The initiation should return to its original rootsng men for the future good of the community.

Every year, in the name of ritual and manhood, thousands of young boys go into the mountains of the Eastern Cape. Dozens come back dead or deformed. How can we let this happen?

The year 2014 saw the world’s first successful penis transplant. Once the jokes died down, the most important question to ask is “why would anyone need that?” The sad answer is that the recipient lost his penis in a circumcision ritual. It was an entirely preventable incident. His is one of 250 penile amputations that are estimated to occur every year during traditional circumcisions.

Since 1995, 945 boys have died during the unmonitored and often illegal initiation camps that accompany every Eastern Cape winter. These are just the recorded deaths. Every season, between 20 and 40 boys die under the mismanagement of the rituals by traditional leaders – and it is estimated that for every death, there are two penile amputations.

Every year, in the name of ritual and manhood, thousands of young boys go into the mountains of the Eastern Cape. Dozens come back dead or deformed. How can we let this happen?

The problems begin with the secrecy that surrounds the ritual. Non-initiated males and women may not be told about what happens in the mountains, and many of the schools are located in almost inaccessible nooks. By removing the schools (both legal and illegal) from supervision and scrutiny, they operate with impunity and shocking standards of care. 

The living conditions of the initiates also play an important role in the rising number of deaths. The huts used to be made from clean, fresh grass – made new for each batch of initiates. Now the huts are often made of plastic with very small entrances and exits. Each one has a constantly smouldering fire and there is no air circulation. This leads to dehydration, which is hugely risky for initiates who are trying to heal from their circumcision. When these huts catch fire, the entrance is often too small to allow for quick evacuation. On top of these living conditions, the boys often have a restricted diet and fluid intake as an endurance test. The reason for the restricted fluid intake is to do with the mistaken belief that the clear watery discharge that accompanies a circumcision (which is how the body brings nutrients to a wound to aid its healing) is an injury itself, and must be prevented through dehydration. Traditional attendants call this discharge umlambo, which means ‘a wound like a river’.

In addition to these difficult physical conditions, the initiates are also sleep-deprived, because of the belief that witches will attack in the night unless the boys sing to keep them away. Pre-existing medical conditions are disregarded, and medication is often left at home for fear of being seen as weak. Some of the schools are run by drunkards, who beat the initiates relentlessly. Penile bandages are often tightened as punishment, and the physical endurance testing may be taken to extremes.

The list of problems goes on to include severe cultural prejudice against Western medical circumcision and the lack of responsibility on the part of traditional leaders to hold the schools accountable.

But there are solutions that can be implemented. Centralising the schools into a larger, more easily monitored and accessible school will ensure the ritual is not being compromised by greed or illegality. After the circumcisions are done, medical professionals can check for complications and ensure minimal disruption to the actual ritual. By keeping the schools accessible, it is easier to catch abusive treatment and remove the abusers quickly. It will also go a long way towards starving out the unethical operators, who rely on their sites being inaccessible.

The largest cause of morbidity and complications is inexpert circumcisions, which are done by untrained attendants. Not only is the actual cutting botched, but the wound care is also inadequate. By allowing trained medical professionals to do the circumcisions, the resultant small, easily monitored wound allows the ritual to take place, and enables the students to spend time being educated rather than being in extreme pain.

Perhaps the most complicated change – but also the most crucial one – is the implementation of a more cohesive initiation programme. By engaging traditional leaders, parents, schools, church leaders and medical professionals, a new programme could be implemented to make the most of this important period in a young boy’s life. Rather than focusing on pain and hazing (like some kind of awful frat house), the initiation can return to its original roots: the education and improvement of young men for the future good of the community. 

The situation may seem dire but with time and effort things can change. Female genital mutilation has dropped according to UNICEF by as much as half among adolescent girls in Benin, the Central African Republic, Iraq, Liberia and Nigeria. A great deal of this change is due to open discussion in population groups. As more mothers and girl children speak out against the practice, its prevalence begins to decline.

All this leads us to believe that this is a problem that can be solved in our lifetimes, but only if it is brought into the light to be solved, rather than cloaking itself in mysticism and tradition.


Ulwaluko is not only the name of the ritual, but also of a non-profit organisation dedicated to making this important rite of passage safe for the boys who undergo it, so that they may become men without physical, mental and emotional damage. The organisation’s website is a fantastic resource, and it is informed by the experiences of a doctor who has worked with survivors of penile amputation.