Dr Suresh Thapaliya, Kathmandu
Winter 2014. New Delhi. I was trying to retrieve a file from an old cupboard in my department’s OPD for referencing the management of a case. I pulled out a file thinking it was the one I was looking for. But I had gotten the wrong one. The file in my hands was three years old. Miss A – read the name of the patient!
It appeared to me that she was of Nepali origin. Out of curiosity, I thought of having a brief glance at the case history. She was a girl from Kathmandu in her mid-twenties, currently pursuing MBBS at a private medical college in Nepal, referred to the department of psychiatry at my institute in New Delhi, possibly on request of the family members. The subsequent pages discussed the history of her presenting illness. She had presented with depression, impulsivity, self-harm and suicidal thoughts with a diagnosis of Borderline Personality Disorder. There were no further follow up notes. She had possibly visited our OPD only once. As months passed by, I would think about her at times. I had to imagine her face as I had never met her. A girl of Newari ethnic origin trying her best to smile, struggling to become a medical doctor. Every time I thought of her, I would repeatedly ask myself – “Did she come out of it to finally become a practising doctor?”’
Winter 2015. I was talking to my friends from Nepal who were in Delhi for personal reasons. As we discussed about mental health issues in Nepal, it came to my mind that they belonged to the same medical college where the girl was doing her MBBS. I happened to ask – “‘Do you know Miss A.? I have been thinking about this girl for a year now. I happened to come across her file at my OPD one day.”’ It would be breach of confidentiality but I couldn’t stop myself as I wanted to know how she was doing at present?
“Are you talking about didi (sister)? Yes, she was at our college, two years senior to us,” one of them said to me.
“Is she fine now? What is she doing?”- I got curious.
“Sad but true. She took her own life.”
“What!?” I was shocked. “Do you know anything more? Did she make it to the internship?”
“Yes she was about to complete her internship. She was good to her juniors but we heard that she was troubled. We don’t know much about the details.”
Knowing that she had ended her life, I felt very bad. She had possibly come all the way to Delhi with her parents, possibly with a hope that he would come out of her mental agony some day. I felt very sorry for the doctor who couldn’t live to start her own practice. The doctor who killed herself!
She was just one of the many Nepalese women who take their own lives. Suicide among women is a hidden problem in Nepal, relatively neglected due to stigma. Like in many South Asian countries, there is hardly any initiative from the government. There is no national suicide prevention program or even a helpline from the government. Unfortunately, recent reports show that suicide is the leading cause of death among women aged 15 to 45 years old. No research data is available to ascertain reason for the same though easy vulnerability to various psychosocial stressors and stigma leading to inadequate mental health service could be possible reasons. The suicide victims in the last few years range from a twelve year old young girl to middle aged women working in the middle East.
During my conversations with friends in Nepal, I have come to know that suicide by medical students and doctors is very common in some medical institutes. A complete research based information is not yet available but inability to cope with stressful situations leading to depression, failure to meet high expectations, pre-existing mental disorders and drug use, lack of support system away from home, all might be contributing in a myriad of ways, resulting in such unfortunate incidents. I continue to wonder if there is any structured support system to offer help to these medical students and doctors in crises. My understanding is that we cannot be merely satisfied with a full-fledged department of Psychiatry functioning in the hospital. We need to build a strong support system to offer hope to them.
September 10 is World Suicide Prevention Day. This year’s slogan was ‘connect, communicate and care’. Let us give some time to ponder over this issue. Let us show our respect to the departed ones.