Secrets and Nightmares of the Teenage Circumcision Circuit

In South Africa thousands of boys are initiated into manhood each year, but all too often they lose far more than they gain.

Secrets and Nightmares of the Teenage Circumcision Circuit

The sun is drooping in the December sky as cicadas weave ominous melodies into the summer air. Their shrill vibrato is the soundtrack to Azola Nkqinqa’s last day as a boy. It’s the time of year when Nkqinqa, 18, and about 50,000 other South African boys, come to one of the many remote initiation schools in order to learn how to be a man. This school is located in the Eastern Cape province — the country’s poorest. In the Xhosa culture, the transition into manhood is marked by a month of instruction from elders, who teach the teens how to be a father, a husband. The Xhosa boys are also circumcised during this time, and most years these schools make headlines because dozens of the boys die during the process.  

Nkqinqa is feeling particularly insecure. It is customary for the patriarch in a family to send a boy off, but Nkqinqa’s father has not been a part of his life for several years, and three of his uncles are dead. So a neighbor named Patrick Dakwa has agreed to take responsibility for him. Dakwa is a community volunteer who spends a lot of time trying to make circumcisions safer, running seminars near the Eastern Cape town of Flagstaff, teaching traditional surgeons how to safely dress wounds. However, since previous initiates are sworn to secrecy about the ritual’s details, as he lies in a hut with the other boys, rabid speculation is Nkqinqa’s only close companion. 

The next day, the 13 boys in his cohort consecutively go to see a surgeon. Using a blade about the size of a steak knife, he slices off each of their foreskins. Dakwa and his fellow health volunteers recommend in their seminars that separate, disposable razors be used for the circumcisions so as to eliminate the risk of HIV transmission. But this is an illegal initiation school that shows little regard for regulations. All boys go under the same knife here.  

The surgeon wraps Nkqinqa’s penis with a traditional dressing comprised of medicinal leaves. The pain is unremitting and debilitating, but Nkqinqa tries not to let his discomfort show. He doesn’t want to appear weak in front of the other emerging men.  

When Dakwa returns later for an inspection of all the boys’ progress, he observes that Nkqinqa is faint and unresponsive. The wound has changed shape and color. Urine no longer is discharged from his urethra, seeping instead out of other parts of the shaft. “This guy is beyond the control of the traditional nurse,” Dakwa thinks to himself.   

He brings Nkqinqa to Holy Cross hospital, about an hour away by car, on a Saturday evening at about six p.m. The next morning, Nkqinqa wakes up confused about where he is or how he got into this white and blue gown. He lifts up the sheets to look at his groin area and finds a devastating absence where his penis once was. He sobs bitterly.  

A visit from his best friend offers little consolation. Even though Nkqinqa explains that his penis is gone, his friend cannot metabolize the information. “I will explain when we are out of the hospital,” he says. Then, Nkqinqa begs his friend not to tell anyone about the situation. 

Nkqinqa’s case is not uncommon. Most amputations happen a few days after the actual circumcision, the result of unsanitary dressing practices which in turn lead to infections like gangrene. Once the flesh is necrotic, nothing can be done — though if the doctors can save any part of the flesh they will tend to opt for a partial amputation. 

Dakwa visits Nkqinqa too. Because Dakwa has counselled several amputees in the past, he knows how important it is to dispel the myths that are spread by some traditional nurses — the worst of which being that the penis would grow back. Dakwa addresses the misinformation head on. The penis is gone forever, he says sternly but tenderly, and Nkqinqa should not entertain false hope.  

Driving into Flagstaff, the first thing one notices is how incredibly dense the traffic is. Cars must slow down to avoid pedestrians, as well as the occasional goat crisscrossing the main street. This part of the country is where most of the between 80 and 250 penis amputations in the country happen every year. The dire economic and social conditions in the province can be observed in the dilapidated storefronts and the treacherous roads. This state of affairs is inextricably tied up in the country’s past, going back to the decision by the government in 1913 to designate some of the land here a “homeland.” (This term was a disingenuous euphemism used to describe a small section of the country — just seven percent — in which black people could legally own land. The lion’s share was reserved for whites.) The extreme concentration of citizens trying to pursue subsistence farming here has perforated the landscape with divots, caused by rampant soil erosion. In 2015, only 31 percent of the local working-age population was employed.  

It was here that, five years ago, Patrick Dakwa founded one of the few support groups aimed at helping Xhosa men cope with the loss of their amputated penises. The 27-year-old’s bubbly demeanor and perennial smile are challenged as he thinks about the tragic cases he sees. Of the amputees, he says most “have a drinking problem and most of them, they use drugs. They tell me, ‘we’ve lost our penis so we feel like there’s no life, there’s nothing.’”  

Dakwa encourages them to talk about their problems and proudly reports that some have managed to become optimistic about their lives through exposure to the group. A few even manage to attend university.  

But amputation is just one of the possible consequences of a botched circumcision. At least 119 South African boys died between 2012 and 2014 after going to a traditional initiation school and getting circumcised.  

