Bugisu: Beyond Mt. Elgon and male circumcision

 By Daniel Edyegu

The mention of Bugisu sub-region often brings to mind five prominent aspects – imbalu (cultural male circumcision), Mt. Elgon, malewa (bamboo shoots), kadodi (cultural circumcision dance) and Arabica coffee. Bugisu is, however, everything above and more.

Despite this reality, Mt. Elgon, located along the Kenya-Uganda border, remains a prominent feature that partly forms the natural heritage for people in the region. The mountain, gazzetted as a forest national park, is the ancestral home of the Bamasaaba.

Candidates destined for circumcision being carried shoulder-high

Whereas the sub-region was synonymous with Mbale district in the past, the vast area led to gradual division of the mother district into four other districts.

Manafwa district led the fray in 1999 followed by Sironko in 2002 and Bududa four years later. While the populace sighed and reclined with satisfaction in the existent districts that had brought services nearer to the people, Bulambuli slipped away from Sironko in 2010.

However, Mbale still remains the economic heartbeat of the region. The people within these districts also maintain a close niche. This has partly been possible due to the shared cultural practices such as circumcision and socio-economic activities like coffee-growing.

A farmer picking Arabica coffee in Bulambuli

John Baptist Nambeshe, the Bududa LC 5 chairperson, explains that being a mountainous area, the creation of the new districts was inevitable as a way of easing access to social services, for mainly people residing on the hard-to-reach slopes on the mountain.

“There are areas that are inaccessible to motorised transport. These were mainly neglected by the mother district. These new districts, though, have in no way wedged an axe between the people. In fact, the districts are just boundaries, but we are one people.” Nambeshe says.

A doctor tests a child with hydrocephalus at CURE Children’s Hospital

Each even year, the Bamaasaba in the five districts plus their ancestral brothers, the Bukusu in Kenya, converge at Mutoto cultural grounds, Mbale district, for the launch of the imbalu. The cultural fete is launched with dances, drinking and partying.

Whereas the Government has initiated safe male circumcision in all its health centre IV units, the Bamasaaba treasure the imbalu as it is considered the passage to manhood.

John Musira, a circumcision surgeon and elder, explains that no amount of safe male circumcision in a health unit can qualify a Mumasaaba boy into a man.

“Unlike the safe male circumcision in the health units where anesthetics are applied to numb the pain, that exact pain during cultural male circumcision is part of the ingredient that qualifies a boy into a man. Besides, a person circumcised in the health unit does not qualify to be a cultural elder neither does he sit in cultural meetings with other men,” Musira explains.

Perhaps to knot the unity among the Bamasaaba much tighter, the people inaugurated the cultural leader, Umukuuka Weasa Wamimbi in 2010. The cultural head, besides presiding over cultural ceremonies and rituals, is considered the centre of unity among the Bamasaaba.

Upon fi rst impression, the CURE Children’s Hospital seems to be a quiet surgical centre with little activity. However, a few yards past the hospital’s reception, the illusion fades fast.

Women, clad in blue uniforms, move around the compound, invoking images of nurses going about their ordinary duties. As it turns out, they are the caretakers and mothers of children admitted here with neurological disabilities.

Inside the pediatric ward, mothers sit on hospital beds next to the ill babies, some of whom are asleep. On another look, you notice these are not the typical ill babies at a pediatric ward.

They either have ‘big heads,’ humps along the spine or an unusual large swelling on the head – all symptoms of neurological disabilities, affecting the brain and spinal cord.

Located on Bugwere Road in Mbale town, the CURE Children’s Hospital was established in 2001 and is the only pediatric hospital in sub- Saharan Africa that specializes in neurosurgery.

More than 1,000 pediatric neurosurgeries are performed at the hospital every year, more than at any other hospital in the world. Annually, more than 5,000 children receive care from this small hospital.

Developments

In June, the hospital will begin offering services for adults. Certain types of brain tumours, spinal disc herniation and other back problems can now be treated at CURE in Mbale.

The hospital recognizes the valuable resources it has: its experience, a reputation for high-quality surgical care and two Cape Town-trained neurosurgeons. Patrick Bitature, a board director at CURE, recently held a gathering of infl uential business leaders in Uganda and put forth a challenge to do more for some of the most vulnerable children in the country.

Roofings Ltd, Total, Umeme and MTN are among the leading businesses and firms responded to the challenge and pledged their support. The most common neurological disabilities in children treated at the hospital are hydrocephalus (76%) and spina bifida (13%). Hydrocephalus is an abnormal expansion of cavities (ventricles) within the brain. It is caused by the accumulation of cerebrospinal fluid.

The accumulation of fluid causes the head to expand. Spina bifi da is a birth defect that involves an incomplete closure of the spinal cord or its coverings.

Given the abnormal swellings they cause on the head and along the backbone, these neurological disabilities are usually associated with superstition in the rural areas, an illusion that CURE has fought to demystify.

Mothers who give birth to babies with defects are often disowned by society and considered outcasts. They are regularly abandoned, harassed or beaten, but they make their way to CURE for the sake of their babies.

Around the world, hydrocephalus is usually treated through inserting a shunt (tube) in the brain and the fluid is drained off, relieving the pressure inside the head.

However, in the first two years, these shunts fail most of the time, a big problem for patients who cannot easily access surgical care.

The hospital’s medical team developed a new method to treat hydrocephalus, using an endoscope. Using the endoscopic procedure, surgery is performed inside the brain, opening the blocked pathway and allowing the fluid to drain naturally.

Derek Johnson, the executive director of CURE, says this method is more economical, less invasive and carries less risk than traditional approaches to treating hydrocephalus.

Surgeons from the UK and USA are coming to Mbale to learn how to treat children with Hydrocephalus using this approach.

“Our hospital is leading the way in how the rest of the world treats Hydrocephalus,” Derek explains. Bitature says CURE and its team are a national treasure for Ugandans.