Injury, bleeding, delayed healing and mangled penises by design

On 4 December 2009 King Goodwill Zwelithini, the reigning King of the Zulu nation, made an announcement that overturned a 200 year old edict of King Shaka–arguably the most emblematic and legendary Zulu king. King Zwelithini revived the custom of Zulu male circumcision that had been abolished by Shaka. The reason for the reinstatement: scientific evidence. Three clinical trials in sub-Saharan Africa, one of which was in South Africa, showed that medical male circumcision, carried out using a simple, safe and affordable surgical technique, significantly reduces the risk of HIV infection in heterosexual men. No permanent adverse events were reported in any of the trials. For these reasons, the medical community welcomed the King’s announcement. “Design” and “innovation”, however responded with a genital mutilating circumcision gadget, the Tara KLamp.

To be fair design and innovation aren’t to blame for the roll out of the Tara KLamp by the KwaZulu Natal Department of Health. The reasons for the roll out have never been explained, a tender was never issued, King Zwelithini’s motives and influence have been called into question and a complaint regarding the Tara KLamp’s procurement and ongoing use has been lodged, by the Treatment Action Campaign, with the Public Protector. Despite these irregularities and possible illegalities the Health Department has obstinately continued to use the device.

However, as far as dubious reasoning for using the Tara KLamp goes, one need look no further than the design on the Tara KLamp itself.

Clamped onto the foreskin, for seven to ten days, the Tara KLamp cuts off the foreskin’s blood supply, which is then, in theory, supposed to die and fall off with the clamp. Sometimes however the clamp must be removed surgically. Writing this description of how the Tara KLamp works I am reminded of the colourful tiny elastic bands used for tail docking on sheep that works on the same principle – cut off the blood flow and the appendage will slowly wither and die and then fall off. The difference: I think the sheep get a better deal with the elastic band.

The very idea that the KwaZulu Natal Department of Health is requiring men to wear a hard plastic apparatus clamped onto their foreskin (which is apparently quite sensitive) in their pants with their various other bits, for seven to ten days, is ludicrous. Is it any surprise then that the Data Safety Monitoring Board of the only medical trial on the use of the Tara KLamp for adult circumcision interrupted the trial?

The trial’s findings were published in the South African Medical Journal in 2009. The article’s title: High rate of adverse events following circumcision of young male adults with the Tara KLamp technique: a randomised trial in South Africa. The adverse events included delayed wound healing, problems with penis appearance, bleeding, injury to penis and problems with urinating.

Despite these findings the Department of Health has put and continues putting tens of thousands of men across KZN at very real risk of these adverse affects, men who should be lauded for taking proactive steps to protect themselves and, by extension, to protect others. Now, near the beginning of this article, I took a broadside at “design” and at “innovation”. Arguably design, and by extension designers, cannot all be implicated in the mere existence of the Tara KLamp. Increasingly however a group of architects, industrial designers, graphic designers, landscape architects, urban planners, indaba organisers, ardent design proponents and “citizen activation through design groups” are making the case for design as the solution to South Africa’s social ills, unsustainable levels of inequality and substantially divergent lived realities. Yet, they remain mum on the limits of design and mum on the failures of design. Ultimately the propensity exists and has been fostered to foreground design, often at the expense of solutions.

Male circumcision in South Africa today plays a salient role in asserting identity, adulthood and cultural norms while doubling as a lifesaving preventative measure. Despite these pronounced positives, traditional (as opposed to medical) male circumcision is also implicated in scarring, medical complications, penis amputations and the unnecessary deaths of young initiates. I’m reminded of a Madagascan friend whose grandfather, in keeping with tradition, ingested his, that is the friend’s, foreskin wrapped in a banana leaf. If, on the one hand, cultural groupings are prepared to invest so much in male circumcision and, if on the other hand, young South African men confronted by HIV are prepared to turn to scientific evidence to protect themselves and to protect others shouldn’t society only allow best practice to meet their needs. Clearly the Tara KLamp as an industrially designed object couldn’t be further from best practice and shouldn’t this fact then galavanise the well meaning, socially minded and progressive designers to collectively say: Not in my name?

Dalli Weyers works for the Safety Lab. He has a Masters degree in Politics Studies and spent a couple of years at design school. He writes in his personal capacity.