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| Sunday, 29 June 2003 |
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Features |  |
| News Business Features Editorial
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Peace of mind after peace by Dr. Narme F. Wickremesinghe, Consultant in Occupational Medicine The eagle has ceased to scream but the parrots will now begin to chatter. The war of giants is over and the pigmies will now start to squabble. - Winston Churchill The chattering has begun on plans to develop the North and East, and squabbling for the piece of peace cake is the talk of the political arena. But never a word of the eagle and giants - the victims of a strife that beset this country for an unparalleled 20 years, using modern weaponry. Reconstruction of the whole country should includes the rehabilitation of all those who experienced the blood and thunder of the strife whether in the war zone or outside it. Strife Victims The combatants have seen their buddies being blasted before their very eyes and only luck saving them, others have been permanently maimed or temporarily injured, still others were victims or onlookers of explosions, and many had a loved one snatched away at the prime of youth. These victims of the strife will carry a scar in their minds for many years to come. Most will heal completely. but some wounds will open again years later and be a burden to society. The Vietnam War from 1964-1973 has many similarities with the Sri Lankan situation (and as many differences), and we should be able to learn from it to rehabilitate our own strife victims. In that war, almost 1 million Americans were exposed to hostile and life threatening situations but approximately 30 per cent of them could not adjust to civilian life at home, affecting also countless others who were in contact with these veterans. Reaction to a Disaster When there is a disaster or a real threat to life it is a normal reaction for a short time to be fearful. They have thoughts, dreams, and images of the event. They have nightmares and are unable to sleep, become irritable and angry, and develop a sense of helplessness and sadness. This is not an illness and such a reaction and rationalising of it ultimately helps in overcoming the temporary stress. However, most will suppress this normal reaction with a numbing response and avoid thoughts, feelings or talking about the event. They feel continuously threatened and reduce their activity and interest in life. They misguidedly label themselves as being ill, make frequent visits to the Doctor, and lack concentration at work. It is this suppression of a normal reaction to a threat to life, that can result in later years to Post Traumatic Stress Disorder and they become psychiatric cripples, if they fail to recognise it in themselves and their friends, and fail to utilise the comrade or social or family support systems. What Can Happen Later The Vietnam experience shows that years after combat or a blast event, there are changes in outlook. They develop a delayed depression with inability to sleep, feelings of worthlessness and helplessness, lack of concentration, thoughts of suicide and attempts at it. They isolate themselves and become distant from friends and family as a result of being cold and uncaring individuals - a continuation of the suppressed feelings at the time of the disaster and of the blunted emotions indoctrinated during combat service to consider the enemy as a sub-human species. This impaired capacity for emotions invariably leads to marital problems, a lack of direction in life and problems at work. To this is added constant irritability, a frightening rage, domestic violence and use of verbal expletives, for no apparent reason, which compounds the earlier mentioned life's problems. This is even now seen in Sri Lanka. It is a continuation of the fight to survive at the time of the calamity. Anger is also expressed against political and military leaders and members of a society who are rumoured to be responsible for getting them involved in the strife or who let them down for alleged ulterior motives. They often feel guilty to have survived whilst their buddies died or were maimed - leading again to suicidal tendencies. Most of them ruminate on the event in a compulsive manner and are unable to settle down to normal life, or a job, or to home life. They are always anxious and vigilant, like in their combat days, even being fearful of a passer-by or a neighbour. What to do now Those who manifest symptoms of post traumatic stress disorder will need individual counselling therapies and drug treatment, and possibly group support. Time has come for the Armed Services and Police to train some of their own personnel in each unit in counselling and in recognising stress reactions in their buddies. Psychologists must also be recruited or trained. For those who have left the Armed Services during this long drawn out strife, the Ministry of Social Services and NGOs can provide the counselling services, and the Ministry of Health the psychiatric services. Such services must be organised in every District now, to mitigate the mental effects of trauma when they do develop and prevent the social chaos that can result. The same services must be made available to other civilians who have experienced trauma or been strife victims. In each District support group amongst themselves should be formed by the veterans, their families, the disabled and their families, and the families of those missing and killed in action - with a counsellor to guide them. In LTTE controlled areas too similar services will have to be organised for it in those areas that psychiatric and psychological problems are likely to manifest most. The International Labour Office (ILO) has presented to the Government a strategy document and a project proposal to deal with ex-combatants on both sides, with occupational training and psychological re-adjustment training, on the request of the Rana Viru Seva Authority (RVSA). Meanwhile the International Organisation for Migration (IMO) has promised funding for a pilot project for registration, monitoring and vocational counselling for ex-combatants, families of those missing and killed, and the differently abled due to the strife. The Government needs to act now on these proposals of organisations with international experience in Demilitarization, Demobilization, and Rehabilitation so that when peace comes the infrastructure will be ready in both North and South Sri Lanka. The RVSA has already trained 600 personnel in 7 Districts with listening and recognition skills to serve combat personnel and their families. It is now organising Ranaviru Womens Support Groups in each District (families of those lost or disabled at war), where in addition to being a psychological empowerment support group, they are referred for self-employment skills and micro enterprise training to the local Sarvodaya Economic and Enterprise Development Services (SEEDS) Units. This program has been found to be greatly beneficial to those in unresolved grief and families of the disabled in different districts. Similarly, the RVSA has conducted empowerment workshops for the disabled to enable them to cope with their post traumatic problems, given listening skills and arranged occupational skills training for them. The RVSA also conducted training on Combat Stress Reactions, Post Trauma, and Re-adjustment on Discharge/Retirement for Service Medical Officers and Field Commandants, some programmes with resource persons from 'the Sri Lanka Trauma Group in England, such as Dr. Padmal de Silva, Prof. Yule and Prof. Jack Rachman and our own experts, Dr. Neil Fernando, Dr. Gameela Samarasinghe, Ms. Shehani de Silva, Ms. Rushika Amerasekera and Ms. Parwani Pinnawela. The RVSA together with the Army are presently doing a needs assessment survey on those completing their engagement or retirement to formulate a psychological and self employment training programme prior to discharge and retirement which will also deal with the recognition and mitigation of post traumatic effects. Conclusion In South Africa, peace came unexpectedly like a tide and there was no time to prepare the ex-combatants for civilian life but an entire Regiment of psychologists and counsellors was a part of the Defence Forces, whose services were quickly mobilised. When peace came in South East Asia and Africa international organisations had to again quickly utilize their expertise. If Sri Lanka acts now, there will be time to develop an infrastructure to deal with veterans/ex combatants problems. Over this 20 year period of modern and guerilla warfare there are thousands upon thousands who have experienced unnatural disasters - and therefore, many are likely to develop psychological and psychiatric problems leading to social problems in the future. Some Vietnam war veterans are still walking the streets. So while the parrots chatter and the pigmies squabble, let us now prepare to brig peace of mind to the eagles and giants - the victims of an explosive strife. Do not forget them, now that their usefulness is over. Let them too participate in peace building and be useful citizens. The work is urgent. Let not society be caught napping. |
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