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HIV/AIDS Program Safe Circumcision June/July Circumcision Season Report

HIV/AIDS Program Safe Circumcision June/July Circumcision Season Report. Key Considerations. ECDoH acknowledges that the tradition circumcision is the competency of the LG and HOTL.

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HIV/AIDS Program Safe Circumcision June/July Circumcision Season Report

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  1. HIV/AIDS Program Safe Circumcision June/July Circumcision Season Report

  2. Key Considerations • ECDoH acknowledges that the tradition circumcision is the competency of the LG and HOTL. • The ECDoH’s involvement and role is to support the circumcision practice by working with and through the established task team led by HOTL. • DoH HIV Conditional Grant 2013/14 – does not have specific budget for traditional circumcision – but for MMC. MMC budget (R20m) extended to support traditional circumcision

  3. DoH Involvement and support • The following objectives are the bases under which the DoH is actively supporting the practice: • Enhance and strengthen traditional circumcision to support the HIV prevention through the circumcision strategy. • Promotion of safety of initiates • Curb and manage circumcision related complications and deaths. (Injuries and Deaths)

  4. DoH Involvement and support • The EC Provincial CMT, comprised of representatives from the HOTL, LG, DoH and Local Circumcision Forums led by local chiefs was established for this season to ensure safe passage of young boys to manhood. • Role of the CMT is to visit all districts provide support and monitor the progress and outcomes of circumcision seasons. • CMT considered the 2013 Winter Season to be starting on 17 June 2013, • The CMT developed a program to visit all districts – started 17 June 2013 to 19 July 2013

  5. DoH Involvement and support • DoH supported the functioning of the CMT and Designated Medical Officer (DMO), • Accommodation for the teams during outreach activities • Food parcels for the teams during daily outreach activities • Hiring of 37 double cabs used during the season. • Protective/identity clothing – delayed with procurement delivered late…to be used during the next season (November/December) • Airtime for DMO • Overtime • Contracting of volunteers to assist DMO

  6. DoH Involvement and support

  7. DoH Support- Cars • Cars – first group of 7 cars hired to up to 18 June 2013 • OR Tambo District x 4 • Joe Gqabi District x 2 • Alfred Nzo (Bizana area) x 1 • The second group of 30 hired cars were handed over by the MEC for Health to Mr Bokwe, CEO of HOTL, on 10 June, in EL • HOTL allocated 6 cars • DMOs allocated 24 cars • 10 additional cars provided by NDoH • OR Tambo – 6; Alfred Nzo – 4 • The cars were allocated to cover all districts but special consideration was paid to areas considered to be hotspots – OR Tambo and Alfred Nzo

  8. INITIATION STATS – 2006 to 2013

  9. INITIATION STATS – June/July 2013

  10. Highlights on Injuries/Deaths • Major causes of injuries and deaths • Beating/Sjamboking of initiates • Dehydration • Infection/sepsis • Gangrenes and mutilation • Only three initiates died at hospital level – NMAH and St Barnabas. The rest are dead on arrival (DOA) and others taken directly from Ibhuma by police and Private Mortuaries. • Reported police cases opened so far - 5

  11. Assault cases in hospitals

  12. Illegitimate tendencies • Boys are as young as 14 years of age • Excessive removal of the skin of the penis (removal from the shaft of the penis to the glance) • Mutilation of the scrotum sack. • Tight dressing which result in poor blood supply (gangrene) • Deprivement of reasonable amount of water which results to dehydration • Incomplete initiation, removal of only the bottom part of the foreskin • Assaults took place in the dark to hide identity of culprits

  13. CRIMINAL ELEMENTS in THE CUSTOM • The custom has been hijacked by criminals who have total disregard for human life. Only interested in money making • Charge rate would be as little as R2, chickens, cell phone or up to R800. • Boys are circumcised using unsterile rusty instruments. • Boys are at risk of contracting HIV during the process. • Some so called traditional surgeons perform procedures under influence of alcohol. • Boys walk long distances before and after circumcision

  14. CRIMINAL ELEMENTS in THE CUSTOM

  15. Health Response Action • Additional bed space: • UGH identified a space at back of OPD area - The space accommodated about 15 beds…full throughout. • St Barnabas for Nyandeni – The old mental hospital… total of 40 initiates were admitted. • St Elizabeth for Qaukeni – working with hospitals closer by to down transfer – Holy Cross and Bambisana. Total of 20 admissions. • St Lucy’s hospital for Mhlontlo – total of 13 admissions

  16. Health Response Action

  17. Health Response Action • Correct Clinical management:- • Protocol on management of circumcision complications developed by Department of Urology, NMAH. • The protocol was availed for the district for distribution to all Regional and District Hospitals with an accompanying memo from the DM to enforce management of these patients according to this protocol • Resources mobilization: • Human resources – doctors and nurses diverted to these special wards • Mthatha Depot for medical supplies – fluids, drugs, dressing packs • EMS to transport referred initiates.

  18. Challenges experienced by Facilities • The mass casualties and admissions created chaos as hospitals were completely not prepared for the admissions. • Staffing – the hospital needed to spread thinly the existing staff complement • Equipment – these special wards were not equipped. Equipment had to be shared from other wards. • Food shortage – due to extra plates that are not budgeted for • Bed occupancy – those critical and admitted in the wards occupied most of the beds • Mental unit in St Barnabas needed to be vacated for Contractors to start with contraction in July.

  19. Of note and Recommendation • No clear and specific resource commitment shown by LG and HOTL • OR Tambo/Alfred Nzo (Nyandeni, Qaukeni, Bizana) circumcision practice is redefined – Circumcision Risk Areas • High level of criminal involvement and non accountability • Devise specific mechanism/strategies to curb and contain further deaths – HOTL and LG to lead • DoH facilities readiness to manage complications

  20. Recommendations • LG/Municipalities and HOTL take ownership of the practice • There should be a high level of accountability…one death is too many • Provision of resources • Year long structured, on-going prevention program – engage all sectors – educational program to schools. • A continuous updated database of all Iingcibi and nurse. • Blacklisting of iingcibiwho commit crimes and continue to disobey standing orders and instructions. • Amakomkhulumust lead the program of initiation in their respective areas…with high level of accountability • Review of policy and legislation regarding traditional male initiation; implemented to the full extent of the law to ensure arrests/convictions. • All circumcision related deaths and assaults be investigated and arrest be made

  21. Enkosi

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