A number of persons recently reached out to me asking my support for banning gramoxone. In the call for banning gramoxone, the target is the banning of paraquat. The reason is that this chemical is the most frequently-used weapon for deaths caused by suicide. While, most of these advocates call for banning gramoxone, the active ingredient is paraquat which is often sold as gramoxone, superzone, herbixone, farmixone etc. In my previous capacity as Minister of Health and Minister of Agriculture in Guyana, I frequently spoke, both in and out of Guyana, of the need for strict regulation of paraquat.
I first spoke about paraquat in 1973, as a young school teacher, at a time when paraquat-induced suicide deaths happened far too often in the communities where I grew up, played and worked. As a young teacher in 1973, suicide took the lives of at least three young people around me. During my terms as Minister of Health and then as the Minister of Agriculture and during the times I served at the World Health Organization and the Pan American Health Organization, my position remained what my position was in 1973, as a then idealist young teacher.
My position is that we must strictly regulate the procurement, storage and use of paraquat. Paraquat should not be sold or bought by just anyone. Laws must restrict who can sell and buy these chemicals. Government has responsibility to ensure awareness and education for the safe storage and use of these chemicals. My position has never been the ban of paraquat. If you ban this product, there is still need for another chemical that must be at least as effective an agricultural pesticide as paraquat. Banning of one pesticide can just result in other pesticides becoming suicidal weapons since there are many other pesticides used in agriculture that are far more toxic than paraquat. Paraquat is a major weapon in suicide not only because of its toxicity, but also because paraquat is available and easily accessible to people. It is for this reason that I have always advocated strict rules governing procurement, storage and use of paraquat or any other agricultural pesticide as part of the strategy to prevent suicide.
When the PPP government established the Pesticides and Toxic Chemicals (Control) Board, one of the reasons was that there needed to be tighter control of what chemicals entered Guyana, who could use them, when they could use them, how they must be stored etc. Safety was a prime reason for the establishment of the Board. But we were acutely aware then that the inappropriate use of these chemicals in the suicide pathway must be taken into account.
In the latest move, the Government of Guyana in 2016 listed paraquat (in all its forms) as a restricted chemical. This means that people can only procure paraquat with the use of identification cards. Previously, rules were made that restricted who could import paraquat into Guyana and rules were enforced where paraquat sales were restricted to registered sale points. We have to continue to make these rules stricter and vigorously enforce them. In spite of rules of who could import and sell paraquat, there are still many sale points that are not registered, contributing to the illegal trafficking of paraquat.
When I was Minister, both at health and at agriculture, we introduced several initiatives as part of a strategy for the safe procurement, storage and use at the local level. These included the following:
The Ministry of Health became engaged in the awareness and education programmes promoting the effective and safe use of toxic chemicals. It became a major public health initiative. This initiative has essentially come to an end and for several years now I have been painfully disappointed that the Ministry of Health has become a non-player in this area.
The Ministry of Health partnered with the Ministry of Agriculture in promoting the safe procurement, storage and use of toxic chemicals. Together, we created a vibrant public-private partnership. Several of the major importers worked with us and developed community awareness and education programmes, TV and radio programmes. NAREI (National Agricultural Research and Extension Institute), GRDB (Guyana Rice Development Board), the PTCCB (Pesticides and Toxic Chemicals (Control) Board) had regular field school programmes with farmers and their families and other community members for the safe use of toxic chemicals. I was present at many of these sessions. While I know some of these have continued at the Ministry of Agriculture, the aggressiveness with which these sessions are pursued has become cold.
As part of the education and awareness programmes, we held workshops with shop owners for the responsible sale of pesticides and toxic chemicals. The idea was that shop owners should only sell these chemicals to people they know have use for them and to maintain a register of persons who bought chemicals. If this programme is still in place, there is only a lukewarm approach.
The Safe Storage Programme was first introduced when I was Minister of Health back in 2003. PAHO/WHO was supportive. In this initiative we pushed for safety cabinets (lock-boxes) for the storage of pesticides and other toxic chemicals. The idea was for the farmers to have storage cabinets at home which have multiple locks, each lock being controlled by different family members. The goal was that anytime the use of these chemicals was for a legitimate use, more than one family member is involved in the access to the chemical. The Ministry of Health had distributed about 100 of these cabinets by 2011. The Ministry of Agriculture started to distribute free cabinets in 2012 and the intention was to distribute about 100 annually. We had urged the private sector and NGOs to become involved in this initiative. The uptake by the private sector and the NGOs was poor. My information is this programme has been terminated.
The Farm Registration and Certification programme was introduced at NAREI. This would have enabled a system that among other things would have provided a special ID that would have restricted the use of paraquat and other toxic chemicals.
These initiatives became linked to the gatekeepers programme. Gatekeepers were familiarized with the laws and the safe and effective use of pesticides and toxic chemicals. We wanted them to become familiar with all those who sold chemicals in their communities and to keep a close relationship so that they can be informed if any inappropriate purchase was made. The gatekeepers programme is not presently in place, although an NGO, Caribbean Voice, is presently putting a similar programme in place.
Guyana imports about 155 tons of paraquat annually. There is still a small amount of smuggled paraquat that enters via Suriname, Brazil and Venezuela. Paraquat is a pesticide that is widely used by farmers in Guyana and around the world. There is no doubt that paraquat is an affordable, effective pesticide. It is very difficult for farmers to find an equally effective and affordable alternative. The affordable availability and accessibility of paraquat is a blessing to farmers and in agriculture. For most countries, the availability of and accessibility to paraquat play an important and indispensable role in sustained agricultural productivity and intensification.
The problem is that paraquat has also been a chemical used in suicide in Guyana and in many countries around the world. Suicide continues to be a growing public health problem in Guyana and globally. Globally, more than a million people die each year. Of this number about 20 to 30% (approximately 200,000) of suicide deaths are caused by pesticide ingestion. In Guyana, between 150 and 200 people die each year because of suicide and about 70% of these deaths are caused by pesticide ingestion. While Suicide is a major cause of death among young people in every country, unfortunately, Guyana is one of the most affected countries for suicide-linked deaths.
I cannot claim expertise in what are the causes for suicide and that I know definitively what we can do to eliminate suicide as a major cause of death and disability. But one thing I do know is that restricting the use of paraquat in Guyana might make it more difficult for it to be used in the suicide pathway. Means restriction is a key element of suicide prevention strategies. Restricting access to common and highly lethal methods of suicide can reduce both method-specific and all-cause suicide rates. Such approaches for pesticide self-poisoning include administrative interventions altering behaviour (particularly the purchase, use, and storage of pesticides) and interventions altering the availability of highly hazardous pesticides in the community.
Dr. Leslie Ramsammy
Former minister of health, agriculture