On Fear and Flies

Most years circumcision season follows Christmas, the longest school break of the year and the dry season weather, the holiday atmosphere and enjoyment of the cocoa harvest, all making January the ideal time to perform this cultural ritual for boys.  The tribes in our district circumcise males only, in groups, historically between the ages of about 8 and 15.  It has been a time for passing on stories and traditions, sleeping outside, moving in groups, dancing and drumming, and no small flow of alcohol.  Some years we barely notice the occasion, then other years seem to be deemed auspicious and many groups of boys go under the knife.  The first January of relative peace after the ADF I remember as a major year, one could meet women circling in the muledu dance in the early morning on many compounds, their heads wreathed with leaves.  I think there used to be multi-year cycles, so the up and down of numbers persists in spite of the process becoming diluted by contact with the rest of the world.

But not this year.  In January the government announced that due to Ebola all circumcision was suspended.  When the district was declared Ebola-free in February, we noticed the upsurge of ceremonies.  It should have all been over by now.  But in the last two weeks, the season has escalated into the biggest ever.  Every night there are drums from one direction or another.  I have two patients admitted now with complications.  Friends come daily asking for “medicine” for their sons.  We hear that even men and boys from other tribes who reside here are undergoing the ritual.  Families are no longer waiting for the age of near-puberty . . They are cutting boys as young as 1 year, who will never remember the cultural significance.  

Why?  The power of rumor.  Everyone believes there is a new fly that has invaded the district and bites uncircumcised males in a very sensitive place, causing irreparable damage.  I’ve been trying to trace this rumor.  One possibility is that four kids in a family all died some weeks ago, and they had swelling in their private parts and stopped urinating I’m told (which could be explained by kwashiorkor, or renal failure from many causes, and it is possible that it isn’t even true).  There was also one kid who really did get a terrible allergic reaction to an insect bite in the groin whom I saw a few weeks ago, and tried to catheterize to relieve his inability to urinate.  I’m sure he made an impression on anyone else who saw him.  How an actual case grows to become a public threat, to the magnitude that hundreds of young boys and young men are undergoing the most painful ordeal of their lives . . . It is amazing really.  I suppose it shows from a public health standpoint that people are very much capable of massive behavioural change in a short period of time if the perceived threat is serious enough.  And this one clearly is.

Meanwhile we listen to the drumming in the dark, and mop up the problems in the daylight, and hope it has a positive effect eventually on HIV prevalence.