The summer of 2016 was the first season Dakwa can remember in which none of the 3,500 initiates died in or around Flagstaff. “December, last year, we experienced three deaths and four amputations,” Dakwa recounts. “June, last year, we also [had] two deaths and three partial amputations and one full amputation.”  

I ask him why amputations are still occurring, given that he, along with some NGOs, have put a lot of time into training traditional nurses in more sanitary methods. He says that there is resistance from the older, traditional nurses — they are not willing to accept instruction from the younger generations.  

Dakwa has clashed with traditional leaders several times during his campaign for safer circumcision protocol. They are opposed to him talking to the media about the matter. “They say I have no authority to speak. I want to preserve the culture, but if there’s nothing to preserve…” He trails off as anger flashes across his face. He talks about inept politicians who have not been able to secure lasting change. “They do nothing to show that they want to protect the culture.”  

Research looking into the causes of deaths and amputations in the Eastern Cape concurs with Dakwa’s experience. A 2015 study conducted by the Human Sciences Research Council found that conflicts between traditional leaders and medical personnel are a major contributing factor to the perpetuation of unsafe circumcision methods.  

In some cases the problem is that schools are not traditional enough — after all, the rite has been carried out safely on many boys for generations. “There’s been a development of charlatans taking the place of more traditional people who are supposed to be doing the circumcisions,” says Zoelle Horowitz, a doctor who spent many years treating initiates in the Eastern Cape. Many illegal schools have popped up, such as the one that Azola Nkqinqa went to, which charge exorbitant rates from boys who are sometimes under age — legally, initiates must be 18 to attend — and employ negligent practices. “So there [are] a variety of bush schools that one could go to, some being more careful and traditional and proper, and some being a bit careless and seeking money, really,” Horowitz says.   

Unfortunately, botched circumcisions aren’t the only thing taking the lives of young men at these schools. 

Because human rights advocate Johan De Waal’s office is located on Keerom Street, just a stone’s throw from Cape Town’s High Court, the area outside his building is always abuzz with robed figures rushing about like pensive clergymen. I have to brief a guard garrisoned behind an imposing desk and a team of secretaries on the details of my visit before I can see him.  

De Waal himself has graying hair and a gentle voice that conspire to give him an air of grandfatherly beneficence. Almost immediately, upon ushering me into his room, he mentions how intrigued he was to hear that a journalist was poking around a case he had handled almost four years ago. “It’s a total and utter travesty,” he starts. 

The case involved two males, aged about 20, who were attending an initiation school run by its chief, Isaac Monaheng. On November 25, 2013, the pair were brought to Stellenbosch Hospital, 40 minutes east of Cape Town. They were already dead when they arrived; the likely cause was dehydration — initiates are typically not permitted to drink water for up to eight days because it is believed that liquids would slow the recovery from a circumcision. But one of them also had abrasions on his back from an improvised whip known locally as a sjambok. 

De Waal was contacted by the local municipality on December 1 because the authorities wanted him to make an urgent application to the High Court to gain access to the school for an inspection. He shows me an affidavit issued by the Stellenbosch mayor, Conrad Sidego, detailing the sequence of events that led to the court application. According to the document, Sidego and a doctor arrived on November 29 with the intention of investigating suspicions of misconduct precipitated by the deaths. “I am extremely concerned about the state of health of these initiates,” Sidego wrote.  

Many of the young men who die after attending initiation schools do so because of dehydration or septicemia that sets in after a botched circumcision gets infected. Often the boys do not seek medical attention. Consequently maladies which may have been treatable if identified early on, progress to a lethal point.  

Because the property belonged to Stellenbosch municipality, and had been rented out to a group that ran the initiation school, a formal investigation was launched to determine whether this arrangement could continue in light of the fatalities. The investigation eventually concluded that the school could resume operations provided that the municipality was allowed to conduct regular inspections and generally exercise more control over the site.  

No criminal charges were laid against the owners of the school or the immediate supervisors who oversaw the boys, including Monaheng. No civil case had been brought before the court either.  

“I don’t know why the family hasn’t laid charges,” De Waal says. “We cannot say we did not know why these kids were dying, if you look at all the evidence. It’s also embarrassing for all of us.”  

On a national level, the state had opened around a thousand criminal cases over a period of five years in response to deaths occurring at initiation schools. (There have also been numerous reports of kidnappings, dehydration and whippings.) Only ten of those cases were ever heard in court. Nomboniso Gasa, a gender activist and adjunct professor at the University of Cape Town, told the Daily Maverick newspaper: “Often people go to lay charges — those who are brave — and after they have laid the charge there is very little follow-up … Police don’t [act] because in many cases they don’t want to be seen to be going against dominant cultural practices, but also because they don’t see this as something which is urgent. So consequently they think after the outcry, it will go away.” 

De Waal goes a step further. “It is a case ultimately about whether we are serious about black lives,” he says, pointing out that the country’s response to initiation in black and white communities is still very different. De Waal, who is white, uses the example of Stellenbosch University — a historically white institution, which has a long tradition of demeaning hazing ceremonies. “You can imagine, if there’s one child at Stellenbosch University who got injured in a residence because of initiation, then you’d get front page newspaper day in and day out, parents jumping up and down. Here, two people died, other people sjamboked … and there’s nothing done.”  

