In most major hospitals in Nepal, at any given time there are about half a dozen patients admitted with organophosphate poisoning. Indeed this is the most common form of poisoning in Nepal and much of South Asia, especially Sri Lanka. Many patients are young women who have tried to kill themselves because they had a quarrel with their husband or could not get along with their in-laws.
The local names of these organophosphate compounds are nuvan, metacid, dalf, and suchlor. These are pesticides that are all too readily available from shops in Nepal. Considered essential by the modern Nepali farmer, these pesticide compounds are deadly when ingested by a human being. Medical students use the mnemonic SLUDGE (salivation, lacrimation, urine incontinence, diarrhoea, gastrointestinal cramps and emesis or vomiting) to help them remember the varied effects of this pesticide in a patient.
These symptoms can be fatal depending on the amount ingested and just how promptly treatment was started. The most essential chemical used to treat organophosphate poisoning is atropine, which is derived from plants from the Solanaceae family suchas datura, deadly nightshade, and mandrake. Ironically, the word atropine comes from Atropos, one of the three Fates in Greek mythology, who decides the manner of a person's death. In the case of organophophate poisoning, atropine is a life-saving antidote.
Organophosphate pesticides inhibit the natural destruction of an enzyme called acetylcholine in the human body, which then sets off the cascade of secretions summarised by the above mnemonic. Organophosphate is now also classified in the West as a major risk for bioterrorism, especially after the sarin (organophosphate) gas attacks in the Tokyo suburbs in 1994 and 1995. Victims complained that "their world went black", followed by all the symptoms of SLUDGE.
The tragedy of organophosphate poisoning in South Asia could be prevented in large measure if there were political will. But as long as a teenager who has fared badly in her SLC exams can go to a general store and easily buy organophosphate pesticides, we will continue to witness these preventable tragedies.