Wednesday, December 13, 2006

There is a lot of controversy in the news about whether or not antidepressant drugs cause suicide. But what happens when depressed or disturbed people do not take these drugs? Maybe something like this (Hat tip to reader Susan):

TORONTO — Andrea Johnson had long battled the "monster" of depression, but in the end decided not to take prescribed antidepressants out of fear that her breast milk would harm her 2½-year-old son, her family said yesterday.

The sister of the 30-year-old who leaped from a Highway 401 overpass early Sunday evening, ending her son's life and her own, said Ms. Johnson made that fateful decision based on two fears: appearing crazy, and hurting her son, Sulla, who was still being breastfed.


Would antidepressant drugs and psychotherapy have helped? Maybe, and the outcome certainly would have had to be better than the alternative. But my real question here is, "why was this woman still breast feeding a two-and-a half year old?"

63 Comments:

Anonymous Ralph Phelan said...

"decided not to take prescribed antidepressants out of fear that her breast milk would harm her 2½-year-old son ... ending her son's life"

Well, that decision didn't work out real well.

What is it about suicidal mothers taking their kids with them? Is it a sex linked thing? I'm going only by what I see in the headlines, which I know is useless as a sample, but it seems like men will do either themselves or the whole family, while women are more likely to take the kids but leave the spouse alive.

3:23 PM, December 13, 2006  
Blogger J. Peden said...

"But my real question here is, 'why was this woman still breast feeding a two-and-a half year old?'"

sarcasm on: Because you hate women?

Btw - if you have the time, Dr. Helen, do you know if there is there any difinitive evidence that taking anti-depressants increases the risk of suicide in those already prone to it by depression?

3:38 PM, December 13, 2006  
Blogger ada47 said...

Well, I won't argue generally against breast feeding a two-and-a half year old (mostly because i don't want to take a side in that particular argument-it wasn't my choice, but, hey, whatever). But I will say that I know several women who got LOTS of social pressure and guilt about discontinuing breast-feeding so they could go on anti-depressants. Breast-feeding is great, but not if it is getting in the way of mom's mental health.

There has been tons written about the breast-feeding wars, and I'm sure this thread will probably go the way of hammering that out a bit more. Let me just say that I am an advocate of personal choice, breast feeding is a great choice for mom and baby, for as long as one feels comfortable with it (which really does put a natural limit of 12-18 months for many of even the most dedicated breast-feeders, and feedies, for that matter), and as long as mom or baby's health is not at risk.

No one should feel pressure to keep nursing, and I think that no doctor should be pressured NOT to advise a patient to stop nursing when her health is truly at risk, nor should any family member feel inhibited about intervening ina case like this.

3:41 PM, December 13, 2006  
Blogger ada47 said...

actually, on the other real question-oh, now I regreat getting off on the breast-feeding track.

OK, I have often wondered if there was any indication that people who were diagnosed with depression and given antidepressants only to go and kill themselves, may have in fact been misdiagnosed and are actually suffereing from bipolar II, which can present as depression but is clinically and probably biochemically different? I asked a psychiatrist about that once and he didn't seem to know what I was talking about. Do you have an opinion, Dr. Helen?

3:44 PM, December 13, 2006  
Anonymous Bruce Hoult said...

> But my real question here is, "why was this woman still breast feeding
> a two-and-a half year old?"'

Why on earth not?!

Sure it's a little bit out of the ordinary for a woman to be whipping one out to feed a 10 or 12 year old in public, as made the news recently, but I sure can't see any reason that people who are able to and want to should not breast feed until the child is school age.

Is this one of those USA prudery things?

3:47 PM, December 13, 2006  
Anonymous bugs said...

Related question: Why are "regular" MDs (i.e., not psychologists or psychiatrists) allowed to prescribe anti-depressants? Do you think this a dangerous practice?

