Aware of the risks of traditional circumcision, the family of 18-year old Yongama Boya had him circumcised in hospital before sending him off to the "bush" to complete the rest of his initiation ritual.

But even that did not save him.

Last week, his uncle found the boy in a coma in one of the grass-and-stick shelters at an initiation school in the Qumbu area of Transkei.

And though he ordered water to be warmed, and tried to give it to Yongama to drink, his nephew died before his eyes, without regaining consciousness.

The Mthatha district surgeon who conducted the post-mortem examination listed the immediate cause of death as "consistent with hypothermia".

In the section on the official form for "conditions leading to immediate cause", he wrote: "pulmonary oedema".

In layman's terms, Yongama had pneumonia, and died of exposure.

"Unnatural causes"

According to death certificate number B7117961 issued on Friday (18 July) by the Department of Home Affairs, Yongama died of "unnatural causes".

He was victim number 22 of this year's winter-season crop of Eastern Cape circumcision deaths: deaths that occur year after year, despite the strenuous efforts of provincial health authorities to stop them.

The causes of those deaths are for the most part roughly evenly split between sepsis, resulting from infected wounds, and dehydration, thanks to the notion that initiates should not drink water for an extended period.

And every year, scores more would-be initiates are admitted to hospital for treatment for problems arising from botched circumcisions, that in the worst cases lead to gangrene and the amputation of the entire penis.

A good youth

Yongama was a Grade 11 pupil at Riverside High School in Mthatha, and, according to his elder brother Mtsasa, was a good-natured, helpful youth.

"He was a quiet, good boy," Mtsasa said. "He was a twin, but his twin passed away when they were young, nine months.

"He was a leader in his group, always attending church. He used even to help people around the location, repairing fridges and radios and all that stuff. He was good."

Yongama turned 18 —the legal minimum age for traditional circumcision in the Eastern Cape — on 15 May.

Mtsasa said that, well aware of the hazards of traditional circumcision, the family decided Yongama should be circumcised hygienically and safely in hospital, by a doctor.

He himself had followed this route, he said.

Yongama's circumcision was accordingly done in hospital during the Easter school holiday.

On 21 June he joined a group of 23 other Hlubi youths at an initiation school in the bush in the Ethwa Location in the Qumbu area.

According to Mtsasa, when the time came for the actual circumcision ceremony, the traditional surgeon saw that Yongama had already been circumcised, and declared, correctly, that he could not re-circumcise him.

Pressure from peers

Pressured by the leader of the three traditional nurses, or iikhankatha, at the school, the surgeon said he risked losing his registration with the provincial health department if he cut the youth again.

When he persisted in his refusal, the nurse began beating the surgeon and he ran away.

"Then the ikhankatha said, come here, I'm going to circumcise him again, and he circumcised him in front of the other people," Mtsasa said.

After the ceremony, the youths were made to sleep on bare ground under shelters of sticks and grass, even though it was rainy and cold, he said.

"We had bought him a blanket so he could be comfortable," Mtsasa said. "They took away the blanket. He was beaten and not given water or food, I'm told."

Condition worsened

In the weeks that followed, Yongama's condition worsened.

When the initiates walked to get food from nearby homesteads, he collapsed repeatedly; when he asked the nurses to call his brother, they refused; when he tried in his weakened state to run away, they caught him and took him back to the school.

When his uncle, Wadana Boya, finally alerted to the boy's plight, went to the school last Friday, he found Yongama, pitifully thin, in a coma.

Yongama died soon after he arrived there.

A commom occurrence

The nurses, according to Mtsasa, claimed that his death was caused by witchcraft, but the other boys said Yongama had been sick for at least a week before his death.

"This thing has happened there several times," Mtsasa said. "In 2005, there was a boy who passed away under the supervision of the same traditional nurse [the one who circumcised Yongama]."

Mtsasa, who works in Durban, drove down the same night, and discovered that the nurse had "cheated the police" by claiming Yongama died of natural causes.

"After I talked to the police, they changed the docket to murder," he said.

Cops investigating murder

"They [the nurses] are doing something that's totally unacceptable. Even the old people from our area, they are complaining about the same thing."

Mtsasa said the Mthatha district surgeon initially put "natural causes" in his post-mortem report.

However, after Mtsasa secured the intervention of the Eastern Cape health department, a second post-mortem was performed by a Port Elizabeth forensic specialist on Wednesday and the cause of death changed to "unnatural".

The investigating officer in the case, Detective Sergeant Vuyani Mvana of the Sulenkama police station, confirmed he was investigating a murder docket, and said statements had already been taken from the traditional surgeon and from Mtsasa.

The nurses had so far not been "available", but once their statements had been taken, all the documentation would go to the directorate of public prosecutions for a decision.

Vulnerable and exposed

Mvana said he had been told that some of the boys— including Yongama —had been forced to sleep in the open, without blankets, despite the bad weather.

On Friday, the shelters at the school were burned, marking the completion of the initiation ritual for the remaining 23 youths, and they assumed the status of men.

On Saturday, Yongama will be buried at Ethwa.

"I don't know what's going to happen at the funeral," Mtsasa said. "We're trying to calm people down: they want to take revenge. But it's not going to wake him up.

"All the people around the area, they're crying."

Sapa