Israeli Circumcision Experts Head to Africa

Techniques Honed With Russians Helps Continent Fight AIDS

Celebrating Circumcision: Israeli health professionals celebrate with South African colleagues after completing a training mission.
Courtesy of Operation Abraham
Celebrating Circumcision: Israeli health professionals celebrate with South African colleagues after completing a training mission.

By Nathan Jeffay

Published December 26, 2011, issue of January 06, 2012.
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When hundreds of thousands of immigrants flocked to Israel from the Former Soviet Union, they never dreamed that their absorption process could prove a missing link in a massive plan to combat HIV/AIDS in Africa.

At the height of the wave of arrivals in the 1990s, Israeli doctors came face to face with a huge backlog of immigrants demanding circumcision. They struggled to keep up, but gained critical expertise in circumcising large numbers of adults.

Nearly two decades later, those skills are proving crucial in the fight against AIDS thousands of miles away, in Africa. In the past five years, doctors have become convinced that circumcision dramatically helps to reduce contraction of HIV/AIDS. International prevention agencies believe that every five to 15 circumcisions performed in Africa will prevent one person contracting HIV/AIDS.

“Any Tom, Dick or Harry with basic surgical training can do two or three circumcisions a day,” said Douglas Ross, CEO of St Mary’s Catholic Mission Hospital Trust in Durban, South Africa, where doctors have received training from an Israeli consortium dubbed Operation Abraham. “But to be able to do 40, you need specialist training.”

“What I got from Operation Abraham [is] tailor-made for the South African setting,” added Ross, after a two-week-long Israeli medical mission departed in November.

Encouraged by the results on the ground, the United Nations and United States recently announced a five-year plan to radically increase circumcision in the HIV-stricken continent. Working with African governments, they have so far circumcised 600,000 men. They are aiming to perform 20 million new adult circumcisions over the course of the plan.

The challenge is preparing doctors to cope with the fast flow of patients that the plan will bring. That is where Israeli medics come in. Operation Abraham, a volunteer outreach initiative, is sending doctors from Israel to different corners of Africa to train local doctors like those at St. Mary’s.

“Before the aliyah from the Former Soviet Union, we in Israel had very little experience with adult circumcision, but all of a sudden in the 1990s we became experts,” said Eitan Gross, medical director of the Operation Abraham outreach initiative. “There is no other place in the world where within a few years they performed 100,000 male circumcisions, so we are keen to share our knowledge.”

Since Gross’s nonprofit, a consortium of nine Israeli medical bodies including the Jerusalem AIDS Project and the Hadassah Medical Organization, was established in 2007, it has worked in five African countries.

In 2008, the non-profit was invited to give a workshop in Senegal. Afterwards, the Senegal Ministry of Health and the Senegal Medical Association became partners in Operation Abraham.

Its expertise has also impacted government policy in the AIDS-ravaged southern African nation of Swaziland, where about a quarter of all adults are infected with the virus that causes AIDS. In 2008, the government there had drawn up protocols for doctors, recommending a particular method — sleeve resection. However, after Operation Abraham convinced officials that a different method — forceps-guided — was more suitable for mass adult circumcision, the protocols were amended accordingly.

The Israeli doctors’ involvement goes far beyond the theoretical level. Over the past four years, 10 delegations of Israeli healthcare professionals have travelled to the cities of Manzini and Mbabane in Swaziland.

They also went to KwaZulu-Natal province of South Africa, where circumcision is in particular demand, both because of the high rate of AIDS and the fact that the king of the predominant Zulu tribe, Goodwill Zwelithini, reintroduced it as a rite for his tribe two centuries after a predecessor suspended it.

Tens of thousands of circumcisions have been performed, and doctors from Zambia and Zimbabwe have visited to learn skills that they have taken back to their own countries. Running the clinics are Operation Abraham trainees: 70 doctors, each of whom can perform some 40 circumcisions a day, and 130 nurses and other support staff.

He said that while the exchange between local professionals and Israeli visitors has mainly been on medical matters, the roots of circumcision in the religions of the visiting Israelis and Senegalese have proved “intellectually simulating and fascinating” for his staff, many of whom are Christians.

For the Operation Abraham volunteers, the delegations are physically and emotionally taxing.

“It’s so sad to go and see so many people suffering from AIDS, but we felt that with these efforts it may not be as bad in the future,” said Lilach Malatskey, a family practitioner who led the latest delegation.

Inon Schenker, Operation Abraham’s global health consultant, believes that the benefits of the team’s work goes beyond AIDS prevention. The populations signing up for circumcision tend to steer clear of doctors, and lack sex education and medical attention for other sexual and reproductive health issues. The fact they are visiting clinics for circumcision presents an “unbelievable opportunity” to rectify this — one that team members are encouraging local doctors to use, both by providing educational material to read during waiting time and by talking to patients. “I saw one young man in KwaZulu-Natal, and taking a few extra minutes to talk to him,” Schenker said. “you could see his eyes shining in front of you. Everyone he heard was preaching to put on condoms, but the ideas we were talking about, such as respect of women, went beyond that. [It] made a difference.”


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