On a summer’s day in February last year, Chief Jonathan Mumena from Zambia’s North-Western Province was deep in thought as he sat outside his home.
He has presided over the 60 000-strong Mumena clan for almost 12 years; he is the chief of a “mighty” people and proud of it. The Mumena are part of Zambia’s Kaonde people, who are referred to as “the lion people”.
“Like lions, we are hunters and live in communal entities. Hunters don’t hunt and eat alone; they bring back meat and share it with everyone,” he said. “We’re a nation with strong and caring traditions.”
Mumena village is as long as it is wide. Its heart is about 50km west of the provincial capital, Solwezi. Chief Mumena’s family runs bus and truck services at a local copper mine, but the enterprise is not what keeps him busy most of the time. His identity lies with his clan. He is the custodian of their culture and they trust him, his wife and four children to take the lead in preserving it.
But, late on that hot afternoon, Mumena’s son, Benjamin (18), had arrived home with a “cultural request” that, his father said, “hit me hard in the face”.
I want to go for MC
Benjamin asked his father to sit down. Looking him straight in the eyes, he said: “Daddy, I want to go for MC.”
Mumena was baffled. He had never heard of the term. “I want to get circumcised,” Benjamin added, seeing his father’s frowning face. “MC stands for male circumcision. I want the foreskin of my penis to be removed.”
Mumena was shocked into a long silence. The Kaonde people do not practise ritual circumcision. His son’s request went against the very culture the chief had been entrusted to protect. Mumena thought: “What are the elders going to think of me if my own son subscribes to something we don’t believe in? How can I let my own family follow the tribal rituals of other tribes instead of their own, and expect my people to respect me?”
But Benjamin had come prepared. He was armed with information to convince his father to support his request.
“The medical experts say that circumcision can lower my chances of becoming infected with HIV by 60% and it will also protect me against getting other sexually transmitted infections.”
According to the Zambian health department, almost one in 10 people in the district is HIV positive.
Mumena knew that Aids had been a “great problem” for a long time in his village. Here, embodied in his son’s request, was something that could help – but it ran contrary to clan culture.
Benjamin said the procedure would be performed by a doctor or a nurse and not by a traditional circumciser or community elder, and would not be part of a larger ceremony. Nonetheless, the chief knew the Mumena people would look “strangely” upon this.
“It was something from the outside that didn’t belong to us,” he said.
Benjamin had heard about MC, also referred to as VMMC (voluntary medical male circumcision), from his friends.
Mumena gathered more information from doctors and “authorities” about circumcision and was surprised by the findings. The protective effect of medical male circumcision was even greater than his son had told him.
Although three recent African studies – in Kenya, Uganda and South Africa – showed that being circumcised reduced a man’s chances of becoming infected with HIV by about 60%, follow-up studies revealed that its impact increased with time. According to the Male Circumcision Consortium, the risk of HIV infection among circumcised men was reduced by 67% after 4.5 years in Kenya and by 73% after 4.8 years in Uganda. A South African study found that circumcision in Orange Farm near Johannesburg reduced the rate of new HIV infections among circumcised men by 76%.
Moreover, the procedure also makes men less likely to acquire human papillo virus, the virus that causes cervical cancer. “So it also helps your wife,” Mumena said. “Circumcision helps your spouse to be less likely to get cervical cancer, because a man can give a woman his HPV.”
Later that month, Mumena allowed his son to be circumcised at a government clinic. He knew he would have a lot of explaining to do to his people, “but this seemed like the solution I had been looking for for my very own people – the one that would help a lot towards them not being wiped out by Aids. I knew it wasn’t a cure and it wasn’t foolproof either, but it was an excellent start.”
Mumena is a devout Christian and turned to the Bible for more direction.
“I learned that God even told Moses and Abraham to get circumcised. And if it was good enough for them, then I reasoned that it’s good enough for us, and I told my people so,” he said.
But then he faced a bigger, more personal dilemma: if male circumcision was a good thing, he would have to lead by example and get circumcised himself. If he did not, he would lose the respect of his people.
So, in June last year, accompanied by his wife, he went on a journey of “cultural revolution” and was circumcised.
“I realised this was not about an individual, but more about couples’ and a family’s health. That’s why I got counselling together with my wife before the procedure.”
Mumena decided that the word had to be spread. Soon afterwards, he organised for voluntary medical male circumcision counsellors to attend a village ceremony at which there were mobile clinics and nurses to perform the procedure.
“The information was rolled out and, as a result, I got 20 men that day to be circumcised,” he said. “The following month we partnered with the health centres in our chiefdom and got 400 people to agree to the procedure. Some walked more than 20km to get circumcised. The fire continues to burn as we speak,” he said.
According to the Zambian government, North-Western Province is the only province that has exceeded targets for voluntary medical male circumcision.
The state aims to have 80% of men between 15 and 49 circumcised by 2015, which, it said, could prevent 350000 new HIV infections by 2025. From 2016, the government will circumcise infant males at its health facilities.
“It is these myths of pain and cultural [erosion] that keep people away from circumcision. But we have to break down these barriers. We have to keep talking about them here in Africa. “Culture is very important, but the number one priority is to keep our people healthy and alive,” Mumena said.
Mia Malan works for the Discovery Health Journalism Centre at Rhodes University.
Have something to say? Tweet or Facebook us on @Bhekisisa_MG
KZN backs circumcision programme to combat HIV
Malawi rules out circumcision for Aids prevention
Circumcision can be the kindest cut
Germany's Muslim, Jewish leaders team up to fight circumcision ruling
As deaths mount, take an inside look at the detectives working around the clock to solve the country’s medical mystery.
Partners and families allegedly drugged women and in some cases even physically restrained them as doctors performed the procedure.
Until now, the national and provincial health departments have not been able to say where services are provided. Here's how we found them.
Bhekisisa means "to scrutinise" in Zulu
In South Africa, Zulu patients who would like to be thoroughly assessed by a doctor, would ask the physician to "bhekisisa" them.