Circumcision: Are you safe?
Oct 17, 2006
THE ringing of a bicycle bell in Nyanama, a Kampala suburb off Entebbe Road, used to signal that either a milkman or fish vender was passing by. Now there is another addition: The circumciser.
By Irene Nabusoba
THE ringing of a bicycle bell in Nyanama, a Kampala suburb off Entebbe Road, used to signal that either a milkman or fish vender was passing by. Now there is another addition: The circumciser.
For three months now, Hajji Abubakar, the ‘mubazi’, has worked as such. Previously, he only used to sit at a mosque, hoping people would come or be brought to him for circumcision, but now, the elderly man, slowly rides his bicycle through homesteads with his basket, looking for new clients to circumcise and also attends to his patients he circumcised previously.
“I get at least three clients a day, most of them below 10 years of age, non Muslims and non Bagisu,†Abubakar says. Traditionally, the past in Uganda, only Muslims and Bagisu circumcised their males. Today, this is no more the case.
Abubakar is one of the many people earning from circumcision which is a new business.
Why circumcision?
The demand for circumcision especially for young boys is high due to the scare of kidnapping children for sacrifice that engulfed the city, and the neighbouring towns. It is believed that once a child has shed blood, it cannot be accepted as sacrifice by traditional healers who allegedly kidnap children for sacrifice.
Scientists also believe that circumcision increases chances of surviving HIV infection if one has had unprotected sex with an infected person.
Studies done by the World Health Organisation in South Africa, Uganda and Kenya, show that male circumcision reduces the chance of men getting infected with HIV by 60%. In the Uganda study led by Dr. Thomas Quinn of Johns Hopkins University in Baltimore, 12,000 volunteers in Rakai were studied. The report said among infected men, circumcision reduces the likelihood of transmitting the virus through sex.
In a PLoS Medicine study published last month, researchers said if circumcision were to include all men in Africa in 10 years’ time, some two million new infections and 300,000 deaths from HIV/AIDS could be prevented. After 20 years, the researchers say, the number of deaths prevented would be between 1.6 million and 5.8 million.
Another researcher Brian Williams of the World Health Organisation says although male circumcision alone cannot bring HIV/AIDS in Africa under control, it should become a major part of programmes to control the epidemic.
In Uganda, many ‘local surgeons’, most of whom have no medical background, are springing up to offer the service. A few of these circumcisers station at mosques, but many are scattered in villages.
Dr. Richard Senoga from Kibuli Hospital says that circumcision should only be done by a trained and qualified medical person and under anaesthesia.
“The so-called ‘local surgeons’ may be cheap but they are not qualified. They all learn on the job and keep making mistakes during the procedure, which can even led to death,†Senoga says.
Common complications
Senoga says people circumcised outside health facilities often experience overbleeding, sepsis, infection and in rare cases, chopped off glans (part of the penis head). Sometimes the skin is cut too short and not stitched to the base. In children, especially fat ones, the penis may retract inside as the skin heals, sealing off the glans form inside.
“We always have to carry out another surgery to correct such complications and expose the penis. It is a serious condition because the patient cannot urinate,†Senoga says.
Dr. Adam Kimalu, a senior surgeon at Mulago Hospital, says the number of cases of bleeding profusely from local circumcision have shot up. “They (quark surgeons) just cut, put gauze and that is the end,†he said. “Many heal by luck, but others end up over-bleeding, which may lead to anaemia or, in rare cases, death. Some people are brought in looking paper white because of loss of too much blood.â€
Kimalu says children are more vulnerable to post circumcision bleeding because they have little blood. “We got a case of a child that bled while sleeping and died!â€
Proper circumcision
Kimalu says circumcision is a surgical procedure that involves partial or complete removal of the foreskin (prepuce) of the penis. He says the procedure must be purely sterile and under anaesthesia to avoid subjecting the patient to neurological shock as a result of pain. “You need to work on someone who is not fighting or struggling,†he said.
Research findings, however, warn that both injections and topical anaesthetic creams can be dangerous and that general anaesthesia should never be used on young babies because of the risk of breathing problems.
Shekh Murushid Settuba, the Imam of Kibuli Mosque, says Muslim circumcisers are accredited and work alongside medical personnel. “It is true most of these learn on the job from their colleagues,†he says. “They make mistakes while learning, but it happens even in hospitals,†he adds.
“After training and experience, our circumcisers are issued with a letter from the mosque, which is like a license,†he says. “But, of course there are those who masquerade,†Settuba says.
Settuba advises that not any Muslim can circumcise and that people should be more careful when dealing with people that move to homes circumcising. “A true Muslim qualified circumciser should have a letter from the mosque and have medicines like antibiotics from hospital,†Settuba says.
Dr. Alex Opio, an assistant commissioner in the Ministry of Health, agrees that circumcision by unqualified personnel is a problem. “We are coming up with guidelines that will later be interpreted into a practical policy that will address all these shortcomings. But until then, the public should just ensure that they undergo the procedure from a health facility because we have no policy to curb the unqualified circumcisers,†Opio says.
