We have been in Karnataka for more than three weeks now, and we fly home after the weekend. Dr Tony Ryan has joined us, bringing his usual energy and drive. We are struggling to find time to hold all of the meetings and visits that we need, which seems ridiculous in the context of such an extended stay. If anything we are even busier now than we were at the beginning.
The world literature shows that, overall, suicide is a behaviour that has deep roots in social conditions. In the UK, the suicide rate is strongly influenced by the level of male unemployment. Access to lethal methods is a significant factor. In the 1960s, the replacement of toxic coal gas with biologically inactive ‘natural’ gas in UK homes was associated with a reduction in the death rate from suicide. Two equivalent factors in South India are economic stress on small farmers, and the ubiquitous availability of undiluted organophosphate pesticides in rural areas.
Climate change is a pressing issue here. There is a pattern of extended drought, which has reduced the availability of water for agriculture. Running water is rationed, both for domestic and agricultural use. In some areas, there is insufficient water to provide irrigation for all the harvests that the climate allows. During this visit, heavy rain has fallen at the wrong time, with a negative impact on agricultural yield. Food prices have escalated substantially, including staples such as onions and tomatoes. The consequent financial pressure on farmers drives them to moneylenders, just as people in the UK turn to payday loan companies. We live in a global community. Suicide in India is directly influenced by global warming, itself driven by profligate use of fossil fuel in industry across the world. The contradictions within the world economic system impact most heavily on the most vulnerable everywhere.
The trouble with framing problems in a global context is that it can make the task of changing things feel impossible. As someone who is lucky enough to go to different parts of the world to see social and health intervention close up, it makes me feel more hopeful to see the progress that is made in India in the face of huge problems. Back in the UK, austerity economics and marketization of health and social care are sweeping away some of the progress that has been made in mental health during my long career. Here in India, projects with humble local beginnings can grow into large, population level initiatives. Intervention has to operate at the local community, secondary care, public health and policy levels simultaneously. Processes have to be sustained over long periods of time. It is very satisfying to be part of these continuing processes, but the experience also offers new ideas and directions forward for us in the UK. Some of our colleagues in Mysuru have set up their own NGO called FRAMe, which is as yet a green shoot development. It is a pointer to a better future.
This week our Indian partners ran the first of a series of training sessions for general hospital doctors on suicide prevention. I am pleased to say that broadly speaking, it worked. We have all learnt from the experience, and we are making some changes, but the curriculum and educational methods were a success. The general hospital doctors were enthusiastic, and they engaged well in educational techniques that are unusual in an Indian setting. As one of the participants said, self-harm is an important subject because it is highly prevalent and it touches everyone’s life.
Colleagues from Edge Hill University are working with our Indian partners on a parallel Tropical Heath Education Trust programme with nurses. You can view an excellent video about that programme here. The pattern of co-ordinated but separate projects is an important element in making limited resources work to maximum and sustainable effect.
I described our visit to Bandipur last week, including the recording of some music and a (sort of) encounter with a tiger. That day a tiger, which might have been the same one, mauled a villager, and a few days after that another villager was killed. The animal was located and slain amid some controversy . These events made us feel sad from a number of different points of view. The paradox of the shooting of the tiger in the name of conservation somehow symbolises the moral and practical dilemmas that we all face in trying to tackle global problems in the 21st century; truly the Bandipur blues again. Here is another blues recorded in the forest. It is a traditional gospel blues made famous by Son House. Naturally enough, I present it for its social meaning, not its manifest content.