Circumcision, christianity and children

Today I did circumcisions. I’m not sure how many I did in the end but it was about 15. I was part of a team of doctors, nurses and numerous other helpers and NGO’s that did 127 circumcisions in a rural community hall. The day was part of a massive nationwide initiative to exterminate the dreaded foreskin in yet another bid to reduce the transmission of HIV. Quoted figures range from 40 to 60% reduction in transmission, so maybe this will make a difference this time. The last ABC initiative failed dismally because no-one Abstained, no-one could Be faithful and both culture and the church disagreed with the Condom! It was a fantastic day which I enjoyed immensely. I was slightly anxious on the drive out in that I had never before done a circumcision, which isn’t exactly a routine Emergency medicine procedure, but my fears were soon laid to rest by a feisty doctor from Johannesburg. She took us through their recipe which was focused and succinct. The anxious participants (no longer called patients or clients) waited in the sun outside nibbling on large pink polony sandwiches while we prepared the makeshift hall into an ‘operating theatre’ with colourful curtains, operating couches, lighting, sterile packs, needles and washing facilities. The process was a production line second to none. The nurses prepared the patient, infiltrated the base of the penis with local anaesthetic, cleaned and draped. Doctors then took over, stretching the foreskin to its max, clamping and then with a flick of a blade the deed was done. Some quick cautery to control bleeding, 4 carefully placed sutures and then back to the nurses who completed the suturing, did dressings and gave advice for ongoing care. This involved instructing the lads to place their tattered member in a cup of water laced with 4 tea-spoons of salt three times per day and also to refrain from intercourse for 6 weeks. This allows time for the epithelium to heal over and reduce transmission. The day was a resounding success and we finished by watching a fabulous African sunset and listening to our medical director on his guitar and then joined hands in the mandatory prayer.

Religion here has been interesting. The hospital was started by missionaries who were apparently given the hill on which the hospital stands because the local Zulu chief considered the hill useless because it frequently got struck by lightning! The missionaries did an amazing job, so much so that the government nationalized all the mission hospitals in the nineties and now runs them on a shoestring and forbids much needed NGO assistance in them. The Christian faith persists though and provides a fabric which pervades throughout the hospital. Most of the doctors here are active Christians and take part in pre-ward round prayers every morning, bible study on Wednesday and a church service on Sunday evening. Prayers are held before every surgical operation and a flamboyant ‘preacher’ does the rounds of the wards praying for all and sundry, which I very much encourage, given the dire straights of most of our clientele.

Every morning we do a teaching ward round in one of the wards. On Friday it was the children’s’ ward and it is always a profound experience. After seeing the usual collection of broken limbs, burns and surgical cases we moved into the isolation area which is a sight to behold. About a dozen cots hold minuscule infants, some with spaceship-like head-box oxygen, and others with iv drips and fluid running into tiny limbs and still others with ultraviolet light or even in incubators. The first one is only 7 months old and his nasty pneumonia has been treated in the community in the traditional fashion with a green sunlight soap enema. This usually has devastating consequences and causes fulminant diarrhoea and frequently kidney failure. The child will survive this time and is now on antibiotics and iv fluids. The cot next door holds a 6 month old baby girl who was born at 27 weeks and miraculously survived. She has started her fragile life badly. Not only is she HIV positive, thanks to her mother, but also has Tuberculosis. This means that she is on no less than about eight different medications daily. She has bad oral thrush, a nasty chest infection and, to top it all, spina bifida. The albino baby next to her has also had a Zulu enema and she too is on iv fluids to save her kidneys. Unfortunately her liver is battling and she is becoming coagulopathic. And on it goes…..failure to thrive, malnutrition, measles, etc.etc. The five biggest killers here are malnutrition, gastroenteritis, pneumonia, TB and HIV. These are what keeps us busy every day.

Socially life has been wonderful. We had a spectacular weeks holiday exploring our area with my sister and her family. Numerous game drives, long golden beaches, scuba diving and time relaxing around pools made for an amazing time. Again and again we are reminded of the paradise in which we find ourselves and sometimes wishing it will go on forever!