Circumcision: 'My experience'

By Angelo Kaggwa

It started as a light conversation with my colleague and friend, Cindra, as we boarded a flight to Kisumu on a Sunday evening in June. But where it ended, even I couldn’t believe – on a surgical bed deep in Kenya’s Nyanza Province.

“Click, click,” sounded the surgical equipment.  But first came the local anaesthetic injection.

Honestly, this wasn’t fun. Actually, it was the painful part of the entire procedure. Ironically, the needle into the base of my penis was meant to ensure I didn’t feel any pain at all.

It didn’t last long, but it felt like ages.

Arrival

“I think I’m getting circumcised in Kisumu,” I told Cindra as we boarded the plane.

“What?” she asked. She probably thought that the noise from the engine was making her hear things.  I said it again. “I’m seriously considering getting circumcised in Kisumu.”

“Why Kisumu? Why now? Why not wait till after this trip when you go back home to Uganda, where you have friends and family?” 

I didn’t get the opportunity to respond as I’d reached my seat and she continued to hers at the back of the plane.

Cindra and I work for AVAC, a New York-based, not-for-profit organisation that works to accelerate global delivery of AIDS vaccines, male circumcision and other HIV prevention options.

In 2007, the World Health Organization and UNAIDS recommended that male circumcision be included in the HIV prevention package of 13 East and Southern African countries with high HIV prevalence, low levels of male circumcision and generalized heterosexual epidemics. This was based on research that medical male circumcision reduced the risk of HIV for heterosexual men by 50-60%.

At the clinic

One of the key things Cindra and I had gone to do in Kisumu was to experience, firsthand, the work of our partners there. So, on Monday, we were scheduled to visit a model clinic in Chulaimbo that provides male circumcision services.

Simon K’Ondiek, one of our Kenyan partners who met us at our hotel with Carole, another Kenyan colleague, took us on an hour-long journey to a government health centre, Chulaimbo Sub-District Hospital, where circumcision is provided by Nyanza Reproductive Health Society.

The project has performed 250,000 circumcisions since 2008 in Nyanza Province. Kenya is targeting one million surgeries in Kisumu, Teso and Turkana districts by 2013. 

We followed a path through the grass surrounded by several dilapidated single-floor buildings and found the circumcision surgical theatre tucked into a makeshift room, with its door open to us and the warm air. A hand-painted sign read, “Services Offered: Counseling & HIV testing; voluntary medical male circumcision; STI screening and management.”

There were three men of varying ages sitting quietly on a bench waiting their turn.

Inside the theatre

One of the guys getting ready for circumcision consented to have us observe him during the procedure.

A nurse gave us surgical masks and we all went inside the room. It was the closest I’d ever been to “live action” in a hospital.

There were two beds, with two really bright lights beside each, two staff – a clinical officer and nurse – both fully covered in green medical scrubs and white masks.

They looked serious with sharp instruments in their hands deftly directing the blood while suturing the male organ of the person lying before them. Click, click, click.

The elderly patient was calm. He didn’t move as the knife moved back and forth loosening the foreskin from his penis. I ‘felt’ the pain, but this man didn’t seem to. The man said it was okay to take pictures as long as we didn’t show his face. He spoke calmly, breathed normally, even laughed at our jokes throughout the procedure.

After about 15 minutes, it was over.

He put his clothes back on, was offered a big bottle of Fanta orange soda and left. I followed him outside and asked him what he was planning to do for the rest of the day.

“It’s still early, I’m going back to work,” he said.

“Really? And what do you do?” I asked.

“I ride a commuter motorbike.”

I was blown away. Here was a man, freshly circumcised and he was going back to ride a motorcycle so that he could put food on his family’s table. And here I was, being chauffeured around Chulaimbo in a Toyota 4x4, thinking it was impossible for me to undergo the procedure because of a busy schedule! The thought of getting circumcised returned.

Challenged

About eight years ago, five of my closest friends got circumcised in one week. Three cited hygienic reasons and the two said their girlfriends pressured them to do it. I didn’t have a girlfriend pressing me, so my motivation was lower. Besides, I was “too busy” trying to get good grades in college.

On this sunny morning in Kisumu, this man’s display of courage challenged me. It occurred to me that all the reasons I gave were excuses. Much of my job involves working at my computer, taking seemingly endless conference calls and traveling on buses, trains, taxis and sometimes planes.

This brave man rides a motorcycle and he was going back to work straight from the theatre—although not recommended. If he could do it, so could I. I went back to the theatre, and on the bed lay a second man—this one a lot younger than the first one.

He too didn’t mind our curious eyes and cameras capturing his procedure and his pink toenail polish.

But quite honestly, although I wanted it, I wasn’t sure what I was getting myself into. I was on a work trip, away from my doctor in New York City and my family in Uganda, and I was considering getting circumcised deep in Chulaimbo.

But back home in Uganda, I would be hard pressed to find a clinic to provide the procedure, as our Ministry of Health was slow in  the rollout of voluntary male medical circumcision.

Plus, this would cost me nothing – thanks to the generosity of the American people. In Uganda, I would have to spend at least $150 to receive the service at a private hospital.

A shot at it

“Well, as long as you’re willing to be tested for HIV and receive your results, you’re set. It won’t last longer than forty minutes,” the doctor said.

The rough-and-ready HIV counselling and testing tent was located adjacent to the surgical theatre. The counsellor was thorough.

He said male circumcision was only complementary to other proven HIV prevention interventions including abstinence, being faithful to a partner whose sero status is known, condom use, delaying sexual debut and reducing one’s number of sexual partners.

He also talked about the six-week healing period during which I was to abstain from sex and how I was expected to nurse my wound for proper healing, no bathing or getting it wet for at least four days.

I was both excited and scared but I was ready. This was my moment and I couldn’t let anxiety or anything else take it away from me. My colleagues asked if I didn’t mind them observing the procedure and I obliged. And suddenly, all curious eyes and cameras were focused on me.

The aftermath

I was pleasantly surprised when, after receiving the mandatory one-litre bottle of Fanta to increase my blood sugar levels and some pain killers, I walked out without any pain.

My lunch was Ugali, sukuma wiki, chapati and deep-fried tilapia. It had been long since I last ate such comfort food. My colleagues kept asking me how I felt, and I was fine.

Even when the anesthetic was gone, I took some drug Cindra offered me instead of the Panadol that I had been given. Back in my room, I took a nap and later watched some tennis – Wimbledon!

I was up by 6:30am the next day and had a productive day with several meetings at the Nyanza Reproductive Health Society.

And at around 3:00pm, I was off to Kisumu Airport for my journey to Entebbe. The next couple of weeks were busy, and except for the weekends, my day typically started at around 7:00am and didn’t end till 7:00pm.

Through of all this, I continued to heal steadily. I had the bandage removed four days after the procedure, as instructed, and one of my doctor colleagues examined the wound a week later to confirm that I was on a steady road to full recovery.