Physicians rank high in suicide cases, experts lament

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•Blame rate of crime on govt, poor health institutions, environment
•Suicide not the answer to depression— Religious leaders

Chioma Obinna, Ebun Sessou, Olayinka Latona and Gabriel Olawale

Last Sunday, a young medical doctor, Dr Allwell Oji reportedly committed suicide by jumping into Lagos lagoon on Third Mainland bridge. His body was recovered three days later by the police while investigations are on going as to the cause. Same day, a woman was also said to have attempted suicide by jumping into the lagoon at Maza maza area of Lagos but she was rescued by fishermen who saw what happened. There was another case of a 500 level student of Tai Solarin University College of Education who committed suicide last week. He refused to go for lectures with his friends and when they came back, they saw him dangling, he had committed suicide. Some time ago, there was a story of a very wealthy politician from Epe area of Lagos, Abanikande who also committed suicide by jumping into the river in Lekki after he instructed his driver to stop and park his jeep. Similarly, a young man who boarded a bus from Mainland and was said to be going to Obalende also jumped into the lagoon. He simply told the commercial driver to stop and before the rest of the passengers knew what was happening, the young man had jumped into the lagoon.

Committing suicide is not a new phenomenon, there was a recorded case in the Holy Scripture, the Bible of one of the disciples of Jesus Christ, Judas Iscariot who committed suicide. Down the ages and in all climes, suicide cases abound but it appears to be on the increase these days which is a disturbing trend. What could therefore prompt a man or a woman to take his /her own life?

Psychiatric disorder major cause

Reacting to what could make someone commit suicide, a Consultant Psychiatrist, Irrua Specialist Teaching Hospital, Edo State; Dr. Obagaye Olukunle who said suicide is a deliberate act undertaken by someone with intention of taking his or her own life explained that 80 percent of people who commit suicide have psychiatric diagnosis.

Olukunle who decried that Nigeria has not paid attention to mental health over time explained that psychiatric disorders are the major cause of suicide cases and that a larger percentage of those who committed suicide suffered depression. He said depression is the major cause of suicide among other psychiatric disorders while the remaining percentages are caused by other psychiatric disorders including drug abuse.

“So if there is increase in suicides then there is possibility of increase in psychiatric disorders or decline in the care which psychiatric patients get in the country.”

He maintained that national problems have over-taken other issues so much that no one pays particular attention to mental health issue. He noted that we seem to be having more suicide cases now merely because the Dr Orji’s case took place in the open, adding that if it had happened in the closet, it would not have made such headlines.

“Suicide has always been with us, look at the case of LAUTECH student who hung himself in the hostel. Obayage identified three major causes to include biological, social and physiological.

He further noted that an increase in economic stress can lead to increase in psychiatric disorder among people who are pre-disposed to have psychiatric disorders.

“People who are genetically pre-disposed may not develop it if they do not find themselves in the environment but when they are pre-disposed coupled with economic problem, then there is tendency that they will have psychiatric disorders.

The Consultant Psychiatrist stressed the need for Nigeria to begin to pay attention to causes of suicide. “I am worried at the response from the National Assembly, I expect the National Assembly to summon stakeholders in mental health to discuss ways to improve mental health in the country. People who are suffering from psychiatric disorders, how do they access care, how many people are likely to commit suicide in the next few days, how do will screen them out, we must start paying attention and it needs to start from the top. Government must respond to medical issue of the citizens.”

He urged Nigerians to look out for signs of psychiatric disorders. According to him, “We must know the signs. When there is increased tension in an individual, when people change from the normal person that people used to know in terms of mood, and inter personal relations, then we are supposed to ask what the problem is. It’s ideal to be sad for some moment, but when it persists for more than two weeks there is a problem. If you have people who have not been sleeping well you should pay attention to it before that person breaks down to the point of crying or soliloquizing.”

Lagos based Consultant Psychiatrist, Dr. Ogunnubi Oluseun Peter,

Physicians have been known to rank high in suicide cases. Most doctors are stressed and depressed because of their workload, poor remuneration, family expectation and friends. Also, the rigor of training to become a specialist, examination stress and its high failure rate are enough to frustrate an average doctor. Also, the disappointment that the profession is not as glorious and as comfortable as one has been made to believe while in medical school. Hence, it makes the 6-8 full academic years spent in school and another 6-9yrs of specialization more or less a colossal waste of time. Many doctors are going through a lot but hardly have time to attend to their health. This they continue to manage till the breaking point.

