Guyana, the drama of the small country with the highest suicide rate in the world

 

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(English version of article published by the BBC in Spanish and Portuguese)

In a tiny corner of GuyExpo, Guyana’s leading trade fair, the Pesticides and Toxic Chemicals Control Board is trying to entice passersby to its stall. A display of glass beakers containing bubbling liquids in the country’s national colours – red, black, green, white and yellow – proves eye-catching. Some stop to take a closer look or pick up one of the leaflets urging ‘Remember! Pesticide stored wise – save lives’. Amid the excitement and optimism of the event, part of Guyana’s 50th Anniversary of Independence celebrations, it’s a stark reminder of the many lives that have been ended here by people ingesting readily available poisons, herbicides and pesticides.

Perched on the northern coast of South America, Guyana has a small but diverse population numbering just over 750,000. But it also has the highest rate of suicide in the world. The World Health Organization (WHO) estimates that 44.2 people in every 100,000 commit suicide – compared to just 6.2 in the UK.

“It’s a statistical way of computing the rate, because nobody knows the true number,” admits Dr William Adu-Krow, country representative for the Pan-American Health Organization (PAHO) and WHO. “And the fact that we have some institutions reporting suicides does not mean that’s the true number. Someone may drink poison but when they go to hospital, because of the stigma, they only say they’re feeling sick or cannot breathe.” Without a toxicological centre, getting accurate data is made even harder.

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“Suicide is very taboo here in Guyana,” says Bibi Ahamad, Vice President for the Guyana branch of New York-based NGO The Caribbean Voice (TCV), who uses social media such as WhatsApp to keep in touch with people who contact her for advice and support. “The number of attempts is very, very high. I spoke with a teen who attempted suicide six times, and no one sought help for her, no one paid any attention to her.”

With little research available, pinpointing the reasons behind the high rate is difficult. A survey of suicide survivors by the Georgetown Public Hospital found key driving factors to be family discord, couple problems and domestic violence. Others cite peer pressure, attitudes towards the LGBT community, poverty, unequal access to education and healthcare, even the glorification of suicide in Indian films and soap operas – or “the Bollywood effect” (reportedly more than 65% of cases are from the East Indian community). “Last year our focus [at TCV] was primarily on raising awareness of the warning signs, myths, the misinformation,” says Ms Ahamad, “but also we decided to focus on issues like drug and alcohol abuse, rape and incest, and teen pregnancy.”

Unfortunately Guyana’s mental health system is, according to a WHO report from 2008, “fragmented, poorly resourced, and not integrated into the general health-care system”. The country has just five psychiatrists and one psychiatric hospital, located in East Berbice-Corentyne – the region with the highest rate of suicide in Guyana. Established by the British in 1867 as the ‘Lunatic Asylum’, the renamed National Psychiatric Hospital is in serious need of attention – with the Minister of Public Health, Dr George Norton, describing its current state as “disgraceful”, following a visit last year. A smaller psychiatric unit also exists at Georgetown Public Hospital.

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The scale of the crisis is significant, particularly among Guyana’s youth. According to the Ministry of Health, between 2006 and 2008, suicide was the major cause of death for 15 to 24 year olds in Guyana. “I think one of the reasons is because they don’t have many people to talk to,” says Daniel Ali, a medical student who last month started coordinating in-school suicide prevention workshops for both teachers and students through Give Foundation Guyana. “They find great difficulty in trusting someone. Because they’re afraid the first response they would get is, ‘Why are you trying to do this to yourself?’ They’re really afraid of the stigma and discrimination against them. The other thing is the issue with confidentiality. They’re afraid that their personal lives or whatever they say might get out in public.”

Guyana’s media is frequently accused of being overdramatic and insensitive in its coverage of suicide and mental health. “Every day, suicides are reported, how they did it, what they did before…” criticises Dr Jorge Balseiro, consultant psychiatrist at Georgetown Public Hospital. In November, when the bodies of two young people were found in an apparent suicide pact, a number of outlets published photos of the pair, laying near the sea wall. Dr Balseiro hopes that a Media and Suicide Prevention Workshop held by PAHO last month may encourage more responsible reporting.

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Engaging with the media is just one of the interventions proposed in Guyana’s National Mental Health Strategy 2015-2020 and National Suicide Prevention Plan. “The idea is to move mental health from a central institution into the community and primary health care,” says Leslyn Holder, Public Education and Training Coordinator in the new mental health secretariat, set up just last month. Plans include opening a new Mental Health Institute and turning the psychiatric hub at Georgetown Public Hospital into a dedicated inpatient unit. There are also efforts being made to introduce training for NGOs; a Masters in psychiatry for doctors; and additional mental health training for clinical doctors and nurses – with a pilot programme already underway on the island of Bartica. “We’re starting from scratch,” says Ms Holder, “which might not necessarily be a bad thing.”

But the government will have to work hard to convince the population that these steps will be implemented, properly funded and have an impact. “For too long,” wrote mental health rights advocate and lawyer Anthony Autar in a recent blog, “our silence has created an environment where the powers that be feel comfortable making lofty public proclamations about plans to address the mental health crisis in Guyana, but follow-up with sloth or inaction.”

One practical step forward has been the creation of a suicide hotline. The 24-hour service was launched last year by the National Police Force, which claims it has had a “100% success rate” in terms of response and referrals. “Attempted suicide is considered a criminal offence in Guyana,” acknowledges Police Sergeant Sherry Mason, “but because it was on the rise we’re not going to charge them any more, because we realise that if someone tries to commit suicide that person is in a crisis. We’re trying to extend our hand to them.”

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Current Miss Guyana World and suicide prevention campaigner Lisa Punch, who set up Prevention of Teenage Suicide (POTS) in 2012, is also calling for more school counsellors. “The new government are getting counsellors to various schools but it’s not enough … let every school have their own counsellor and not have them rotate. They need someone to confide in, to talk to, to let them know that everything is ok – this is part of growing up, because they feel like they’re the only ones going through what they’re going through.”

“I think the best person that can identity with a situation and be able to express it is a person who went through the ordeal,” adds comedian Kirk ‘Chow Pow’ Jardine, who has been breaking through the taboo to share his story of surviving suicide. “I was an active drug addict for 21 years and in those 21 years I started giving up on life … I thought all my problems were more than me.” But after seeking help through rehab, Mr Jardine was able to turn his life around. “Now I am the number one stand-up comedian in Guyana. And instead of bringing tears to people’s eyes, I bring laughter and smiles.”

Carinya Sharples

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