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In Sri Lanka, a New Wave Of Pain

Doctor Tries to Ease Mental Devastation

By Neely Tucker
Washington Post Staff Writer
Friday, January 7, 2005; Page A01

BATTICALOA, Sri Lanka -- Ganesan is a rare man in Sri Lanka.

He is a father, husband, and the only psychiatrist for 1.3 million of the world's most traumatized people. His roving practice along this island nation's eastern shore stretches over 150 miles, all of it devastated by last week's tsunami.


Ganesan, the only psychiatrist on Sri Lanka's eastern coast, is coordinating medical relief.

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Even before the wave, when his clients were one of the world's most suicide-prone populations, his practice was filled with paranoid schizophrenics, manic-depressives, rape victims and thousands of torture victims from the civil war (one subset of patients: people with pencils jammed in both ears simultaneously).

Now add to that the families of more than 15,000 tsunami fatalities in the region. Tens of thousands of homeless, jobless, destitute refugees. Orphans in the hundreds.

There is a time for cognitive psychotherapy in an office with dim lights, a box of tissues and 50-minute sessions. Then there is a time for a psychiatrist of international education and experience to leap into the trenches.

"To talk about psychological needs when you've got thousands of people using one toilet in a refugee camp -- it's absurd," says Ganesan, who goes by one name as is common here, talking above the din in the office where he is coordinating medical supplies for refugees. "It's not what a doctor should do."

In these traumatic days, Ganesan has tossed dozens of corpses into the back of his pickup, distributed medicine to children, coordinated efforts of hundreds of foreign aid workers from dozens of countries, buried a friend and, just for a moment yesterday, had a quiet session with a violently psychotic young man crippled by delusions and drug addiction.

"His actual workload is at the hospital, but he's volunteering everywhere," says S.J. Thiruchelvam, the regional manager for World Vision, a nonprofit charitable organization that has helped Ganesan develop the area's first mental ward. "He's done a marvelous job in the whole district since he arrived."

There are moments when life reveals itself, insight reached through periods of great suffering and hardship. In the spiritual sense, the first teaching of Buddhism, the principal religion of this nation, is that life is suffering and that this cannot be avoided.

This is the lesson that Ganesan has come to understand in his time on this leeward shore: To suffer is to survive. To bear it with grace and courage is to live.

Three or four phones are jangling in the regional government medical office, the nerve center for relief efforts on the coast. Ten or 12 people are having conversations at once. Fingers are tapping out e-mails and memos on four computers perched on the edges of desks. Three men have just walked in with donated copy machines, a printer, toner and too many cardboard boxes to count.

Across the hallway, there is a stockroom with shelves packed with thousands of newly donated bottles of ibuprofen, tetracycline, diazepam, paracetamol, amoxicillin, potassium chloride, chlorphenamine, cloxacillin, syringes, gauze and mounds of bandages.

Ganesan traverses this temporary office, making sure things wind up in the right place, at the right time, and in the right hands.

It's hectic, and Ganesan, a handsome, balding man of 41, is keeping up by talking into his cell phone constantly, calling out to co-workers, stepping into the courtyard to argue with the hospital director and speeding across town in his four-door pickup for a generator and a small refrigerator. The days start at sunrise and go late into the night. He smiles often, laughs, is gregarious under pressure -- of which there is plenty.

Written on a whiteboard in the corner is a shorthand list of the latest agencies to parachute into town:

Yale University

Indian Medical Group

Northwest Medical Team

Kandy Teaching Hospital

Colombo Medical Professional Group

MDM -- Greece

Malaysia Medical Group

Canadian Medical Group

Polonnaruwa Medical Professionals

This does not count the local and international agencies that already have offices in the area from the civil war -- the U.S. Agency for International Development, the World Health Organization, UNICEF, the International Red Cross, Oxfam, CARE, and the national and local Sri Lankan groups.

There were 81 such organizations before the tsunami.

He has no idea how many there are now.

Ganesan's job, for which he volunteered and is not paid, is to connect this onslaught of international aid -- all of it earnest and well meaning and completely ignorant of the situation on the ground -- with specific camps or individuals.

There are dozens of offers from dozens of countries for teams of grief counselors, but Ganesan tries to talk them out of it. The time for such therapy, he says, is weeks or months into the future, not during the immediate crisis.

Still, it can work out. Here's one example, in an interior village:

"Vakari is desperate for medical help, but they have no doctors," he says, tapping out each step on a piece of paper. "The Malaysians offered a medical team, but they had no money. The World Health Organization had money, but no team. I know people at all three, so I connected the dots, and now the Malaysians are going to Vakari for eight weeks."