Opio said local circumcisers must be sensitised about correct and safe circumcision, especially among the Bagisu to minimise the spread of HIV/AIDS due to the use of one knife on several clients.
THE ringing of a bicycle bell in Nyanama, a Kampala suburb off Entebbe Road, used to signal that either a milkman or fish vender was passing by. Now there is another addition: The circumciser.
For three months now, Hajji Abubakar, the ‘mubazi’, has worked as such. Previously, he only used to sit at a mosque, hoping people would come or be brought to him for circumcision, but now, the elderly man, slowly rides his bicycle through homesteads with his basket, looking for new clients to circumcise and also attends to his patients he circumcised previously.
“I get at least three clients a day, most of them below 10 years of age, non Muslims and non Bagisu,†Abubakar says. Traditionally, the past in Uganda, only Muslims and Bagisu circumcised their males. Today, this is no more the case.
Abubakar is one of the many people earning from circumcision which is a new business.
Why circumcision?
The demand for circumcision especially for young boys is high due to the scare of kidnapping children for sacrifice that engulfed the city, and the neighbouring towns. It is believed that once a child has shed blood, it cannot be accepted as sacrifice by traditional healers who allegedly kidnap children for sacrifice.
Scientists also believe that circumcision increases chances of surviving HIV infection if one has had unprotected sex with an infected person.
Studies done by the World Health Organisation in South Africa, Uganda and Kenya, show that male circumcision reduces the chance of men getting infected with HIV by 60%. In the Uganda study led by Dr. Thomas Quinn of Johns Hopkins University in Baltimore, 12,000 volunteers in Rakai were studied. The report said among infected men, circumcision reduces the likelihood of transmitting the virus through sex.
In a PLoS Medicine study published last month, researchers said if circumcision were to include all men in Africa in 10 years’ time, some two million new infections and 300,000 deaths from HIV/AIDS could be prevented. After 20 years, the researchers say, the number of deaths prevented would be between 1.6 million and 5.8 million.
Another researcher Brian Williams of the World Health Organisation says although male circumcision alone cannot bring HIV/AIDS in Africa under control, it should become a major part of programmes to control the epidemic.
In Uganda, many ‘local surgeons’, most of whom have no medical background, are springing up to offer the service. A few of these circumcisers station at mosques, but many are scattered in villages.
Dr. Richard Senoga from Kibuli Hospital says that circumcision should only be done by a trained and qualified medical person and under anaesthesia.
“The so-called ‘local surgeons’ may be cheap but they are not qualified. They all learn on the job and keep making mistakes during the procedure, which can even led to death,†Senoga says.
Common complications
Senoga says people circumcised outside health facilities often experience overbleeding, sepsis, infection and in rare cases, chopped off glans (part of the penis head). Sometimes the skin is cut too short and not stitched to the base. In children, especially fat ones, the penis may retract inside as the skin heals, sealing off the glans form inside.
“We always have to carry out another surgery to correct such complications and expose the penis. It is a serious condition because the patient cannot urinate,†Senoga says.
Dr. Adam Kimalu, a senior surgeon at Mulago Hospital, says the number of cases of bleeding profusely from local circumcision have shot up. “They (quark surgeons) just cut, put gauze and that is the end,†he said. “Many heal by luck, but others end up over-bleeding, which may lead to anaemia or, in rare cases, death. Some people are brought in looking paper white because of loss of too much blood.â€
Kimalu says children are more vulnerable to post circumcision bleeding because they have little blood. “We got a case of a child that bled while sleeping and died!â€
Proper circumcision
Kimalu says circumcision is a surgical procedure that involves partial or complete removal of the foreskin (prepuce) of the penis. He says the procedure must be purely sterile and under anaesthesia to avoid subjecting the patient to neurological shock as a result of pain. “You need to work on someone who is not fighting or struggling,†he said.
Research findings, however, warn that both injections and topical anaesthetic creams can be dangerous and that general anaesthesia should never be used on young babies because of the risk of breathing problems.
Shekh Murushid Settuba, the Imam of Kibuli Mosque, says Muslim circumcisers are accredited and work alongside medical personnel. “It is true most of these learn on the job from their colleagues,†he says. “They make mistakes while learning, but it happens even in hospitals,†he adds.
“After training and experience, our circumcisers are issued with a letter from the mosque, which is like a license,†he says. “But, of course there are those who masquerade,†Settuba says.
Settuba advises that not any Muslim can circumcise and that people should be more careful when dealing with people that move to homes circumcising. “A true Muslim qualified circumciser should have a letter from the mosque and have medicines like antibiotics from hospital,†Settuba says.
Dr. Alex Opio, an assistant commissioner in the Ministry of Health, agrees that circumcision by unqualified personnel is a problem. “We are coming up with guidelines that will later be interpreted into a practical policy that will address all these shortcomings. But until then, the public should just ensure that they undergo the procedure from a health facility because we have no policy to curb the unqualified circumcisers,†Opio says.
Opio said local circumcisers must be sensitised about correct and safe circumcision, especially among the Bagisu to minimise the spread of HIV/AIDS due to the use of one knife on several clients.