• Unspoken trauma & related surgical repercussions

Since ancient times, the Sri Lankan culture and heritage has been dependent predominantly upon the religious beliefs, philosophy and literature related to Buddhism which focuses on the wellbeing of all living creatures on earth. Children swaddled in their mother’s laps learn stories of Buddha through whispered tales in which elephants and tuskers had many highlights. The Buddha’s life story had many links to elephants and tuskers. The folk tales began with Queen Mahamaya’s cryptic dream in which she was bathed in a spring water pond in the Himalayas by goddesses, to be dressed with garments from heaven itself and again to be transported back to her chamber. Then, a milky white baby tusker holding a white lotus in its trunk gave a melancholy call before entering into her womb. The seers of the land are said to have interpreted the dream as a sign from the heavens, that she was to conceive a blessed son. 

According to Buddhist literature, at a time when the Buddha moved out of the residing shrine at Kosambi to a forest sanctuary, in order to rectify some conflicts between the Kosambi monks, it was a tusker named Parileyyaka who took care of him. Then, the telltale describes how the Buddha tamed the intoxicated tusker Nalagiri, who was sent by Devadatta Thera during the failed attempt to assassinate the Buddha. In addition to these elephant tales related to the Buddha’s biography from India, there are several historical elephant related tales from ancient Sri Lanka. In the chronicle the ‘Deepawansa’, it has been described that King Dewanampiyatissa had to clean and utilise his massive elephant stable for  Mahinda Thera to preach Buddhism to the large gathering.  As per the chronicle ‘Mahavamsa’, the highlighted story about a majestic tusker has been elaborated during the reign of King Dutugemunu. During his battle to reunite the country by liberating Anuradhapura, in the process of capturing the fortress of Vijithapura, the royal tusker Kandula had played a pivotal role. The ultimate battle by Dutugemunu against the invading ruler Elara had been a duel on an elephant's back. Dutugemunu on Kandula defeated the invader who was on his gigantic tusker Maha Pabbatha. A couple of centuries later, King Kashyapa was said to have travelled on elephant back to fight against his brother Mugalan, near his famous Sigiriya rock fortress. It is apparent that Sri Lankan kings have used the services of tamed elephants during the process of constructing large monuments and dams to form massive reservoirs. These elephants were used as a labour force and were given love, affection and humane care in return. 

The bond between man and these giants has been strong. The Sri Dalada Perahera, Kandy, has been a historical procession performed annually to pay homage to the tooth relic of the Buddha. This ceremonial procession, considered as the epitome of Buddhist cultural activities in Sri Lanka for centuries, may highlight the highest quality human-elephant interaction possible by providing the opportunity for the great celebrity tuskers to carry the casket containing the tooth relic during the perahera procession. Elephants and tuskers have been a part of Sri Lankan human civilisation from the very beginning of its roots. Both species not only have coexisted and interacted peacefully for centuries, but have also helped the wellbeing of each other.

The first highlighted record of the human-elephant conflict (HEC) in Sri Lanka appeared during the early colonial era when tuskers were taken down for ivory. In addition to trade-related elephant killing, colonial official, voyager, explorer and ultimately a big game hunter, Samuel White Baker had initiated ‘elephant game hunting’ in Sri Lanka in the 1840s. During his eight years stay in then Ceylon, Baker had guided the massacre of thousands of elephants and tuskers. There are records that he had killed 11 elephants before breakfast one day and 104 within three days. His contemporary, Major Thomas William Rogers during his 11 years in Sri Lanka had killed 1,400 elephants prior to his death in a lightning strike in 1845. Major Thomas Bridges Boucher Skinner and Captain Galloway are said to have slaughtered at least 700 elephants each in the mid-19th Century. This game hunting would have been responsible for the extinction of elephants from the central highlands of Sri Lanka, mainly around Mahaelithenna, the current day Horton Plains. Still, we honour their ‘legacy’ by calling waterfalls and national parks in their names. For a nation that had a massive respect for the wellbeing of any living creature upon their religious beliefs, such game hunting experiences may have shown a conflicting perspective of life.

