At least 17 US troops have committed suicide in Iraq; Army seeks answers

NEW YORK Nov 24 - Rebecca Suell wants answers, and not the ones the US Army is giving her.
Why does the Army keep calling the last letter her husband sent to her, the one he mailed from Iraq on June 15, a suicide note? Can taking a bottle of Tylenol really kill you? And how did he get his hands on a bottle of Tylenol in the middle of the desert anyway?
The questions may differ, but experts say the desperate search for answers - and the denial - are usually the same.
Since April, the military says, at least 17 Americans - 15 Army soldiers and two Marines - have taken their own lives in Iraq. The true number is almost certainly higher. At least two dozen non-combat deaths, some of them possible suicides, are under investigation according to an AP review of Army casualty reports.
No one in the military is saying for the record that the suicide rate among forces in Iraq is alarming. But Lt. Gen. Ricardo Sanchez, the top American military commander in Iraq, was concerned enough, according to the Army Surgeon General's office, to have ordered a 12-person mental health assessment team to Iraq to see what more can be done to prevent suicides and to help troops better cope with anxiety and depression.
Army spokesman Martha Rudd said the assessment team returned from Iraq two weeks ago, but that it will take several weeks to come up with recommendations. Until then, she said, no one on the team will have anything to say to the press.
Whether the suicide rate among the troops should be considered high is impossible to say because there is nothing to compare it with, experts say. What would be considered a ``normal'' rate for an all-voluntary military force of men and women on extensive deployments to the Middle East, under constant pressure from guerrillas who use terror tactics?
Rudd said that by the Army's calculations, its suicide rate in Iraq is roughly 12 per 100,000 - well below the civilian suicide rate for US men of 17.5 suicides per 100,000. The comparison is misleading, however.
The civilian rate is an annual figure, and the Iraq figure covers only about seven months. Furthermore, the troops have not yet spent their first holiday season in Iraq - a time when the risk of suicide is traditionally at its highest.
The troops in Iraq include thousands of women, who typically have a lower suicide rate than men. And the Army figure does not include possible suicides among the non-combat deaths yet to be explained.
Whatever the 12-month suicide figure turns out to be, the Army is not satisfied that it is low enough. The Army has an extensive suicide prevention program, with soldiers ``all the way down the chain'' of command trained to recognize the warning signs of suicide and how best to intervene, Rudd said.
``Zero suicides is our goal,'' she said. ``We may not get there, but we're going to try.''
In all, 424 US troops have died in Iraq. The military has characterised 130 of the deaths as ``non-hostile,'' including 106 since President George W. Bush officially declared major hostilities over on May 1. Most if not all the confirmed suicides occurred after May 1, according to the military. According to an AP analysis of military reports, non-combat deaths include 13 caused by a weapons discharge, two from drowning, one from breathing difficulties and one described only as ``medical.'' An additional 13 are listed with no cause given.
For Rebecca Suell and many of the families of soldiers who are believed to have killed themselves in Iraq, answers are as hard to come by as sleep.
Night after night, Suell said, she lies awake asking herself the same questions.
Why, as sad and as tired of Iraq as he said he was, would her husband take his own life when she had just told him how much she loved him, how much the kids missed him and needed him?
Why would a man who loved the Lord so much - who told her on the day he died that he felt he was getting closer and closer to God every day - defy his Lord's strictures against taking his own life?
But the more she sobs, the clearer it becomes that Joseph D. Suell, posthumously promoted to sergeant, was in crisis the day he died - so desperate to come home that he even asked his wife to talk to his commanding officer.
And she did.
She told him, she said, how life was so hard without her husband, how going to nursing school and working at Wal-Mart and trying to raise three children, all at the same time, was too much for her to bear alone.
She told him how her husband had no sooner finished serving a year and half in Korea than he was sent to Iraq, that in five years as a soldier she had been with him less than 18 months.
She told his commanding officer that their youngest daughter didn't even know her father, that he was away the day she was born, and that all her husband really wanted was to be at home with his family in Lufkin, Texas, for Christmas.
Just a month or two, she begged, and then you can have him back.
His commanding officer, she said, told her that the Army was doing everything it could to get him back to her but that he couldn't promise it would happen in time for Christmas.
The Army will not talk about Suell's death, nor does it publish, out of concern for the families, the names of soldiers who have killed themselves in Iraq.
But Rudd, the Army spokesman, said it is not unusual for family members to question whether a loved one's death was a suicide. It is for that reason, she said, that it often takes months to complete an investigation into a soldiers death.
For the sake of the family, Rudd said, ``we need to be absolutely certain.''
In many respects, Joseph Suell does not fit the profile of a soldier who commits suicide. Typically, mental health experts said, such suicides are triggered by a ``Dear John'' message from home.
