The Gambia Committee on Traditional Practices affecting the health of women and childrenGAMCOTRAP, with support from the Inter African Committee on Traditional Practices based in Addis Ababa has provided over one hundred thousand Dalasi to nineteen Circumcisers from the Upper and Central River Regions to engage in Alternative Employment Opportunities Project.

The Chief of Kantora, Alhajie Bachu Ceesay of Garawol, Alkalo Lasana Manneh of Basse Manneh Kunda amongst others reminded the circumcisers that they voluntarily stopped the practice of FGM after getting the facts about the effects it has on sexual and reproductive health and called on them to make best use of the opportunity provided to them to enhance their economic status. The Alkalo of Kaba Kama, Aja Fatou Danso who was part of the delegation that witnessed the presentations, commended GAMCOTRAP for the approach it takes to present facts on FGM with respect and dignity in the communities. She noted that the support given to the Circumcisers will go a long way towards addressing poverty in their families while protecting girls from harm.

Speaking at the presentations the Executive Director of GAMCOTRAP Dr. Isatou Touray, said the process involved series of training to create awareness amongst circumcisers on the effects of female genital mutilation and other harmful traditional practices, microfinance before the presentation of the AEO. She called on the communities to support the circumcisers and emphasized the need for bringing up girls in a positive manner to be good role models in society without harm.

In receiving the support, all the beneficiaries expressed their appreciation to GAMCOTRAP for fulfilling its promise. They vowed to keep to their words to protect girl children from FGM. The support was based on a feasibility study amongst beneficiaries, followed by training on microfinance and management of small scale business enterprises. The circumcisers identified animal rearing, petty trading, Pottery, tie and dye and support to develop gardening as their areas of interest.

The Circumcisers who benefited are Dusu Kanteh and Nyama Damba of Manneh Kunda, Mariama Samura of Kaba Kama, Aja Mabintou Bahaga of Tinkinjo, Jonfolo Fofana of Chamoi, Jibel Kandeh of Samba Kunda, Koreh Sanyang of Sare Mamadi, Hulay Damba of Simoto Touba, Hatou Kanteh and Bai Kanteh of Garawol, Sunkaru Damba of Tambasansang, Kumbayel Sowe of Keneba Kantora, Kani Kanteh and Isatou Damba of Kanube, Penda Damba and Haja Bintou Sinera of Gunjur Kuta, Sira Janko of Kundam Mafatty, all of URR and Aja Fanta Jawneh of Dobong Kunda and Siya Fatty Bantanto in CRR.

The cash presentations were witnessed by eleven different Alkalolu, women's leaders and family members of the circumcisers who have decided to stop practicing female genital mutilation.

Results from three randomised controlled trials in South Africa, Kenya and Uganda, in 2006 showed that following circumcision, the incidence of HIV infection was reduced in men by more than half.

According to the new policy document, circumcision will be rolled out for males of all ages in a culturally sensitive way and in a clinically safe setting.

The programme will involve some strengthening of the health infrastructure, but according to Peter Mutie, head of communications at the National AIDS Control Council (NACC), the existing health centres are sufficiently equipped for the rollout.

"We are trying to fast track it so that by mid-2008 we can start rolling it out," Mutie told IRIN/PlusNews.

Although a handful of ethnic communities in Kenya - including the Luo, Suba and Teso in western Kenya and the Turkana in northwestern Kenya - do not practice circumcision culturally, Mutie said the government's programme would focus on the whole country.

"Most of our tribes practice circumcision as a rite of passage, but many do it traditionally, using the same blade for several boys, a practice we would like to eradicate; others don't remove the entire foreskin, which is the medical way to do it - they just cut off a bit of it," he said.

Mutie added that in order to limit resistance to the programme, social mobilisation exercises would precede the rollout, with community members being trained to educate their peers on the benefits of male circumcision.

"This is a programme that needs very careful implementation, and education is key - for instance, people need to know that it is not in any way a guarantee of protection from HIV," Mutie said. "

He stressed that traditional circumcisers would play a key role in re-educating their communities. "We cannot totally remove their role - they are useful advisers whom people look up to, so they can be taught to advise the young initiates on safe sex and other healthy practices," he added.

The news about a national policy will be good news for many NGOs and medical practitioners who have been awaiting guidance on male circumcision. Among these is Marie Stopes Kenya, which started a pilot project on male circumcision in western Kenya a year ago using World Health Organization guidelines. The organisation is part of the national male circumcision task force.

Testing the waters

"Our pilot is a free mobile outreach, where a team of five members - a doctor, clinical officer, care assistant, nurse and driver - goes into various communities and sets up camp in a room at a local medical centre or in a tent, and invites people to come or bring their children for circumcision," said George Obhai, monitoring and evaluation manager at Marie Stopes Kenya.

Before the mobile team arrives, the local hospital or clinic is contacted to conduct community mobilisation, and on the day every man getting circumcised receives counselling from a trained member of staff before the procedure is carried out.

"Interestingly, many of the ideas people have about male circumcision work in our favour, even among the Luo; for example, people believe that it improves the sexual experience and that ladies prefer circumcised men," he added.

Obhai noted that male circumcision has not been a hard sell in western Kenya because the Luo, Teso and Suba are surrounded by circumcising communities, and many of them know people who have been circumcised. The HIV prevention benefits it offers, also made the practice popular in the region.

