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Mad rush for circumcision

Gone are the days when circumcision was associated with the Islamic faith and cultural rituals. Today, the practice has become more or less a lifestyle, with many Christian parents flocking to surgeons to have their boys' foreskins cut.

There is a mixture of pain and fear in Joanitah Lumbuye’s eyes as she rocks on a bench outside Kibuli Muslim Hospital’s Paediatric ward on this hot Monday morning, looking fixedly at her two-month-old baby boy.

Will he be all right? Will he hurt so much? Will he cry into the night? Lumbuye finds herself thinking of Eleazar, sleeping quietly in the hands of his paternal aunt, Annet Nakirya Gingo. Despite reassurances that all will be well, Lumbuye is thinking hard about the difficult decision to have her first son circumcised.
But now it’s done. Twenty minutes ago, Eleazar was brought out of the theatre by a nurse wearing a green uniform, after a doctor cut the foreskin from his penis. 
“The proposal to circumcise was brought by his dad,” says Lumbuye, without looking away from the still baby.
 
“It was not easy – because of that pain. I battled with the decision in my heart. Initially I thought it was not worth it; but then you think of the advantages and you take that painful decision.”
Those ‘advantages’ have shaken the foundations of many parents’ religious and social beliefs. Christians like Lumbuye who, since childhood, regarded circumcision as a thing for Muslims or tribes like the Bagisu, now have no problem going to Church on Sunday and having their sons circumcised on Monday.

“It is not about religion now,” says accountant Gingo, who had her first son, Joshua, circumcised when he was three weeks of age. “Many of my friends have circumcised their boys and they are not Muslims.”
Health centres are recording ever increasing demand for circumcision, with a medical officer at Kibuli saying that on some days, 80 percent of clients are non-Muslims.
“We used to do on average 200 procedures a month, but now it can go up to 700 in a month,” says Dr. Mahmood El Gazzar, the medical director. “In January this year we did nearly 700. Many people now come for circumcision for medical reasons.”  Records show that in 2006, Kibuli carried out 1,550 circumcision procedures, 1,850 for 2007 and 2,250 last year.
At Saidina Abubakar, a health centre at Mengo, Kampala, Dr. Godfrey Magona says these days they perform about 90 circumcision surgeries a month, compared to around 50 in 2005.
New craze

Although many non-Muslims have long embraced the benefits of circumcision, the current craze amongst non-Muslims has its origins in medical research and fear of human sacrifice.
In 2005 and 2006, researchers in Soweto, South Africa, Kisumu in Kenya, and Rakai in Uganda, discovered that circumcised men were less likely to catch HIV if they slept with an infected woman than their uncircumcised counterparts.
 
The Ugandan study, led by American and Makerere University researchers, opened in August 2003 involving 5,000 sexually active men. In Kenya, American, Canadian and Kenyan researchers began work in February 2002, with nearly 2,800 participants.

At the outset, all the men were tested and found to be HIV-free. Some of the men were then circumcised while others were not. After at least two years, during which the men’s health and sexual behaviour was monitored, they were tested again. It was found that in Uganda, the risk of contracting HIV was reduced by 48% among the circumcised men; while in Kenya circumcision reduced the risk by 53%.  Scientists know that during unprotected sex, the glans, tender part of the penis normally covered by the foreskin, can get bruised and hence make it easier for the man to pick up the virus from his partner. Under the foreskin, there are also immunological cells which are a prime target for HIV. The foreskin can also develop ulcers associated with sexual infections, which also make it easy for one to pick up or pass on HIV.

Therefore, removing the foreskin allows the male sex organ to develop a toughened surface that would not easily get bruised or penetrated by the virus or other STDs from a female partner.
This was one of the reasons that persuaded Lumbuye to have Eleazar circumcised.
“I often heard on ‘Impact [Radio] Doctor’ that circumcision reduced a man’s chances of catching sexually transmitted infections,” says Joanita, a Credit Administrator with Stanbic Bank.

Child sacrifice

But it is not just that. According to doctors Godfrey Magona of Saidina Abubakar and Hamid Mulindwa of Kibuli, many parents are having their boys circumcised to immunise them against child-sacrifice. Of late there have been stories of little boys being kidnapped for purposes of human sacrifice only to be spared once the witchdoctors realised that they were circumcised. The latest of these was Shafik Mugombe, who was taken from Kyebando in Kampala, declared ‘unfit for sacrifice’ in Kirinya, and dumped in Mukono, according to a January 2009 report in The New Vision.
“I was also persuaded to circumcise because of this human sacrifice which is on rampage,” says Lumbuye. “In one of the newspapers the survivor said they rejected him when they discovered that he was circumcised.”

Even before she conceived, Grace Nawadda, an administrator in a Kampala research firm, had heard all these arguments and decided that if she ever got sons, she would get them circumcised. And when her first born, Jordan Calvin came along seven months ago, Nawadda also believed that circumcision would enhance his personal hygiene.
Many boys and men do not pull up the foreskin to clean the penis properly, which renders their genitalia unhygienic. Removing the skin makes a man cleaner, and these days trendier.

Religion barriers

So, Nawadda and her husband agreed on circumcision. She even took a week’s leave which she hoped to use to nurse the baby. But the boy’s grandparents on both sides, being the staunch Catholics that they are, rejected the idea.
“When I told my mother, she was like ‘what?’” says Nawadda.

