THE JOHNSON GETS THE CUT
As for phallic
terminology, my mental age is stuck somewhere in high school or college. I can
rattle off many a euphemism for the male organ, for instance. I can make a
quick retort to another guy by using language that refers disparagingly to the
size of his member. I can even… well, that’s enough. Suffice it to say this is
totally inappropriate when discussing sexually transmitted diseases, and
especially HIV/AIDS.
All of this
came to mind last week as I escorted fourteen boys (aged 14 – 15) from my
school to undergo safe male circumcision (SMC). Circumcision is the last thing
that I thought I would be promoting in Peace Corps. Back in the United States,
and in Europe, the opinion is very much mixed as to the wisdom of the
procedure, and that reflects my own thinking. But we learned in training that
things are much different here in Southern Africa.
A few years
back, scientists noticed that in African countries with high rates of
circumcision, HIV rates are much lower. Field studies confirmed the
correlation, and with that began a massive SMC effort for men and adolescent
boys. The stakes are high. HIV infection rates for adults in Botswana stand at
over 30%. The main driver is heterosexual sex, and women have a slightly higher
prevalence rate than men. SMC reduces the chances of a man getting infected by
60%. If a large majority of men get circumcised, HIV rates should fall
dramatically.
Our role in
schools includes training students on the ABCs: Abstinence, Being faithful
(i.e. no multiple sexual partners, which increases infection rates
geometrically) and Condom use (every time). All of this requires considerable
behavioral change and it must be learned. SMC is different, in that its success
is not fully dependent upon behavioral change.
The
Botswana government, United States agencies (USAID, CDC and PEPFAR), the World
Health Organization and ACHAP (Africa Comprehensive HIV AIDS Partnership a/k/a
the Gates Foundation) are all behind a huge campaign to get males to undergo
SMC. Peace Corps volunteers are on the front lines of all this, because we are trusted
in our villages and we can deliver results.
Last fall,
I organized separate talks by a nurse for Form 1 and Form 2 boys. I then
collected consent forms signed by them and their guardian (usually the mother
or other female relative). We scheduled appointments for boys to attend a
counseling session at the local clinic (with their guardian) followed by the
procedure. Many boys signed the form, fewer followed up with the appointments
and procedure.
Last week,
things were different. After lunch on Thursday, an ACHAP luxury combi (minibus)
picked up 14 interested boys from our school and took each of them to their
homes. The nurse accompanying them spoke with their mother/guardian and got the
consent forms signed.
The next
day, Friday, after lunch, the ACHAP combi returned to school to pick up the 14
boys. This time, I accompanied them. We headed to a special one-day SMC clinic
occurring in a village 15km from Goodhope. Once on the road, I handed each of
them a piece of hard candy. The candy had come from the United States in a
recent care package mailed to us. I made a point of telling the boys that the
“sweets” came from America, and they responded with delight.
Upon
arrival at a vocational-technical college, we were directed to two classrooms
that had been set up for the event. In one, a nurse completed forms for each
boy and conducted a rapid HIV test, to make sure each one was negative. In the
other, the classroom had been outfitted as a field operating room with three
gurneys, privacy screens and medical equipment. The team had an assembly line
process going. Still, there were other males already waiting ahead of us.
So the boys
and I sat under a tree for about thirty minutes. We were joined by members of
the Botswana national track and field team. SMC clinics often get sports
figures to show up, to boost the morale of the waiting boys and to provide an
aura of “coolness” to the occasion. I talked to the athletes a bit. They were
focused on winning a competition over the weekend so as to get to a world
championship in Europe in a few months.
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| Sports stars in Botswana frequently promote circumcision |
Some of the
boys were distracted, and clearly nervous. One boy showed me that his heart was
pounding hard. I tried to reassure them. I asked about where they lived. One
boy responded that he stays in Kgoro, and walks about 12km each way to school every day. He leaves home at 5:30 AM to
get to school by 7. In the afternoon he leaves school at 5:30 PM and gets home
at around 7. Another boy, a bit of a braggart, said rather naively that he
possesses a large unit. I responded that if that were the case, perhaps the
doctor would need to use a bigger knife. That brought peals of laughter from
his schoolmates. Sensing an opening, I wanted to make some salami themed jokes,
but then I thought the better of it.
The boys
were called into the classroom/operating room in groups of two or three. They
emerged one by one after about a half hour, armed with a can of fruit drink, a
half box of cookies and a commemorative blue backpack with the words “Be Smart.
Be Clean. Get Circumcised” emblazoned on the back. Each told me that he was
fine, and did not feel a thing. They sat near me and wolfed down the food and
drink. About ten minutes later, each boy began to feel groggy, an after effect
of the pain medication. They wanted to go home and lie down. We sent home the
first group of seven in the combi. They needed room to stretch out. Some had
unzipped their undersized school uniform pants to relieve a bulge within. Each
log was bandaged with gauze and it was then taped upright to the abdomen.
I was
offered the chance to leave with the first group, but I thought it better to
stay until the last boy had finished. In America, boys this age would likely
have a parent waiting to drive them home after the procedure. Here, these guys
come from homes with no cars, maybe even from homes with absent or deceased
parents. While it goes unsaid, many of these boys decided on SMC because they
want to avoid the fate of a parent or other relative living with HIV or dead
from AIDS.
It was
getting late when we pulled out in the ACHAP combi with the second group of
seven boys. We drove each of them home, where hopefully they will have someone
to welcome them, put them to bed, bathe the incision site the next day, and see
that they get to the clinic two days later. By the time we got to the remote
village of Kgoro it was 7 PM and the sun was setting. We drove by a cluster of
maybe seven students wearing the Lotlamoreng school uniform. They were walking
along the gravel road in their final stretch toward home. We dropped the Kgoro boy
off at his home, a two-room cinder block shack on the edge of the village.
I followed
up with the boys on Monday morning. Each survived the weekend. All but a few
had made it to the local hospital on Sunday for a check-up. One who did not was the boy from Kgoro: it
was too far for him to walk to the hospital in his condition. So he asked for
and I gave him a permission slip to leave school and walk the 1 km up the road
to the local clinic. He’ll be fine for now, and maybe as a result of this he
will have a brighter future.
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| Back at school, this boy proudly wears his "Be Smart. Be Clean. Get Circumcised" backpack |
I am
looking forward to the next group of boys who will travel with me to the SMC
clinic this coming Friday. I may even develop the courage to tell them a
joystick joke.
