Suicide attempts through drug overdose are putting pressure on critical care facilities at East London’s Frere Hospital, according to the latest South African Medical Journal.
The report, written by a former intern at Frere, said there were 380 suicide attempts in one year, and the numbers were overloading the hospital’s intensive care and high-care units.
Frere CEO Dr Rolene Wagner said that although the total number of drug-overdose suicide attempts had increased since the study, fewer were being admitted to the critical care units.
In her article, Kirsten Rowe, now doing community service at Galeshewe Day Hospital in Kimberley, describes a study done of the critical care units (including ICU and high care) in the year from March 2014 to February last year.
Rowe writes that of the 380 patients, 71 were admitted to the CCU (critical care units) for overdose and 7.7% of these patients spent time in the ICU.
Given that there are only 16 beds available at both facilities at any one time, this places huge pressure on the units.
The study found that the total number of overdose patients seen in casualty over the course of the year was 352, with an of 29 patients per month.
“There were peaks noted in December (40 patients) and October (36 patients) – the same two months when male suicides peaked in South Africa in 2009. Overdose patients accounted for 6.8% of all patients seen by the physician on call in casualty throughout the year,” she wrote.
Recent statistics from the South African Anxiety and Depression Group showed that 23 citizens succeed in committing suicide every day and 230 attempt it. There were no separate figures for the Eastern Cape.
Most of those admitted were young girls and women.
“Females were found to peak in the 13- to 19-year and 20- to 29-year age groups. Males peaked in the 20- to 29-year age group. Both sexes saw an early peak followed by a slow decline until the 60- to 69-year-old age group.”
The study found that “the two most common categories of substance ingested were tricyclic antidepressants at 29.8% and cholinesterase inhibitors or organophosphates at 22.8%”.
Organophosphate refers to pesticides such as rat poison and cockroach poison; tricyclic tablets are depression drugs often prescribed to treat chronic pain as well.
Talking to the Daily Dispatch, Wagner said although suicide attempts admitted to casualty had increased last year, the number admitted to high care had decreased dramatically.
“Last year we had a total of 1248 patients through our adult ICU as well as our high care units. Of these, there were a total of 41 para-suicide patients – that is someone who has attempted suicide and survived. A suicide patient is one who has died,” she said.
Nozibele Ntshinga, assistant manager in the critical care unit at the hospital, said Wagner’s figures covered March last year to date, the year following the one in the study.
“Of those 41, ICU admitted a total of 22 para-suicides. From that 22, nine were organophosphate poisoning aged between 18 and 49. These were both male and female,” she said.
Ntshinga said 13 – five males and eight females aged between 18 and 47 – had taken an overdose of a tricyclic drug.
In that period two died in ICU, one female from organophosphate poisoning and one male from a tricyclic overdose.
Wagner said: “If you look at it, 3.3% of all ICU admissions were related to para-suicide. We don’t think it’s an overwhelming number; it’s just that it’s a statistic that makes you notice it because it’s a public health issue.”
Rowe writes that in the year of the study, 28 patients had been admitted to ICU for overdose – an average of two patients a month.
“These patients accounted for 5.6% of all ICU admissions, and a quarter of all medical ICU admissions,” she wrote.
A similar study carried out at Cecilia Makiwane Hospital (CMH) 10 years ago yielded similar results, she said.
Wagner said anyone who attempted suicide was not in a healthy mental state.
“There are acute situations that lead to the event, or there could be an underlying chronic situation that led to that event. The acute situation is often a traumatic incident where the person can’t cope and so they take the action of trying to take their life.
“Often people think of a para-suicide as someone asking for help, but I don’t like to think of it as attention-seeking, I always try to take it as someone who has attempted to take their life but failed, fortunately failed,” she said.
Anda Magengelele, a social worker based at the hospital, deals with most of the para-suicide cases.
She said when it came to youths, they were aged between 15 and 21 and were predominantly girls.
She said they offered various reasons. Sometimes it was a means of manipulation; however, some said they were bullied at school or had boyfriend-related issues. Being affected by social media and poor parenting were other reasons.
“With adults it’s both male and female and most of the issues are around debt, marital problems, infidelity, family problems in general, sibling rivalry and work-related issues,” Magengelele said. Other issues included a diagnosis of HIV.
Dr Anjali Vaidya, a clinical manager at the critical care unit, said the majority of para-suicide patients who came into ICU were as a result of ingesting substances.
She said one of those was an insecticide used in farming called Amitraz. “It’s quite new. We’ve had a few Amitraz poisoning cases…they can’t breathe and that’s how they tend to die, but if they come to us soon enough…we’ve had 100% success with Amitraz,” she said.
Ntshinga said with other medications, a patient’s kidneys were affected.
Wagner said the unit had good success rates when it came to stabilising patients. Patients stay roughly three days before being transferred to another ward.
Ntshinga said: “Those who are admitted to ICU won’t have just taken , there will be alcohol as well. Those ones, they come in a bad shape, they are critical when they come in.”
Vaidya said some patients come in with what appears to be poisoning and, upon investigation, they learn the patient has ingested something they received from a sangoma. These patients were not included in the figures.
“We had one patient last year who went to a sangoma and was given something to drink, and it turned out to be organophosphate – he’s one of the patients who died. So it comes from sangomas as well, people go for help and are inadvertently given something that kills them.
