“whatsoever  you  do  to  the  least  of  my  brothers  that  you  do  unto  me” (Matthew 25:40)

This story is about Premasiri, a thin and tall 35 year old farmer sporting a beard. His hometown was Polonnaruwa, but was working in the sugar cane cultivations in Hingurana situated in the Ampara District of the Eastern Province of Sri Lanka.

One day, while driving in Polonnaruwa, I noticed a young man sitting on a very low stool by a way-side boutique. He appeared depressed. As he was tall, his knees were jutting out. He also had another similar stool by his side. I stopped my vehicle and observed what he was doing with the additional stool he kept by his side. What I saw surprised me. He was sitting on one stool and then transferred his body to the other stool while keeping his feet steady on the ground. He repeated this motion to move forward. This was the way he moved from place to place. He could not stand up, bear his weight and walk. A sad plight indeed!

It was a meeting by chance. I approached this man and asked his name. He said he was Premasiri. I inquired from him as to what happened to him and why he moved in this manner with the help of the two small stools. It was a long story spanning several months and I listened to it carefully. At this stage I never divulged to him that I was the Surgeon at the Polonnaruwa Hospital.

The story of the injury and the subsequent treatment

Premasiri said,

Sir, while I was working in the sugar cane cultivations and moving around in the field on the18th of June 1985 at about 5.30 in the morning a trap gun which had been set for wild boar in the field fired as I disturbed the cord and activated the trigger of the trap gun. Both my legs were injured and I fell flat on the ground near a canal where the trap gun had been set. On hearing a loud noise of the gun firing, my fellow workers rushed to the scene, carried me, laid me on the floor of a tractor trailer and took me to the Ampara Hospital many miles away. I was bleeding from my wounds but none of my fellow workers knew what should be done except wrapping a piece of cloth to the injured legs.  Sir, I was lucky to survive that journey in a tractor which took many hours and reached hospital only at about 3 pm.

According to Premasiri, the Ampara hospital did not have surgical facilities at that time. After the application of splints and dressings to the injured legs in the Emergency Department of that hospital he had been transferred to the Badulla General Hospital for necessary treatment. That journey had taken another three hours.  He had undergone surgery at the Badulla Hospital and two plaster casts had been applied to his lower limbs. He had spent 3 months in that hospital far away from his home in Polonnaruwa.

Premasiri: a disappointed man

Premasiri was hasty and expected rapid healing of his fractures. At the end of three months as he was still in plaster and could not get about, he had decided to leave the hospital on his own against medical advice. From there he had gone to a village “osteopath” in the Anuradhapura District. The plaster casts were removed and the application of oils and medicinal herbs was started. From his home in Polonnaruwa he had to travel to the clinic of the osteopath every two weeks for a further period of three months. Six months had passed, but there was no improvement. He could not stand up, bear weight and walk. By then he had also exhausted his meagre financial resources and had to depend on others for his sustenance. He was disappointed again!

Premasiri, improvises the stools

He gave up all forms of treatment except the application of herbal oils. By then his legs were thin, wasted with weak muscles and this added to his problem of being unable to walk. It is at this stage that he improvised the two stools that enabled him to get about at least short distances.

Advised to enter Base Hospital, Polonnaruwa

I thought for a moment whether I could help this man to get on his feet once again. At this stage I informed him that I was the Surgeon at the Polonnaruwa Hospital and advised him to get admitted to my ward as soon as possible. I also told Premasiri that I will do my best for him. Premasiri was happy that someone had come forward to help him. He agreed as he could not go on with the help of two stools anymore and entered the hospital the very next day.

When I examined him in the hospital and subsequently carried out an X- ray examination (the only investigation available) of his legs, I came to the conclusion that the fractures in both legs had not healed and all the muscles were wasted. As a result of these problems he could not get up, bear his weight and walk.

What did I do?

• It was no easy task. His knees were stiff as he had kept his knees bent for some time. I had to gradually stretch his knees daily till I was able to get the legs straight. During this time he was encouraged to contract his leg and thigh muscles passively to make it strong. There was no Physiotherapist in the ward and it was my duty together with the nursing staff to encourage Premasiri to follow instructions for his benefit. He was cooperative and determined to get on his feet once again and that made our task easier.
• Once the legs were straightened, I applied a plaster of Paris casts to both legs that extended above the knees. These casts were strengthened on the back with two “broom sticks” so that the knee joints could be held firmly without bending. He was advised to continue with the exercises to his muscles and also perform straight leg exercises to strengthen his Quadriceps muscles which are all too important if he is to walk again.
• After about two months, an X- ray of his legs showed that the fracture of the bones in his legs were healed and solid enough to bear weight.
• Then he was encouraged to be on his feet with the help of a pair of crutches. An attendant in the ward helped him initially. He was also encouraged to move around the bed holding on to it. At the end of a month he was on his feet and was able to walk slowly one step at a time with the plaster cast and the help of the crutches.
• Next we removed the plaster casts and advised him to walk with crutches. Knee bending was also advised at this stage. Gradually he got on his feet and was able to walk without the support of crutches.
• At this stage he was advised to leave hospital almost three months after admission. He  continued the exercises at home and attended the clinic regularly till he was able to get about freely. However he was not able to continue his farming activities and had to seek alternate employment.
• He continued to apply herbal olis to his legs, but I had no objection to that.
• Nearly a year had passed since the injury, for him to get back on his feet initially with crutches, overcome his disability and give up his stools. He maintained close contact with me till I left Polonnaruwa in April 1988.

A rare meeting after 26 years

After I left Polonnaruwa in April 1988 I lost contact with Premasiri for many years. In September 2014 I organised an exhibition of my surgical photographs for the purpose of health education. This was titled the Pictorial Journey of Surgery and held at the Auditorium of The College of Surgeons of Sri Lanka in Colombo and in a school hall in Polonnaruwa. This was given wide publicity in the newspapers. Premasiri had come to know about the exhibition and visited the exhibition in the hope of seeing his photographs as well.

While at the exhibition a visitor approached me and said, Hello Sir, I am Premasiri can you remember me. I looked at him but could not recollect who Premasiri was. Then he said, Sir, I am Mr. Banku. That rang a bell and I realised who Premasiri was. Like everyone else he had aged a bit but was steady on his feet moving freely without any difficulty. He remembered the photographs that I had taken of him while he was in hospital at various stages of his care and went round looking for these photographs too. He was rather disappointed that he could not find those displayed at the exhibition.  He inquired as to why his photographs had not been displayed? That was a lapse on my part as I had not met him for many years and had forgotten to exhibit those photographs.

I was happy that I saw Premasiri and he was happy too, but disappointed at the same time because I had not displayed his photographs at the exhibition. He enjoyed the photographic exhibition posed for a photograph and parted leaving his phone number with me. Since then he has been in contact with me from his home town in Polonnaruwa where we first met way back in 1986.

Mr Banku will remain in my memory forever now!

Acknowledgement

Premasiri was a man with strong courage and determination to get back on his feet. I thank him for all the details given to write this story and also for the consent to illustrate the story with his photographs.

*Bankuwa is the Sinhala term for a stool. As he was using a stool to get about I called him Mr Banku in the ward. He did not mind me addressing him in his nick name and enjoyed it too! That name continues even today long after he was cured and the stools were not needed any more.

Dear Reader, I recommend that you take sometime to read the next heart breaking story of Lalitha, which spoke to so many readers and I even received funds through them after publishing the story to help their family : ‘FROM DARKNESS TO LIGHT’