Wednesday, May 18, 2016

The Palali Syndrome

Dr Ruwan M Jayatunge 

Palali is a well-known area in the Jaffna Peninsula in the Northern Sri Lanka. Palali has an important airport that serves as the main lifeline in the North. A large number of soldiers travel to the Northern Peninsula through the Palali Airbase. During the Eelam War, Palali Air Base played a key role (like the Tan Son Nhut Air Base during the Vietnam conflict) providing essential food items, medicines and ammunition to the troops. Throughout the Eelam War, many battle casualties were transported to Colombo via Palali. Therefore, Palali is a part of the combatants who fought in the Eelam War for nearly three decades. Palali is in their memories, sometimes in their intrusions. Palali has become a symbol and metaphor that recounts combat trauma in Sri Lanka.  Palali represents the symptom complex of battle stresses that has been experienced by the new generation of combatants. It has developed in to a syndrome.  Palali syndrome describes various clinical and psychosocial ailments experienced by the Sri Lankan combatants and in the final score how it affects the society at large.
Shell shock to Palali Syndrome was a long and agonizing path for the soldiers who fought numerous battles. These battles were fought in different countries under different circumstances. But in every battle the combatants experienced the gruesome realties of war. Combat trauma made dramatic transformations among the soldiers. Some were healthy transformations and some transformations were extremely detrimental. Shell Shock and Palali Syndrome describe the destructive effects of combat trauma on soldiers, their family members and the society.
In the early years of World War 1, Shell Shock was believed to be the result of a physical injury to the nerves. The term Shell Shock was coined by the British Pathologist Col. (Dr.) Fredrick Mott. He regarded Shell Shock as an organic condition produced by miniature hemorrhages of the brain. Shell Shocked soldiers exhibited symptoms of extreme fear, shaking, psychogenic blindness, psychogenic paralysis and sometimes aphonia.
Sheffield (2001) indicates that front line soldiers of the WW 1 were constantly exposed to artillery barrage and mortar attacks. It is estimated that 60% of deaths in World War I were caused by shrapnel. During World War I, 10% of British battle casualties were categorized as having some form of shell shock or neurasthenia. Jones et al., 2007 was of the view that Shell shock was largely free from stigma when used in the early phase of World War I because it was perceived as a wound, or a neurological lesion.

The Echoes of Palali Syndrome
War is a multi-layered, multi-factorial phenomenon, which is filled with gruesome acts of violence. In a war not only the combatants even, the civilians undergo a tremendous amount of combat related stresses. Stresses are unavoidable in a situation like war. Therefore, people who lived in war zones became heavily vulnerable. Their psychological makeups begin to change rapidly.
War is a wholly human-made catastrophe, which is a gigantic process of social and self-destruction. As Plato once said “only dead have seen the end of the war. This means the psychological scars following combat can stay behind for many years. It can change the psychological markup of a person making him more dysfunctional. As the Salvadorian psychologist Martin-Baro(1990) wrote of his own country, what was left traumatized were not just Salvadorian individuals , but Salvadorian society. This expression is very much applicable to Sri Lanka. Many combatants, civilians as well as members of the rebel groups have become the victims of Palali Syndrome.
Following the Sri Lankan conflict a large number of civilians, members of the Armed Forces and the LTTE carders had been killed. Total deaths estimate over 90,000 lives. Many had become permanently disabled. A large numbers carry psychological scars of the war with them and suffer silently. Some have sublimated their anxiety and stress to the family members and to the society. Hence, war trauma has become a vicious cycle.
The Country was in an armed conflict for thirty years and during that period, the society was severely traumatized. Even three years after the war the Sri Lankan society is still experiencing the repercussions of the Palali syndrome. Many distressing and heartbreaking stores reveal the magnitude of combat trauma in the country. If necessary psychosocial rehabilitation is not provided adequately to the victims of war trauma it would harm the spirit of the Nation. During the past years, psychological needs of the combatants were not properly addressed. Much attention was paid to the physical injuries rather than psychological damages. Effective psycho social rehabilitation was not conducted and the repercussions of the mismanagement of combat trauma are visible even today.

Private LXCX29
Private LXCX29 joined the Sri Lanka Army in 1996 and served in the North. While serving he was exposed to combat situations. He was stunned by witnessing mortar attacks by the enemy and witnessed the deaths of several soldiers. He was shocked and could not participate in the military offensive anymore. His body started shaking and he vomited several times. He experienced a severe headache. Private LXCX29 was sent to the Medical Aid point and treated with analgesics. After several hours of rest, he was again forced to go to the active combat. He obeyed the orders with revulsion. He was frightened for his life. After the operation, he was again posted back to his mother unit. While serving in the unit he had nightmares and ruminations of the combat related events. He was afraid of participating in another military operation. When he got his leave turn, Private LXCX29 overstayed and did not report. He tried to find a job but failed. He had severe headaches, difficulty concentrating, was forgetful and became scared of loud noise. His mental health was at a stake. Unable to find a suitable employment Private LXCX29 was compelled to work as a labourer in a farm. With his failing mental health, Private LXCX29 worked in the farm for several years. His employment ended unexpectedly when the Military Police found his whereabouts. He was arrested and then taken to his Unit. He was dealt by the court martial under the military law. He was sent to 18 months in Prison.

