'We are Pedi [Northern Sotho]. My son always knew that the day would come that he would have to go to initiation school. It is our culture. I went there myself when I was 12 years old and the lessons we learned I still remember. We were taught respect," says 44- year-old Motladi Phala, beaming with pride.
Phala fights back the tears as he looks towards his son, who is huddled together with the other initiates in the courtyard of the royal palace of Chief Robert Mampuru in Etwatwa, a township near Daveyton on the East Rand.
The Benoni-based attorney can hardly restrain his tears of excitement, saying: "I am very happy."
His 13-year-old son has just completed the traditional rite of passage into manhood.
Phala's elation is reflected by the 22 other mothers and fathers who struggle to tell their children apart from the rest of the initiates, who look identical, with their bodies covered in a reddish-brown muddy substance and a loin cloth their only attire.
Outside the tent pitched next to the chief's home, the community has gathered to welcome them back after their four weeks away from their families, learning the lessons of being a man.
Representatives from the departments of health and justice, the ward councillor and other traditional courts have come to celebrate the occasion.
There is excited chatter as community members shuffle to get a glance of the initiates. Little children peep curiously out from behind their mothers' skirts. Shirtless young men whip one another with wet tree branches in a battle of endurance that provides a sideshow to the ceremonials inside the tent.
For Phala, the graduation ceremony is affirmation that he made the right decision.
"Sending your child to koma [initiation school] is a tough decision for any parent to make," he says, looking at a certificate given as proof that his son has completed the ritual. "But it was important for my wife and me that he [would] know his culture.
"He has learned that life is full of challenges and that he must appreciate what he has. Those experiences are good for him."
However, Phala's sentiments are not shared by all community members: Gift Mtshali shakes his head in disapproval as he looks on.
"I don't have a problem with initiation, but these boys are too young. How do you tell an eleven-year-old that he is a man?" he asks incredulously. "I have a son around that age. I won't let him do that."
According to the Gauteng health department, boys in the province who are younger than 18 can be circumcised, provided they get parental consent. "To just cut something from your body and then, all of a sudden, you think you are a man is lame," he scoffs.
"I respect their culture totally," says Mtshali. He is Zulu, and initiation hasn't been practised in his culture for centuries. "But this scares me. Really, it gives me goose bumps."
The custom has been heavily criticised in recent years and has even been referred to as a public health crisis: scores of boys die and hundreds more are hospitalised during the initiation season every year owing to botched circumcisions.
A 2010 report by the Commission for the Promotion and Protection of the Rights of Cultural, Religious and Linguistic Communities notes that circumcision has been singled out "as the major cause of amputations and initiates' deaths".
If the removal of the foreskin, which forms part of the initiation ritual, is not done correctly, it can lead to amputation of all or part of the penis and, in some cases, death. According to government reports, more than 60 initiates died because of bungled circumcisions in Mpumalanga, Limpopo and the Eastern Cape between May and July this year.
But Phala says the reports did not deter him from sending his son to initiation school. For him, it is an integral part of his identity.
"Koma is a school like any other. Before you send your child to school, you have to do your research. You do your homework and find out as much as you can about the place."
Mampuru's school came highly recommended by the local chief in Sekhukhune, where Phala grew up.
"It was sad to hear about the death of initiates, but I didn't have doubts about my son going to initiation school. I did my homework and I was comfortable with my choice. The outcome of koma depends on who the school is run by," he says.
In fact, says Mampuru, none of his initiates withdrew because of the reported deaths.
"This is our fifth time hosting an initiation school in the East Rand [it was held in 2002, 2003, 2006, 2011 and 2013]. We've never faced a problem such as this [deaths]. The number of kids that we take for initiation is the same number that comes back."
Mampuru says initiation is an inevitable part of cultural practice and that chiefs who run initiation schools must take responsibility for them. Part of the belief is that kings and chiefs are custodians of initiation schools.
"As a chief, you know that starting an initiation school is a big responsibility because parents are entrusting their children to you," he says.
"When my initiates go to koma, I go with them and stay with them until the process is complete. I'm the one who has to ensure that they are well taken care of. I can't just send somebody else, because this is my responsibility. Koma must be taken care of diligently.
"Nowadays, chiefs sit back thinking: 'I've appointed somebody to do the work for me. I can sit at home'.This is how problems like those in Mpumalanga arise. I take care of my own school because it is my name at stake," says Mampuru.
The chief says he saw a need for an initiation school in the East Rand after many families moved away from their villages to Gauteng for better opportunities.
Mampuru says he runs a tight ship: prospective initiates need written parental consent to be allowed into his school. And a partnership between the HIV prevention organisation Society for Family Health (SFH), the chief and the provincial health department means that initiates get full medical screening, including HIV testing and counselling, before going to initiation.
