MANZINI, Swaziland — The government of Swaziland is looking for a few good doctors (and nurses!) to join an HIV prevention effort to provide medical circumcision to more of the country’s young men.
Physicians and nurses who volunteer will perform circumcisions in clinics throughout Swaziland, which has the highest HIV prevalence rate in the world. Jhpiego is providing technical assistance on this unique HIV prevention initiative and recruiting doctors and nurses from the U.S., Asia and Africa to help the Ministry of Health in Swaziland address a pressing need and meet its ambitious goal of providing medical circumcision to all those who want it.
A country of 1.1 million people, Swaziland has been working to provide circumcision services to all men, aged 15–24, within five years. But there are only about 125 registered and employed doctors in the entire country. While many of the Swazi doctors and nurses have been trained in circumcision skills by Jhpiego, demands on their services are great. The volunteer recruitment is a response to the Swazis’ urgent need.
Scientific trials have shown male circumcision to be an effective intervention to prevent the spread of HIV/AIDS, and it is recommended by the World Health Organization (WHO) as among the techniques to be used in the fight against AIDS. Male circumcision is not a traditional practice in Swaziland, where 26 percent of adults and 42 percent of pregnant women are HIV-positive.
The American Urological Association (AUA) has reached out to its members to help Swaziland in this HIV prevention effort. As one of the first volunteers, Dr. Edward “Chip” Collins of San Francisco can attest to the rewards of participating in the project.
“I felt like I was needed,” said the 66-year-old, African-American urologist who traveled to the southern African country this spring with three AUA colleagues. “My grandfather was a surgeon, my father a dentist . . . we are loaded with doctors in my family. We were brought up understanding that service was first and that medicine was a great opportunity to provide service.”
During their visit this spring, Collins, his urology partner, Dr. Ira Sharlip, Dr. Kevin Pranikoff, a member of the Board of Directors of the AUA, and Dr. Winifred Adams, of International Volunteers in Urology, met with representatives of the Swaziland Ministry of Health, the President’s Emergency Plan for AIDS Relief (PEPFAR)/U.S. Agency for International Development (USAID), WHO and PSI, the organization informing Swazi men about the availability of circumcision services.
Pranikoff, of Buffalo, saw the opportunity to volunteer as both a personal and professional imperative.
“What is one of the great medical challenges of our times? The AIDS epidemic. We’re urologists. When does a urologist have an opportunity to participate in an endeavor that may actually affect a population? We’re at the right place and at the right time. Both as an individual and as the premier urological association, how could we not help?” said Pranikoff, 64.
According to health experts, 15,000 medical circumcisions performed each month for one year would avert 64,000 new adult HIV infections.
“When I was called about this project, I thought, ‘Fantastic idea,’” said Collins, who first read about medical circumcision as an HIV prevention tool two years ago and looked for a way to help.
Sharlip, a clinical professor at the University of California, San Francisco, who is active in the International Society for Sexual Medicine, recognized the potential of circumcision as an HIV prevention strategy. He reached out to colleagues at the AUA and led its committee on the issue.
For Adams, the volunteer mission was her first as a physician. A native of Nigeria, the 33-year-old, who lives in Palo Alto, California, also thought it would be “great to see what the need was in Africa since it is close to my heart.”
The doctors spent two weeks in Swaziland, meeting with project leaders, visiting three health facilities and conferring with Jhpiego-trained African colleagues.
After their briefings, the four volunteers saw patients at Litsemba Letfu Male Clinic in Matsapha, the Family Life Association of Swaziland Clinic in Manzini and Raleigh Fitkin Memorial Hospital and, between them, performed 254 circumcisions.
“We saw our job on multiple levels,” said Collins after his return to San Francisco. “The most important part was to try to figure out how we would create a pathway for those of us in urology who were interested in being volunteers . . . whereby we were able to bring well-vetted, board certified circumcising physicians into play.”
The major challenge for physicians interested in volunteering will be finding the time to leave their practices for several weeks, he said. But Pranikoff was confident that “once a pipeline (for volunteers) is started, we can create a constant flow.”
The outreach for volunteers goes beyond the U.S. Most recently, three surgeons from the Surgical Society of Ethiopia, assisted by six nurses from the Nyanza Reproductive Health Society in Kenya, traveled to Swaziland as part of the prevention effort. They circumcised 406 men at three public hospitals.
Francis Okoth Onditi, a nurse who has worked directly on circumcision prevention efforts in Kenya, was among the recent volunteers.
“HIV and AIDS is a worldwide issue across the continents, between the countries, among communities, in the households and to the individuals affected or infected,” Onditi, 30, wrote in an e-mail. “The demand for MC (male circumcision) is likely to increase fourfold in Swazi and I would wish it is provided by well trained personnel to avert infections and give a clear message concerning the up to 60% protection provided by MC, other strategies still standing.
“To increase accessibility and meet the national targets of the country, I am much available in the war against HIV. It is not Swazi’s problem but ours as the living.”
Like her Kenyan colleague, Olivia Akinyi Rachuonyo said she would volunteer again. “In every four circumcisions I attend, I prevent HIV in one person,” said the 26-year-old nurse. “For us to combat HIV globally, I (am) willing to do it in any part of the world irrespective of the race, tribe or religious background.”