Private NXVX28
Private NXVX28 participated in several military operations and experienced physical and mental fatigue. He had intense rage, lack of motivation and avoidance. He had no way of explaining his difficulties to his platoon commander. Day by day his aversion and avoidance grew and he found it difficult to be in army camps. Seeing military uniforms and military vehicles on a daily basis caused him severe distress.  He did not wish to be in the military anymore and became a deserter. In 2004 he was caught by the police and taken to the police station.  Somehow Private NXVX28 managed to escape from the police custody and he started running.  Several policemen chased him. Eventually Private NXVX28 realized that there was no escape from the police and he decided to intentionally stick his leg under a passing train, He sustained a crush injury with massive bleeding.  He was then taken to the hospital and his leg was amputated. Nevertheless after his discharge from the hospital Private NXVX28 had to face charges.

Private Wimalasurendra
Private Wimalasurendra served in the operational areas for several years and witnessed enemy attacks and the hardships of the war. He became de-motivated and frequently troubled by the work related stresses. In order to evade combat operations and to receive forced evacuation he went in to self-harm and shot his right hand. The bullet went through his right arm damaging the radius and ulna bones. He was taken to the Palali Hospital and treated accordingly. Upon his discharge he was posted to a nonoperational area and given light military duties.  While serving in a non-combat zone his sleep became disturbed and he had stress related physical and psychological symptoms. Private Wimalasurendra was referred for a medical assessment and diagnosed as having Adjustment Disorder. While taking treatment as an outpatient from the Military Hospital Colombo on the 25th of April 2006 Private Wimalasurendra became a collateral victim of the LTTE suicide bombing that aimed to kill the Army Commander General Sarath Fonseka. The explosion killed at least eight persons including the LTTE female suicide cadre who disguised as a pregnant woman. The Army commander sustained critical injuries. Private Wimalasurendra was found among the dead.

The Laborer Who Handled Human Remains at the Palali Air Base
Mr. GXVXX52 worked as laborer in the Palali Air Field. His duties included placing dead soldiers into body bags and helping to transport the remains to the undertakers in Colombo by air. While working at the air base he became acquainted with many soldiers and some of the combatants who died in action were known to him. He worked a number of years handling human remains at the Palali Air Base. By 2003 he had nightmares, intrusions about the dead soldiers and experienced severe avoidance. He started abusing alcohol to forget unpleasant ruminations. His life was becoming a hell and at a certain point he could not bear the suffering anymore. Mr. GXVXX52 willfully came to the Psychotherapeutic Center in Colombo and pleaded for help. He agreed to any kind of work other than handling human remains or work at the Palali Air Field which triggered his intrusive memories.

A Distinguished Officer Turned in to a Serial Murder
Major Anuruddha Wijebahus’s story could be described as one of the horrifying stories of Palali Syndrome. Anuruddha Wijebahu was a bright student from a leading school in Kandy. After completing his school education, he joined the Kothalawala Military Academy and passed out as an infantry officer. He was attached to the (VIR) Vijayaba Infantry Regiment as a career officer. Anuruddha Wijebahu served in the operational areas experiencing numerous combat related stresses. Gradually his psychological makeup changed and there were clear personality changes in him. Although he sought psychological help, his treatment schedule was interrupted due to bureaucratic interferences. Henceforth he went to the operational areas without any treatment or monitoring. His mental health was declining and Major Anuruddha Wijebahu experienced transient severe headaches. He had extreme rage, hyper arousal, combat related ruminations and homicidal intensions. Without any type of treatment Major Anuruddha Wijebahu gradually became a cold-blooded serial killer and murdered a number of innocent men. When he was serving in the 215 Brigade in Mannar in 2004 He took one of his victims to the Manthottam camp and intoxicated him. Then he stabbed the victim then chopped off his body, put the remains in to a barrel, and then set fire. Later the Police caught him and while in custody at the Bogambara Prison, Major Anuruddha Wijebahu committed suicide. If the bureaucratic machinery did not interfere, this officer could have received appropriate treatment and we could have evaded a number of disastrous slaughters and spared his life.

The Story of Army Jine
Army Jine was a brave soldier from the Sri Lanka Commando unit who had exceptional combat skills. Affected by the combat stress his conduct became intolerable. He was charged with disciplinary infractions. Hence, Jine became AWOL. While living as an absentee at large Jine committed highway robberies, murders and rapes. He lived in the jungle with the survival tactics, which he had mastered; Jine evaded the law and enforcement authorities for a long time. According to some reports, Jine had committed nearly 27 rapes. Eventually he was gun downed by the Police.

