Deaths and mutilations can easily be avoided by introducing the principle of centralization and by using medical practitioners to perform the circumcisions. The traditional values of the ritual can be restored by the implementation of a strong initiation program that addresses current societal issues.



Centralization


Traditionally initiation schools are built in secluded locations, away from the community. Some of these locations are almost inaccessible and virtually impossible to find, making adequate monitoring difficult and complicating matters in the event of an emergency. Ideally, monitoring teams should visit all initiation schools within 3 days of circumcision being performed so as to identify complications early. This is not possible in the current situation where we have numerous small initiation schools.


Furthermore, isolated initiation schools are prone to allowing abusive situations to develop resulting from the lack of supervision. Practices similar to hazing occur frequently, ranging from physical abuse and sleep deprivation to tightening penile bandages and extreme forms of fluid restriction. Marihuana and alcohol abuse amongst helpers is the norm.


The solution is to concentrate multiple small initiation schools into one large school per location or chief, accommodating between 25 - 100 initiates per school in an easily accessible location. This will allow for a controlled environment that can easily be monitored and supervised.



Safe circumcision


Poorly performed circumcisions using traditional methods remain the largest cause of mortality and morbidity. Poor hygienic methods on the part of traditional surgeons lead to transmission of diseases such as HIV and hepatitis B. Inadequate surgical methods result in a higher number of complications such as uncontrolled bleeding and the excessive removal of penile skin.


However, most complications (infection, penile injury, delayed healing) result from incompetence on the part of traditional attendants. Experienced attendants will diminish the wound size by pulling the skin of the penile shaft towards the glans, and then use a certain bandaging technique to hold this in place. This greatly reduces the chances of infection.


Unfortunately most attendants do not use this technique and bandages are often applied too tightly which compromises penile blood supply, leading to delayed wound healing or even tissue loss through necrosis. Additionally, tissue starved of oxygen is more susceptible to infection. Other problematic factors are poor aseptic practices and delays in seeking medical assistance.


The training program of traditional attendants is proving to be ineffective, as not enough attendants are trained and most of them only work for a short period of time. The result is that the majority of the active traditional attendants are not adequately trained.


The solution is to replace the crude traditional circumcision methods by safe circumcision performed by qualified medical practitioners. This aseptic technique leaves a small wound that requires minimal care and ensures rapid healing.



Initiation program


The ritual was traditionally regarded as a teaching institution to prepare boys for the responsibilities of manhood. However excessive emphasis is now placed on circumcision and physical ordeal, with much of the educational aspect being diminished. Social responsibilities and conduct are hardly being discussed.


The solution is to develop a strong initiation program incorporating traditional leaders, community elders, church leaders, and other role models. The program should be viewed as a wonderful opportunity to disseminate specific messages at this crucial point in the life of an adolescent boy. Topics should include culture and heritage, religion, moral values and ethics, human rights, environment, relationships and family planning, interpersonal and sexual violence, substance and alcohol abuse, career planning, road safety awareness, etcetera.


 
 

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