Such an amazing day today, seeing the voluntary male medical circumcision (VMMC) program set up in an abandoned marketplace. In Kifanya, a village about 70 km south of Njombe, the MCHIP/Tanzania blue and yellow pick-up truck rolls to a stop in front of a large structure. Along the side of the truck is written Dondosha Mkonosweta –meaning “roll up your shirt sleeve”—which is slang for getting circumcised. Saidi, one of the MCHIP team, explains to me that the local government dispensary was too small to fit the surgery beds, so they decided to use an abandoned marketplace next door.

The marketplace was very new and completely unused; it had been built by a donor without consulting the community. As it turned out, no one wanted a market in that location. Long concrete platforms in rows line the inside, there is a high roof overhead, and the structure is open on three sides, with three rooms on one side. After two full days of scrubbing and cleaning, a new surgical site was ready.

A tent was pitched to provide privacy for HIV counseling and testing and physical examinations, and the rooms in the far end were set up to include two surgical beds in each room separated by screens. A generator was brought in for electricity, as well as an autoclave and a water tank. The post-operation area is out in the open, but covered. The newly circumcised boys and men can sit here and have a bottle of water and some biscuits before beginning their walk home. Some come on foot from a distance of 15 kilometers or more.

After chatting with some of the clients and providers, I go into the surgical theatre to say hello to the surgeons. Inside each room, a team of two providers are standing by the bedside of a boy or man who is draped in blue, with a hole cut in the center and an iodine-swabbed penis poking through. The providers are wearing masks, goggles, hairnets, white aprons, and cheery blue Dondosha Mkonosweta t-shirts.

I recognized half of the providers despite their masks; among them are Iringa’s pioneer nurses. Because the Ministry of Health allowed for “task shifting” of surgical duties to nurses for scale up of VMMC, about 60% of these surgeons are nurses. They cheerfully greeted me, looking up from their suturing or their injection of anesthesia. I say the traditional pole kwa kazi (“sorry you are working”) and then add hongera (“congratulations”) for good measure.
 

Marya Plotkin
Monitoring and Evaluation Advisor, Jhpiego