The decision to take Nkqinqa away was a weighty one. Any initiate who prematurely breaks off the full ritual—normally a monthlong affair that includes the circumcision, recovery, and cultural teachings—would likely be ridiculed as a “half-man.” Nonetheless, Dakwa insisted that Nkqinqa be taken to a medical facility. “If he [had been] there for the next 12 hours, he might be one of the statistics, counted as a dead person,” Dakwa concluded.
He convinced a community member with a van to drive Nkqinqa to a hospital, where he was admitted immediately. The young man awoke the following day, confused about how he came to be in a strange bed, wearing a white gown dappled with blue dots. Groggily he looked down the front of his gown at the gaping absence where his penis had once been.
“Seeing this thing, that there’s nothing here, so I felt like, I felt like I lost my mind,” Nkqinqa recalled.
Even compared with other traumatic causes of amputations—soldiers injured by improvised explosive devices, for example, or the thousands of victims of penis cancer globally each year—those arising from botched circumcisions in South Africa can seem particularly bitter. Not only is there tragic irony in the fact that the very rite of passage meant to usher a boy into manhood is the reason for the loss of one of the key identifiers of manhood, but there is the double whammy of social stigma added on.
Before his circumcision, Nkqinqa was well-known in the community as being helpful and polite. After the amputation, his personality wilted. He dropped out of school for two years and became a recluse. “I started to drink alcohol a lot,” he told me.
Nkqinqa doubts he will ever be able to have a child, but if he does, he says he would not allow his son to participate in traditional circumcision.
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Despite the late hour of the looming transplant in April, van der Merwe said he eschewed caffeinated drinks before beginning what would ultimately prove to be a nine-hour procedure—weighing the benefit of mental stimulation against the possibility of the caffeine causing a tremor in his hand. Every inch of his body had to be completely still for the microscopic surgery, during which he, at times, rested his arms against the patient, his body against the bed and his head on the microscope.
Since the first kidney transplant in 1954, solid-organ transplants have been done many times around the world. Penis transplants, however, fall into a category with face or hand transplants known as “vascularized composite allografts” or VCAs. These are relatively new—the first face transplant was completed in 2005—and more intricate because they involve several kinds of tissue: skin, blood vessels, muscle, and nerves. “With these transplants, complex parts of the body are reconstructed in function and appearance,” said Dr. Alexander Zühlke, the lead plastic surgeon on this and the first penis transplant back in 2014. That first operation was so remarkable because it allowed the patient to regain full urological and reproductive functions, including the ability to father a child, which he did in 2015.