A boy has confessed to circumcising at least 35 youngsters after quitting school to perform the ritual in exchange for cash.
The teen admitted to having used an unsterilised, home-made scalpel to circumcise youngsters for as little as R25.
Police arrested the 15-year-old, who lives with his unemployed mother at Mchonkco Village near Mthatha, last week.
Health officials were shocked to learn that he had started performing circumcisions at the age of 10 - without any training.
About 91 initiates died in the Eastern Cape last year after botched circumcisions.
A spokesman for the provincial department of health, Sizwe Kupelo, said it was costing over R1000 a day to treat each initiate.
The teen, who may not be named because he is a minor, has been summoned by elders to appear before a traditional council at Ngqeleni. He faces a fine of one cow for illegally performing the ritual.
Tearing up, the boy told the Sunday Times: "I did it because I know I can do it. I used to practise on other boys at school while doing grade 1. It's simple. When one of my friends asked me to do it in 2005, I did it."
The boy, who was initiated himself in 2008, said there had been no "casualties" from his operations.
He started so young because: "I don't have a father. My mother is unemployed. I am the breadwinner at home. That's why I dropped out of school in grade 2. I had to find a way to make a living.
"I wash my tools with water, and that's it. If I have to deal with more boys later, I just wipe it."
His 28-year-old mother said: "I am a woman, and have nothing to do with initiation. I was not aware that my son was a surgeon. When I asked about the cash he brought home from time to time, he said he was helping other initiates."
Mthatha hospital complex's chief medical superintendent, Dr Mbuyiselo Madiba, condemned the teen "surgeon" and blamed the local community and traditional leaders.
"A traditional nurse must be known to the community and the chief. How can they allow a boy who should be at school to do this? Initiation is not about cutting tissue or foreskin. It's moving from being a boy to being a man, and helping a young man through this transition. He should have been arrested long ago."
Police said the teen faced a charge of contravening the Circumcision Act.