That was good, but the continuing problem is that too many people want to come right now. They want to jump on a plane and be here tomorrow. That is wonderful -- burned-out Batticaloa needs help -- but there are already more doctors in town than anybody knows what to do with, and not everything is a success story.

There was the unfortunate incident of the Korean team of a dozen physicians who parachuted into town. Only one spoke English. They were able to find one man in a refugee camp who spoke English, Tamil and Sinhalese. They did not bring enough medicine, so they had to rely on local pharmacies.

This resulted in a translation and pharmacological mix-up in which one of the good doctors thought he was giving children vitamin syrup to drink. It was actually calamine lotion.

"At least we found out it won't kill you," Ganesan bursts out, slapping a knee.

You've got to laugh around here because when he arrived in 1999, few knew what a psychiatrist was. There had not been one in the war-ravaged district for more than 20 years.

An ethnic Tamil, Ganesan was born in the far north of the country, in Jaffna. He married his college sweetheart, Shanatini, in the capital, Colombo, while they both studied medicine, and the couple moved to England to practice.

The pay was marvelous -- his salary was about $75,000 a year -- but it was unsatisfying. He would come home from the office feeling like he'd worked all day but not done much.

"We wanted to be of use," he says now. "And we belonged here."

So Shanatini and he came home, had a child and took up grueling tasks: She became the only pediatrician for a region of 500,000; he became the sole psychiatrist for more than a million.

His government salary: about $300 a month, a pay cut of roughly 95 percent.

If patients did not know to come to him, he went to them. He worked with children's agencies, with groups that campaigned against violence toward women. He saw all the attempted suicide patients and the war torture victims that he could. He set up 16 clinics in cities along the coast and spent a third of each month on the road.

The work was and is overwhelming.

There were and are days when he has six or seven attempted suicides -- swallowing poison being the favored local method -- a national problem whose basic causes still escape him. There have been years when Sri Lanka has been the world leader in suicides per capita, a fact that makes him shake his head.

There are also at least 20,000 torture victims in the region, says Ananda Galapatti, a friend of Ganesan and local counselor who has published in international journals about psychological relief work. That number does not include traumatized children and the shell-shocked and those suffering from post-traumatic stress disorder.

"If you wanted to undertake a traditional psychiatric practice of seeing patients one on one for an hour here -- well, you'd need thousands of doctors," Galapatti says.

So Ganesan set up local volunteers to conduct talk sessions or simply to play games with children, or he enlisted family members to help with mentally disturbed adults. With help from World Vision he was able to set up a working mental ward in the back of the city's hospital grounds.

The one-story, concrete building has steel cots with vinyl-covered mattresses and a rough-hewn wooden bench for a dining table. In the front courtyard, he constructed a quiet garden by planting trees, and built a small pool for goldfish and later a gazebo.

He let the patients' family stay with them. He opened all the doors and let patients, some seven to 10 of whom stay there at a time, go where they wanted.

When the tsunami hit, Ganesan and his family were inland several miles on a motorcycle day trip. By nightfall, he was back in the city, first taking the injured to the hospital in the back of his truck, then returning again and again to pick up corpses.

"I remember the smell, the stench of it all, and the swish sound of throwing the bodies in the truck," he says, stopping during a tour of the hospital ward. "There were bodies of babies, infants. Bodies of women."

Ganesan assesses his own mental health to be pretty fair.

"I don't sleep much, but it's because I'm so busy," he says. "Perhaps if I had nothing to do, I would be sleepless and think about all the damage and grief. This seems to be the better use of time."

For a moment, here on the ward, the catastrophe feels far away. He walks outside to sit by the small goldfish pond. Two young female patients approach. Both are Muslim and both are manic-depressives. They brighten at his smile, at a small bit of conversation.

It lasts only a minute.

There is a call from the office. A young man has just brought in his brother. The brother has hallucinations. He beats up his elderly parents. The family has spent a fortune on traditional cures, none of which has worked.

So in the aftermath of one of the worst modern natural disasters, the young man has traveled by boat, bus and car for eight hours, all the way up the shattered coast of Sri Lanka, to get his brother to Batticaloa.

Ganesan puts the world's biggest crisis on hold. He pulls up a chair and opens a notebook and speaks softly to the brother. He begins to make notes.

What is helping the many, if you cannot help but one?


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