Dear Minister Aaron Motsoaledi
Everybody writes an open letter these days so now it’s my turn. Your speech at the Cosatu conference, shows that you continue to back medical circumcisions in areas hard- hit by HIV.
But the word “medical circumcisions” is somewhat of a dirty word among rural doctors I’ve met. As a journalist interested in rural health, I have been living next door to Mosvold hospital, in the far northern reaches of rural KwaZulu-Natal, to get the down low on what is really going on.
When speaking to doctors here about their work, it’s almost inevitable that medical circumcisions will come up in conversation. Some doctors are violently opposed to the practice, well not violently. They do the procedure a hundred times a day without harming the man’s jewels but they would rather not be in theatre doing one simple operation after the other. Others are more positive quoting the research that shows circumcisions do reduce the risk of contracting HIV.
Doctors against medical circumcisions say that many a circumcised rural man has expressed the belief that they are far less likely to contract HIV, if at all and are hoping to get involved with more women using fewer condoms.
Healthcare workers don’t speak to the media on the record because it is up to the Department of Health spokesperson, but let’s hear from the Canadian doctor Mary Toulson who isn’t worried about protocol. She worked at KwaZulu Natal’s Mosvold hospital till the end of June this year.
“I hate medical circumcisions,” she says with passion. This is because Toulson has too often been approached by patients asking for a circumcision because “they want more sex.”
Toulson also feels the circumcision camps place additional burdens on Mosvold, a short-staffed rural hospital. Rural hospitals in KwaZulu-Natal are typically short-staffed. The operations that take place three times a week make work even more hectic for Mosvold’s nine soon-to-be-seven full time doctors who serve an estimated 150 000 patients.
When increasing rural staff’s workloads with hundreds of circumcisions a week, it is worth thinking about medical staff retention in rural areas. I mean it’s where just over forty percent of the population lives but where only just over ten percent of the all doctors that graduate each year go to work, according to Medical Recruitment NGO Africa Health Placements.
Dr Toulson says there have been days that so many doctors were doing circumcisions that other patients suffered. There were times when she worked in the Outpatient’s Department and couldn’t find a spare nurse to translate for her and help her understand her Zulu patients. This was because too many nurses where busy in theatre with circumcisions. Dr Lungile Hobe, at nearby Msileni Hospital, was far more positive about circumcisions, so it’s a not a clear cut issue but one that bears looking into before mass circumcision roll outs.
If one takes a walk through Mosvold hospital on a Monday, Wednesday or Friday one will see men and boys in blue gowns, usually reserved for the sick and weak, waiting for the great circumcision operation. Or perhaps, if they have gone wondering looking for the bathroom, one will catch sight of their naked buttocks because the theatre gowns leave a little more exposed than they should. They wait on a bench in a line and walk into theatre one by one with a brave look on their faces and fear in their eyes.
My translator and I chatted to a few about why they were being circumcised.
One teenager who just gave his name as Sipho said he was definitely going to have lots of girlfriends when he was well or when his-soon-to-be circumcised part was well.
Then there was the little 13-year-old who took his penis in his hand and explained that he was having a circumcision so he could wash his manhood in the bath with less trouble and keep it clean. He did a little display for us and I was happy the hospital gown kept things a little less obscene.
I was relieved to hear the text book answer, “It reduces HIV infections but I will still wear a condom,” from 21-year-old Stembiso Nxumalo who I later learned was a nursing student at Mosvold. He admitted to me post-op, when he told me it was still sore and swollen, (didn’t need to know) that plenty of rural boys don’t understand the operation and feel they are invincible afterwards.
It’s not all men who think they are suddenly being given a magic operation to prevent them from contracting HIV but Dr Touslon is not alone in saying that she has heard too many men asking for the operation with the idea of getting a lot more action once they have been snipped.
The Health Department needs to be aware that when medical circumcisions are done on a mass scale – doctors don’t have much time to explain to the men what circumcision is actually about. It is concerning that those on the front line say the mass roll out of circumcisions is encouraging promiscuity. And from a nurse, saying yes there are rural men in his community who get completely the wrong idea. It is certainly contributing to staff dissatisfaction among overworked doctors in a remote area where there are chronic doctor shortages.
Umbrella medical organisation, The Rural Health Advocacy Project’s manager Marije Versteeg says she doesn’t know of any research into whether medical circumcisions are confusing the HIV message, but would love to hear of some.
So while this mass roll out of the giant snip snip continues, how about asking some doctors in Northern KwaZulu Natal, where it is happening every few days, what they think or more importantly what the patients think.
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