Even among civilians, one of the common triggers ``is a rupture of a relationship,'' said David Shaffer, a Columbia University psychiatrist and former consultant for the Department of Defense.
But there are always deeper reasons, usually far murkier and far more complex, experts said. Like the wars they fight, no two soldiers who commit suicide face the same mix of potentially deadly stress.
``In most previous conflicts you went, you fought, you came home,'' Rudd said. ``In this one they went, they fought, they're still there.''
Rudd said she knows of no studies that show a definitive correlation between length of deployment and military suicide rates. But Michelle Kelley, a psychiatrist who studies deployment-related stress for the Navy, said the longer the deployment, the greater the strain on a relationship with a loved one.
The military, she said, needs to be especially watchful for anxiety and depression among its troops in the weeks ahead. For civilian and soldier alike, the Christmas season and depression go hand in hand, Kelley said. But for a soldier, she added, a weapon is always at hand.
Soldiers, she said, must be encouraged to seek help when they need it. For that reason, she expressed concern about the case of Pfc. Georg-Andreas Pogany.
The soldier, assigned to a Green Beret interrogation team, began throwing up after seeing the severed body of an Iraqi civilian three days after being deployed to Iraq. After seeking help for a self-described anxiety attack, he was ordered back to the United States and became the first soldier since Vietnam charged with cowardice - a charge later reduced to dereliction of duty.
That, Kelley said, is ``the last thing you want to do'' if you want soldiers to seek help in times of stress ... You need to make it clear to those people who have witnessed something traumatic that they need to talk about it - that they won't be stigmatised for doing so and that it's not going to follow them through their military career.''
Shaffer, the Columbia University psychiatrist, said it is not that simple. A commanding officer's decision to file a cowardice charge might, in some circumstances, even be a morale boost for the soldiers under his command, he said.
Shaffer warned against drawing any conclusions based on the number of suicides in Iraq.
Suicide rates vary greatly over time, he said, and also vary with race, ethnicity, religion and other factors. African Americans, for example, have a lower suicide rate than the general US population. So do those who describe themselves as deeply religious. Drug use, alcoholism and a low education level, on the other hand, are correlated with higher suicide rates.
A comparison of the suicide rate among troops in Iraq with troops in other wars such as Vietnam are meaningless, he said, because the makeup of the fighting forces were so different. (According to the Army, there are no reliable statistics on the suicide rate during the Vietnam War.)
Shaffer said there is also some evidence that those who serve in the Army for a long time have a higher suicide rate than civilians. This is probably because ``some longstanding servicemen do develop alcohol problems over time, and alcohol use is very strongly related to suicide,'' he said.
Rudd, the Army spokesman, also adds something else to the mix:
``Technology today allows people to connect with the home front much more quickly and intimately and often than in previous conflicts,'' she said. That's not necessarily a good thing if the news from home is bad. Young people can be impulsive, she said, ``and Dear John letters and things like that can be very upsetting to a young soldier.''
For Rebecca Suell, who so badly wanted her husband back, there are still only questions.
Why, she demands to know, her voice rising in anger, did the Army send her husband to Iraq after he had mangled his arm in Korea? After they discovered that his asthma was getting worse?
She has taken her 4-year-old daughter, Jada, to the cemetery, she said. ``I've told her, 'That's where your daddy lives now - right next to your grandfather. And that's where we will all live someday, next to the people we love most.' But she doesn't understand.''
So what is she supposed to tell Jada, Rebecca Suell said, the next time she asks: ``When is my daddy coming home?''' - AP

Training doctors to tackle local diseases

A UNIQUE feature of University College Sedaya International (UCSI) is its offer of a totally homegrown medical programme tailored and customised to effectively tackle local diseases.
The programme is written and approved by locals with no foreign influence or interjections either wholly or partially.
Explained Medical Science Faculty dean, Professor Doctor Jammal Ahmad Essa: “Its customisation to local conditions and situations enables doctors to treat local patients more effectively.”
He said anatomy was the same everywhere, adding that all doctors, either trained overseas or locally, shared basic knowledge but not of diseases.
“The only difference between homegrown and foreign programmes is the peculiarities of diseases. In our rural areas, we may have more parasite-related diseases than Europe and because of that, parasitology is delved deeper into in our programme. In foreign programmes, the subject may not be even included.”
He added that homegrown programmes provided students with more practical training crucial in the medical profession.
“The more the student practises, the better he becomes. A doctor needs good knowledge and practice. Knowledge alone won’t make him a good doctor,” Dr Jammal said.
The programme also allowed interactive learning whereby students were expected to source for the materials they needed and the lecturers were there to guide them, he added.
