Asanka Pushpakumara is not just lucky to be alive. The 24-year-old – with the looks and dreams of a football star – is one of an estimated 93,000 Sri Lankans who are alive today because of a joint Sri-Lankan-British project that removed the most hazardous pesticides from the shelves of local hardware stores.
Many millions more young lives could be saved if the intervention were extended globally, said experts from the World Health Organization (WHO) on Monday in a major new report on suicide.
The report says 800,000 people die by suicide each year (one every 40 seconds), and it is the second leading cause of death among people aged between 15 and 29 after road traffic accidents.
Hanging, pesticides and firearms are the most common methods, with an estimated 150,000 occurring each year from pesticide self-poisoning alone.
Mr Pushpakumara is typical of those affected. From a poor rural district in north Sri Lanka, he helps his family grow corn, sesame and soya from a tiny small-holding of no more than an acre.
He works seven days a week but earns little more than 23,000 Rupees (£100) a month, two thirds of which goes on bills.
“I can see the world,” he says gesturing to his phone. “But I’m poor. In the days we farm and in the night we take it in turns to make sure the elephants don't trample the fields. That’s my life.”
The issue of suicide is clouded with myths and one of the most common is that those who are suicidal are determined to die or that it’s always a reasoned and planned act.
In fact, says Professor Michael Eddleston of the University of Edinburgh – the lead researcher on the Sri Lankan project and an expert on suicide – most attempts here and around the world are impulsive and occur in a flash of frustration or anger.
“We know that suicidal impulses are usually short-lived,” said Eddleston. “If the person can be helped to survive this short period of high risk – by restricting the sale of the most lethal toxins – then they usually do not try again”.
For Mr Pushpakumara, that moment came when the girl he was to marry left him because of his poverty.
“She called me to say she was sorry but that she could not stay with me. She said it was because I had nothing. It was then I took a drink [of pesticide] from a cup.”
Since the 1950s, when the Green Revolution brought highly hazardous pesticides into small-scale farming, it is estimated that more than 14 million premature deaths have been linked to pesticide self-poisoning.
Although highly regulated in most of the developed world, lethal pesticides are as easy to purchase as alcohol in much of the developing world, with millions of small rural hardware and agricultural stores stocked with them.
Fact vs fiction | Six myths around suicide and suicidal behaviour
1. 'Banning pesticides will have a serious impact on agricultural production and the livelihood of low-income farmers': Evidence indicates that selective bans on highly hazardous pesticides, along with promotion of suitable alternatives, does not influence crop yield.
2. Only people with mental disorders are suicidal': Suicidal behaviour indicates deep unhappiness but not necessarily mental disorder. Many people living with mental disorders are unaffected by suicidal behaviour – and not all of those who take their own lives have a mental disorder.
3. If someone is determined to die there’s nothing that can be done to prevent it': There is clear research evidence that many suicides are preventable using simple approaches such as recognising a person as being at risk and talking to them, and restricting access to highly lethal methods of suicide to buy time while suicidal feelings pass.
4. Once someone is suicidal, he or she will always remain suicidal': Heightened suicide risk is often short-term and situation-specific. While suicidal thoughts may return, they are not permanent and a person with previously suicidal thoughts and attempts can go on to live a long life.
5. Someone who is suicidal is determined to die': On the contrary, suicidal people are often ambivalent about living or dying. Someone may act impulsively by drinking pesticides, for instance, and die a few days later, even though they would have liked to live. Access to emotional support at the right time, and preventing access to highly lethal methods of suicide, can prevent suicide.
6. You need to be a psychiatrist or health expert to prevent suicide': Government officials have a key role to play by removing or limiting access to the methods that people commonly use to attempt suicide. Anyone can help prevent suicides by looking out for early warning signs in other people and offering them help and by supporting friends, family members, co-workers and community members.
Source: World Health Organization and Food and Agriculture Organization of the United Nations
They are sold in compact bottles for smallholders and cost only a few pounds. Research shows that in the case of suicide, there is a strong link between the purchase of pesticides and alcohol.
“The worst of these pesticides are nearly as dangerous as chemical nerve agents", says Eddleston. “In many countries it remains the case that you can buy them in a local store and keep them on a shelf at home. Imagine being asked to keep a bottle of sarin stored safely under the stairs and that’s what you are dealing with.”
Had Mr Pushpakumara lived in neighbouring India the chances are he would have died as the sale of pesticides is not regulated there. But in Sri Lanka the most toxic pesticides have gradually been removed from the shelves with each wave of regulation resulting in fewer deaths.
Before regulation was brought in, Sri Lanka had one of the world’s highest suicide rates, and pesticides accounted for two-thirds of those deaths. But as the most toxic chemicals have been banned, the country’s suicide rate had dropped from 57 to just 17 per 100,000. There is no evidence of a negative impact on crop yields.
The research, led by Professor Eddleston in conjunction with the Sri Lankan authorities and others, has been instrumental in establishing clear evidence of cause and effect.
This has led to regulatory action being taken in Bangladesh, South Korea and other countries shows a similar impact, prompting the WHO on Monday to call for tighter regulation worldwide.
“The intervention that has the most imminent potential to bring down the number of suicides is restricting access to pesticides that are used for self-poisoning”, it said. “The high toxicity of many pesticides means that such suicide attempts often lead to death, particularly in situations where there is no antidote or where there are no medical facilities nearby.”
Professor Eddleston estimates that about 70,000 Indians living in rural communities die from pesticide suicide each year. “A national effort to remove the most toxic compounds from agriculture would result in a sudden fall in pesticide and likely total suicides within two years of the ban, saving perhaps 50,000 people every year,” he said.
Mr Pushpakumara continues to farm in Sri Lanka. His circumstances have not changed but he now has much greater support from his family and local health care services.
“Perhaps I took my eye of him because he was the oldest,” says his mother. “Now he has our full attention and it’s a pleasure. He has the most beautiful singing voice of the family.”
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