A day at a circumcision site

Thobias Zachariah, 30, walked about 15 kilometres from his village, Msakambewa in Traditional Authority (T/A) Kanduku to Mwanza District Hospital to be circumcised and save his wife from cervical cancer.

“I heard on radio that if I am circumcised, I will protect my wife from cervical cancer and also reduce chances of contracting HIV. As a loving husband, I could not do otherwise,” said Zachariah, a father of two.

On a queue outside the circumcision tent alongside others, Zachariah, an entrepreneur, is the only married and oldest man there. On his face are stories of anticipation for a new life after circumcision and on his mind is his wife. He had passed the first test—an HIV test—and got negative results.

Unlike previous circumcision services, Voluntary Male Medical Service (VMMC) starts with an HIV test and counselling. This according to Ministry of Health was considered important because the primary reason for circumcision is to contribute to reduction of new HIV infections in addition to other services.

Reports indicate that Malawi is one of the countries in the sub-Saharan region with high new HIV infection rate. The 2014 National Aids Commission (NAC) HIV and Aids estimates indicate that 42 000 new infections are registered annually.

“My wife will be happy. She convinced me to be here and I am happy that as a family, we will live a new life. I have been unfaithful, but I will be responsible from now onwards,” Zachariah explained, looking invigorated.

After some minutes, his turn comes. He undresses and lies flat on a bed with his hands covering the eyes not to see his foreskin being chopped. Three service providers are there to attend to him.

First, he gets an injection to numb that part of the body, then the foreskin is removed before the wound is covered with bandages. Five minutes later, Zachariah walks out of the tent assisted.

On his face, is the same story of new hope and happiness although with some traits of pain. He waves at those still on the queue and walk away.

But Zachariah’s experience does not cut across. Some men reluctantly offer to be circumcised, while others walks away in tears.

“It is a painful experience,” explains Elliot Kungulu, 17, “but I am happy that when the wound heals, chances of contracting HIV will be low.”

Interestingly, almost everyone on the queue has a primary reason for being circumcised. The most common reason is HIV protection, but very few understand the connection between circumcision and HIV infection.

At Kunenekude VMMC site—about 20 kilometres away—another boy, Samson Magombo, 20, failed to justify his decision to be circumcised.

“I just wanted to be circumcised,” he briefly said.

But Mwanza VMMC coordinator Geoffrey Kumpama insists that the communities are well informed of the procedure and attributes the failure to explain the benefits to circumcision distress.

“We have been everywhere with the messages. Some people were reached with big screens and this can be read from the turn-out at VMMC sites,” explains Kumpama.

He argues that in three weeks, they circumcised 523 males, adding it is a success because Mwanza is not associated with circumcision practice. He says this is the first time the district has access to medical circumcision.

VMMC is being funded by the World Bank through NAC in Neno, Mwanza, Balaka, Machinga, Mangochi, Likoma, Nsanje, Kasungu, Ntchisi, Dowa and Mchinji. Each district had three VMMC sites.

The Mwanza story is similar to that of Balaka where scores of men were found eagerly waiting to be circumcised with some complaining that they had been at the site for three days without being assisted due to congestion.

Mwanza district health education officer, Mercy Nyirenda, confirmed and cast fears that they might not circumcise every registered client by the end of the exercise today, August 30.

“The target was 3 600, but 6 970 registered and in three weeks only 1 297 have been circumcised. Most people live 20 kilometres away and we don’t have equipment for outreach service. Additionally, we are understaffed. Instead of six service providers, we have four and every day, many people access the service,” said Nyirenda.

One crucial challenge that cuts across the programme is shortage of materials and staff. The exercise began in districts such as Mwanza, without basic equipment. For sites in Mwanza, the relief was the nearby hospitals.

Kumpama confirmed relying on public hospitals for materials such as bandages, iodine, gloves and painkillers, which are supposed to be provided by NAC. Mwanza District Hospital public relations officer Dikirani Chanza notes that the development creates deficiency in their drug stocks.

Of four clients found at Mwanza site, who had come for check-up, two complained of excessive bleeding and one had a wound that was not healing.

“These are common problems we are facing, but the main reason is negligence by the clients to follow the advice we give them. However, we are able to correct these problems,” said Kumpama.

Malawi adopted VMMC as part of the fight against new HIV infection to reduce HIV transmission and other sexually transmitted infections towards an HIV-free generation. The exercise, which is also embraced in the HIV prevention strategy, is highlighted in the VMMC communication strategy of 2012 and targets 2 458 727 males aged between 10 and 34 by 2020.

However, this will not be achieved if authorities do not up their efforts. Most of the challenges being registered in VMCC sites are known. A VMMC chronological events document by Ministry of Health reports that four major challenges haunt the initiative. These are financial and human resource, limited commodities, equipment and sensitisation.

Ella Chamanga, health promotion officer for the Department of HIV and Aids Communication and Prevention in the Ministry of Health said despite some few challenges registered in some districts, the exercise has been a success. She said they bought all materials in time, but some district health offices such as Mwanza delayed to collect some of their VMMC consignment and ended up using hospital materials.

Chamanga, however, noted that some districts such as Mangochi and Balaka registered higher demand than target. She said there are plans to extend the period to ensure that every willing individual in the targeted districts is circumcised. n