Post-op care and MMC Follow-up

A lot of my work at CMMB focuses on the preoperative portion of MMC, with scheduling dates for circumcision, creating promotional flyers for mobilization, and coordinating community events to educate and promote MMC. The other part of my job is spent behind my computer imputing data, doing quality assurance checks, and reporting. This means I don't always get to interact with our patients, see the surgeries, or assist the nurses in their daily activities. I definitely enjoy the work I do and recognize it's importance, but sometimes its just fun to get out in the field and interact with some patients! Luckily, last week I was able to go along with one of the teams doing follow-up visits for a group of patients they circumcised 3 days prior. This is standard procedure for CMMB to check the healing progress of each patient 3 and 7 days after surgery. We traveled to the clinic and reviewed each patient that had been circumcised 3 days prior. Each boy had obviously read the post-op instructions we provided them that gives instructions on how to clean and care for their wound, because none of them had any problems with infection or removed sutures. The most common problem we saw was slight swelling due to patients not positioning their penis upright.

 

    After conducting all the follow-up reviews we were told about another patient who was circumcised several weeks ago and is now having a problem. We called the patient and received directions to his house in order to assess the problem and provide treatment. We eventually found our way to this boy's village, stopped to ask some locals which house this boy lives in, and found the boy at home with his grandmother. There was no electricity in the house, so our nurse had to review the patient from the light coming in from an open door. We discovered the boy had wound dehiscence, which means a rupture along the surgical suture line. This is commonly caused by infection, frequent erections, or excessive tension at the suture line. Our nurse was able to provide treatment and medication to help alleviate some of the boy's pain. We promised to return the next day to assess the healing and left the boy to rest with his grandmother. It is not often that we see complications like this after MMC, but they do exists. Currently CMMB's rate of complications is less than 1%, likely due to the amount of follow-up care we provide our patients and the instructions we give them before, during, and after their surgery. I'm happy to say the boy is now completely healed and has returned to school. Although it was an unfortunate occurrence, I'm glad I was able to witness our nurses in-action caring for and treating our patients.

Khuphuka Project Sports Event

On Saturday CMMB was invited to attended a community sports event held by an NGO called the Khuphuka Project. The event featured a soccer tournament for the guys but also had volleyball and netball games for girls. Netball is basically South Africa's equivalent to basketball, except the hoop has no backboard. Between soccer matches, the Khuphuka project planned discussions for the youth on topics about MMC, teen pregnancy, and violence. CMMB was invited to the event to help facilitate discussion on MMC and educate the community. I attended the event with our new Community Mobilizing Coordinator, Mr. Ngcamu. We were able to watch a few soccer games before the first discussion on MMC began. Skumbuzo, the event coordinator from Khuphuka Project, first introduced to topic of MMC and then asked players from each soccer team to take part in a discussion about the role individuals and the community have in preventing HIV through circumcision. Some teams argued that it is only the man's decision and responsibility to be circumcised, while other teams argued the parents and partners of men should also take part in making this decision. After the discussion, Mr. Ngcamu spoke to the crowd to educate them on MMC, the benefits of circumcision, and the services CMMB provides. The day was a great success and I'm so glad CMMB was invited to take part. The event showed me these communities are truly interested in the health and well being of their youth, and are ready to be proactive about combating issues like HIV, teen pregnancy, and violence.

Opening of the MMC Center of Excellence

Speakers at the event

Circumcised Zulu men

Last week CMMB was invited to the opening of the MMC Center of Excellence at the North Dale Hospital in Pietermartizburg. I was able to attend the event with 2 of my colleagues, Mr. Mthiyane and Mr. Ngcamu.  The MMC Center of Excellence will be an international center  for training doctors and nurses on MMC procedures as well as providing MMC services to boys and men throughout South Africa. Special guests attending the opening included the MEC of Health,Dr.Sibongiseni Dhlomo, and the Zulu King, King Goodwill Zwelithini. The event had a huge turnout. Circumcised men from all over the KwaZulu-Natal Provice came in their traditional attire to celebrate the Center and the accomplishments being achieved through

Zulu men singing traditional songs

circumcision for preventing

Zulu King

HIV. The event featured speeches from the MEC, the Zulu King, several other guests, traditional dances from Zulu men and women, a play, and lots of music. The event made it obvious that circumcisions are a large focus for men in South Africa and the government is doing all it can to spread the message so that all men accept MMC and make it a priority in order to prevent HIV.

CMMB and Sizanani Camp

 
 Over the Easter holiday, CMMB held a massive 7 day circumcision camp to make MMC services more accessible to school boys while they were out on holiday. Like all of our other camps, we provided HIV counseling and testing, TB screenings, STI screenings, circumcision, and HIV/MMC education. However, this camp provided something extra for the school children. CMMB partnered with the Sizanani group to teach life skills to adolescent boys and girls. Before the camp began, the Sizanai group trained several community members to help as counselors for teaching life skills. They recognized the importance of capacity building within the community in hopes that these new counselors can continue to instill valuable life skills to adolescents. During the camp the Sizanani group used games, roll playing, songs, crafts, and other team building activities to help convey their lessons on becoming responsible, successful, and happy adults. The camp was a great success in providing circumcisions for HIV prevention, but it was equally successful in teaching valuable life skills that those children with carry with them for the rest of their lives.

