In Tanzania, medical circumcision services rely on a predominantly female nursing workforce

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The following is a guest post from IntraHealth International.

By Mkama Mwijarubi

In November 2010, Tanzania embarked on a nationwide campaign to scale up medical circumcision — which can decrease a man’s risk of HIV infection by up to 60 percent — in regions where men traditionally do not undergo it. Hundreds of nurses were trained to perform the procedure.

In Tanzania, more than 70 percent of the country’s 39,000 nurses are women. This sometimes complicates things, as some male clients are hesitant to undergo circumcision at the hands of a female health worker. I had the opportunity to sit down with Anagretha Gasper Cossam, a nurse midwife at Bariadi Town Council Hospital Tanzania, and ask a few questions about this particular aspect of her work.

Question: Did you ever provide circumcision services before you started working in this program?


Anagretha Gasper Cossam, photo credit Mkama Mwijarubi

Answer: I had not done a circumcision procedure before. But the one-month training I attended exposed me to how the procedure is carried out. At first I was very slow, spending up to one hour with one client and using many stitches. With experience, my hands have become used to the procedure and it now takes me less than half an hour. Since it is an important procedure that you perform on a human being, it’s important to be careful. Nowadays I even assist those who need to improve their skills.

Q: What is the biggest challenge in providing these services?

A: We usually confront different traditions from different communities. Some of our clients’ traditions do not support high standards of personal hygiene. So we have to educate them about basic personal hygiene to make sure that the wound from the procedure heals properly.

We also insist that the clients should not disregard coming back for a check-up seven days after the operation. A common challenge we confront is that most clients only come back for the first check-up on the second day after the operation. Since they seem to be healing, they often do not show up for the second follow-up visit on the seventh day.

Q: Has providing [medical] circumcision added anything to your career?

A: The first is satisfaction. I am always open to new challenges in my work, so I was excited when this became an additional service I perform. I am proud that I completed the training and am able to perform the procedure well. This job has exposed me to a new skill that will remain with me for the length of my career.

And I feel that I am helping prevent HIV both in the communities I work with and in my country. I do this through counseling sessions with our clients and through providing male circumcision services. Some of the people I talk with have never talked freely about their sexual behaviors. I have an opportunity help them adopt behaviors that will help them stay safe.

Q: Do circumcision clients avoid you because you are a woman?

A: Unfortunately, yes. Some clients say they do not want to be circumcised by a woman. We reason with them that circumcision, like other medical services, is provided by male and female health workers alike. Some of them agree. Some are adamant and wait until a male provider is available to attend them.

Q: As a female health worker, do you feel comfortable providing a service that is solely for men?

A: I have no problem. My training and feeling as a nurse is that I am ready to provide medical services to anyone.

Thanks to health workers like Anagretha and IntraHealth International’s work in Tanzania, more than 500,000 men and boys have undergone voluntary medical male circumcision, which decreases a man’s risk of contracting HIV through heterosexual intercourse by at least 60 percent. IntraHealth’s work in Tanzania is funded by the US Centers for Disease Control and Prevention.

Mkama Mwijarubi is a program officer at IntraHealth International.

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