Related comment: SSRI-type anti-depressants can have devastating withdrawal symptoms. I'm wondering if some of the reported suicides are caused by people making ill-advised adjustments to their dosages. Not blaming the victims here - it's just that these drugs can be very dodgy if they're not taken strictly according to directions.

3:53 PM, December 13, 2006  
Anonymous Anonymous said...

This stuff is rarely "Closely Monitored", with a Skilled Psychiatrist.

Internal Medicine M.D.'s, and Pediatricians prescribe "Anti-Depressants" like thier candy.

Paxil made my daughter really nuts, we had to put her in a pediatric Psyche ward for 2 weeks and slowly wean her off it. Not covered by our health plan by the way. $25G

My wife was trained to "always trust the Dr."

He just shrugged when I pressed him about what happened to the daughter.

DO NOT let anyone you care about use Paxil unless closely as in multiple family members working with a highly skilled Psychiatrist.

Econ-Scott

e.g. "Why did mild mannered elderly Grandpa Murder Grandma, 2 cops & himself ? You think the Paxil had anything to do with it ?"

4:16 PM, December 13, 2006  
Anonymous Anonymous said...

I agree with Bruce. If the child is eating solids and nursing for added nutrition and comfort, that age is not so high. In our workaday world, it may seem impracticable but not every mother nursing at that extended age is suicidal or going to take the child with her.

Also I think if you can understand her, why she might have chosen to keep nursing, you can understand why she took the baby with her.

4:18 PM, December 13, 2006  
Anonymous Anonymous said...

"Why was she still Breastfeeding ?"

Hmmmm, could be she didn't have another baby right behind to kick the first one off the breast.

She probably liked the experience as much as the toddler.

Econ-Scott

The Drugs may have saved her maybe not. Depression is an evil monster, hard to manage.

4:21 PM, December 13, 2006  
Blogger ada47 said...

anon 4:16
That is also my impression, that many docs see themselves as drug dispensers, and not health monitors.

Dr. Helen, I'd like to hear your perspective on the psychiatrist/psychologist divide, if there is one, as it relates to drugs and, say, "talk therapy". The stereotype is that psychiatrists perscribe drugs but are not generally interested in the helping the patient resolve stress or trauma or crises by behavior modification or cognitive therapy, and psychologists are generally resistant to drugs and diagnoses. Personally, I've known many exceptions to those broad and perhaps unfair characterizations, but I have found them to be startlingly true among the over-50 set.

Any thoughts?

4:27 PM, December 13, 2006  
Blogger Pete the Streak said...

"Why was she still breastfeeding at 2 1/2?".
She obviously read that formula containing soy milk would turn her child gay. Not that there's anything wrong with that......

5:42 PM, December 13, 2006  
Anonymous Anonymous said...

Actually if more children were breast fed for longer periods of time there might be less need for anti-depressant pills and psychologists for 3 year olds.

5:45 PM, December 13, 2006  
Blogger TMink said...

As a therapist I routinely send my patients to psychiatrists and they do the same. I have not experienced prejudice toward the other discipline in the fields that is of any importance.

Many of the psychiatrists that put teens on antidepressants send them to me. I can monitor them for any manic episodes MUCH cheaper than a psychiatrist can.

And depressed people kill themselves. It is bad that way.

Trey

5:49 PM, December 13, 2006  
Blogger Helen said...

Ada47,

It is very important to make the correct diagnosis before putting someone on medication. Antidepressants treat unipolar depression, panic disorder and anxiety. Howover, if one is misdiagnosed with a depressive disorder and is really bipolar, antidepressants can send them into a manic or hypomanic state and increase the frequency of cycling. Certainly there are risks with this cycling behavior.That said, suicide rates for bipolar disorder is about 15% so it is imperative to treat it with the right meds etc. This is why I think psychological testing is so important--to make reasonably sure that what you are treating is the illness that the patient actually has.

6:25 PM, December 13, 2006  
Anonymous Jim said...