Motivation

Transportation/MMC promotion!

February has been a hectic month. Between scheduling appointments, doing MMC education in schools, booking clients, performing MMC at different clinics, and setting up camps to perform MMC within local communities, the stress can really pile up. Fortunately my team and the people we serve provide me motivation each day. I’m so impressed with how hard our team works, how willing they are to work long hours in order to get the job done, and how appreciative our clients are to receive MMC services. 

A few weeks ago the Department of Health (DOH) organized a 3 day MMC Camp in a rural community in order to bring MMC services to boys that don’t have easy access to a clinic. The DOH asked CMMB to assist at the camp to circumcise as many boys as possible. The camp was a great success. We worked non-stop for 3 days in order to circumcise the

Patiently waiting

130 boys that showed up for MMC. We had to work extra late one night in order to circumcise every client who showed up that day. Our team was more than willing to stay late even with the hour drive home ahead of us. The last client of the night was a boy who went to school and also worked on his father’s farm. He waited all day to be circumcised, missed a day of school, and was unable to take care of his father’s cattle. When we asked him why he chose to wait until 7:00 p.m. to be circumcised instead of just coming back the next day, he said he didn’t want to go home without being able to show his father that he is now a man.

Mother registering her son for MMC

Our team normally works during the week, but we’ve also started working on weekends in order to reach more boys who aren’t available during school days. This past weekend we set up a Saturday camp to circumcise boys from a nearby school. We used the local tribal court and converted it into a surgical room with HIV counseling and testing in the tent outside. Every client that shows up for MMC must sign a consent form before we circumcise them, and if they are less than 16 years old they must have a parent or guardian sign their consent. Most clients are between 16 and 49, but on that day one client showed up who was only 13 years old. The week prior to this camp, CMMB went to the nearby high school to do MMC education and hand out consent forms for boys under 16. Unfortunately, this boy was from a local primary school and didn’t know about the necessary parental consent. We had to turn him away because he was too young. About an hour later the boy showed up with his mother so she could sign his consent form. After registering her son and signing the consent form, I had a chance to sit and talk with the mother while she waited for her son to be circumcised. She’s a 62 year old mother of 16 children, and her 13 year old son is the second youngest. Her son wanted to be circumcised because his father died of AIDS. She said she is current taking classes to learn how to read and write, and she was very proud to be able to sign her son’s consent form.

This job is definitely hectic, hardly every runs smoothly, and can be pretty stressful, but each day I find new motivation to continue working to ensure this project is a success. It’s pretty great to have a job that’s so rewarding.

Ingwe Municipality Youth Event

MMC activities have picked up quickly since this year started, and we are doing a lot of promotion and education in order to keep the ball rolling! The Ingwe Municipality held a youth event one weekend and CMMB decided this was the perfect opportunity to promote the importance of MMC and share the services that CMMB provides. We asked one of our employees, Baba Mncwabe, to speak at the event because he is well known and respected in the community. I went along with Baba Mncwabe to represent the company, help educate, and of course take pictures.

Sitting on stage at the Youth Event

The youth event had a great turn out. Lots of young men and women showed up and listened to the different messages on how to stay healthy, make good decision, and be successful in life. Finally it was Baba Mncwabe's turn to speak. He gave a brief speech on what is medical male circumcision (MMC), why it is important, and the services CMMB provides. MMC is an important aspect of HIV prevention, and we try to stress this message to women and men. Although MMC only directly pertains to men, women should also know why MMC is important. Our MMC project is called "Impilo Ekhaya", meaning health at home, and the name is meant to emphasize the prevention of HIV in men can affect an entire family.

Baba Mncwabe giving his speak on MMC

Between speakers there was also a lot of entertainment. There were poets, dancers, and musicians that all celebrated the Zulu culture. The last 2 performers were especially entertaining. They danced and sang while wearing traditional Zulu clothing. I always love going to these community events because they ALWAYS have a good message, good food, and plenty of entertainment.

This boy performed onstage while his dad sang and played guitar!

Sunday Outing

This Sunday Lauretta surprised Winrose and I with an outing to Midlands Meander.  She told us that she and her family were just going out for lunch and invited us to go along, but it ended up being so much more.  First we stopped in the town of Howick to take pictures at a view point of the Howick falls.  The views here in South Africa are so amazing.  We took a couple pictures at the waterfall and then continued driving. 

Next we stopped at the capture site of Nelson Mandela where a new monument has been built.  At first look the monument seemed to be an abstract of metal shards, but once we stood in the right spot we could see Mandela’s profile outlined with the metal. We also walked through the small museum on site that gave a history of Mandela’s life.  It talked about his upbringing, how he was captured at this site during apartheid, his life in prison, and his rise to leadership as South Africa’s first democratic President. We also had lunch at a little restaurant near the capture site. 

 After lunch, we drove to a type of market place where we could walk around and window shop.  There were coffee shops, dress shops, craft shops, and home décor shops. I didn’t buy anything, but it was nice to walk around and look at all the crafts.  We finally headed home after our busy Sunday to get some rest. Winrose and I were so thankful for our little surprise.  We had no idea that there is so much to do around our small town of Bulwer.  We are definitely looking forward to another outing, and hopefully soon.