Kadawatha Madura
Madura was a top sportsman in the Army who was mishandled by his superiors. Many occasions he was harassed and Madura underwent harsh work related stress. Following unbearable work related atmosphere he became AWOL and joined the underworld. Madura organized several armed robberies and he was engaged in extortions mainly in Kadawatha. Madura was shot dead in Kadawatha town when he was confronted by the Police.

Wambotta the ex-Army Soldier
Kitulgamaralalage Ajith Wasantha alias Wambotta was born in Embilipitiya. In 1993, he joined the Army, enlisting as a member of the 3rd Sinha Regiment. After sometime, he left the Army and formed a criminal, gang, which consisted of over 50 heavily armed military deserters. Since Vambotta had the powerful political backing and political patronage, the Police found it was extremely difficult to make any arrests. The gang led by Wambotta had done over ten murders and a number of extortions. The notorious gangster Wambotta was ambushed and killed by another underworld gang at Aswatte in Kosgama.

A Brigadier was charged with the shooting of his wife
In 2007, Police arrested Brigadier Chandana Rupasinghe, of the Puttalam Army Camp in connection with the death of his wife, who succumbed to gunshot injuries, at the National Hospital. Thejangani Rupasinghe, the 37-year-old wife of the Brigadier had been shot in the head. Brigadier Chandana Rupasinghe had served in the operational areas and participated in a number of military operations.

A Lady Doctor was shot by a Disabled Soldier
In 2008, a disabled soldier of the Commando Regiment shot a lady doctor named Dr. Miss W.D. Lakshmi, of the Bandagiriya Central Dispensary following a personal argument. According to the internal sources, the disabled soldier who committed the murder was wounded in the battle and became a psychological casualty of the war. He was temporarily attached to the Udawalawe camp. The reports further reveal that the accused soldier had not received appropriate rehabilitation and psychological treatment probably suffered from PTSD. During the argument, he went in to a sudden rage and shot the Doctor.

A Lady Accountant killed by a Deserter
At Mutwal a lady accountant from a private firm was murdered and her 12 year daughter was raped by an army soldier in 2008. The perpetrator became AWOL several months before the crime. He waited near her house then entered and committed the crime. The victim was assaulted with a blunt weapon to her head and she succumbed to the injuries.

The SF Rider who became a Criminal
Lance Corporal Harshana Nuwan was an expert motor cycle rider in the Special Forces. He participated in a number of SF operations in the North. He encountered frequent battle stresses, which he could not cope with. Often he was charged with disciplinary breaches. To evade the punishments he became an absentee. While hiding from the military police Lance Corporal Harshana Nuwan organized several bank robberies in which he used his riding skills. He was nick named as Son Baba by the underworld. He masterminded several contact killings and abductions. The Police took an immense effort to track him down.

An Army Sergeant Plants a Bomb in a School Van
An army explosives expert was arrested for alleged involvement in the Kurunegala school van explosion which left one 12-year-old school girl dead and 11 injured in 2009. According to the initial investigations indicated that the army sergeant had smuggled two kilos of C-4 explosives out of the Minneriya camp and planted them on the van around midnight in an apparent bid to kill the owner-driver, whom he suspected of having an illicit affair with his wife.

The Murder of Dr Goodwill of Karandeniya
Two Army soldiers suspected of killing Dr. Priyanka Prasad Jayasinghe a respected medical practitioner of Karandeniya using a9.mmpistol had been arrested by the Police. The two soldiers have allegedly taken a contract from an Army captain to kill Dr. Priyanka Prasad Jayasinghe of the Borakanda government hospital in the Karandeniya of Galle district. This murder subsequently caused mass protests in Karandeniya.

Psychosocial Rehabilitation of the Victims of Palali Syndrome
The magnitude of combat trauma in Sri Lanka cannot be ignored. Most of the psychological scars are unhealed and it can affect the person as well as the society. These psychological and emotional traumas resulted from witnessing killings, handling human remains, exposure to life and death situations, and numerous other battle stresses. This is a form of invisible trauma in the military. But it has direct implications on the mental health of the soldiers as well as their family members and the society at large.
The combatants contributed enormously to end the war in Sri Lanka. Their blood and sweat were used by the politicians for their glory and at the end of the day the combatants did not receive appropriate psychosocial rehabilitation. This is a heartbreaking situation and every day we hear social miseries that have direct or indirect connections with the Palali syndrome. The war trauma is still hounding the society in gigantic proportions.

There are many psychological 
 victims of the Palali syndrome who need professional support. Among them are active and ex members of the military and their family members. The Nation has a moral responsibility to look after the wellbeing of the soldiers who sacrificed their physical and mental health for an unified Sri Lanka.

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