Friday, August 3, 2007

Circumcision: The kindest cut safety

Jan Ajwang

With several authorities including World Health Organisation recommending male circumcision as part of the package to fight HIV/ Aids, the practice is getting more popular by the day.

In March this year, WHO and Unaids, the joint United Nations Programme on Aids recommended the practice for heterosexual males and argued that it reduces the risk of infection by 60 percent. Thus circumcision would join Abstinence, Behavioural Change and Condom use as an additional option in the fight against the scourge.

Yet with the green light to circumcise, in Uganda, more than ever, more people are rushing for the option. Previously, circumcision was a practice for mainly the Muslim, Bagisu, and just a handful that did it for health reasons. Now that more people are opting for circumcision, the best hygiene practices are a must for everyone. The demand for circumcision has doubled at Kibuli Hospital where the majority of operations have been taking place.

As a Muslim missionary hospital, circumcision has always been a major operation even before it became popular. Many people including non-Muslims have, and are still getting circumcised. You, your spouse, friend or brother may be next for the operation and you just never know where you could go wrong.

A child was recently hospitalised at Kibuli Hospital after circumcision that was done by a local 'surgeon' in the community went bad. 'It damaged his urethra and he now has to be operated by a urologist, in an operation that is more costly compared to what would have been paid if they had done the circumcision under the best clinical conditions," said Mr Sinani Mbulambago, the Hospital Administrator.

Compared to the Shs40,000 that would have been paid at the hospital for a proper surgical procedure, the latter operation costs between Shs400,000- Shs450,000. To avoid such or worse cases, circumcision should be done under the best clinical atmosphere rather than use 'local surgeons' in the neighbourhood, at some mosques or cultural ceremonies.

"We cannot trust the way they do it; it is not clean and medically trusted. To avoid the risk of infection, circumcision should ideally be done by skilled health personnel," says Dr. Denis Otim of Kibuli Hospital.

The surgical operation involves careful dressing of the wound with stitches and prescriptions of drugs. Yet this may not be the case with circumcision done outside the hospital. For instance in cultural ceremonies, the proof of one's manhood could be illustrated in his ability not to stagger at the pain when substances as crude as local brew, salt or pepper are sprinkled on the freshly circumcised penis. In extremes, the same knife could be used for more than one person.

"In the process, one could be exposed to infections such as HIV/Aids," Dr. Otim says. Alternatively, the wound may not be taken care of well and could become septic, resulting in a delay in its healing and other infections.

Mr Mbulambago explains that after the operation, one is advised to protect the wound from water, and is given antibiotics to keep germs at bay and painkillers to reduce pain. The patient is advised to return for examination after two days until he heals. If you work, it is advisable to get the operation done on Friday and take the weekend off to rest so that by Monday, you can not only go for the check up, but turn up for work. If one cannot return to the hospital, he can at least visit a nearby trusted clinic or health centre where they can get similar attention.

"If the patient mismanages it, the wound gets septic or they could also be affected if they don't return for check- up when they are expected," Mbulambago explains. He also advises that one must not wear overly tight clothing after circumcision because it can affect the wound.

It takes at least 7-10 days for the wound to recover, but it could vary depending on the sensitivity of one's skin. It's also advised that if one is sexually active, intercourse should be resumed at least after one month of the operation.

"If you have sex within a week or so after circumcision, you will get hurt given that the underneath tissue takes a longer time to heal," says Dr. Otim. An operation costs Shs40,000 for children and Shs60,000 for adults but could vary in case of other complications. The price is even higher at private clinics and hospitals.