Last week, a 24-year-old woman from Kathmandu was rushed to Tribhuvan University Teaching Hospital for treatment of a drug overdose. The woman had consumed multiple tablets with the intent to end her life, and it was her second attempt to kill herself.

“We advised the right treatment to doctors attending the patient and also closely monitored her,” said Dr Apeksha Bista, a specialist in the Poison Information Center. “Along with treatment, several tests were carried out to assess the impact on her vital organs. The woman survived, and we referred her for psychiatric care.”

This was among the 284 cases where the Poison Information Center either directly supervised or provided treatment advice in the last one year. The centre’s assistance has saved lives, not only in big city hospitals but also in far-flung health facilities across the country. However, the country’s only poison information centre, which started a year ago, is now on the verge of closure due to a shortage of funds.

“This project, which was initiated with financial and technical support from Brown Emergency Medicine and logistic support from ASK Foundation, as a pilot initiative is nearing completion,” said Dr Dinesh Kafley, executive director at the Tribhuvan University Teaching Hospital. “ This is the only centre in the country that has been helping health workers in saving lives. Without resources, we are not in a position to continue the centre.”

Studies show pesticide ingestion is the second major cause of suicide in Nepal, after hanging. Among those who consume pesticides, 95 percent ingest insecticides like aluminium phosphide, organophosphorus, and aluminium and zinc phosphide, among others. Despite the authorities banning dichlorvos and the removing the most toxic formulations of aluminium phosphide from sale years ago, suicide by pesticide ingestion has not declined.

In the last fiscal year, 7,223 people in Nepal ended their lives, according to the Nepal Police data.

“Just a few days ago, a doctor from Sankhusabha district sought help for the treatment of a 17-year-old girl who had ingested cypermethrin, an insecticide,” said Dr Rakesh Ghimire, coordinator of the Poison Information Centre. “We not only provided treatment guidance but followed up twice. The patient fully recovered and has been discharged from the hospital.”

Experts say deaths due to pesticide poisoning can be reduced if poisoning cases are managed optimally. Health workers, including doctors, can call the Poison Information Centre hotline at 01 4502011 for treatment assistance.

“Many healthworkers have already sought help,” said Ghimire. “Those who do not know or have not reached out could also call for expert advice. Doctors at the centre will provide the latest data and information on antidotes for treating poisoning.”  

Doctors at the centre say besides intentional suicide attempts, cases of accidental drug overdose, ingestion of mosquito repellent, toilet cleaner, nutmeg (spice), toothpaste, and mushroom poisoning are frequently reported to them.

According to doctors, most patients get cured if they are taken to the hospital on time, as physicians know the proper antidotes for poisons. They say that with detailed knowledge of toxicology, which overlaps biology, chemistry, pharmacology, and medicine, is not extensively taught in Nepal’s medical schools. Toxicology studies the adverse effects of chemicals on living organisms and their diagnosis and treatment.

Experts also point out that seeking support helps patients’ relatives financially, as they do not have to rush mild cases to big hospitals and hire an ambulance.

Dr. Ramu Kharel, an Assistant Professor of Emergency Medicine at Brown University in the USA, who led this collaboration for a poison information centre in Nepal reflected on the journey and called for future support.

“This project began as a pilot to assess the feasibility of establishing the first institutional poison information center in Nepal, and we are proud to say that we have demonstrated that this is indeed feasible, ” said Kharel. “For continued sustainability of this programme, the Nepali government must take the lessons we have learned together and support this centre through funding.”

He also said that along with finding ways to support service, concerned agencies also support Nepali doctors to get international opportunities to get trained in medical toxicology. Creating trained human resources in medical toxicology will provide the ultimate benefit for future sustainability of improved poisoning care in the country.