Suicide at 14?

Where should the responsibility lie?

There were small reports, barely noticeable, on the city pages of a couple of national dailies a few days back. And almost no follow up since. Tanvir, son of Allah Ditta, resident of Okara, a 14-year-old suffering from cancer, committed suicide by throwing himself from a fourth floor window of the Jinnah Hospital in Lahore. This news has not caused any ripples in the news world or in the policy circles at the provincial level.

One of the reports just mentioned that the head of Jinnah Hospital, has constituted a committee to look into whether there was any negligence on the part of the hospital staff or not. Tanvir had been under treatment at the hospital for the last 10 days. He had attempted to kill himself a day earlier too, but that attempt had been foiled by staff on duty. At 2.45 am on the morning of the incident he was successful. He reached a window and threw himself from it and suffered serious head injuries and succumbed to them at the spot. The administration at Jinnah Hospital also made the point that they had mentioned to the family of the deceased that he had been quite depressed and had attempted to kill himself a day earlier too.

Though the hospital administration took the plea that the child was very depressed at the diagnosis of cancer and the depression was the cause of the act, the newspaper reports also mentioned that though Tanvir had been at the hospital for the last 10 days he had not been getting requisite medicines for the treatment of his cancer and he was also very worried that this would put significant financial pressure on his father and family as well. The reports also said that Allah Ditta, Tanvir’s father, works as a labourer.

The diagnosis of cancer is definitely a grave event. A lot of cancers are still not very amenable to treatments, and even where treatments are available they are expensive and require significant resources of time, energy and money to manage. It would not be surprising at all if over the 10 days that Tanvir was in Jinnah Hospital and would have heard doctors/nurses discuss his case that he might have become depressed. But this should have been anticipated by the medical team. And if he was indeed depressed, as the hospital administration maintains, it should be easy to see what steps, if any, the medical team had taken or were planning to take to address the issue. Just saying that the medical team had conveyed news of Tanvir’s depression to the family is not saying anything at all: the medical team cannot pass on the responsibility of Tanvir’s care, whether he was depressed or not, to the family while he was admitted in the hospital.

But one of the reports also said that Tanvir committed suicide as he was not getting any treatment or medications for his ailment over the 10 days that he had been there. If true, this could cause a depression too. It was also reported that he also felt that his ailment would impose a heavy burden on the family as well. These claims need to be investigated. What sort of cancer did Tanvir have? Could Jinnah Hospital have helped Tanvir? What diagnostic investigations did they do over the 10 days that he was there? If they could have helped him, did they? And if they could not have helped him, did they convey this to Tanvir’s father (as Tanvir was still a minor), and could they have referred Tanvir’s case to any other institution within Lahore? Could Shaukat Khanum have helped Tanvir?

Tanvir had attempted to kill himself a day earlier too but his attempt had been foiled by the staff present at the time. Again, the hospital staff holds that they had conveyed this to the family. But if Tanvir was depressed and had already attempted killing himself once, had the hospital initiated or implemented any protocols to keep an eye on him or to deal with the issue medically? Just letting the family know that their loved one had tried to commit suicide is surely not the only or the right way to deal with the issue.

One of the reports did mention that the Principal of Jinnah Hospital has given instructions to have grills installed on all third and fourth floor windows so that a repeat of such an incident does not take place. This is an administrative way of addressing the issue that ensures that the institution and people working there are not held responsible, especially legally. But surely the responsibility of the hospital and the medical team is much more than that. They have to see whether they had done everything for Tanvir that could have been done and/or if they missed out on things there.

It is hard to imagine the despair that Tanvir must have felt. The decision to end a life and that too by oneself and at the age of 14 does not happen easily. Was it his cancer diagnosis alone that drove him to this decision? Or was it lack of facilities and treatment options and his worries about the financial implications for the family that were factors too. If the latter were also reasons, this needs to be investigated. Public hospitals do offer free or subsidized services to the poor, or so they claim, across Pakistan. If they do why did Tanvir feel that he was not getting treatment?

The news of Tanvir’s suicide will not trigger any major media follow up or any major investigation. The reports from the day showed that everyone was ready to move on by pointing out that Tanvir had cancer, that he was depressed and he had already attempted to end his life once. The implication was that Tanvir himself was responsible for what happened to him. But it is a sad reflection on the state of our health systems: another reminder of where we are as a society and polity. Even the suicides of the poor and the ill are not enough to shake us.

The writer is an Associate Professor of Economics at LUMS (currently on leave) and a Senior Advisor at Open Society Foundation (OSF). He can be reached at [email protected]