De Waal is not alone in questioning whether the government truly does value black lives. Since 1994, several acts — presided over by the majority black government — suggest that violence done to people of color is tolerated more readily than in white communities. The most brutal instance of this was seen in the 2012 Marikana massacre, during which 34 striking miners were killed by police with levels of impunity last seen during apartheid. More recently, when student protests for free education broke out in 2015 and 2016, the police’s unequal treatment of white and black citizens became so blatant that the white students would stand in the front row to deter police brutality. It often worked. 

I meet Isaac Monaheng, who runs the initiation school where those two 20-year-olds died in late 2013, at one of the swanky cafes that line Stellenbosch’s streets. The atmosphere is decidedly European, not only due to the mainly white residents who patronize the establishment; the tall exotic trees also conjure a genteel Germanic ambience. Though Monaheng, a black man, has spoken to the media many times about the incident, his gravelly tenor voice betrays his discomfort. He orders a hot chocolate that will go almost untouched as he explains his side of the story.  

He starts by going over the business aspects of traditional circumcision. Each year, beginning in November, the initiates typically spend about two months on the property, he says. The entire ritual, which involves the slaughtering of a sheep, costs each boy’s family roughly 4000 Rand, or about $280. All initiates need written consent from their legal guardian to participate. Monaheng belongs to the Basotho people, a group that, along with the Xhosa, practice this form of circumcision. Others, like the Zulu, have largely discontinued the traditional form of the ritual.  

Monaheng says that initiation is an opportunity for men to pass on cultural insight about manhood to the next generation. But also, beyond the verbal tuition, the rite is seen as a test of endurance — in addition to withstanding pain and going without water for days, boys go through a period of eating austere, unsalted food. Surviving the test serves as proof of one’s worth as a man. It remains a highly valued tradition. Even Nelson Mandela went through the Xhosa version of the ritual, an event which he writes about in his autobiography, Long Walk to Freedom 

When I ask about the two boys who died under his care, Monaheng’s countenance stiffens. “I was in and out of courts, trying to tell these people, ‘We are not taking the boys there to kill them. No. That is not our intention.’ It’s also not nice for us; it was also very very bitter,” he says.  

He leans forward on the table as he recalls the incident. It was very hot, and though it goes against custom, Monaheng says he instructed the caretakers to give a boy water on the third day when he reported feeling weak. The minders followed the instructions and soon the boy began to look a little better. He even got up to go urinate. But the next thing they knew, he suddenly collapsed. As the caretakers were tending to him, the second boy fell to the ground as well.  

Monaheng appears remorseful about the incident. He says that more water should have been given to the boys earlier and he has since built what he calls a halfway house on the property so that initiates can get water without having to leave the school — to depart the initiation process early would be to court stigma. But when it comes to culpability he seems to hold many different views.  

When asked who should be held responsible, he says, “The caretakers, the person who’s been granted permission to do that [circumcision] … of course me as well, as I am the overseer; I should be there very often to avoid these kinds of mistakes.” 

When I ask about the sjambok wounds he says, “That was a mistake.” The caretaker who inflicted the wounds has since run away. But then he goes on to downplay role of the abrasions in the outcome, saying, “I don’t think that is what could kill a boy.” 

Institutions like Monaheng’s are regularly monitored by various stakeholders, and in the almost three decades that the school has been running, no other fatalities have been recorded. Across the country most of the deaths occur in illegal and unregistered schools. In June 2015 alone, 11 boys were rescued from such schools by police. In the same year over 150 unregistered schools were shut down 

Monaheng fiddles with his hot chocolate. “I think I’m doing very good work,” he responds when I ask him if there is anything else he would like to say. “Nobody can stop the culture.”  

Three years have passed since Azola Nkqinqa’s penis amputation. In the intervening years South African doctors at the University of Stellenbosch have twice successfully performed penis transplants — the initial one, in 2014, being the first such procedure in history. The two recipients’ donated penises function completely normally. One transplantee even had his first child in 2015. But as impressive as such innovations are, it will be a long time before they become accessible to rural amputees like Nkqinqa. 

Until that time, booze continues to be the medication of choice for a lot of them. Nkqinqa confirms that he too started drinking heavily, and that he dropped out of school for two years immediately after the amputation. “I gave up on life, once I saw that this thing is no longer there,” he says.  

His anxiety was exacerbated by the ridicule he endured when the other kids at school found out. Girls would giggle when they saw him, boys would mock and jeer. But with the help of the support group Nkqinqa says he managed to adopt a positive attitude. Now he accompanies his mentor, Dakwa, to public events where he has become a kind of spokesperson, encouraging amputees to reintegrate into society. He says too that he doesn’t harbor any ill feelings for those responsible for the loss of his penis.  

I ask him what value he sees in the ritual engaged in by so many Xhosa boys at the many initiation schools across South Africa.  

“They will call you a man,” he says. “And you like that word because it means everything to you.”