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Pesticides and suicide risk
Last Tuesday, 75-year-old Kenneth “Stew” Parvatan was found dead by his young granddaughter, hanged with a bed sheet at his home in the village of East Canje, in rural Guyana. Guyana has the world’s highest suicide rate, according to a report released this month by the World Health Organization (WHO). In 2012 there were 277 suicides, a rate of 44.2 per 100,000 population.
That compares with a world average of 11.4 per 100,000, and a rate of just 6.1 for low- and middle-income countries in the Americas. Neighbouring Suriname has the world’s sixth-highest suicide rate—27.8 per 100,000. T&T’s at 13.0 is lower—but above the world and regional average, and also of great concern.
The other Caricom countries for which the WHO provides statistics have fewer suicides. The per capita rate is 2.3 per 100,000 in the Bahamas and Barbados, 2.8 in Haiti, 2.6 in Belize and 1.2 in Jamaica. Suicide statistics are notoriously unreliable. For social and religious stigma, many go unrecorded. But the trend is clear. Guyana has a problem. Guyana’s per capita suicide rate is the same as Jamaica’s murder rate—also 44 per 100,000 last year.
Bringing down murder rates is at the forefront of government policy in most of the Caribbean. Suicides, too often, are quietly ignored. On the surface, Guyana looks happy enough. Georgetown bustles. There are clear signs of poverty both there and in the countryside, but not the pall of gloom which haunts drab apartment blocks in ex-Soviet eastern Europe, another region with high suicide rates.
Guyana ranks 121st of 187 countries on the UN Development Programme’s human development index, which looks at health and education standards as well as economic welfare. That is a low ranking, but not a disastrous one. The Philippines, which places just above Guyana, has a suicide rate of just 2.9.
“Stew” Parvatan was in many ways typical of Guyanese suicides. Three-quarters are male. Most are middle-aged or elderly. Men over 70 are five times as likely to kill themselves as those in their teens and 20s.
Most suicides are rural. “Stew” lived in Berbice, an agricultural district in eastern Guyana, which has two-and-a-half times the Georgetown region’s suicide rate. He was an Indo-Guyanese; more at risk than other ethnic groups. As a method, hanging is not unusual. But poisoning with herbicide is more common; sadly, it kills slowly, and with maximum distress.
The Guyana Foundation, a recently founded non-governmental organisation, this month released findings from a small-scale study, based on in-depth interviews by Serena Coultress, a researcher with the Global Health programme at Maastricht University in the Netherlands. She talks of hopelessness and frustration among men who are unable to fulfil their expected role as provider, and turn to domestic violence, alcohol abuse, and sometimes suicide.
There is a need, she says, to look beyond immediate coping strategies and encourage broader social change. Cultural and sociological explanations are the first call for most researchers, but they do not tell the full story. Environmental pollution may also play a major and damaging role, says Prof Gerard Hutchinson, a psychiatrist and Head of the Department of Clinical Medical Sciences at UWI’s Trinidad campus.
A well-supported body of research suggests that exposure to organophosphate pesticides can lead to suicidal impulses, with disastrous results. That is in addition to more obvious physical symptoms, such as extreme tiredness, breathing or heart problems, weakness or stomach pains.
A paper from the journal Advances in Psychiatric Treatment reports unpredictable “swings into depression on the one hand and irritability and anger on the other.” It talks of “impulsive suicidal thoughts that are out of the blue and may result in serious action being taken. Tractors may be put into full throttle and aimed at walls or ditches; shotguns may be taken from their cabinet, loaded, and placed into the mouth of the sufferer; or nooses may be tied and fastened to supports.”
In the main, Caribbean farmers and agricultural workers are rural middle-aged or elderly males, the group most at risk from suicide. Most are broadly aware that pesticides are dangerous. But few are fully informed, and there is too little training from agricultural support staff. Written warnings with big words and small print have little impact. Pesticides can be absorbed through the skin.
“I have never seen a farmer wearing full protective gear,” says a professional woman who works closely with rural communities. Masks may be worn, sometimes gloves; but full cover-up clothing is almost unknown, not least because it is hideously uncomfortable for physical work in a hot climate.
There has been little obvious sign of a suicide control strategy in Guyana. There have been workshops on suicide prevention, but with little follow-through. There is no functioning telephone helpline—though the police, to their credit, have announced plans to set one up, using trained civilian counsellors. (In T&T, a non-governmental organisation, Lifeline, has a hotline number: 645-2800).
Hotlines are vital. So are social workers. But, if Prof Hutchinson is right, agricultural advisers can also play a life-or-death role in suicide prevention.
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