Nigeria as a system has failed its medical doctors. People are migrating everyday out of this country because the environment is very terrible. It’s only in this country that doctors will be massively sacked for demanding for their legitimate wages. It’s only in this country that a non doctor will be grandstanding to have all the assets of doctors and want to be this or that without willing to go through the rigor of medical training.

It’s only in this country that medical doctors will be owed for six months to one year. It’s only in Nigeria that people will finish in medical school and getting housemanship (which is the compulsory one year training after medical school) will be much more difficult than it is for a camel to pass through the needle’s eye. It’s only in this nation that doctors will spend 6-9 years to specialize only to be jobless afterwards as no hospital is willing to employ such if he or she does not have the right connection. It’s only in Nigeria that medical doctors work an average of 28-36 hours per day!

The environment is hostile, frustrating and unproductive for the younger ones, hence the reasons for the recent surge in those that are leaving the shore of this country for a better place.

Unfortunately, those who don’t have the means to do so will continue to cope with the system until they get to the breaking point.

Unfortunately, when they are at this point, there is no adequate provision through a strengthened mental health system to assist them. The government has continued to pay a lip service to the development of the mental health system. Mental health policy has been ignored, mental health bill which should serve as an avenue to provide succour to the emotionally ill by ensuring that certain percentage of the health budget goes into provision of more mental health facilities, counseling centres, suicide prevention units, drug subsidy etc has been lying fallow in the national assembly since 1982/83.

The pressure from some of us as individuals as well as Association of Psychiatrist in Nigeria (APN) for the passage of mental health bill had fallen on deaf ears.

Unfortunately, the  World Health Organization  (WHO) has projected that depression will be the second commonest cause of illness worldwide come 2020. This means it will be far ahead of cancer, stroke, HIV/AIDS etc.

The world is moving towards incorporating psychological care into all facets of care rather than the usual dogmatic focus on physical care, failure of which we may have more deaths in our hands. Most Nigerian doctors are practicing abroad because we pay lip services to issues of psychological illness, stigmatization and attribute it to either personal weakness, evil spirit or payment for one’s sins.

Consultant Psychiatrist, Federal Neuropsychiatric Hospital, Yaba, Lagos, Dr. Adegbohun Abosede

I would like to divide this into two major factors: work related factors and personal factors. The challenges of practicing medicine in Nigeria are enormous. Most doctors’ view of what life would be after studying medicine is far from today’s reality. To say the work is huge and stressful is an understatement; more importantly for a doctor working in most of the ill equipped hospitals we have in this country. So, witnessing avoidable deaths can be a major stress for a doctor. By the virtue of our training, we know a lot can be done for a patient, but one is caught in a situation of not being able to help because of lack of infrastructure or basic hospital needs such as oxygen, and this could later predispose the doctor to develop depression or commit suicide.

The work load is huge; a doctor gets to do more than ideal on a daily basis. Some doctors attend to 120 to 150 patients daily as against the standard practice of about ten in some countries. The work environment is not too conducive for a more thorough work to be done because of the factors earlier mentioned. They are tired and may suffer all sorts of humiliation in the course of carrying out their duties.

The level of job satisfaction is quite low and the quality of services rendered is sometimes not as expected as a result of poorly equipped facilities. As we speak, some doctors are being owed five month’s salary and can’t even fend for their families nor take care of themselves.

The demand from some others is quite high. Doctors are viewed as ‘super humans’, even when ill, so far they can still talk, others would continue to make demands of them.

It could also be due to personal factors in the doctor: A doctor is like any other human being, he may be faced with life challenges that could tip him to depression. The country is presently in recession and this could tip people to commit suicide. He may also view life as being unfair to him after the rigors of medical education and as such resort to end it all.

He or she may be suffering from chronic medical illnesses such as cancer and may resort to suicide as a result of this. It may also be that the doctor has depression which got complicated with suicide. Those with some psychotic illnesses may also commit suicide in the course of their illness.

Any of the factors listed above or combination of any may predispose a doctor to commit suicide. All hands must be on deck to make sure the physician is well.

Physicians who are experiencing high level of depression should be encouraged to seek help. Those who sought help should not be stigmatized. There should be awareness on suicide among physicians, society and the government.

The issue of suicide is not limited to this environment alone, even in abroad you find out that physicians have high level of suicide and they use several means to carry out such act because they have access to series of drugs in which they knew how to use but such issues are under reported.

There is need for high level awareness among communities, depressed people should be encourage to seek help like every other normal person.

