For five weeks this winter, Health-e News freelance contributor Tembile Sgqolana regularly visited an initiation school in Komani, Eastern Cape, where his son was undergoing initiation. He saw first-hand how much responsibility falls on the amakhankatha, or traditional nurses, who care for initiates around the clock. His observations in this story relate to one initiation school.

43 initiates died during this year’s winter initiation season across several provinces, with 75 initiates hospitalised and 180 rescued from illegal initiation schools, according to figures released by the Cultural, Religious and Linguistic Rights Commission. 

Fourteen of those deaths occurred in the Eastern Cape.

According to the commission, more than a hundred criminal cases were opened and at least forty arrests made at illegal initiation schools over the same period.

In October 2025, the provincial Department of Cooperative Governance and Traditional Affairs announced training sessions for ingcibi, or traditional Xhosa surgeons and amakhankatha, traditional nurses, in the OR Tambo and Alfred Nzo districts after skills gaps were identified.

For thousands of young men undergoing traditional initiation each winter, the health and safety rests largely in the hands of one group of men: the amakhankatha, or traditional nurses.  

At the Komani initiation school that Health-e News visited, much of the day-to-day responsibility for the initiates rested with the traditional nurses.

They monitored wounds, prepared food, watched for health problems and stayed with the initiates throughout the five weeks. They were also expected to provide guidance and discipline.

The first eight days after circumcision, known as ifuku, are particularly important. During this period, an initiate remains in his hut while his wound begins to heal.

“During the five weeks, the first week is the more serious week as the traditional nurse is always in the hut with the initiate,” one ikhankatha told Health-e News.

“They only go out to have a chat with other traditional nurses and staying in the fire for a few minutes,” he says. 

After the first eight days, initiates can begin visiting others, but remain under the supervision of the amakhankatha.”

More than wound care

Anele Tatiya, a traditional nurse, says the Eastern Cape Department of Health trains traditional nurses ahead of initiation seasons.

“The training also focuses on hygiene, diet and the well-being of the initiate,” he says.

Chief Gwazinamba Matanzima, deputy chairperson of the Eastern Cape House of Traditional Leaders, says health training has become an important part of the traditional nurse’s role.

“They are trained by the Department of Health, but their syllabus is too clinical,” according to Matanzima.

“Traditional nurses have a duty to take care of the wound,” he says.

But their responsibilities extend beyond an initiate’s physical health.

“They are taught how to be protectors, take care of their families and to be responsible men,” Matanzima says.

“Traditional nurses need to be old people who will be responsible and be able to teach initiates about life. They must be people who can express their feelings and problems to.”

When things go wrong

South Africa’s Customary Initiation Act regulates initiations and sets requirements aimed at protecting initiates and preventing unsafe and illegal practices.

But what happens on the ground still depends heavily on the people caring for initiates every day.

During our five weeks visiting the Komani school, Health-e News saw some traditional nurses drinking alcohol while on duty. Parents were also observed bringing alcohol for traditional nurses.

Community members say when parents are absent for long periods, responsibility for the initiates rests with the traditional nurses. 

In some instances, older initiates help care for younger boys.

The Eastern Cape Department of Health has linked poor wound care, dehydration, malnutrition and lack of supervision to many of the complications and deaths reported during initiation seasons. 

Chief Matanzima says the role of traditional nurses is critical to keep initiates safe. 

But according to Matanzima, their role is about more than getting boys safely through initiation.

“The aim of ulwaluko is to produce men of character, discipline, and responsibility,” he says. 

“But character is caught, not taught. And boys catch it from the men who show up.”

The observations shared in this story is based on several visits over a five week period to one initiation school in Komani in the Eastern Cape.