“We’ve also had a few admissions with unintended poisoning,” Vaidya said, where some people did not know the effects of what they were taking. — vuyiswav@dispatch.co.za
Suicide bids place burden on hospital
The report, written by a former intern at Frere, said there were 380 suicide attempts in one year, and the numbers were overloading the hospital’s intensive care and high-care units.
Frere CEO Dr Rolene Wagner said that although the total number of drug-overdose suicide attempts had increased since the study, fewer were being admitted to the critical care units.
In her article, Kirsten Rowe, now doing community service at Galeshewe Day Hospital in Kimberley, describes a study done of the critical care units (including ICU and high care) in the year from March 2014 to February last year.
Rowe writes that of the 380 patients, 71 were admitted to the CCU (critical care units) for overdose and 7.7% of these patients spent time in the ICU.
Given that there are only 16 beds available at both facilities at any one time, this places huge pressure on the units.
The study found that the total number of overdose patients seen in casualty over the course of the year was 352, with an of 29 patients per month.
“There were peaks noted in December (40 patients) and October (36 patients) – the same two months when male suicides peaked in South Africa in 2009. Overdose patients accounted for 6.8% of all patients seen by the physician on call in casualty throughout the year,” she wrote.
Recent statistics from the South African Anxiety and Depression Group showed that 23 citizens succeed in committing suicide every day and 230 attempt it. There were no separate figures for the Eastern Cape.
Most of those admitted were young girls and women.
“Females were found to peak in the 13- to 19-year and 20- to 29-year age groups. Males peaked in the 20- to 29-year age group. Both sexes saw an early peak followed by a slow decline until the 60- to 69-year-old age group.”
The study found that “the two most common categories of substance ingested were tricyclic antidepressants at 29.8% and cholinesterase inhibitors or organophosphates at 22.8%”.
Organophosphate refers to pesticides such as rat poison and cockroach poison; tricyclic tablets are depression drugs often prescribed to treat chronic pain as well.
Talking to the Daily Dispatch, Wagner said although suicide attempts admitted to casualty had increased last year, the number admitted to high care had decreased dramatically.
“Last year we had a total of 1248 patients through our adult ICU as well as our high care units. Of these, there were a total of 41 para-suicide patients – that is someone who has attempted suicide and survived. A suicide patient is one who has died,” she said.
Nozibele Ntshinga, assistant manager in the critical care unit at the hospital, said Wagner’s figures covered March last year to date, the year following the one in the study.
“Of those 41, ICU admitted a total of 22 para-suicides. From that 22, nine were organophosphate poisoning aged between 18 and 49. These were both male and female,” she said.
Ntshinga said 13 – five males and eight females aged between 18 and 47 – had taken an overdose of a tricyclic drug.
In that period two died in ICU, one female from organophosphate poisoning and one male from a tricyclic overdose.
Wagner said: “If you look at it, 3.3% of all ICU admissions were related to para-suicide. We don’t think it’s an overwhelming number; it’s just that it’s a statistic that makes you notice it because it’s a public health issue.”
Rowe writes that in the year of the study, 28 patients had been admitted to ICU for overdose – an average of two patients a month.
“These patients accounted for 5.6% of all ICU admissions, and a quarter of all medical ICU admissions,” she wrote.
A similar study carried out at Cecilia Makiwane Hospital (CMH) 10 years ago yielded similar results, she said.
Wagner said anyone who attempted suicide was not in a healthy mental state.
“There are acute situations that lead to the event, or there could be an underlying chronic situation that led to that event. The acute situation is often a traumatic incident where the person can’t cope and so they take the action of trying to take their life.
“Often people think of a para-suicide as someone asking for help, but I don’t like to think of it as attention-seeking, I always try to take it as someone who has attempted to take their life but failed, fortunately failed,” she said.
Anda Magengelele, a social worker based at the hospital, deals with most of the para-suicide cases.
She said when it came to youths, they were aged between 15 and 21 and were predominantly girls.
She said they offered various reasons. Sometimes it was a means of manipulation; however, some said they were bullied at school or had boyfriend-related issues. Being affected by social media and poor parenting were other reasons.
“With adults it’s both male and female and most of the issues are around debt, marital problems, infidelity, family problems in general, sibling rivalry and work-related issues,” Magengelele said. Other issues included a diagnosis of HIV.
Dr Anjali Vaidya, a clinical manager at the critical care unit, said the majority of para-suicide patients who came into ICU were as a result of ingesting substances.
She said one of those was an insecticide used in farming called Amitraz. “It’s quite new. We’ve had a few Amitraz poisoning cases…they can’t breathe and that’s how they tend to die, but if they come to us soon enough…we’ve had 100% success with Amitraz,” she said.
Ntshinga said with other medications, a patient’s kidneys were affected.
Wagner said the unit had good success rates when it came to stabilising patients. Patients stay roughly three days before being transferred to another ward.
Ntshinga said: “Those who are admitted to ICU won’t have just taken , there will be alcohol as well. Those ones, they come in a bad shape, they are critical when they come in.”
Vaidya said some patients come in with what appears to be poisoning and, upon investigation, they learn the patient has ingested something they received from a sangoma. These patients were not included in the figures.
“We had one patient last year who went to a sangoma and was given something to drink, and it turned out to be organophosphate – he’s one of the patients who died. So it comes from sangomas as well, people go for help and are inadvertently given something that kills them.
“We’ve also had a few admissions with unintended poisoning,” Vaidya said, where some people did not know the effects of what they were taking. — vuyiswav@dispatch.co.za
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