It is a chilly Wednesday morning and Grant Shuga is interacting with his peers under a tree by the roadside.
The boys, almost 30 of them, have been sitting here for about 30 minutes, having walked from Amidu Village in Balaka. In the shade, they are waiting for a vehicle from the Christian Health Association of Malawi (Cham) to come and pick them up to Comfort Clinic, some 30 kilometres away, to access voluntary male medical circumcision (VMMC).
The boys have come with their parents who want their sons to get circumcised by skilled health workers at the clinic run by the Catholic Church.
When the vehicle arrives, the boys scramble for the ride. Grant says he just cannot wait to be circumcised.
“The campaign for us to go and get circumcised at the clinic is good, but we are many in our village. We have to take turns to access the procedure,” he says.
Four years ago, government adopted VMMC as a way of reducing HIV infections following findings that it reduces the risk of contracting the virus by 60 percent. The procedure is also credited with enhancing personal hygiene and protecting women from cervical cancer.
Some of the boys, who were eagerly waiting for a turn, had a chance to undergo traditional circumcision when initiation ceremonies were in session in their village.
Although circumcision is a cultural obligation in the Eastern region, the young men and their parents say they prefer doing it with the assistance of health workers because it is safer and more beneficial.
Asked why they want their sons to get circumcision at the hospital instead of the village-based initiation camps, the parents said they are convinced it has several advantages.
“At the hospital, trained staff do the circumcision. Besides, they use safe tools and this is important for the boys’ health,” says a father of two of the boys in the vehicle.
But there is a more interesting twist.
For some, the VMMC campaign is also a cost-cutting measure.
“In Balaka, this is the season of initiation camps when young boys are taken to be circumcised as a rite of passage to adulthood. However, this year is tough. Most of us did not send our children because we cannot afford to pay for them due to the ongoing food crisis in the district,” said a Mr. Lazario of Thom Village.
The parents pay up to K5 000 to have the boys initiated. Besides, the parents pay extra costs because the initiates need daily food supplies for the entire period at the camp.
Balaka is one of the districts hit hard by the drought that has drastically reduced the country’s maize yield.
Christina Kachingwe, wife to group village head Magombo in Traditional Authority (T/A) Amidu, aides the boys from the area to get circumcised at Comfort Clinic and make sure they all return home safely afterwards.
She explains: “After hearing of the campaign, my husband and I agreed to take the lead. Being the village head, he organised village meetings to encourage parents to register their children. I decided to be the chaperon for the boys to make sure they meet in designated points from where Cham picks them up. Together with their parents, I go with them to the clinic. Afterwards, I make sure everybody gets home safe.”
Overcoming cultural and religious myths, the village head’s wife admittedly feels duty-bound to ensure all children in her area grow up to be healthy citizens.
“Medical circumcision is safer for these kids than getting what they go through in initiation camps, locally known as ndagala, where they face the risk of HIV infection as the elders use unsterilised equipment. That aside, the boys are subjected to harsh conditions and some boys die due to inadequate care given after circumcision,” she laments.
Recently, police arrested two initiation counsellors after a 13-year-old boy bled to death in their initiation camp following traditional circumcision.
In contrast, after they are operated on at the clinic, the boys come again to the clinic for two post operation check-ups.
Since the campaign started last month, nearly 3 000 boys have been citcumcised by trained health workers in Cham facilities—Comfort Clinic; Kankao Mission Hospital and Kapire Health Centre—in Balaka.
Gift Werekhwe, Cham coordinator for the VMMC campaign in Balaka, the response is so overwhelming that the health workers sometimes tell the clients to come again the next day to avoid compromising on quality.
“It is pleasing that parents are realising the need to get their kids circumcised at a health facility and not initiation camps,” he said.
Cham executive director Dr Mwai Makoka says this campaign is another example of the unwavering commitment the association has in ensuring Malawians get the best in health care.
“Cham is committed to providing quality health care for Malawians. Even through VMMC campaign, we want to reach out to as many underserved populations as possible,” he explained.
The six-week initiative is part of an ongoing VMMC programme funded by Pepfar through the Centre for Disease Control and Prevention (CDC).
The campaign is taking place at Pirimiti Hospital and two satellite camps in Zomba as well as St Gabriel and Likuni mission hospitals in Lilongwe.