Initiation casualties Leonard Mkhwanazi, 15, (centre) and Simphiwe Mlaba, 16, wait to be transported home after being discharged from hospital. The writer says it is considered a disgrace to go to hospital and the young men will suffere prejudice as a result. File photo

In this first of a three-part series on ulwaluko, Mthetho Tshemese questions the mocking of young initiates who are hospitalised.


As I approached the ward where I was to meet Dr Busisiwe Cawe, a family physician and head of the surgical unit, and Sister Nasiwe Jojwana, operations manager at Mthatha General Hospital, a sharp, foul stench filled the air.

Occupying the ward were 14 young men, aged between 13 and 21. They had gone for ulwaluko (initiation) and ended up in hospital being treated for various injuries.

Every winter and summer school holidays, scores of young men get injured and/or die in initiation schools in the Eastern Cape.

For the past decade or so this has become one of the expected “tragedies”. The 14 young men form part of the 300-plus admitted to hospital that season.

You may ask: what is the big deal and why do youngsters endanger and risk their lives while these injuries and deaths are well publicised? Shouldn’t they just refuse to go to the initiation school? And why do families send their children to a place where injuries and death to some are sure to happen?

Ulwaluko is emphasised and socially constructed as a non-negotiable marker of ubudoda (manhood) for many tribal groups in the Eastern Cape, including amaXhosa. It includes circumcision as part of the broader initiation process, with many rituals.

The risk and possibility of being injured and/or dying carries high individual psychological value for many men who undergo ulwaluko.

That one is prepared to undergo such a high-risk process has high social dividends as young men are respected for undergoing the ultimate endurance of pain.

For many of these young initiates such bravado represents strong and desired masculinity. While the emphasis is meant to be about the psychological transition from being a boy to a man, what is mostly written about is the circumcision part of ulwaluko. It is important that we report the challenges associated with the process. However, we also need to critically interrogate our assumptions about what constitutes a man and ask ourselves if a three-to-five-week process would make one a man. Even more pointedly, do we really believe in the idea of making a man?

Ultimately, families are responsible for what happens in their homes and the rituals performed. From choosing a credible ingcibi (traditional surgeon) and ikhankatha (traditional nurse/minder), to monitoring wound management and what umkwetha (the initiate) is taught about being a man, the initiate’s family is responsible.

Men in families play a critical role throughout the process, with women playing a supportive role. Done properly, young boys return home to massive celebrations, and tens of thousands of young men do come back alive. However, the continuing injuries and deaths of initiates has reached crisis levels.

Early in their lives young boys in the Eastern Cape get to know that “ikwekwe yinja” (a boy is a dog).

Granted, the way in which boys are treated and brought up differs from family to family, community to community, village to village, and township to township.

However, it seems that across the board, being a boy in the Eastern Cape has no social status.

This is evident when there are traditional feasts where men are seated according to their seniority and grouped according to their “ranks” and receive their “benefits” (usually food, meat, and alcohol) accordingly. In such ceremonies boys, just like dogs, are at the mercy of men who will “throw” a piece of meat or bone at them – that is, ukusikelwa.

It is a dishonourable shaming and bullying and boys are under psychological pressure to undo their “dog” status and become human beings who are respected in society. And that can only happen through them undergoing uIwaluko.

The 14 young men admitted to Mthatha General Hospital were less worried about the bad smell coming from their bodies. They did not even consider themselves lucky to have survived.

Instead, they considered their lives to be worse as they would have to face their families and communities with an uncertain identity. They are not boys, and most certainly are not men according to their communities. What are they? They reported feeling that they represent the ultimate shame which symbolises spoiled, uncertain, and undesirable masculinities.

For many of them, coming to the hospital reflects weakness on their part, and comes with shame and guilt which can never be corrected for the rest of their lives. A few reported that in their communities they will be told by other men that the only option to make amends and erase their shame is through undergoing ulwaluko again.

