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A week before Christmas, amid increasing anxiety about the state of Nelson Mandela's health, the international media assembled in Pretoria, South Africa and began asking questions about the iconic former leader's future wellbeing. Would he ever leave hospital? Would he live to see another year?
For domestic South African journalists, however, the story had another angle. In Mandela's Eastern Cape homeland, the breaking story was that his illness meant he would almost certainly miss his grandson's initiation ceremony back home in Qunu.
Mandela, like many powerful political figures in South Africa, is a Xhosa. For Xhosa boys, their ceremonial transition to manhood - a process known as Ukwaluka - includes traditional circumcision. It is a time honoured ritual woven deep into the fabric of their society. Mandela recalled his own three months at initiation school in 1934 in his memoir A Long Walk To Freedom.
"An uncircumcised Xhosa man is a contradiction in terms," he wrote, "for he is not considered a man at all, but a boy. A boy will cry, but a man conceals his pain."
Today's rites of passage ceremonials tend to last for three weeks rather than three months, but the core elements remain the same - and so do the risks. Circumcision is carried out in a manner which has changed little in the 80 years since young Nelson cried "Ndiyindoda! I Am A Man!" Without access to anaesthetic, painkillers, or even antibiotics, boys' foreskins are cut by traditional surgeons. The more enlightened perform the operation with sterile surgical blades. But old habits die hard, and penknives or traditional daggers are still often used.
In recent years, South Africans have grown increasingly accustomed to reading about initiation gone tragically wrong. In 2001, the government passed the Traditional Circumcision Act in an attempt to prevent more death and dismemberment. Since then, more than 500 boys are known to have died in the Eastern Cape alone. Last month, December 2012, at least 15 boys died, and 64 were hospitalised. Most deaths occur as a result of septicaemia which could be treated with access to basic drugs, such as penicillin.
Speaking out against a practice that is woven into the fabric of Xhosa society is not easy, but it seems that a tipping point may have been reached. Doctors such as Mamisa Nxiweni are growing increasingly vocal, blaming bogus surgeons, and a rise in commercialism with families paying up to 300 Rands (about $40) for a service which used to be performed freely, in exchange for some labour while the boys were at the school.
As Dr Nixiweni told People & Power filmmaker Mayenzeke Baza: "Surgeons forget about the boys' wellbeing and just concentrate on how much money they will make."
Baza, who as a Xhosa himself has first-hand experience of the ritual, spent the past two years researching and filming traditional circumcision ceremonies in the Eastern Cape.
"There are two periods every year when our young boys, usually aged 17 or 18 are 'sent to the mountain' for initiation. It happened to me too when I was that age. And every year, in July and in December, our newspapers are full of stories about boys dying, and boys losing their penises. It felt to me like our customs are killing our kids," he said.
He does not believe that initiation ceremonies should be stopped, but he is among a growing number of South Africans who think that age-old traditions need to move with the times. This year, a handful of ceremonies included a more medical circumcision procedure. In 2013, a new fund, worth 20 million Rand (about $2m) will be launched to encourage more boys to be safely circumcised as part of their initiation.
Despite the option of free medical circumcision, there is still huge pressure on young boys to follow the traditional model. Sibusiso Gaca, an 18-year-old pupil at the prestigious Queen's College, allowed Baza to follow him as he prepared to be circumcised. Even after a school friend died in June, he remained convinced that only by following in his father's footsteps, could he enter manhood and gain the respect his society demands.
"For me, hospital is a last, last, last resort," he said. "According to my beliefs, I have to go to the bush to be circumcised, this is our identity."
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