In four districts of Nyanza Province, more than 2,700 men have volunteered for circumcision through Marie Stopes since April 2007, and the numbers are increasing every month; 80 percent of the men and boys being circumcised are from traditionally non-circumcising communities.

But this success is not uniform; among the Turkana of northwestern Kenya, an isolated and very traditional society, it has been much harder to push the circumcision agenda.

"When we took the mobile team to Turkana last year, we got two cases on one outreach day, on another day we got three cases," Obhai said. "We pulled out because we simply didn't have the financial resources to justify continuing at the time, but once we are able to set up some more mobile teams we will go back to the region."

Marie Stopes also uses people from within the community as peer educators, and hopes to incorporate the traditional circumcisers into their programmes.

"In the past we have experienced resistance from them [traditional circumcisers], as we are perceived as trying to take away their source of income or their role in society," Obhai said. "For instance, in many areas, this coming August is a circumcising period, so we'd like to encourage them to maintain their role as counsellors and even pay them an allowance for that, but to bring the boys to the clinic for circumcision."

The pilot has been particularly successful in reaching rural populations with little access to modern medical facilities, and prisoners, who also lack access to healthcare. The social mobilisation is also being used as an entry point for education about the traditional ABC - Abstinence, Be faithful and use a Condom - prevention strategy, as well as as an avenue for promoting voluntary counselling and testing.

Marie Stopes' outreach has recorded five complications with the procedure in the year it has been operational - two adverse reactions to the anaesthetic and three post-op infections.

The organisation intends to replicate its mobile outreach across the country following the success of the Nyanza experience.

The community of Basse Manneh Kunda and their Circumciser, Dusu Kanteh, made a public declaration to stop female genital mutilation in their village. This declaration was made at this year’s celebration of Zero Tolerance to FGM organized by GAMCOTRAP in the Upper River Region. Speaking on behalf of the Governor of the region, the deputy Governor, Mr. MS Kah said his office is fully aware of the efforts being made by GAMCOTRAP and called on the region to give the organizations their support in the bid to protect women and girl children in particular. The National Women’s Councillor, Aja Kumba Kora, a native of Manneh Kunda thanked GAMCOTRAP for giving her village the opportunity to gain in-depth knowledge on the effects of FGM and early marriage on the reproductive health of women and girls. She noted that despite years of resistance from her community, she was happy that they have reached consensus to stop FGM and promised that they would all work towards protecting their children.

Speaking to a crowd of over one hundred women and men, the Chief of Basse, Seyfo Muhammad Krubally, urged the women to take advantage of the sensitization to gain knowledge and to be aware of their role in protecting girls from harmful traditional practices. The Alkalo Lasana Manneh and Chairperson of Manneh Kunda Village Development Committee, Manlafy Sanyang, all welcomed GAMCOTRAP to the community and expressed their support to its activities. The Local government Councillor for Basse Ward, Mariama Jaw, noted that despite the slow pace experienced in changing peoples attitudes and perspectives, after two decades of awareness creation, the people of URR are positively responding to GAMCOTRAP’s call to protect girl children from FGM, the depressing bane of early marriage, and other harmful traditional practices.
 
In line with the theme for this year’s celebration of Zero Tolerance, Partnering with the media to reach Zero Tolerance to FGM, GAMCOTRAP joined the Kanyeleng women in Dampha Kunda in Tumana District led by their women’s leader Haja Magansa Jabbie and their former Circumciser, Aja Mama Ceesay in developing positive songs that promote the welfare of women and girls against FGM, early marriage, and other concepts that dis-empower women and girls. The Dampha Kunda programme was supported by a well known traditional communicator, Lamin Keita alias Takka Titii of Janjanbureh.

Meanwhile, GAMCOTRAP has responded to a call by the women of Basse Mansajang Kunda with a sensitization programme with one hundred participants, mostly young mothers, their circumciser and traditional birth attendants as well as men. The training focused on the effects of FGM and early marriage on the sexual and reproductive health rights of women and girls. The Deputy Governor of URR, M.S Kah said he was in his official capacity representing the Governor, Mr. Omar A. Khan, who urged the participants to leam a lot from the sensitization because they are an important target to stop the practices. He commended GAMCOTRAP, through its Executive Director, Dr. Isoto U Touray for its commitment to the empowerment of women and to stop harmful traditional practices. Amongst the speakers was the chairperson of Mansajang Village Development Committee, Omar K. Baldeh, who noted that sensitization is to create awareness and to enlighten the people but cautioned that in the long run when there is a mass awareness, there would be a law to the stubborn ones who insist on continuing to harm children in the name of tradition.

Speaking at the ceremony, the chief of Sandu District, Seyfo Jung Bah, expressed happiness in witnessing such an important meeting and seized the opportunity to officially invite GAMCOTRAP to his district for parents to be aware of the effects of FGM. He noted that it was through awareness that some of the circumcisers have stopped for the greater benefit of society.

The series of outreach activities were supported by the Community leaders of the various villages, GAMCOTRAP advocacy team and religious advisers, Oustass Muharnadou Sanuwo and Saikou Fayinke, an Islamic preacher at Basse Community Radio and a native of Manneh Kunda, former circumcisers from Koba Kunda and Kaba Kama. GAMCOTRAP was supported by Action Aid The Gamhia to celebrate this year’s Zero Tolerance to FGM Day in the Upper River Region.