Smiling sheepishly, one young man volunteered to sing a song which is sung in his community to mock those who go to hospital: “Xa unengqondo ungafownela iambulance uyophathwa ngabafazi? (If you are sane would you call an ambulance to go and be treated by women?)” The group sang along and everyone erupted in awkward and painful laughter. Asked how they will handle the rejection by their communities and family members who do not see them as men, the young men reported they would isolate themselves, avoid going to traditional ceremonies, stay home, focus on their studies, and choose friends who will accept them.

It was at this point that Sister Jojwana and Dr Cawe, both women, gave them practical advice on how best to handle certain situations.

Suddenly, there was silence in the room and one of the most articulate young men asked me; “Bhuti uyayazi apha esibhedlele kukho ubhuti osebenza apha osithukayo othi singamalulwane? (Are you aware that here at the hospital there is a male employee who ridicules us and calls us bats?)”

Ilulwane (a bat) is one of the derogatory names used to mark or identify anyone who ends up in hospital as neither a boy nor a man, just like a bat is supposedly half bird and half mouse. In some places an initiate who ends up in hospital is called notywetywe, nofotyela, umdlezana, and impukane. Ask any man who comes from the Eastern Cape and he will say there cannot be any further psychological injury to one’s masculinity than to be called one of these names.

All the admitted young men reported that it is better to be called inja and be a boy than having to live with the stigma and shame of having gone to hospital.

What is clear about ulwaluko is that there are avoidable injuries and deaths of young men which are guaranteed to occur because of the collapse of family and community structures. Tragically, men from the Eastern Cape must accept that we have failed ourselves and the young men who end up in hospitals and graveyards because we fail to do the basics right. No penis becomes gangrenous overnight and seeing that some of these young men end up with penile amputations is an indictment on all of us, especially those whose only contribution to the crisis is that “we must not talk about our culture”.

It turned out that the said staff member is one of the kitchen staff who, allegedly, swears at and mocks the young men every time he delivers food, and who sometimes does not give them enough food simply because he hates the fact that they have come to the hospital, thus “shaming our culture”.

Both Sister Jojwana and Dr Cawe shook their heads in disbelief and reassured the young men they had done the right thing in reporting the matter, which would be investigated and reported officially without causing any harm to them.

Sadly, the staff member’s prejudice and discrimination is thought to be widespread among many men in the Eastern Cape, regardless of age, education and other status. You cannot be considered a “real” man if you have been to hospital.

My mind went back to 1994 when I underwent initiation. When we came back I was part of those who “policed”, mocked and ridiculed those considered sissies and not real men for ending up in hospital.

I recalled the violence, stabbings and gunshots that formed part of post-initiation fights where the “unreal” men were defending their masculinity and showing us how real they were.

I recalled that a number of these “unreal” men left their homes while others dropped out of school because they could not take the pressure that came with the stigma of being “unreal”.

How could we be so cruel, I wondered. We were just being normal, I suppose. After all, this was, and to some extent still is, a norm.

As I sat in my consultation room later, I thought to myself: It is not our culture to have young men getting injured and losing their penises. It is not our culture to have young healthy men dying every initiation season. It is not our culture that the only time we visit initiates is when our family member is in the bush.

It is not our culture that young teenage boys think the removal of a foreskin makes one a man. What are we teaching them about manhood? It is not our culture that because you are no longer with the mother of your children you do not take care of your children and play your role when they go for initiation. It is not our culture to call our boys dogs, and instead of showing compassion to those who end up in hospital, we ridicule, bully and psychologically abuse them.

Initiates don’t just go to hospital or die.

Instead, they are failed by their fathers, uncles and brothers.

To all men from the Eastern Cape, perhaps we should accept that a lot of us are circumcised and have undergone ulwaluko but until we ensure that no young boy dies or gets injured during initiation, we cannot call ourselves amadoda.


*Tshemese is a clinical psychologist at the Nelson Mandela Academic Hospital in Mthatha. He is a PhD candidate at the Nelson Mandela Metro University focusing on ulwaluko and healthy masculinity. He writes in his personal capacity.

** The views expressed here are not necessarily those of Independent Newspapers.

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