First mobile circumcision clinic opens in Uganda

20 June, 2011, Esther Nakkazi

Uganda is targeting to circumcise 4.2 million men in five years aided by a mobile clinic to reach remote areas and most at risk populations like fishermen.

Aaron Lubega comes riding his motorcycle to Bbali Health Centre IV, Kayunga district. The 30 year old is clad in blue jeans and quickly walks into the counseling tent.

He was circumcised a week ago. He is here at the mobile clinic for follow up.

“Even after the cut I was wearing jeans but inside I had tight underwear to keep the penis in one position. I rode to town an hour after the surgery,” said the father of 6 and 9 years old boys.

Lubega a police officer decided to have the ‘cut’ to prevent sexually transmitted diseases and to keep good hygiene for when in the field, he spends many days without bathing and his colleagues who are ‘cut’ are cleaner.[frax09alpha]

The mobile clinic parked near a health facility

Uganda is targeting to circumcise 4.2 million men in five years aided by new technologies that reduce circumcision surgery time and a mobile clinic to reach remote areas and most at risk populations like fishermen.

Public health experts say it is important to reach a critical mass of people to create an impact. “The more people circumcised, the more HIV infections averted,” said Mark Breda, program manager Makerere University Walter Reed Project (MUWRP).

Already, World Health Organization has endorsed safe MMC as an effective HIV prevention strategy, based on research findings that it reduces the risk of HIV acquisition of circumcised men by 60 percent.

The Medical Male Circumcision (MMC) mobile clinic- the only mobile clinic in East Africa for safe MMC –custom built in South Africa- was availed by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Makerere University Walter Reed Project (MUWRP).

“The mobile clinic can provide circumcision services to the hardest to reach, most at risk populations in Uganda safely and at a cost saving. We can circumcise more people per day at a fraction of the cost,” said Breda.
Since it was started in November 2010 about 7,000 men have been circumcised. At its first location at a remote fishing village in Northern Kayunga District for three months, more than 300 men were circumcised.

Inside the MMC mobile clinic is a self contained surgical unit and two surgical beds. The smell of Jik- a disinfectant- heavily hangs around the air outside.

In a day, 35-40 circumcisions are carried out using technologies that enable more surgeries, are safe and cheap, said Dr. Peter Masaba the prevention coordinator MUWRP.

The MMC mobile clinic uses a new technology, MOVE, which combines task shifting to optimize staff and space. Proficiency is important for instance a nurse does more of the mundane things that a doctor does.

“You divide labor. Everyone is on the move all the time. When you stand you break the move,” said Masaba also a surgeon with the mobile clinic.

“It will take not more than 15 minutes on the table unless the client has a problem.” 99. 5 percent of all the clients are discharged after an hour for a procedure that takes 8-20 minutes, or twice that time at a medical facility.

There is hope by MUWRP that other partners replicate this new delivery method.

At the MMC mobile clinic circumcision is free supported by PEPFAR while at national referral hospitals it costs up to 80,000- 140,000 and 400,000 in private hospitals.

Counseling services

Godfrey Aganza, a student, is one of the clients about to undergo the ‘cut’ at Bbale health Centre IV where the mobile clinic is packed. The 18 year old first undergoes counseling in a tent adjacent it.

In here, they discuss STDs, HIV/AIDS, family planning and general health education. They also undergo a series of counseling sessions about all of the risks and benefits of medical male circumcision.

The commonest question among clients is if there is pain during erection after circumcision and the most widely held myth is that circumcision is a family planning method, said Isaac Kasozi a counselor at the site.

The men must also pass both a basic physical and a written test examination to tests their understanding on the issues raised during the counseling sessions and in the education materials.

One of the questions is; for how long do you need to abstain after circumcision. There are multiple choices but the right answer is 42 days to abstain from sex even after the wound heals.

Those who fail this pre-service test are put on a one to one training until they pass it because it is a prerequisite to help them understand what circumcision means.

The men also have to undergo an HIV test but picking the results is optional. Fortunately, said Masaba, all of them want to know their results and most of them are negative.

The few who do not qualify have; a heart problem, allergy to medicines used at the clinic, are on drugs or have congenital abnormalities on the penis- like the position of the urethra-these are referred to a specialist, said Masaba.

After counseling, Aganza moves with his file to the next tent where they take his records and he consents to the surgery. Consenting age is 18, below that (up to 15 years) they assent and a parent comes over to consent.

The average age is 15-35 years.

Aganza later emerges from a tent in a green theatre gown. He joins other men waiting to enter the mobile clinic, which takes two at ago.

The mood is jovial with jokes and laughter. But some are visibly frightened. Asked why they chose to circumcise; ‘to reduce STDs, to have better sex, my wife demanded for it, my penis is too big, you become efficient, it is easier and faster to put on a condom’ are some of the answers.

Most of them knew about the free service from a friend. But MUWRP conducts community sensitizations on circumcision with local political, religious and opinion leaders for each site. They also place loud speakers at market places, use community radio stations and centrally located billboard.

The mobile clinic is parked at a central referral and the patients are followed up after surgery. The come back for follow up visits on day 7 and day 30 to ensure that their wound has healed completely.

“When we leave a place there should be referral. MMC is not an isolated programme it is the activity of the ministry of health,” said Masaba.

“I was pricked (for sterilized) then felt nothing. They just told me they had finished. Cutting took only about 5 minutes,” said Aganza ready to go home.

Asked why they chose to circumcise; ‘to reduce STDs, to have better sex, my wife demanded for it, my penis is too big, you become efficient, it is easier and faster to put on a condom’ are some of the answers.

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