Dr. Ajayi Bolanle, Chairman Association of Resident Doctors, Federal Neuro Psychiatric Hospital, Yaba

There are several issues that lead to such action, but stress is the number one thing that can make a doctor or even anybody break down. It’s a known fact that medical profession can be stressful due to workload. Several studies have shown that doctors have high tendencies of breaking down which are objective studies that have proven that doctors have possibility of coming down with a psychiatric illness. Some doctors could have a genetic history of psychiatric illness which is actually weighty. Someone who has a genetic history may come down with it later in life especially when exposed to stress.

Again, we know that there is economic recession and the stress in the country, coping mechanism for stress in the country is poor, some people cannot cope well. We all have different body chemistry so some people are coming down with depressive illness because of the economy status, unemployment, nothing to do, carrying burden of family. So a lot of people are coming down with depression now.

Dr. Oladipo Ishola, University of Benin Teaching Hospital, UBTH

The comatose situation of the country’s health sector such as incessant strikes, decaying infrastructure which made doctors look incompetent when materials to render some basic services at the hospital are not available and the patient eventually died, at night you will have to cope with the trauma.

Doctors are one of the groups of professionals that are mostly exposed to poverty and the helplessness of the common man in our society, and when you care for another human being, their problems become your problem as well, hence you share in their laughter, sorrow or frustrations.

It become worse when you see your colleagues who travelled overseas faring far better despite your waning patriotic zeal that Nigeria will be better.

But the worst of it all is professional rivalry, when the people around you do not want you to succeed. Patients should also learn to appreciate their doctor. This is the sole joy of a Doctor that no one can take from them. Their service to humanity shouldn’t only be rewarded in heaven but a simple thank you can go a long way to making a doctor’s day. These are the worst of times to be sick in Nigeria and it’s also the worst of times for health personnel. I know so many who are without a job and are struggling to survive. Even those with a job are living from hand to mouth.

A member, Lagos State House of Assembly, Abiodun Tobun, said “the truth is that, there is tension in the land and it seems people feel there is no more hope and when you look at them, you wonder why a man should kill himself. The husband of one of my younger sisters committed suicide because he owed his company one million naira. His company wanted him to pay the money but he could not so he committed suicide. That is to tell you how bad the situation in the country is.

A lecturer in Yoruba language in the department of African Languages and Asian Studies, University of Lagos, Mr. Deji Medibu, believed the medical doctor’s action could have emanated from curse(s) place on him for whatever reason.

In his own view, a traditional leader in Abule-Onipanu community in Ibeju-Lekki, Lagos argued that

“it was not natural, it has spiritual explanation. For those who were poor and frustrated, it is understandable but what can we say about those who were rich. It is just to tell you that, there is evil power, I pray that God will deliver us from the evil people. The doctor in question could have offended those who decided not to forgive him. They promised to punish him and they did. Another reason is that, the doctor could have done some evil to some people in the past and later backfired on him”.

Religious clerics speak

Most suicide cases are not spiritual — Ahmad

The Chief Missioner of Ansar-ud-Deen Society of Nigeria Sheikh Abdur-Rahman Olanrewaju Ahmad in his opinion described those who commit suicide as worst criminals explaining that God gave life to man as ‘trust’ hence man has no right to take his or her life.

In his words: “Before anybody could get depressed there must be signs that things are not well with him or her. There would probably be a change in his social habit, maybe such person has marital problem or a lot of debt hanging on his neck, silent medical ailment or such person has been betrayed by a close friend. But the Islamic system is structured in a way that we pray five times daily and it is the responsibility of the congregation to ask after anyone who has not been consistent to find out what is wrong with him or her. However, depression is a psychiatric problem, it is not necessarily madness and clerics do not have the expertse to single handedly on their own handle the problem of depression but in our own case we have a referral system in areas outside our expertise. Nigerians believe that everything is spiritual and they go to their Imams and Pastors before they go to hospital, some religious leaders even tell their congregations not to use medication but in our own case we believe that if someone gets to the stage of depression or there is likelihood that the person is heading towards depression, we do referral and we have referred people to Neuro-Psychiatric Hospital in Yaba and to hospitals for health related case.

