June 18, 2024

Making the ‘rite cut’

4 min read

A pioneering collaboration that safely upholds an age-old tradition has resulted in the medical circumcision of 71 young men between the ages of 9 and 17 in the industrial town of Sasolburg. Dubbed The Rite Cut, the initiative saw Netcare Vaalpark Hospital, the Netcare Foundation and the Fezile Dabi District ­Municipality unite in a landmark event that will have a profound impact on the community.

Traditional male circumcision (ulwaluko), an initiation rite that marks the transition from childhood to adulthood, holds deep cultural significance in South Africa, says Mande Toubkin, general manager: emergency, trauma, transplant and corporate social investment for Netcare. “In many traditional societies, expectations surrounding circumcision are undeniably powerful and have led to instances where young men have undergone unsafe non-medical circumcisions, often with potentially life-threatening repercussions.

“As healthcare workers, we are mindful of the profound cultural significance of traditional male circumcision and the safety and well-being of these young men. The Netcare Foundation is honoured to support this vital community initiative that merged tradition with medical expertise to offer a safer path to adulthood. Our sincere gratitude goes to the medical professionals, families and community leaders who came together for The Rite Cut: a pioneering and inspirational model for the safe continuation of culturally relevant traditions,” she adds.

Specialist general surgeon Dr Boitumelo Nkgudi, who practises at Netcare Vaalpark Hospital and was one of the surgeons to participate in the programme, says it is essential for young boys and men to make informed decisions about their bodies. This includes circumcision – a surgical procedure to remove skin or tissue from the genitals. “If a young man chooses to opt for circumcision, it must be done safely and with adequate pain control and access to a doctor for checkups after surgery.

“Non-medical and traditional male circumcision can increase the risk of health complications including sepsis, genital mutilation, gangrenous penis, excessive bleeding, septicaemia and permanent disability from the complete or partial amputation of the glans or shaft, among other issues that can be life-threatening.”

General practitioner and specialist anaesthesiologist Dr Sias Searle, who works from Netcare Vaalpark Hospital and is the vice chairperson for the South African Medical Association (SAMA) Vaalriver branch, emphasises that circumcision is a personal choice that may depend on factors other than medical benefits, such as cultural, religious or ethical beliefs. “It is important to consider all aspects and consult a doctor before deciding. There are several medical reasons to encourage circumcision in men. It can help lower the risk of sexually transmitted infections (STIs) such as HIV, HPV and herpes, and protect against penile cancer and the risk of cervical cancer in female partners. It may also prevent inflammation of the glans and a tight foreskin that cannot be pulled back. 

“While there is substantial evidence that circumcision can protect against several diseases, there are risks involved with any surgical procedure. Neonatal circumcision, on the other hand, is a more straightforward procedure with a low rate of adverse events. In contrast, juvenile or adult circumcision can come with bleeding, haematoma or sepsis risks. It is therefore crucial to undertake circumcision in a clinical setting with experienced healthcare providers to avoid serious complications. Safety, pain and cost are the primary concerns for those considering circumcision, while perceived protection from STIs, improved genital hygiene and enhanced sexual pleasure are facilitators of acceptability,” notes Dr Searle, who also participated in The Rite Cut initiative.

According to Sr Karen Jansen van Vuuren, nursing manager of Netcare Vaalpark Hospital, there has long been a high demand for voluntary male circumcision during the July school holidays at the hospital. “Discussions with the people of the Fezile Dabi District revealed a similar pattern and a pressing need for assistance with medical circumcisions in the tiny district nestled in the northern reaches of the Free State. Netcare Vaalpark Hospital – together with Pulane Pule, local area manager of Metsimaholo Sub-District and Jerry Mokhampane, the VMMC [voluntary medical male circumcision] clinical specialist for Fezile Dabi District – resolved to work together to assist children and young adults from disadvantaged population groups in the area who have chosen medical circumcision.”

She explains that the screening programme conducted as part of the initiative identified several uncomplicated cases. “As part of our agreement with the district, we provided post-operative care where access to a clean water supply posed challenges while offering to assist with any possible post-operative complications. In addition, the programme included pre-op health talks and follow-up care instructions in Sesotho and English.  

“A certificate of bravery, which carried every patient’s name and a bravery sticker, was an essential and popular component of the programme. The feedback from the community was overwhelmingly positive and heart-warming, with the young men proudly showing off their personalised certificates. 

“Apart from its clinical benefits, The Rite Cut initiative contributed to a healthier generation while reducing the disease burden. As healthcare workers, we are proud to be associated with this rewarding initiative that holds tangible and measurable benefits for our communities,” says Sr Jansen van Vuuren.

“Without the tremendous support and involvement of several leading local healthcare professionals – who all donated their time and expertise – this initiative would not have been possible. We wish to thank surgeons Dr Teboho Malindi and Dr Boitumelo Nkgudi, general practitioner Dr David Motau (who is also the chairperson for SAMA’s Vaalriver Branch), Dr Sias Searle and registered nurse Sr Juanita Searle for supporting the initiative.

“We also sincerely thank the nurses, reception team and the Netcare Vaalpark Hospital pharmacy staff for volunteering their time. A particular word of thanks to the nursing staff for their kind donations toward meals for the patients and to 3M for donating consumables; EMPACT catering for supplying refreshments as well as snacks for the children; and last but not least, to SAMA for their kind donation of sweet treats for the patients.”

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