Cynthia Nhlapo, the senior programme manager responsible for medical male circumcision at SFH, says the screening before circumcision and subsequent check-ups ensure "that none of the boys die from bleeding or dehydration or any other condition that is medically related".
Such collaboration also occurs in Orange Farm, west of Johannesburg, where initial research conducted by the Centre for HIV and Aids Prevention (Chaps) in Johannesburg in 2005 showed that medical male circumcision – that is, the surgical removal of the entire foreskin of the penis, reduces the risk of HIV transmission and infection by up to 60%.
The Bophelo Pele circumcision centre in Orange Farm, a Chaps project, was the first site to prove medical male circumcision, sometimes also provided by doctors to initiates attending traditional initiation schools, as a measure to prevent HIV infection. The project works with traditional leaders in the area to improve the safety of initiates.
In traditional circumcision, no anaesthesia is provided, clinical hygiene practices are often not adhered to and, in some cases, only part of the foreskin is removed. Traditional circumcision forms part of a larger rite of passage that is performed in outdoor camps.
The effect of partial circumcision on HIV prevention is unknown, because findings that male circumcision reduces men's risk of infection with HIV are based on studies in which all participants' entire foreskin were taken off.
Mlungisi Nazo, a counsellor at the New Start Medical Male Circumcision clinic in Tsakane near Brakpan, was part of the Orange Farm project.
"In Orange Farm, we would talk to the initiation school 'teachers' who would agree to us doing the medical circumcision. Because we were not competing with the culture, we gave them space to handle the traditional stuff their own way," he says.
However, he says their reception on the East Rand has been lukewarm. "People in Tsakane are not responsive to medical circumcision because there are a number of traditional initiation schools in the area, so some people prefer to go there. Some think getting circumcised medically is a betrayal of their culture."
Nazo says it is important that people understand that what he does is purely medical and has no bearing on a person's religious or cultural beliefs. "Medical circumcision is not here to compete with the culture, but [to] complement it."
Thamaga Mathole, the chief's assistant, says there is plenty of room for co-operation within the boundaries of the set tradition because "koma is secret and sacred".
"We are developing, society is dynamic. Culture is dynamic. It's not a statue. We're not permanently in dust. There are doctors who have gone to initiation schools and they understand exactly what the tradition contains," he says.
The chief used to have a medical doctor permanently stationed at the previous initiation schools he hosted, but the doctor has since relocated.
But, Mathole warns: "You cannot have a person who has not been to initiation school coming into an initiation school."
The custom is jealously guarded and is "not for public consumption". It has a strong sense of exclusivity and secrecy, a fraternity that allows little, if any, outside interference.
"Even if you have been to hospital [and have been circumcised medically], you can't enter koma. If you go there [initiation school], you will have to stay on and finish the ritual. Hospital is hospital. Koma is koma. They differ in many ways. Why would you go to hospital and then go to initiation school?
Safe and sound
"There is no competition. Medical circumcision is not a new thing. It's been around for years and years. So has koma," says Mampuru. "The hospital and koma do not go together."
Mathole says initiation is a custom that has been passed on from generation to generation and it was where the king's or chief's legions were trained. This element, he says, has remained in the custom.
"There is this concept of power within. This is a [warrior] regiment. Mampuru is preparing them. He initiates them, he ensures that they come out [as] fit and fresh as they are now – ready to protect.
"The initiates graduate as soldiers. If you go to hospital, what do you learn about combat?"
The ceremonials are now over for Phala's son and his fellow initiates: they will return to school with their peers.
Mathole says they have an important role to play in the chieftaincy. They are now the messengers of the royal court, charged with delivering summonses for the chief.
More importantly, they will assist the chief with the next initiation school, which will be hosted in the next two to five years.
Until then, Phala and the other parents are happy to have their children back home safe and sound.
"It is such a relief for us as parents in the urban area to have a place where our children can safely practice their culture," he said.
A round of applause breaks out in the crowded tent as the initiates make their way down the red carpet laid over the gravel road to the royal court where food will be served.
The formalities give way to the festive dancing of old women in traditional dresses, who proudly ululate and sing: "Our sons have become men. They can go on with their lives now."
Circumcision: A sharp twist of the knife and all is lost
Arrests made in Eastern Cape after botched circumcisions
DIFF: From small town to big screen
Zimbabwe's anti-HIV circumcision drive fails to take off
Initiation has become criminal, says Motsolaedi
Pontsho Pilane explains why women may choose a Caesarean section over a vaginal birth, especially in the private sector.
A doctor shortage in war-torn Mozambique paved the way for a new breed of surgeons that have slashed deaths among new mothers.
A novel and easy way to disinfect water using freely available solar power is helping to combat the spread of disease in developing countries.
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.