Circumcision

(Sorry, no foto´s with this posting, in the interest of maintaining a PG rating)
Read no further, if discussion of male genitalia is not your cup of tea…
In the US, circumcision is one medical practice that I consider unecessary . Essentially, it is done for cultural reasons, or, as in my experience, for no good reason at all. Medical experts argue over the benefits of the procedure. Certainly, if you don´t have a foreskin, it can´t get infected, and circumcised boys have a lower incidence of bladder infections than the slight risk in uncircumcised boys. In the US, boys are usually circumcised if Dad is circumcised, and the practice varies widely by ethnic group (Caucasian middle class boys are always circumcised, Hispanics almost never, and other groups are all over the map). In some cultures, it is considered a right of passage to adulthood, and is done in early adolescence. Overall, about 50% of male newborn infants in the US are circumcised.
Female circumcision is practiced in some countries, and involves mutilating a girls genitalia to disempower women. It appropriately generates international outrage, but I have yet to hear a peep of complaint over the male version of the practice.
Now, after a decade of subtly discouraging (unsuccessfully) circumcision in Kodiak, I find myself back in the business of “male genital mutilation”. This is because, although there are few good medical reasons to circumcise a male infant in the US, there is a pretty good reason to do so in sub-saharan Africa: men that are circumcised have a 30% lower incidence of HIV than those that are not. With HIV prevalence ranging from 20 to 40%, that benefit could potentially add up to millions of saved lives. HIV rates are significantly lower in areas where circumcision is practiced. Every sub-saharan African country (EXCEPT Mozambique) has a government policy to encourage the practice. San Lucas clinic does them as a service, and to generate a little cash flow (a clinic visit costs 1 metical, or about 15 cents, and a circ costs 500mets, or about $16).
Every week we do a half dozen or so (just a drop in the bucket, considering the number of babies born. Interestingly, most of the infants are children of muslim families, who often would do the procedure anyway. They seem to be a little more sophisticated than the rest of the clientele: a bit cleaner, better dressed, more educated than the majority of the patients who come from the slum across the alley. We also do get a few adult Mozambiqan men. The people here are pretty stoic: while I cant imagine an American male ever consenting to a circumcision under local anesthesia, ´whereas they don´t even flinch here.