and continues until around the end of the mid-year school holidays in July depending on the area. This is a difficult time for the young boys who go to initiation schools hoping to come out as men. It’s a particularly challenging time for hospitals in the Eastern Cape where the old ritual of circumcision is vigilantly observed. Most of the participants in initiation ceremonies in the Eastern Cape are Xhosa males.

With the Xhosa people of South Africa, circumcision is part of a series of rituals that are performed to facilitate the transition from childhood to manhood. This is a deeply personal and meaningful process that former President Nelson Mandela also took part in. For generations, boys have looked forward to initiation rituals and returning back to their families as healthy and wiser men. However, things do not turn out this way for many young boys in the Eastern Cape and other areas where the tradition is still practiced.

Botched circumcisions often result in permanently damaged private organs and sometimes, even death. Since May, no less than 60 boys and men have died in the Eastern Cape. Half of those passed away after attending initiation schools in the last six weeks. The Holy Cross Hospital is the closest hospital to a few of the initiation schools in the Eastern Cape. According to media reports, the hospital has a high admission rate for injured initiates.

Dr Dingeman Rijken is one of the doctors tasked with treating the boys who come in. He is saddened that the number of botched circumcisions continues to rise despite the intensive efforts to prevent them. Rijken developed a basic training manual which he circulates in the area. The manual includes prescribed methods of ensuring that circumcisions are done in a sterile and medically appropriate setting by someone who is educated about and understands the anatomy of the male sexual organ. Circumcisions must be performed by an experienced person. As it is, some of the injured males were told not to seek medical attention immediately as their injured organs would heal and grow back.

Rijken explained his predicament: “I have had to tell eight boys this season that they’ve lost their glans or parts of their penis, so it is a health problem. We can’t run away from it, we need to address it.”

The most severe injuries are as a result of cutting beyond the foreskin of the penis, improper bandaging techniques which limit the blood supply to the injured organ, dehydration and malnutrition. Dr Rijken said that gangrene can set in in a matter of a few hours. Some initiates wait as long as 10 days before seeking medical attention and by then, not much can be done to save the penis or in many cases, the initiate’s life.

The initiation process puts pressure on injured initiates to suffer in silence so that they will not be accused of being weak men who cannot handle physical pain. Others are forced to remain at the school in the bush and receive traditional treatment from the often untrained managers of the school.

Rijken is convinced that the only way to make circumcisions safer is to combine the efforts of traditional leaders, government health departments and the community. Educating the community is instrumental in saving the lives of initiates. “At a certain point if you see so many boys are dying, then it’s time to talk about it.” As initiation season draws to an end, one can only hope that there won’t be any more injuries and fatalities.