By Nana Hanson-Hall and Ann LoLordo

Dr. Kevin Pranikoff has always thought of retirement as the time when he would be able to travel on a humanitarian mission to Africa or Latin America without worrying about the patients or practice he left at home. He’s not retired yet, but when the urologist from Buffalo had the chance to volunteer on an HIV prevention effort in Swaziland, Pranikoff couldn’t say no.
 
Swaziland, with the highest HIV/AIDS rate in the world and only about 125 registered and employed physicians in country, is trying to meet the need of men ages 15-24 who want to undergo a safe, effective medical procedure that helps prevent the spread of HIV: male circumcision. A project supported by USAID’s Maternal and Child Health Integrated Program (MCHIP) is underway to recruit volunteer doctors and nurses to work with Swazi health professionals in performing medical circumcisions in hospitals and clinics.
 
While many of the Swazi doctors and nurses have been trained in medical circumcision, demands on their services are great. The volunteer recruitment of providers from Africa, Asia and the U.S. is a short-term response to help the Swazi Ministry of Health address its pressing need for skilled professionals and meet its ambitious goal of providing medical circumcision to all those who want it.
           
A member of the Board of Directors of the American Urological Association, Pranikoff was on the inaugural trip this spring with San Francisco urologists, Drs. Edward “Chip” Collins and Ira Sharlip, and Dr. Winifred Adams, of International Volunteers in Urology and a resident of Palo Alto, Ca.
 
“What’s one of the great medical challenges of our times? The AIDS epidemic,” said Pranikoff, 64. “Urology is a great specialty. But it’s a specialty that takes care of one patient at a time. We treat a kidney stone or prostate cancer or a urethral stricture. But we all know the great advances for civilizations and population have to do with people doing public health, things like vaccinations or clean water or infectious diseases.”
 
Now, he said, a surgical procedure – medical circumcision – is among the tools that can help prevent one of the great health challenges of our time.
           
Scientific trials have shown male circumcision to be an effective intervention to prevent the spread of HIV/AIDS and is recommended by the World Health Organization as among the techniques to be used in the fight against AIDS. Male circumcision is not a traditional practice in Swaziland, where 26% of adults and 42% of women are HIV positive.

“When does a urologist have an opportunity to participate in an endeavor that may actually affect a population?” asked Pranikoff in a telephone interview. “We’re at the right place and at the right time. And how could we possibly not answer the call? Both as an individual and as a premier urological association how could we not?”
 
After arriving in Swaziland this spring, Pranikoff, Collins, Sharlip, and Adams met with representatives of the Swaziland Ministry of Health, the President’s Emergency Plan For AIDS Relief (PEPFAR)/the U.S. Agency for International Development (USAID), the World Health Organization (WHO), PSI, the organization informing Swazi men about the availability of circumcision services, and Jhpiego, which is providing training and technical assistance on the unique HIV prevention initiative.
 
After their briefings, the four volunteer physicians were pressed into service. They saw patients at Litsemba Letfu Male Clinic in Matsapha, the Family Life Association of Swaziland Clinic in Manzini, and Raleigh Fitkin Memorial Hospital, performing 254 circumcisions between them.
 
According to health experts, 15,000 medical circumcisions performed per month for one year would avert 64,000 new adult HIV infections.
 
Pranikoff said his work with health providers at the Family Life Association of Swaziland clinic was fulfilling and inspiring. “The people were just wonderful there. They were an incredible group of dedicated individuals devoted to their mission and to their patients,” the doctor said. “And they were very welcoming to me.”
           
Adams, traveling on her first overseas medical mission, was impressed with the stoicism of her many teenaged patients who received a local anesthesia in preparation for the procedure. “They didn’t wince. They didn’t complain. They were so young and yet so brave,’’ recalled Adams, 33, a native of Nigeria.
 
Most recently, three surgeons from the Surgical Society of Ethiopia, assisted by six nurses from the Nyanza Reproductive Health Society in Kenya, traveled to Swaziland as part of the prevention effort. They circumcised 406 men at three public hospitals.
 
Edward Omondi Ochieng', a 30-year-old nurse from Kenya, said he volunteered to enhance his experience in medical circumcision and “to participate in improving the capacity of health care workers to circumcise, to make a huge contribution in reducing HIV prevalence and incidence, and to improve the general health of Swaziland as a society.”

Nurse Denish Odhiambo Omoro, 40, of Kenya, said he would volunteer again. “If called upon, I would be willing to give my service to the people of Swaziland,” he wrote in an email, “and any other country which will need service, for the fight against HIV has no boundary.”