Everyday we push forward the frontiers of knowledge and with it comes the demand and need for attitudinal change at all levels of society. After all knowledge without contextual application is meaningless as it creates KAP gap (knowledge, attitude and practice). Failure to ensure that people make use of gained knowledge leads to apparent divisions of geographic spheres into various phases with descriptions as developed, developing and underdeveloped regions. For a smooth transition to occur between knowledge generation and transformation of practical attitudes, there ought to be a seamless linkage. This is where the role of the the executive specifically its enforcement unit comes to view.
These new ideas are generated through research and development units (R&D)be it within academic or industrial establishments. Their sole aim is to generate and develop solutions that seek to propel society's forward movement. It is important to understand that R&D units fall within the highest and most excellent brains any society can boast of hence their propositions are often light years ahead of the other classes of members of the society who are supposed to be the true beneficiaries in any case. In view of the seeming gap between R&D sectors and society at large, the responsibility to ensure the propagation of generated ideas falls on the powers that be.
The 2011 UNAIDS World AIDS Day report highlights that an increase in uptake of male circumcision is also starting to contribute to declines in new HIV infections. Studies show that 2000 new HIV infections were averted among men in Kenya’s Nyanza province after scale up of voluntary male circumcision. Estimates in the report highlight that circumcising 20 million more men across Eastern and Southern Africa would avert around 3.4 million new HIV infections by 2015. Male circumcision is the surgical removal of some or all of the foreskin (or prepuce) from the penis. Circumcision is very ancient and it is among the oldest recorded operation. Traditional circumcision is found worldwide, in Africa, Asia, Oceania and the Americas.
The simplest of all traditional methods is the tehe of the Polynesian islands and Phillipines. The foreskin is just cut lengthwise along the top, with nothing removed. A wooden spatula is placed under the foreskin, above the glans, to protect it. Then the foreskin is cut lengthways with a sharp stone, cutting down on to the sliver of wood. Similar techniques are sometimes found in Indonesia and parts of Africa, though full circumcision is more common in those regions.
The desert Arabs traditionally used a technique of constriction to minimise bleeding which has its counterparts in many modern surgical approaches. The foreskin was pulled forward as far as possible then tied up tightly with a cord. It was left like that for half an hour or so, then cut off in front of the knot. The string was then slipped off and the inner skin pushed back to meet the outer (which had, of course, sprung back once it was freed). Again the penis was bound up tightly to minimise bleeding, along with the operator's own idea of suitable medicament (which in most cases probably caused more infections than it prevented).
Uncircumcised boys (koteboto) in the Ghanaian setting are teased like hell. Being koteboto in Ghana means you have to be at many public places of convenience like the KVIPs, boarding school bathhouses among others when these places are least patronised. For this reason coupled with our religious inclinations, every parents in Ghana take steps to circumcise their baby boys when they are ripe for the ritual. In the rural areas where health facilities are rare, far and inaccessible both in terms of physical location and money, the choice of a traditional circumciser does not come any more handier. This practitioner or expert circumciser is locally referred to as a wanzam. The wanzam is an itinerant usually Muslim man who specialises in the craft of circumcising young boys who have come of age. They move from village to village plying their trade to whom it may concern. They often come sudden and unannounced at least so far as the uncircumcised boys (koteboto foo) are concerned.
In his book 'The Boy in the Oversized Smock; School Memories in Living Color', Kwame Frimpon gave an apt description of the 'sitting room surgery procedure conducted by a wanzam.
"The wanzam first properly secured the patient about to be circumcised. It is imperative that the boy is well secured because excessive movements and gyrations could result in a bad accident. Patients are known to bleed to death if an artery is accidentally severed during the surgery. The word anesthesia is unheard of in the rural African medical lexicon, and screams of boys that were undergoing this kind of surgery were common place. Ideally, two adults hold the extremities of the legs with the genitalia dangling between the legs. A couple of adults take care of the upper torso. The wanzam then pulls the loose end of the penis and slices it off with one simple stroke. A wanzam's knife is reputed to be the sharpest in the world, and the dexterity of the wanzams with knives is the stuff of legends. After slicing this off, he removes some veinlike growths at the top base, and this is where the shrieking is at its zenith. The whole process lasts less than five minutes. The more skillful wanzams get the surgery done in two minutes or less.