“Student-centred programmes are designed to foster and encourage students learning in the most effective way.
The university is imparting knowledge through making the students responsible for their own learning. Lecturers will be guiding the students in their pursuit.
“Year One and Two students will be taught largely by basic medical scientists supported by clinicians. Early clinical exposure will allow students to further develop their interviewing and physical examination skills.
“Hospital visits will provide them the avenue to practise their training, which, in turn, benefits them in their transition to a clinical environment.”
Doctor Jammal said when they found the answers on their own, the students learned better than when they were being spoon-fed by the lecturers.
He pointed out that failures were minimal in the medical school because the programme was not exam-oriented.
“There is no huge exam to evaluate the understanding of the students at the end of the year. Instead assessment is done in the students’ daily course of training.
“It’s a continuous evaluation outside the programme … a continuous assessment.”
Doctor Jammal explained that the seminars and workshops the students attended and their interaction with people were all being assessed and the marks accumulated to the end of the year.
He also emphasised that it was the attitude and aptitude of the students he was looking for when they came for the interview.
Students interested in joining the profession have to go through an interview after being shortlisted.
“It is that we in UCSI do not emphasise academics. The students must obtain either Bs or As in these major subjects — biology, chemistry, physics and any maths-related subjects in STMP, A levels or any equivalent. These students will be called for interview,” he said.
He pointed out that it was not the academic ability that would make a good doctor but the attitude and aptitude towards the profession that was crucial or rather the determining factor.
“Students with good academics minus passion will be robotic doctors whereas those with passion will genuinely care for their patients. Students are not selected on the basis of their technical knowledge only.
“I’m more interested in their passion, attitude, how they interact with people, what do they think of other human beings. To be a good doctor, you must be able to give rather than to take. It must come from the heart not the brain.”
Doctor Jammal is interested in training thinking and caring doctors.
The passion for the profession and the very stringent selection of students also contribute to the few failures in the medical school.
The faculty has a capacity for 100 students but Dr Jammal is not looking at numbers as he is keener on quality.
UCSI has a total of 19 lecturers in the Medical Science Faculty, not counting the specialists and consultants of major hospitals in Terengganu very much involved in the students’ training.
Part of the course is psychiatry, which is greatly emphasised by the Health Ministry.
“This is due to the stressful lifestyle of modern times. Students get to practise in the country’s biggest and most reputable psychiatric hospital at Tanjung Ranbutan in Perak,” Dr Jammal said.
The Doctor of Medicine (MD) programme is a five-year integrated full time programme at the UCSI Connnaught Campus in Kuala Lumpur. The first batch of doctors will be graduating in July next year.
The programme is further divided into two phases — Phase One for pre-clinical training, including Basic Medical Sciences for the first and second year, and Phase Two for clinical training at the UCSI Clinical School, Kuala Terengganu, attached to the General Hospital, Kuala Lumpur, and district hospitals and health centres within Terengganu.
This phase is for year 3, 4, and 5 students.
In due course, the faculty will be adding two more programmes — automatric and esthetic medicine. Both have been submitted and are currently awaiting approval.
Two other medical-related courses — pharmacy and nursing — are also in the offing. Pharmacy is a four-year degree programme while in nursing, there are three choices.
The early part of the degree programme of the School of Pharmacy focuses on the fundamentals, starting off with integrated courses where four main disciplines are taught in each body system together with related diseases and the drug therapy involved.
Prerequisites for entering the School are Grade C in chemistry, maths and biology-physics at A levels or Grade B for similar subjects in STPM, Grade B3 in chemistry and maths and B4 in biology or physics in UEC or its equivalent. A strong SPM credit in biology or O-levels is compulsory.
This year will see the university’s first batch of pharmacists.
The Bachelor of Nursing (Hons) is a four-year (eight semesters) full-time programme. Aimed at upgrading the education of nurses, the programme gives equal emphasis to the profession’s art and science and prepares students to qualify as registered nurses.
To be eligible, students must have at least three principals in science subjects, a credit in Bahasa Malaysia and a pass in English at SPM level.
The Diploma in Nursing is a three-year (six semesters) full-time programme, preparing students to qualify as registered nurses. The emphasis is on the art of nursing (caring) for individuals.
The science is integrated throughout the programme to enable students to understand the rationale behind the care given to patients. The programme is open to students who have completed secondary school at SPM level.
UCSI gives due recognition to students who excel in their studies but who also require financial assistance. Hence, the university offers scholarships and academic awards through various avenues open to all students.
These scholastic awards also come in the form of students recognition every semester under the provision of the Dean’s Lists, Achievement Awards, President’s Awards and Chancellor’s Award.
Study loans from PTPTN and many other financial institutions are available for eligible students.