Israeli Surgeons Helping Swaziland in Drive to Curb HIV

Minutes before being injected with local anesthesia, he said: "I've been told it's not painful. Even if it is painful, it won't stay."

Six Israeli doctors are slated for two-week stints this year under the program, organized by the Jerusalem AIDS Project and underwritten by Hadassah, a U.S.-based Jewish organization, and other donors.

One of the first to arrive was Melvyn Westreich, a jovial, portly plastic surgeon who retains the accent of his native Bronx neighborhood despite three decades of living in Israel. He helped organize the mass circumcision campaigns there in the 1990s and now oversees the country's mohels, religious men who circumcise baby boys in bris ceremonies, typically on their eighth day of life.

The surgery for adult men is more complicated, with a greater possibility of heavy bleeding and other problems. Men typically heal in a few days, and they are supposed to abstain from sex for several weeks while the wound closes completely. Resuming intercourse too quickly may make them temporarily more vulnerable to HIV, scientists say.

In Swaziland, Westreich has focused on improving the flow of patients through the clinic. Saving even a few minutes with a new stitching technique, or injecting the men with anesthesia in a waiting area rather than in the busy operating room, means more circumcisions can be done each day, each week, each month.

"The trick is to get the most done with the personnel available," he said.

The mission has not gone entirely smoothly. The Israeli doctors expected mainly to train Swazi doctors how to circumcise adults, they said. But many Swazi doctors already know how to perform the surgery. What they need most of all, they have told the Israelis, are extra hands to help get enough done to impact the epidemic.

The beleaguered Swazi health system routinely runs low on such basics as sutures, gloves, dressings and surgical tools. To control bleeding, the Israeli doctors brought along a cauterizing machine not available in Swaziland.

Yet in a series of occasional "Circumcision Saturday" events, the Swazi surgeons have shown that they can each do 10 of the procedures -- which take about 25 minutes -- per day.

If that speed could be maintained every weekday, medical experts here say, it would take just four doctors at each of five separate facilities to reach the target of 1,000 circumcisions a week.

The demand for circumcision -- especially surgeries that are free or subsidized -- appears to far outstrip supply in Swaziland. At one Circumcision Saturday, a crowd of men grew unruly after it became clear that the doctors could perform subsidized circumcisions on only about half of them; the crowd later dispersed after being given vouchers for other dates.

The men in the waiting room Friday morning said they knew others who wanted the procedure. Some of the patients planned to give reports to friends and brothers after it was over.

As Westreich finished one procedure, he asked Cilongo Fakudze, 28, an unemployed taxi driver, "How was it?"

With the anesthesia still working, Fakudze replied, "It was not that bad."

Then Fakudze gingerly climbed off the operating table, lowered his maroon hospital gown and walked slowly -- with delicate, bowlegged steps -- to a recovery room.