"The wanzam first properly secured the patient about to be circumcised. It is imperative that the boy is well secured because excessive movements and gyrations could result in a bad accident. Patients are known to bleed to death if an artery is accidentally severed during the surgery. The word anesthesia is unheard of in the rural African medical lexicon, and screams of boys that were undergoing this kind of surgery were common place. Ideally, two adults hold the extremities of the legs with the genitalia dangling between the legs. A couple of adults take care of the upper torso. The wanzam then pulls the loose end of the penis and slices it off with one simple stroke. A wanzam's knife is reputed to be the sharpest in the world, and the dexterity of the wanzams with knives is the stuff of legends. After slicing this off, he removes some veinlike growths at the top base, and this is where the shrieking is at its zenith. The whole process lasts less than five minutes. The more skillful wanzams get the surgery done in two minutes or less.
There were no mothers there, not because of the boys' nudity but the women used to cry as the boys cried, so the wanzams deemed it appropriate that they were stayed home. Since nothing is supposed to touch the wound, no underwear is worn during this recuperation period. A little sling is used to suspend it so it doesn't drop and touch the thighs; basically a newly circumcised boy walks gingerly around with his hand in the form of a protective arc in his cloth shielding this member. To avoid this comedy, some simply disappear from view until everything is over."
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| Wanzam at work |
The fact that so many traditional societies have performed circumcisions in primitive conditions for so long is a dramatic demonstration of both its cultural simplicity and the low risk of the operation. Of course this was the case until the advent of the dreadful pandemic, HIV/AIDS. The disease with short acronym but complex implications for humankind. Male circumcision has been associated with a lower risk for HIV infection in international observational studies and in three randomized controlled clinical trials. It is possible, but not yet adequately assessed, that male circumcision could reduce male-to-female transmission of HIV, although probably to a lesser extent than female-to-male transmission. Male circumcision has also been associated with a number of other health benefits.
However the manner in which the operation itself is conducted could expose the boy being circumcised to HIV infection risk. The literature abounds with reports of morbidity and even death as a result of circumcision." Complications may be immediate or delayed, and complications from bleeding, infection and poorly carried out circumcisions can be catastrophic. The immediate complications may be classified as surgical mishap, hemorrhage, infection and anesthetic risk.
For this reason, it came as a shock to me (and I believe many others) a report that a 70-year old wanzam only named as Abdullah has literally cut off a baby's penis at Maamobi in Accra, Ghana. The Police said Abdullah claimed he had problems seeing properly. and is accused of peeling off more than the foreskin of a four month old baby. During the procedure, the baby was struggling during the circumcision exercise, and with a poor grip from the parents, the wanzam’s knife went overboard cutting a huge chunk of the baby’s penis. The wanzam severed the penis, the whole thing is cut off, left with a small piece; the most sensitive part is removed; [albeit] he is able to urinate alright. The little boy was sent to Korle Bu Teaching Hospital for treatment. The certified wanzan with over 20 years of experience, the police said, would be charged for negligently causing harm.This has provided more evidence for the campaign against their practice.
The way of I don't carelism leads to the city of had I known, and had I known is always at last. There are four issues arising here. Firstly, how possible that right in the heart of Accra and nowhere else in Ghana, this primitive practice still thrives? What make a parent patronise the services of a wanzam when cheap and safer health centres are within reach? Is it ignorance or stupidity? Secondly, if it is due to ignorance, then how is the campaign for the abolition of the practice in view of the danger it poses? In fact the constitution of Ghana outlaws all outmoded customs and practices and in my candid opinion this practice cannot escape the law. If it cannot escape the law, then thirdly, who issued a certificate to a 70-year old visually challenged with trembling hands to practice? Was due diligence done on him such as taking a test before renewal of his certificate or it was business as usual? Do officials in charge of such activities actually understand and appreciation the relevance of their roles in ensuring orderliness within our society? I had wish to say heads must roll for this negligence which has cost this innocent boy his most valuable property (MVP), but knowing how weak out institutions are, I won't waste a stroke of my ink.
As researcher on HIV/AIDS, my humble appeal to all prospective parents of baby boys is, please understand that it is a privilege and not a right to deliver a baby boy alive. Many still births and miscarriages are boys. Even more serious is the fact that greater number of under five mortality are boys. Therefore it is very irresponsible on your part to expose such a special gift to grave danger as the risk of HIV infection or severance of the entire MVP. I can assure the parents of this boy that if the doctors are not able to fix his MVP via plastic surgery, he will never ever forgive them. The worst case scenario dreaded by any parent is to have a a peeved child who constantly accuse you of being responsible for his handicap. Mothers and parents, please for God's sake, take your baby boys to a health institution for safe and harmless circumcision and do not patronise the services of "unsafe and harmful" sitting room surgery provided by a wanzam.