Mothers breastfeed until four or even five in places where clean water and decent food are hard or get, which was almost everywhere until the last century or so.

This is way out of the ordinary, but that in family that nearly all died in the Siskiyous, the four-year-old survived because her mom happened to be breastfeeding an infant still.

I will say something in the breastfeeding wars, since it has erupted aagin. People need to get over it.It is not too much to expect women to keep covered, but when they get all funny abut what is going on under the baby blanket, they are crossing the line into someone else's business.

6:39 PM, December 13, 2006  
Anonymous Cousin Dave said...

ada47, your theory about misdiagnosed bipolars is a good one. Here's another one. When you're really depressed, you have no motivation. You might feel the impulse towards suicide, but that would involve getting up off the couch, so that makes it too much trouble.

So you start on an antidepressant. And after a few days, it begins to kick in a bit. You're starting to get better. You have a bit of motivation now. Unfortunately, your mental state is still a bit precarious and you are having ups and downs. And during one of those downs, you get the suicide impulse again. But now you feel sufficiently motivated to get up off the couch and actually do something about it.

This is the danger point. I think therapists need to take care with potentially suicidal patients who are starting antidepressants, until they get past this point.

12:14 AM, December 14, 2006  
Blogger ada47 said...

cousin,
I like your theory as well. I've known, unfortunately, two suicides and a potential suicide (big truck got her on the off ramp before she got herself) personally, and all three would fit into your category. Depressed to the point of immobility, then some improvement, to the point where everyone around them thought they were "getting better" then the potassium cyanide (all three were scientists, and the two "successful' suicides killed themselves near work, where they had access to the stuff). So I think it takes a certain amount of motivation to actually drink the poison, pick up the gun or draw the knife. Antidepressants might give the clinically depressed just enough energy to get off the sofa, turn off the remote, and do the deed.

Incidentally, I think the two theories (misdiagnosed bipolar II and getting off the sofa) are not competing alternatives but two viable models to explain separable populations of individuals.

Dr. Helen, I'm clearly way out of my realm here (I'm just a cell/developmental biologist), and I don't mean to pollute your field with crack-smokin' ideas. Please feel free to comment and/or shut me up if I am out of line.

1:06 AM, December 14, 2006  
Blogger tomcal said...

When our kids were young, we had a friend who believed in breastfeeding up to the age of 4. At one point she and her husband had 2 kids, age 2 1/2 and 4.

I was always very entertained when we'd be over there for dinner; one of the kids would walk up and say "Mom, I'm hungry", and out would flop the boob.

Personally I wouldnt have put up with it, as I always felt that the boobs were off limits for me while the kids were on them. A year or so was the limit for me.

But I have to say that the kids are doing fine, one is in law school and the other is a sophomore in college majoring in psychology, go figure...

3:27 AM, December 14, 2006  
Blogger Helen said...

Cousin Dave and ada47,

You are correct that right after starting antidepressants is the crucial time for suicide--for the reason you stated, that people who are truly depressed who were too lethargic before now have the energy to do something, including suicide. This is why it is so important to monitor patients who are depressed and first put on medication. One of the problems is regular MDs who prescribe with no real understanding of mental health issues. "Here's some prozac" says a general practitioner to someone who says they are depressed and off the patient goes. In my experience, a psychiatrist is best to monitor these meds but even they need to be careful and take time with a patient on a regular basis to make sure they are tolerating the medication. Many do not--it is time consuming and difficult.

6:36 AM, December 14, 2006  
Anonymous Anonymous said...

Many docs give out the "free samples" of various types of pills to see how you like them and at no cost to the patients. It's a business, and drug reps are marketers. Some of the old-time drs are driven solely by concern for the patient; others, it's a business and accountability for business results ... so sue me.

7:51 AM, December 14, 2006  
Anonymous Anonymous said...