“It is unfortunate that the rate of suicide increases in Nigeria in spite of the fact that Nigerians are very resilient set of people, it is strange now hearing of people committing suicide, Nigerians don’t take their lives, we love life and hate death either as Muslim, Christian or whosoever, the larger percentage of our daily prayer is against misfortune and death. For people to now take their own life voluntarily then we are dealing with a lot of negative transformation in our society. Sometimes, it has to do with internet exposure for the younger ones because they read and see it happening in the western world”

“For religious leaders, these are the things that we look out for, we should involve in special counseling before it gets to the stage of depression for people to know and believe that nothing is beyond the power of their creator and all problems can be solved. If it is medical problem, it can be solved or whatever case it may be. There is an adage that says if there is life, there is hope. It is unfortunate that most people are going hopeless maybe because of the economy but I tell you that one of the greatest sins in Islam is to take one’s life because this is a life that doesn’t belong to you, no matter what the problem is, life is given to us as trust, the owner of life is the only one who has right to take it when He wills. Suicide, whether as individual suicide or those who are suicide bombers, they are the worst criminals, they do not only kill themselves but also kill other, Islam condemns suicide and it is not acceptable. The Society must come together and find out why people increasingly resort to suicide and there should be collaboration between psychiatric experts and religious leaders. The referral system should be strengthened so that as soon as religious leaders see the sign of depression, such person will be referred to health experts. We know that prayers are efficacious but when there is need to take very proactive measures medically, we should not substitute it with prayers”

Suicide not answer to man’s problems —Bishop Sola Ore

Chairman, Lagos State Chapter of Pentecostal Fellowship of Nigeria, PFN, Bishop Sola Ore said

“various reasons could be responsible though some people talk about recession but I think that is not the major issue. From the cleric perspective, I will say failure to know who you are in the Lord and to believe that God is still in charge of your life can lead one to take some wrong steps. Although things are hard and terrible, there could be domestic problems or emotional trauma but that should not lead to taking one’s life. Almost everybody is prone to suicide but it depends on how one manages depression. I have gone through depression before, every human being no matter who you are, can be depressed but it depends on who speaks to you during your depressed mood.

“As a nation, we should believe that our best is yet to come, God is in control and suicide is not the answer. There is an adage that says if one is not yet dead, there is still hope and that means that there is still hope for someone who is still alive than the dead. What is bad today could be the best tomorrow

There is need for people to guard their thought, if you dwell on the negative, you get negative result. We should stop comparing ourself with others, move closer to God, believe that things will get better for us and realize that there are some people whom we are better off out there.

Allah is against suicideê —Akorede

Chief Imam of Akure, Sheikh Yayi Akorede on his part argued that, “it is a great offence before Almighty God for someone to commit suicide because whatever condition you find yourself, one should accept that everything is known to the Almighty God and you cannot use your own imagination. Allah (SAW), said in the Holy Q’uran that one must not kill oneself either because of poverty or for any reason, and thinking that committing suicide is the solution to one’s problem is a great sin”

It is unfortunate that we are experiencing high rate of suicide in Nigeria, although the current recession we are passing through in Nigeria and the world at large is causing lot of trauma to most people but that is not an excuse for one to commit suicide. It is painful that a very promising young medical doctor could just end his life by jumping into the lagoon

“I will encourage that we speak positive things into our life, if we profess negative it will come to pass later in life. We should always pray for ourselves, family and the nation even though we are in a very terrible condition, Almighty God knows how to intervene and change it for better. But if we continue to curse ourselves or leaders, such curse will reflect later in the future. Some might say it is the work of evil ones but I believe if one is closer to God, God’s power is superior to all forces of darkness.

Nigerians should endure—Apostle Bamgbola

Chairman, Lagos chapter of Christian Association of Nigeria (CAN) Apostle Alexander Bamgbola however counseled that “Nigerians should endure the hard times, challenges or trials that come our way. Time changes because God changes time and seasons, and when we do not like the times we are, we should pray to God to help, uphold us and help us to endure because there is always a change ahead. No matter how bad the situation maybe today tomorrow will surely be another day. The Bible says ‘Weeping may endure for a night but joy cometh in the morning’.

“I will encourage every Nigerians to hold on to God, as Christians, we know that anyone who commits suicide is heading to hell, so why would a man choose to commit suicide? No matter the pressure on him, if it is about the economy, we are all in it together, we should pray to God and He will change the time for good for us in Nigeria. We are still better off than some other countries but we still have hope.

“The young man who committed suicide made a choice although a very wrong choice because every choice has consequences. He could have been going through some psychological challenges but that is not enough for one to take his or her life. I pray that God will continue to uphold us in His right arm of righteousness to endure and pray that the Lord will change our times”.

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