JOHANNESBURG, South Africa — Initiation schools have long been a respected African rite-of-passage: monthslong camps drenched in machismo and secrecy that transform African boys into men.
But the deaths of about 20 boys since the end of June from botched circumcisions and exposure have horrified South African officials and left many puzzling over how to regulate a centuries-old tradition without destroying it.
"Many of these issues that have to do with culture or religion are very sensitive issues," said Dr. Eddie Mhlanga, head of maternal, child and women's health in South Africa's health department.
Every winter, between the months of April and October in the southern hemisphere, thousands of boys across South Africa disappear into the mysterious schools.
In his autobiography "Long Walk to Freedom," former President Nelson Mandela describes his own initiation nearly seven decades ago as "a kind of spiritual preparation for the trials of manhood."
The boys are protected from the cold winter nights only by rudimentary huts they build themselves. It is not uncommon for temperatures to fall below freezing in parts of South Africa. They are taught to fight and to farm and eventually are circumcised.
The schools have always been a harsh training ground that claimed a few lives every year, Mhlanga said.
But the death toll has soared.
Five students from one initiation school in Lefatlheng, in the North West Province, have died since last week and 15 others were hospitalized with various exposure-related ailments, local health officials said.
Police raided the school and arrested the principal on murder charges. Authorities also shut down another school in the province where two students had died.
In the Eastern Cape Province, 160 initiates were treated at a hospital and two died after botched circumcisions. There have been other deaths elsewhere, but officials did not have exact figures because of the secrecy surrounding the schools.
"We cannot allow such atrocities against our young people to continue unabated," North West provincial Health Minister Molefi Sefularo said in a statement.
Initiation schools today have become highly commercialized, charging as much as $60 per student — a small fortune for many impoverished South Africans, said Cornelius Monama, spokesman for the North West Province health department.
To boost attendance, some schools kidnap boys, Monama said. The boys are frightened to run away, because legend says anyone who leaves early will go mad. At the end of the school, their parents are forced to pay.
Traditionally, initiates were in their late teens and well prepared for the ordeal. Currently, some initiates are as young as 10: "Now they pass from boyhood into boyhood," Mhlanga said. Those running the schools are younger and far less experienced themselves, he said.
Many have never performed circumcisions before and risk giving the boys infections or spreading hepatitis and HIV among them by using the same dirty razor for all the circumcisions, he said.
The Northern Province passed legislation in 1996 loosely regulating the schools.
They ran workshops this year telling school leaders about the importance of clean drinking water and a healthy environment and asking them to bring sick initiates for help within three to four hours. Local health facilities gave schools clean razor blades, dressings and disinfectants.
Yet seven people have died in the province so far this year, most from pneumonia or extensive bleeding, said Charley Mkadimeng, spokesman for the local health department.
"It looks to us that the paramount issue is of the schools not cooperating," he said.
Local officials are planning to meet traditional leaders to find a way to tighten the law to make sure this does not happen again, he said.
In the North West province officials plan to meet traditional authorities to find out how "our concerns about health as well as the traditional process can coexist," Monama said.
Ideally, the schools would be barred from accepting anyone younger than 16, Mhlanga said. Initiates would stay in warm quarters and receive regular visits by a nurse. The circumcisions would be performed in a sterile medical facility.
But even Mhlanga admits that in the clash between culture and health, it would be difficult to enforce those rules.