Later, with post-colonial urbanisation of the island, more and more land had been used for the benefit of mankind. Initial gradual deforestation with subsequent ill-planned hastening had led to the loss of many natural habitats of the wildlife in Sri Lanka. With that, the wild elephants who were distributed all around the country by the 18th Century, had got restricted to the dry zone lowlands of the island, except for a few limited regions of the wet zone in the periphery of the Central and Sabaragamuwa Provinces. The Mahaweli development project initiated in the early 1960s and accelerated in the early 1980s had been the largest multipurpose development project in Sri Lanka. With Mahaweli water being redistributed over the dry zone, many new human establishments were created and developed all over the dry zone. The steady expansion of human habitats and agricultural lands has clearly worsened the human-wild elephant conflict in Sri Lanka over the last three decades. Probably, the initial generation of relocated inhabitants in Mahaweli development areas knew how to coexist with the giants with minimal harm to both parties due to their traditional lifestyle. Subsequent generations, who have been victims of the open economy, probably lacked such principles and values, and appeared to invade their activities into or almost into forest reserves; extensively disrupting elephant habitats and fragmenting elephant travel corridors. These acts have worsened the human-wild elephant encounters in Sri Lanka during recent years. Such excessive conflicting interactions have not only worsened the manmade injuries and deaths to wild elephants, but also, the crop raiding, property damage, human injuries and deaths caused by elephants. Sri Lanka has the second-highest number of human deaths related to the HEC in the world behind India, and undoubtedly the highest per 100 square kilometres land area in a country. The number has grown from less than 40 in 1990 to more than 175 last year (in 2023). Meanwhile, more than 400 elephants have lost their lives per year in Sri Lanka due to human activities over the last few years, the highest in the world. These numbers clearly emphasise the magnitude of the longstanding and worsening socio-economic and environmental conservation problem associated with the HEC in Sri Lanka.

Data on demographics of elephant attacks, clinical repercussions of human injuries related to wild elephant attacks and the clinical outcome following treatment have never been evaluated beforehand in Sri Lanka. Trauma surgical repercussions of HEC including wild elephant attack-related human deaths and non-fatal injuries have been commonly encountered in the rural areas of the island, well away from the cities with established trauma care facilities. According to a recent review carried out at the Base Hospital, Dambulla, human injuries caused by wild elephant attacks have led to high injury severities, disabilities and fatalities. Almost 90% of the victims have been in the economically productive age group, and among fatalities and ones with long-term disabilities combined together, two-thirds have been males between 18-60 years.  Sri Lanka has a free healthcare system where treatment expenditure is borne by the State when a patient is admitted to a Government hospital. A preliminary evaluation had suggested an average treatment cost of Rs. 495,000 (approximately United States Dollars [$] 1,250) for a victim of an elephant attack. Further, the Sri Lankan Government grants Rs. one million (approximately $ 3,225) as compensation for any fatality or permanent disability resulting from wild elephant attacks and Rs. 150,000 (approximately $ 485) for partial disability. Hence, when strategies are formulated to reduce the human injuries due to wild elephant attacks, the burden created on State health expenditure and cost effectiveness have to be considered in the decision-making equation. Due to the severe injury patterns of the victims, more than 40% of the cases had required critical care support with prolonged hospital stays due to head injury, complex thoracic injury and complicated orthopaedic injury. The majority of these trauma victims had not received global standard prehospital care before being transferred to the surgical facility with significant delays. Such inferences have highlighted the deficiencies in initial trauma care management in rural areas of Sri Lanka, signifying the need to have an improved prehospital trauma care structure for better outcomes. Development of a streamlined trauma system and a dedicated trauma care hospital network equipped with adequate infrastructure and human resources would be the sustainable answer for this ongoing concern of uncoordinated overall major trauma care in Sri Lanka. All major trauma victims including the ones resulting from wild elephant attacks would surely benefit from such a development. 

In addition to safeguarding the human victims of the HEC in the country, it is an essential responsibility of the humans with a higher moral compass to protect the lives and safeguard the rights of these voiceless, innocent giants who have been mere victims of a greater threat, man’s greedy expectations. They have been villainised for the simple act of defying such greed and protecting what has been their right. For a country with a recent economic collapse created solely due to irrational human policy and decision-making, marketing Sri Lankan wildlife and heritage to the globe in a responsible manner is a noteworthy method to absorb foreign income to the island. Many tourists around the world would be visiting Sri Lanka between July and September to experience the Kandy Esala perahera festival and the Minneriya/Kaudulla annual wild elephant gathering. If we do not own up to having the ethical responsibility to safeguard wild elephants who have been an integral part of our culture for centuries, ‘selfish’ Sri Lankans would surely be forced to reconcile with the beasts to stabilise the ongoing economic downfall.

(Paramie Jayasundara is a student at the Visakha Vidyalaya with an interest in wildlife photography and Bingumal Jayasundara is the Consultant Surgeon at the Base Hospital, Dambulla, with an interest in wildlife conservation)

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The views and opinions expressed in this article are those of the author, and do not necessarily reflect those of this publication