George Mwidu, 42, is an energetic clinical officer who has seen and circumcised more than 13,000 men since 2009.
By John Agaba
George Mwidu Lyavala, 42, is more than meets the eye. The energetic clinical officer has seen and circumcised more than 13,000 men since 2009, making him arguably the person who has cut most men medically in Uganda, by peer estimates.
This is about three per cent of all the 418,223 men circumcised under the projects funded by the US president’s emergency plan for Aids relief (PEPFAR) in the country.
It means Mwidu has circumcised about three men per day, assuming he has worked daily in the past four years.
“I am now so used that it takes me about eight minutes to prepare the patient, cut the foreskin, treat to prevent bleeding and stitch him,” he says in an interview at Kayunga Hospital. “I think I have ever circumcised slightly more than 30 men in one day.”
In 2007, the World Health Organization (WHO) recommended medical male circumcision (MMC) as one of the interventions in the fight against HIV, after trials in Uganda, Kenya, and South Africa showed it reduces the risk of female-to-male sexual transmission of the virus by about 60%.
In Uganda, the MMC programme was launched in September 2010, targeting 80% of uncircumcised men – about 4.2 million men – by 2015. PEPFAR and UNAIDS projected that circumcising 4.2 million men could halve Uganda’s HIV incidence.
By March 2012, according to the Uganda AIDS commission’s (UAC) annual performance review of the national HIV and AIDS strategic plan (2011-12), only 380,000 men were circumcised.
I found Mwidu training clinical officers — men and women — for the Star East response team on MMC. From him, I learnt the Star East project trains more personnel who can assist in the MMC projects. They include councilors and nurses who assist doctors and clinical officers in circumcision.
Mwidu started off his career as a clinical officer at Kayunga Hospital. His role was generally to diagnose, order for and interpret medical tests, and treat disease and injury. Medical assistants also carry out surgical procedures and refer patients to other practitioners.
“Even at that time, I had a soft spot for HIV patients,” he says.
“I would never leave an HIV/AIDS patient unattended to, no matter how busy. If I could do anything to help prolong a patient’s life, I did so willingly. When the opportunity to contribute directly to the fight against the virus came, I jumped onto the occasion.”
Mwidu joined the Makerere University Walter Reed Project (MUWRP), which is spearheading the implementation of MMC in the country, funded by the PEPFAR.
“We started by mobilizing people into circumcision, moving from health centre to health centre,” recollects Mwidu.
“We moved with the district health team. But, like you would expect, at the start, it was not easy. Many people would just look on.
“Even when we demonstrated to them that the surgery was not as painful and that in about three weeks they would be healed and doing their daily routines and that the services were free, only a few accepted to get circumcised until MUWRP rolled out the intervention in 2009.”
The clinic officer was involved in the pilot study done at Kayunga Hospital to test the safety and acceptability of circumcision as well as the proposal to allow clinical officers to perform the circumcision because medical doctors were not enough.
“The results were encouraging. By 2010, we had cut about 300 men without any adverse problem.”
That very year, MMC was rolled out free in the rest of Kayunga. Mwidu was on the team which circumcised about 2,380 men by the end of 2010.
In 2011, the number rose to about 6,687 men but soared even higher in 2012 to about 14,970. In 2012, they also spread to the surrounding districts of Mukono, Buikwe, and Buvuma. This year, they have a target to circumcise over 31,149 males.
However, these figures aren’t one bit close to the desired target of 4.2 million men by 2015.
According to the Monitoring and Evaluation of President’s Emergency Plan (MEPEP), a body funded to monitor PEPFAR’s performance in Uganda, all PEPFAR funded projects implementing MMC in the country have only circumcised about 418,223 sexually active men – men between the age group 15 to 49.
According to UAC, 5.9 million men who are not Muslims are not yet circumcised. The country needs to reach a circumcision prevalence of 80% to achieve results.
“You need to circumcise about 20 men to avert one HIV infection. This calculates to about 4.5 million sexually active men if we are to register concrete results in the fight against HIV,” says Mwidu.
Mwidu doesn’t spend his working time ‘cutting penises’ only. He also trains clinical officers of the nitty-gritties of the circumcision procedure. He has been a trainer for about two years.
“We started in 2010. That year we trained about 200 health workers — clinical officers, nurses, and councilors. We teach them to record patients on arrival, what to do before undressing someone for circumcision, how to hold the surgical scissors during the actual cutting, how to stitch and to dress the wound after the procedure. We also teach them the importance of follow-up.”
Mwidu says by 2012 when PEPFAR stopped funding the project, they had trained more than 800 people. “So, now we are training personnel for other projects, like the Star East, Star West and others.”
He says: “When men come for circumcision, we explain to them what circumcision is, we tell them they will experience some pain, some bleeding, and some sensation as the wound heals and the glans get used to life ‘out of the foreskin’.
(Usually after circumcision the head of the penis becomes more sensitive than normal and sheds off skin before new and tougher skin develops.)
“We also tell them that there could be some injuries involved, but that the main reason for circumcision was to reduce their risk of contracting HIV.”
Also, he adds, they explain to the men that when they are circumcised and don’t contract HIV, they can’t pass on the virus to their spouses because they don’t have the virus.
They tell them that MMC also reduces the risk of their partners contracting other sexually transmitted infections like syphilis, gonorrhea, genital warts, name it, plus cervical cancer.
“There is this common fallacy that circumcised men are better than the uncircumcised when it comes to sex; that they last longer, and that actually some women prefer them. I don’t know about that. But, we tell them of the advantages and the disadvantages of circumcision so they consent knowing all issues around circumcision,” says Mwidu.
He says his most memorable moment in the four years he has been ‘cutting penises’ was when a man he circumcised decided to have penetrative sex three days after the operation.
“It is an unfortunate one, but it’s the most memorable,” he says. “The man was a fisherman from Galilaya, near Lake Kyoga. We had told him that he can only have sex after the stitches had been removed and the wound fully healed, usually after six weeks. But he decided to have sex after three days.”
“It was a disaster. After having sex, he feared to come to the camp to tell us. It’s the people we had circumcised him with who came and told us that one of them was doing badly. Then we went to see him. The man was shattered all over. All the stitches had given way. The whole penis was swollen.
"And he was in pain. We had to stitch him afresh. And ask him not to have sex until we examined him and passed him healed. He said he didn’t know he could get an erection when still ‘sick’. So when he got an erection, he went and had sex.”
Mwidu says circumcision is only a fraction of his daily schedule at the Hospital; however, there isn’t any one time he is happier and at ease than when he is cutting God’s men. “When I’m in the theatre? You don’t know,” he laughs. “It is the thing I enjoy most. I work as I talk to my patients. I ask them whether they are feeling some pain or not. Then I tie the bleeders, and stitch the wound. And before you know I’m done… In a way circumcising men makes me happy. I feel like I’m directly contributing to the fight against HIV.”
Born in Kamuli district, the father of four attended Budini Boys’ Primary School, Budini College both for his O’ and A’ levels, in Kamuli district, before joining the Gulu School of Clinical Officers to pursue a diploma in chemical medicine. He graduated in 1994. For close to 20 years now he has been a medical assistant.
He is married to Resty Mwidu. Him, the wife, and children live in Kayunga Central Ward, Kayunga Parish, Kayunga Town Council.
He says his big disappointment are people who go propagating word that MMC does not reduce the risk of men contracting HIV, discouraging others from circumcision. “They are making our work and the fight against HIV difficult.”
George has circumcised more than 13,000 men