In South Africa, circumcision ritual becomes health crisis

JOHANNESBURG -- The young South African thought he was going to the hills to become a man. He came back with a horrifying injury that made him an outcast.

In 2012, Asanda lost his penis to gangrene in a botched circumcision ritual performed by a traditional surgeon wielding the same spear on more than a dozen initiates. He was an unusual case among thousands of men hospitalized after such ceremonies in past years because he broke a code of secrecy about the tradition and spoke out in protest. For that, he endured public humiliation and even a severe beating a few months ago.

"People would just stare at me, as if I were not a man," 25-year-old Asanda told The Associated Press. He did not want his family name published for fear of a bigger backlash from his community.

This month, youths in some rural areas will head to secluded huts for circumcision rituals meant to usher them into manhood, an annual rite of passage during the current South African winter, and in the summer at year's end. Officials hope to prevent another wave of injuries and deaths triggered by factors including infection and the tight binding of penis wounds, which cuts off blood supply, as well as sleep deprivation, exposure to winter cold and other harsh conditions.

Septic shock causes many fatalities. The problem is most severe in the Eastern Cape province, where nearly 500 young men have died in circumcision rituals since 2006, including 83 last year, according to the provincial health department.

Officials further north in Mpumalanga province reported 31 deaths in 2013. Twenty-three people, including doctors and traditional surgeons, face charges including negligent killing for the Mpumalanga deaths, South Africa's National Prosecuting Authority announced Tuesday.

Initiations are mostly practiced by the Xhosa tribe in eastern South Africa. Tens of thousands of young men undergo ritual circumcisions every year, according to the South African Medical Association, which urges practitioners to have a male doctor, preferably one who had been through the ritual himself.

Last week, the Congress of Traditional Leaders of South Africa, which promotes traditional values, blamed casualties on untrained opportunists seeking to make money from initiates' families, and announced a partnership with the state and medical professionals to educate villagers about safe circumcision.

Asanda was circumcised near Lusikisiki town in the Eastern Cape on June 18, 2012. He fled the initiation school, but was forced to return and was beaten, said Dingeman Rijken, a Dutch doctor who later treated him. A bandage on Asanda's penis cut off blood flow and he was hospitalized, according to Rijken. After the gangrenous flesh fell away, Asanda was discharged with a catheter to help him urinate.

Rijken said an injured penis with dry gangrene eventually falls away from the body by itself, while a penis with wet gangrene sometimes has to be amputated to prevent further infection.

"Amputating a penis is not something you do easily, because of the mental implications," Rijken wrote in an email. "We know that these boys are going to lose their penis, but they will often blame the doctor for taking it off. Most of them come with hopes that it will become all right or grow again (which is what they are also being told by traditional nurses). On arrival, they are tired (sleep deprivation), malnourished (diet restrictions), dehydrated (fluid restriction): it takes a number of days for them to be able to discuss these things."

A 21-year-old man who identified himself only by his first name, Bheki, described in an AP interview how he lost the tip of his penis in a ritual. After overcoming extreme distress, he said he is in a romantic relationship and can have sex because part of his penis remains intact. He also plans to continue his studies in university.

"I know God has good plans for me and I have big dreams," said Bheki, who is reluctant to tell his father about his injury and did not want to give his family name for fear he would be humiliated in his community.

Ashamed and weakened, Asanda told his girlfriend that he had injured himself by falling off a bicycle, and she suspected him of cheating on her because of his aloofness.

Asanda shocked his community by complaining about unsafe circumcisions at a local meeting. The next morning, Asanda was beaten by several villagers and accused of being an "impipi," or "traitor" in the Xhosa language, he said.

"I would always feel like sitting on my own," he said, describing his ordeal. "It would feel like I'm not alive."

Asanda left his home village but now wants to return. He's not sure when he'll go back, though, or what kind of reception he'll receive.