The Medical System and Suicide in Argentina & Honduras
Jhoanny Perez
St. Johns University
When it comes to the way human beings think, act, and react to situations they may differ from individual to individual. They may differ from male to female, from age, from social class and from education. How? You may say? If you are poor, you may live in unsanitary conditions with little control over your situation, and little
ability to change it, due to economic status. This was the situation I observed when I went to Honduras for a ten day public health brigade and a medical health brigade. I was not there as a pre-med student, but in triage, consult, and citologia, I witnessed and observed the common problems that stress and depress the people of Honduras. I equally, visited Buenos Aires, Argentina and Corrientes, Argentina. There, I was able to learn about the system of psychiatric and mental health hospitals and now I am able to compare it to the knowledge I acquired in Honduras. Suicide is the subject that interest me in studying in this project. I know more about it when it comes to Argentina, but the importance of questioning the possible reasons and methods of suicide in Honduras can be and will be enough to form a strong argument.
The Education System in each Country:
When I was in Honduras, in our medical brigade with Global Brigades, one of the doctors gave us a presentation on the system in Honduras. We learned how doctors acquire their training and licensing 1. In Corrientes, BA in the psychiatric hospital, we discussed how students become psychologist. First, in Argentina, one can become a psychologist with an undergraduate education, students have four years of theory
training and on the 5th year they have a practice practicum and after they can work as psychologist, whereas, in the US one must undergo graduate school 2. In Honduras,doctors have to go through four years of medical training for free in public universities. However, they have to take the degree to be reviewed by the top university that holds the board of medical sciences. The board has to agree that each of the classes taken at other universities match their curriculum or are equivalent or else one cannot practice as a medical doctor. Additionally, doctors in Honduras must do social medical work, in other words, service their community for a certain time before getting their licensing 3.
How hospitals and clinics are set up in each country:
In Argentina, psychiatric clinics exist in itself, they have psychiatric hospitals that specialize and are for psychiatry only. However, since the law is changing now and the government is closing the psychiatric hospitals, therefore, more and more general hospitals are calling themselves mental health hospitals. Why is this? This is because they believe now that a patient can have other physical problems in addition to their mental or psychiatric state. The patient is believed to have the right of a holistic approach to treatment. Furthermore, one professional does not have all the answers, but two, three, and four different branches might work together to achieve it 2 . To add, I learned that mental health hospitals in Corrientes, BA have low budgets and low support, therefore, sometimes they are crowded 2.
In Honduras, in the same presentation mentioned earlier in this paper, our doctor explained the availability of hospitals and clinics. I may not have learned much about the psychiatric hospitals, but the information of available resources to rural poor Honduras, was enough for me to analyze their physical and mental states. Our psychology and emotions are often shaped by our environment and what is available to
us, that is important to remember when we touch on Honduras. In Honduras, they have what are called cesamos, cesar's and clipp clinics 2.
Cesamos, are clinics that have medical doctors and odontological centers. People go there to see a doctor or a dentist. Cesar’s, are nursing centers ran by only nursing personnel. People go there when they need to be nursed back to health. Clipp clinics, are clinics placed in the entrance of Honduras and several other communities and are meant to decongest hospitals. People go to clipp clinics for issues that are not
considered emergencies, but need fast care 2. All these clinics, are meant to decongest larger hospitals.
Hospitals in Honduras tend to be very crowded. In the presentation about The Medical System in Argentina, by a Global Brigade doctor, I learned that often babies are placed in a box because they do not have enough beds for them. In other extreme cases, they place two new borns in a box because they lack room and have an excess of new borns 2. From this, we can see how the lack of resources in rural Honduras can deprive ones mental health. Imagine a mother in the middle of giving birth, and not having a room available for her, or a bed for her baby.
( See voice clip attached to my email for the actual presentation which I recorded). In this clip, a psychiatric hospital is mentioned but it doesn't seem that they are common in rural Honduras. Later on, you hear about the privacy and best care of private hospital, but keep in mind this care is not seeked for its high price. Later, we hear the doctor mention the lack of privacy and space in public hospitals 2. Imagine the stress, and the anger people can experience in these situations and how this can affect their mental and emotional being. This kind of information in Honduras even though not specifically about psychiatry, gives me great knowledge of what might constitute to someone’s reason for feeling sad, depressed and low self-esteem when attempting to end their live. But whay might happen if someone does try to end their life?
You may say, when such a situation happens in the US for example, a suicide assessment is made by either a doctor or a social worker. Surprisingly though, suicide seems to be a prohibited word in Argentina according to Dr. Rodriguez in the mental health hospital we visited in Corrientes, Argentina, San Francisco de Asis 1. Our curiosity stroke by the statement made by the director. You never, ever, ever, say the
word suicide or ask did you try to kill yourself, he explained to us. In Argentina, the justification behind this medical policy, is that if a professional mentions the word or asks if he or she attempted suicide, they believe it will give them the idea and in many cases the patient goes Aja! thats what I need to do to end this crisis 1.
Before moving on to suicide, the method, population, and the reasons, lets first examine how the patient in a crisis like this is treated. In Corrientes, as we learned from director of the mental health hospital, cases are treated in a family approach 1. It does not matter what the medical issue is, it can be an alcohol problem, cocaine, marijuana, tobacco addictions, and so on 1.
