In this rural District the majority of the people were farmers. They were exposed to variety of dangerous practices which caused injuries requiring admission to hospital for surgery. There were occasions when these were fatal. A variety of such injuries too had to be treated in the local hospital with the limited resources that were available. I had no experience of treating such injuries in the past as they are seen only in rural hospitals where I had not worked before.

Trap guns

One such injury was that caused by a Trap gun. I had never heard of, seen or treated trap gun injuries until I came to Polonnaruwa. On referring medical literature published in Ceylon ( at that time ) I came to know that these injuries had been reported in the Ceylon Medical Journal by Gratian as far back as 1888. So, it was nothing new.

On reading further I learnt more about trap guns. It is a locally assembled illicit firearm used by farmers in remote villages to kill wild animals that destroy their crops. I also learnt how it is manufactured by the local blacksmith.

A metal pipe (1) is used as the barrel of the gun and is closed at one end. This is filled with gun powder and projectiles, consisting of nuts, bolts, screws, ball bearings and pieces of metal. Then the firing mechanism is brought out near the closed end and is covered by a metal cap (2). A metal strip is fixed above this (3) and, is supported by a chip of wood (4) to which a cord (5) is tied. This structure is placed on a support (6) and the cord is tied under tension to a post (7).

When a passing animal or a human being, unaware of the trap, accidentally strikes the cord, the wooden chip is displaced and the metal strip falls on the firing device causing the gun to fire. The projectiles escape from the open end and can travel some 20-30 feet and strike the victim, animal or fellow farmer.

Source – In The Line of duty

The life & times of a surgeon in war & peace

Author – Gamini Goonetilleke

Although set for wild animals that destroy their crops, a fellow farmer can accidentally strike the cord and activate the firing mechanism and thus sustain injury.

The injuries were pretty serious and most of the victims admitted to hospital were young males. I noted that most of the injuries were at the level of the knee or below the knee. There were victims who had sustained these injuries and were associated with damage to bone, blood vessel and nerve. It was rather unfortunate that in some I had to perform amputation as saving the limb was not possible. This was no doubt a serious issue for the farmer depriving him of his livelihood, but that was the only way I could have saved their lives, as for a surgeon saving life comes before saving limb and was done in the best interest of the victim.

There were also farmers / blacksmiths who suffered injuries as a result of the explosion caused by the explosive (gun powder) used. I remember a farmer who suffered such an injury and was admitted with his hand completely mangled by the explosion. I had no option but to amputate his hand. What an unfortunate situation. That accident that could have been prevented!

Although trap guns are banned, they continue to be used since the farmers have no other way of protecting their crops. It is sad that although this illicit weapon has caused injury and death to many a farmer, the authorities concerned have turned a blind eye to this problem. Many more will surely suffer the same fate in the future.

INJURIES CAUSED BY TRAP GUNS

Attacks by wild animals

Farmers injured by wild and domestic animals were admitted to the ward on and off. There were patients admitted after being gored by domestic bulls and buffaloes. Some were serious as illustrated earlier. Then there were those wounded by wild boar, bear, wild elephant and even crocodile. Some of these injuries were fatal.

Bear bites and scratches

The bear has teeth which are short but set in powerful jaws, and the claws used for climbing are sharp and long and these are used to inflict injury. Most of the victims attacked and injured by the bear admitted to my ward had their injuries on the face and scalp. Some also had associated fracture of the bones of the face. Plastic surgical procedures carried out by the general surgeon resulted in recovery.

Photos :

Injuries by wild Elephants

As expected those attacked by wild elephants had multiple injuries, fractures and the majority were fatal. However I remember treating a patient who was lucky to escape multiple injuries and survived to be admitted to the hospital. He required urgent attention.

What was the problem?

Although escaping multiple injuries, the vicious attack by the trunk of the elephant had damaged his wind pipe. Air escaped from the air way to the tissues leading to a swollen face, neck and chest and difficulty in breathing. Urgent surgery was required, but the procedure was simple and carried out under local anaesthesia. That was to do what is called in surgical terms a tracheostomy (opening into the wind pipe) that relieved his distress. A few days later he recovered fully and went home a happy man.

Winnowing fan injuries

After the harvest the farmers have to separate the paddy grain from the chaff before storing the grain in bags.

I was made to understand that in ancient times paddy farmers resorted to the use of wind power to separate the grain from the chaff. However with time mechanisation of agriculture took place and various types of machine-driven fans have been devised to winnow the paddy grain. I witnessed these fans being used in the fields and realized the danger of using these fans.  The danger was because the fan blades of these machines were exposed and during the rotation of the blades anyone who gets too close to the machine can be injured by the blades. The farmers had not realized the danger of these machines as they did not have protective covers and many were using such machines. Furthermore there was an additional danger of being injured by two fan belts which too were exposed.

Fan Blade Goes Through Face – farmer has a narrow shave

I wish to describe another injury that I was called upon to treat. It was a serious injury and something that I would not like to see again. This man had a winnowing fan fixed to his cycle. It was operated by an electric motor which too was fixed to the cycle. He used to take this fan from one paddy field to another and his work involved the winnowing of the harvested paddy. The fan had no protective cover and was used so often that some of the fan blades had undergone metal fatigue resulting in fractures of two blades. These had been welded subsequently. That day when the fan was in use, a piece of one blade broke and flew off, only to hit his face. That part of the blade went right through the right side of his face cutting the right side of the nose. Luckily the eye escaped injury. He was admitted to my ward with the part of the blade impacted on his face. My immediate reaction on seeing this injury was to take a photograph as this was a once-in-a-life-time experience. I had my camera with me and was able to capture the injury on this man’s face. I did not have the facility of any special radiological investigations to assess the depth of the injury and associated damage. However as surgery was necessary immediately, I decided to go ahead.

At surgery the part of the blade embedded in his face was removed. I also took photographs of the man after the operation and once more after he had recovered fully. The patient went back home to the surprise of everyone. The pictures tell the story. Such injuries can be avoided if adequate precautions are taken. Sadly, such events continue to occur even today.

Victims of Trap Guns – Disabled

A note about Artificial Limbs – Those days these farmers who lost their limbs after being injured by Trap Guns had great difficulty in obtaining artificial limbs. They had to resort to the use of primitive prosthesis made by local carpenters. Some had to use crutches for long periods. The Jaipur limb was of great benefit to farmers as these artificial limbs consisted of a rubber foot which made it possible for them to walk without shoes and also work in the field. The Jaipur limb was invented by Dr P K D Sethi, from Jaipur, India and specially designed for farmers.

Artificial limbs should be cost effective, available within a reasonable period of time and most importantly it must be appropriate to the future life style of the victim. In the words of Dr Sethi “limb fitting is a complex business. Social, cultural and economic considerations are as important as the technological issues”.

There is no doubt that health education and legislation is necessary to avert such dangerous practices. Till then we are bound to see such  preventable accidents.

 ARTICLE  PUBLISHED  IN  VIDUSARA –  SINHALA  SCIENCE  JOURNAL

Interview with Gamini Goonetilleke