“Mummy actually quarrelled with me. She said ‘we are not Muslims, we are Catholics. If God had not wanted that foreskin there, he would not have put it’.”
But how about protecting him against human sacrifice?
“Of all the children in this country, why is it your child that they will be interested in? Just pray to God and be vigilant,” her mother retorted.
Nawadda’s father-in-law was emphatic – Don’t you dare touch the boy – while the mother-in-law offered a persuasive option: “At least you prick his ears; I understand they wouldn’t sacrifice a child with pricked ears.”

According to the American National Institutes of Health, various surveys have shown that between 50-86% of African men and women favour circumcision. A Uganda assessment report said last year that 77% of fathers and 95% of women wanted their sons circumcised. There are concerns, however, about pain, safety, cost, as well as religious and cultural inhibitions.
For instance, Charles Kaddu, a boda boda cyclist based at Kyengera on Masaka Road, who professes Catholicism, appreciates the medical benefits of circumcision but he fears to circumcise his two sons because they might convert to Islam.
 
“There are many people who may be ready to convert for various reasons, but once they think of being circumcised, they remain in their faith,” Kaddu said last week. “If you are to circumcise your sons, you have to be vigilant to teach them their religion.”
Whether it is Nawadda, Lumbuye or Gingo, many mothers who opt for circumcision have one thing in common – FEAR.
 
At Kibuli, as parents waited outside the theatre, they kept their ears on the wall. “Why has our son stayed there so long?” wondered one man, without asking anyone in particular. His wife, seated next to him, responded with a look that spelled FRUSTRATION.
A woman, waiting with a friend, heard a cry and said “haaaa, that must be my child crying”.

Dr. Magona says that the non-Muslim mothers are the most fearful about how the child will cope. They ask so many questions and they need a lot of reassurance. They want to know if the doctor will apply anaesthesia; and how long it will take to heal. They worry that the pain will be too much for their little boys; or that something might go wrong.

A parent’s fear

Nawadda was in that position. If a child can cry a whole night because of colic or because he is hungry, she thought, how much more will he cry if they cut him? And what if it is not done badly and his manhood is affected, who will be to blame?
She thought of her Muslim neighbour whose baby’s circumcision went wrong; the wound started producing puss and the baby had to be hospitalised.

“Yet the process itself is not painful at all,” says Dr. Magona, who has practised medicine for eight years. “I explain that the only pain is for the injection to administer the anaesthesia. Some mothers who are strong watch the process and when they see that the child is quiet, they believe you. Others see the baby crying and you see the mother also want to cry.”

Kibuli’s Dr. Mahmood says that once done properly by qualified medical personnel, circumcision is safe. Both he and Magona say the younger the child, the faster it heals after circumcision. So anywhere between one and six weeks may be an optimum age to circumcise. The healing time also depends on the size of the wound formed by removing the foreskin. While a small wound may heal faster, the foreskin may grow again and necessitate circumcision to be redone.

“But it also depends on the hygiene,” warns Dr. Magona. “If one has to dress the wound with warm salty water, one has to wash their hands before preparing the water and then use clean cotton-wool. If the wound is not kept clean, it will become sceptic. And we discourage use of things like Omo detergent or [double-colour] capsule powder.”
At Kibuli Hospital, Lumbuye was told to return Eleazar after three days for review. As we talked, she was already thinking of how to get him home.
 
“Please let us hurry with the questions; I want to get him home before he wakes up and starts crying,” she said.  Moments later, the baby stirred briefly in his sleep and I feared he could ruin the interview. Another six minutes – at 11.20a.m. – and he screamed like he had been bitten by a red ant.
“O-ooooooh!” Lumbuye sighed, as she took the baby from his aunt. They hurried away into a special hire taxi to their home at Kirinnyabigo, near Mutundwe in Lubaga Division.
Lumbuye would later tell me that the baby cried all the way home until after 3p.m. when he slept. And when he woke up, he was his normal self again.

24 hours later

It is that peaceful baby that I found with the housekeeper at Kirinnyabigo when I visited 24 hours later. “I expected him to make noise the whole day but he is just peaceful, except for the usual crying of babies” Lumbuye said as she ushered me into her house.
But within minutes, Eleazar was crying again. His mother took him from the housekeeper and walked around the compound before returning with him asleep. Sometimes, she says, babies cry when they want to sleep.

Three days later, Eleazar was returned to hospital and it was deemed unnecessary to replace the dressing. The wound was healing ahead of schedule.
“I am okay. I am very happy,” Lumbuye said when I asked how she was feeling. “I know it’s done. It was a good decision.”

rimkav@observer.ug


ABOUT CIRCUMCISION

WHEN? From 1 week old; the younger the better.

HEALING PERIOD: children: 1-3 weeks; adults: over 3 wks

WHERE? Any hospital, but popular ones are Kibuli, Old Kampala hospitals and Saidina Abubakar in Mengo.

COST:KIBULI: below 5 years: Shs 60,000; over 5 yrs: Shs 85,000.

OLD KAMPALA: Children up to 10 years: Shs 30,000 to 45,000 depending on age.  Over 10 years: Shs 55,000 (includes fee for dressing

SAIDINA: Shs 20,000 to Shs 70,000 depending on age.

 

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