Sindh – HTV https://htv.com.pk Fri, 05 Jun 2020 07:00:58 +0000 en-US hourly 1 The Alarming Rise of Suicides in Thar https://htv.com.pk/health/suicides-in-thar Fri, 23 Aug 2019 10:05:08 +0000 https://htv.com.pk/?p=45730

There comes a situation in life when a person thinks dying by suicide is a lot easier than dealing with emotional pain. And people in Tharparkar are being pushed to take that decision. Thar is an extremely underdeveloped part of Sindh and that too contributes to the reasons why Tharis commit suicide along with prolonged […]

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There comes a situation in life when a person thinks dying by suicide is a lot easier than dealing with emotional pain. And people in Tharparkar are being pushed to take that decision.

Thar is an extremely underdeveloped part of Sindh and that too contributes to the reasons why Tharis commit suicide along with prolonged spell of drought, use of drugs and domestic violence.

According to the SSP Tharparkar, Abdullah Ahmed, around 100 people died by suicide in the region in 2018 alone, while this year 44 people have taken their lives so far.

“When a mentally ill person develops extremes of pessimism and learns helplessness then he/she starts getting suicidal thoughts,” explains Dr Raza ur Rahman, the meritorious professor and former chairman of the Psychiatry Department at the Dow University.

In Pakistan, not just in Thar, there are a number of reasons why mental illnesses are prevalent:

  1. Lack of basic necessities of life
  2. Lack of peace and political instability
  3. Unemployment
  4. Health issues
  5. Poverty
  6. Homelessness
  7. Family disputes and a range of social pressures.

(The Hymen Right Commission Report of Pakistan 2018)

Related: You Can’t Eat Away Depression, Because Depression Eats You Away

Dr Rahman says that the causes of depression contribute towards development of suicidal thoughts.

On the other hand, Dr Quratul Ain, who works as a consultant psychiatrist in Karachi, says that while there are many factors which can influence a person’s decision to end their life, in most cases the person has severe depression and bipolar disorder.

“There are stages of depression: mid stage, moderate stage and severe stage. In moderate and severe stage, mostly, a person has overwhelming feelings and great emotional pain. Dealing with emotional pain is difficult for them and they think death is easy,” she says.

More women die by suicide in Thar

The number of women dying by suicide is higher than men in Pakistan than just Thar. According to Dr Rahman, one of the reasons is that females are readier to admit depressive symptoms than men.

Secondly, many depressed males start abusing alcohol and drugs so they are diagnosed as alcoholic or drug addict rather than depressed.

Thirdly, hormones of menstruation and parturition make women prone to depression.

Related: Is Being Single The Only Cause Of Depression Among Pakistani Women

On the other hand, Dr Quratul Ain says women are vulnerable to depression because of our patriarchal society, unfair practices and socio-economic problems. Ahmed agrees that in most cases they find out the married woman who died by suicide had a tussle with her mother-in-law or was in an unhappy marriage.

“Poverty, domestic violence and unfair treatment makes women’s lives miserable. Most of the women either jump into a well or hang themselves from a ceiling fan,” says Ahmed and claims that most of the women who committed suicide in Thar belonged to the Hindu community. It is no secret that the minorities in Thar face a lot of problems that can adversely affect their mental health.

The figures related to suicide are sketchy in Pakistan but mental health professionals see an increased number of such cases in their practice.

According to the Human Rights Commission Pakistan (HRCP) report 2018, 1,338 people died by suicide in the country. “Domestic problems were the most common causes for suicide among both women and men. Negligence on the part of husband and conflict with in-laws was the main reason that forced women to commit suicide while most men faced financial problems.”

Is suicide preventable?

This year’s theme of World Mental Health Day, which is on October 10, is ‘suicide prevention’ as it can be prevented.

However, Dr Quratul Ain says depression is not considered an illness in Pakistan and thus, people don’t seek professional help.

“But suicide is basically a cry for help by victims. Most suicidal people do not want death; they want the pain to stop. The impulse to end it all, however, overpowering, does not last forever so proper intervention will help,” says Dr Rahman.

For prevention the assessment of suicide risk is most important, he says, adding that there are many risk factors for suicide. These include but are not limited to previous suicide attempt, presence of a psychiatric disorder, family history of suicide, losses, emotional pain and sexual abuse.

Dr Rahman elaborates that proper psycho-social intervention can save many lives. These interventions include effective management of mental, physical and substance use disorders, easy accessibility of different clinical interventions and support for those seeking help, restricted access to lethal methods of suicide, availability of family and community support, learning skills for problem solving and conflict resolution.

Related: 8 Things People With Depression Want Their Friends To Know

Mental health and stigma  

As compared to other countries, reported rate of suicide in Pakistan is low due to social stigma and legal issues that envelop the problem. Ahmed says that people don’t report suicides and try their best to hide the cause of death. “But, in 90% of the cases the police somehow find out and register a case under 174 of criminal procedure,” he shares.

According to Dr Rahman, suicide is prohibited in Islam, therefore, various obstacles restrict open discussion of the phenomenon.

“Another reason of underreporting of suicide is because it is considered a criminal offence under the Pakistan Penal Code (PPC), with punitive laws imposed for attempted suicide punishable by a fine of Rs10,000 and/or imprisonment,” he adds.

Recently, the Mental Health Act (MHA) of 2013 has documented suicide as an illness and cry for help rather than a crime but this disparity in MHA & PPC has to be removed.

“It is a pity that despite its importance no official data on suicide is available and it is neither included in the national annual mortality statistics of Pakistan,” points out Dr Rahman. The compilation of accurate data is important in persuading health policymakers regarding seriousness of the issue, he says.