In Argentina, the family is viewed as responsible for those mentally challenged. The family has to be involved, consequently the family is also viewed as the cause of the situation. Therefore, the cure very often involves the family because the patient benefits from the support of their loved ones. To add, this approach is humanistic and
relational, and it emphasises that a human being is part of a society. Therefore, the family as a part of society has a responsibility towards this human. The patient has this right and the right to education, shelter, nutrition and a dignified life all supported and provided by a family. Interestingly enough, it is worth to mention that patients when it comes to treatment, are treated where they want to be treated. For example, the
hospital director explained that if a patient wants to be seen under a bridge, the doctor must go see that patient under the bridge. Furthermore, the doctor is still responsible for his patient even after he or she leaves the hospital 1.
Similarly to the collective approach in treatment for a patient, a collective approach will be used too for professionals. To further explain, the treatment will be decided and evaluated by a team of professionals from different departments by taking into consideration the patient’s overall health. This is, for a law that was passed ordering the closings of psychiatric hospitals. This law though, will ask hospitals left opened to provide a more humanistic approach to treatment by providing all the resources education, carpentry, cooking, music, painting, nutritionist,
internal medicine, psychiatry, social work and that all come together for the betterment of the patient and the family 1. For Honduras, I did not find any evidence of the approach they use, but in triage and consultation in my medical brigade, I was witness to how the whole family is taken into consideration: their living conditions, their water consumption, and the health of their children and families. Let's now dive into the old trends of killing oneself.
History of Suicide in Argentina & Honduras:
In my immersion in the study of psychology in Argentina, I learned by
Dr. Javier’s mentioning, that ten years ago people would throw themselves into the Parana River or from a high building. Their attempt was one of high intensity because they wanted to make sure their attempt did not fail. This marks the difference between the US and Argentina, in the US people do not succeed as often. In the US, a doctor, worker or psychiatrist is able to mention and ask if the patient was trying to commit suicide and this in part is because in the US it is not something that a patient hears and then goes to do, hence suicide is not as taboo and it is not as common in the US for someone to plan something so prone to succeeding. It is more dramatic in Argentina because it is a definite attempt and a solution to them according to Dr. Rodriguez.
When it comes to the history of Honduras suicide rate, some information exist online. According to Reyes, Americo and Espinoza 1993, in the years 1991- 1992, 52% of suicides were committed by people younger than 30. Prevalence was in the male sex. September and October were the months in which the suicides occurred and the most common means used in those times were hanging and poisoning 3.
Suicide in the present Argentina & Honduras:
We now know that such extreme measures such as diving into the Parana river and hanging oneself were ways in which people committed the act of killing oneself. Moving forward, we now will examine present trends in both countries. When I visited the psychiatric hospital in Corrientes, Argentina Dr. Rodriguez was able to answer two of my questions concerning motives for suicides, most common means and gender rates. According to the director of the mental health hospital, low self-esteem is the most common motive in adolescents. For females their means are pills, and for males their means are weapons like a gun or a knife. The most prevalence seems to be in males 1.
Differences and similarities between Argentina & Honduras:
If we look at both countries, we might see how they have similar things. They both have poor and rural areas where little to none resources are available. Dr. Rodriguez mentioned in his lecture to us, that public hospitals receive less funding, from the presentation about Honduras medical system and hospitals I concluded the same. Hospitals there are crowded and have little space and no privacy.
Differently, in Argentina, there is now one kind of suicide that has become so common, that it now has its own name. They call it political suicide. In one of the conferences we had in Buenos Aires, Dr. Noel explained to us that psychologist in Argentina have more power than in other countries because they are involved in the politics 7. I mention this piece of information because it might be useful in analyzing now how political suicide happens and why. According to Cun Shi, and his article in the New York Times, Juan Duarte, older brother to Eva Peron, the politician, committed suicide in 1953. Similarly, with the same means, a gun, Alberto Nisman, also a politician, who was involved in some scandals ended his own life too. They were both found with
bullets in their heads 4.
Firearms, is the most common method in Argentina, but in second place according to Aidacic et. al, 2008, comes hanging. Recall that in the past hanging and was used in Honduras, but in Argentina it is still used today. 38% suicides in Argentina are due to hanging 5. Consequently, as mentioned earlier, men are more likely to attempt suicide and it is because they use firearms as opposed to females who use pills. But the difference is not there in itself.
The difference is in the willingness to seek help. According to Moscicki 1994, and Canetto & Sakinofsk 1998, gender differences exist in suicides because females more likely to report suicide behavior. Thereafter, females are more likely to treat their depression more successfully than males and they treat their alcohol problems far more than males do 6.
Finally, the medical systems in each country is different. I have outlined here the conditions of the people of Honduras and how that might affect them psychologically for real data in the internet is almost non existent. I have outlined the most common methods and reasons for suicide in each country and information on the differences of gender.
References:
5 Ajdacic-Gross, V., Weiss, M.G., Ring,M., Hepp, U., Bopp, M., Gutzwiller, F., & Rossler, W.(2008). Methods of Suicide: International Suicide Patterns Derived from the WHO Mortality Database. Bulletin of the World Health Organization, 86, 726-732.
6 Canetto, S.S, Sakinofsky, I. (1998). The Paradox in Suicide Gender. Suicide & Life Threatening Behavior, 28, 1-23.
6 Moscicki, E. K.(1994). Gender Differences in Completed and Attempted Suicides. Annals of Epidemiology,4, 152-158.
4 Shi, C. (2015). How Argentina Suicides the Truth. The New York Times. February 10, 2015.http://www.nytimes.com/2015/02/10/opinion/how-argentina-suicides-the-truth.html?_r=0
2 The Medical System in Argentina Presentation. August 5th, 2013. Global Brigades Inc.
1 Hospital de Salud Mental “San Francisco de Asís” Lecture. July 28th,
2015.
7 Visita Academica de Delegacion de St. John’s University. Julio 22, 2015. Prof. Marcelo C. Noel. Pontificia Universidad Catolica Argentina.