Keeping in view the gravity of the situation, the Sindh government has appointed a full-time psychiatrist at the Civil Hospital but it is important to note that the total population of Thar is around 1.8 million. While such an effort is good but more needs to be done before the region becomes the suicide capital of the country.

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Poverty and HIV: A Deadly Nexus https://htv.com.pk/health/poverty-and-hiv Thu, 30 May 2019 08:04:03 +0000 https://htv.com.pk/?p=44781

In April, the issue of HIV surfaced in Ratodero, Larkana, when about 12 children visited a hospital with symptoms of fever, vomiting and weight loss. A large number of children visiting the hospitals with the same symptoms rang alarm bells and a local pediatrician sent the blood samples of 11 children for testing. They were […]

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In April, the issue of HIV surfaced in Ratodero, Larkana, when about 12 children visited a hospital with symptoms of fever, vomiting and weight loss.

A large number of children visiting the hospitals with the same symptoms rang alarm bells and a local pediatrician sent the blood samples of 11 children for testing. They were all tested HIV positive.

As of May 20, around 553 children have been tested HIV positive.

A pediatrician, who was believed to be the only qualified doctor for children in Ratodero, was held responsible for the outbreak.

Though the virus can also be transmitted to children through breastfeeding and through mother to fetus, in the case of Ratodera, the mothers of virus affected children were also tested but they didn’t carry the virus.

According to the WHO consultant and physician, Dr Arshad Altaf, the infection spread due to reuse of syringes and drip sets used by quacks in this area.

Keeping in view the number of children affected, it is unlikely that only one doctor is responsible for the outbreak because in Pakistan even qualified doctors use the same syringes,” he says.

The WHO defines a safe injection as one that does not harm the recipient or the provider and does not result in waste that is dangerous to the community.

The Poverty Nexus

The reuse of single-use disposable syringes that led to a HIV outbreak in Ratodero can be attributed to poverty. Dr Altaf mentions that patients in rural areas are extremely poor and cannot afford to pay extra. Therefore, doctors offer services in which cheap medicines and injections are part of the package.

On the other hand, once diagnosed, it is important to note that HIV cannot be cured. It can be treated and contained. HIV patients have to take medicine all their lives.

And for the people of Ratodero, they have to travel for treatment as the town is quite far from Larkana and Karachi. But their poverty restricts them to do so, says Dr Altaf adding that when the child’s health improves parents think he/she doesn’t need treatment anymore and so they stop going.

RELATEDAIDS In Children – Problems, Prevention And Prognosis

A local journalist Sheeraz Mehmood Pathan, who has been covering the HIV outbreak in Ratodero, also shared that he met some families who told him that they have already visited Larkana seven to eight times for the treatment of their children, and it is financially taxing.

Keeping in view the large number of HIV affected children and poverty, parents hoped that the government might consider setting up a facility in their town. However, this has not been the case. So far, the government with the help of an NGO called Global Fund has only been providing free-of-charge medicines to the patients.

Moreover, poverty also restricts parents from taking proper care of their children. Dr Fatima Jehangir, a consultant family physician at the Ziauddin Hospital, says that HIV affected children need more nutritional care to boost their immunity because this disease makes them immunocompromised, making them more prone to infections. But most parents cannot afford to provide such care.

Under 5 Most Affected

According to the findings of a preliminary report submitted by a Field Epidemiology and Laboratory Training Program team on May 16, the most affected age group in the 534 HIV positive cases so far is between two and five, followed by age groups six to 15.

Among these, female children have been the most affected and the youngest child in the outbreak is less than a month old.

The report also revealed that around 14,810 individuals were screened between April 25 to May 16 and the number of HIV positive cases was found to be 534. Of them, 49.4% were male and 50.6% were female.

Such a significant number of patients in a small town of just 0.33 million people, according to the Census 2018, requires specialized doctors. Dr Jehangir says that usually infectious disease specialists treat HIV patients and during this treatment long-term precautions have to be taken to stop further spread. Monitoring of blood markers also have to be conducted in order to determine the stage of the disease. However, Ratodero lacks such facilities or doctors.

Immediate Action

The report says an immediate action should be taken against quacks, unauthorized laboratories and blood banks. So far, the Sindh Healthcare Commission has sealed around 71 clinics in Ratodero alone. It also suggests that more HIV screening camps should be set up at THQ hospital Ratodero to identify hidden cases.

Recently, only after the outbreak the government set up a ward for HIV affected children in Chandka Hospital Larkana, which was previously unavailable.

Pathan said that as of May 23, around 317 children have visited the ward. “At least seven children have died so far while the condition of five more is critical,” he mentioned.

RELATED: HIV In Pakistan: An On-Going Battle!

Dr Altaf elaborates that in order to prevent reuse of syringes there should be a mechanism where the health facility, small or large, if private, properly disposes these syringes in a sharps container and after that, it either burns or buries these syringes in a proper pit.

Incineration is common in Pakistan, but incinerators are only available at medium to large government facilities in rural areas, he says. There is no mechanism where the government health centers, where there is a functioning incinerator, accepts healthcare waste of private facilities, he adds.

He suggests that the government can institute a mechanism in which it can sub-contract the sharp collection system to a contractor and then the contractor charges a nominal fee per kilo for the sharps and transports the waste to the incinerator. In fact, Dr Altaf recalls that this system was functional in the early 2000s in Karachi but it could not sustain because the laboratories and health centers wouldn’t pay the collection charges regularly to the contractor.

Such an attitude needs to change lest we want more children to fall victim to medical negligence.

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