This will sound extremely harsh but that woman's son Sulla was doomed anyway. To her, he was just a prop in her egocentric drama filled live. At best he would have grown up depressed, suicidal and possibly homicidal. I do not fault her for being the way she was. I would bet every cent I have that her parent(s) had long ago stripped her of any shred of self esteem she may have had. It is possible that her actions broke a long self perpetuating chain of the depressed passing on depression to the next generation.
Dr.S

10:22 AM, December 14, 2006  
Anonymous Anonymous said...

"Dr."S:
You must have an advanced degree

11:05 AM, December 14, 2006  
Anonymous Anonymous said...

Dr. Helen:

I am presuming you are a Holy "Psychologist" and not an M.D.

An M.D. you know, the latest 9 year old they decided to make a Dr. and when licensed, legally able to perform Brain Surgery, Open Heart Surgery, Breast Surgery, and or Prescribe POWERFUL Psychotic and Anti-Psychotic drugs with directions to take as prescribed and see the nurse about your followup appointment.

1:56 PM, December 14, 2006  
Anonymous Anonymous said...

The WHO recommends that mothers breastfeed for a MINIMUM of two years. The AAP states that children weaned under the age of two are at greater risk for illness, and says that there is no upper limit to breastfeeding and no harm in nursing for three or more years per child.

So why should she not still be nursing her child at 2 1/2? If the breastfeeding relationship is mutually desired by both mother and child, who does it harm?

Maybe instead of asking the "real question" about her lactation habits we should be asking what might have been done to help this mother, who was probably suffering from PPD. And the thousands of others every year effected by the same illness.

3:00 PM, December 14, 2006  
Blogger Jeff said...

Breastfeeding at 3, 4, 5 years old is a great idea, especially if it takes the kids minds off of the fact that Mommy and Daddy are first cousins....

5:24 PM, December 14, 2006  
Blogger Kent said...

This cartoon seems relevant:

http://www.abqjournal.com/pix/trever_2006/1trever11-21-06.gif

Trever is a superb political cartoonist who I don't believe has gotten as much attention as he deserves. I'd describe his politics as center-right with a strong libertarian streak.

5:54 PM, December 14, 2006  
Anonymous Anonymous said...

I too find 2.5 years of age to be a bit excessive for breastfeeding and I'm not a prude by any measure.

Your child should be on solids and weaned by then... There is a LOT of stress due to breast feeding on the mother.

6:31 PM, December 14, 2006  
Blogger Silvermine said...

2.5 is not a ridiculous age to breastfeed. I didn't manage to nurse my son after he got teeth, but I know other people who nursed 3 year olds.

BUT... if you're truely depressed and need help but are afraid for the baby, then I think it's perfectly reasonable to just stop breastfeeding a kid who really will be just fine without it.

I'm actually suffering from PPD and make the same choice she did. However, my daughter is 4 months, and I'd really like to nurse her for at least 6 months, hopefully closer to a year. Partly because nursing not only helps her, but it's good for my mental health. It makes me feel good about me. It gives me something to be proud of.

9:40 PM, December 14, 2006  
Anonymous Anonymous said...

You don't use teeth to suckle.
Sometime a child can bite, but you teach them "NO!"

9:54 PM, December 14, 2006  
Anonymous Anonymous said...

Your child should be on solids and weaned by then... There is a LOT of stress due to breast feeding on the mother.

I could see this post was finding fault with mothers nursing older children.

Again, breast milk supplements solids at that age. There IS NOT a lot of stress on many mothers who CHOOSE, as a private family decision, how to raise their children.

BUTT OUT of judging others based on this one sick woman's actions. Diagnosing via PC or TV is stupid; DrHelen is entitled to her throwaway comment as a reader and professional woman, but this is not such a rare thing for women of all cultures. Respect the situation and don't generalize/stigmatize. Can make for a healthier society when the children are raised too.

9:58 PM, December 14, 2006  
Anonymous bugs said...

Well, as a nursing father I would say that children of Republicans should be breast fed until they're old enough to get jobs and hire their own wet nurses; children of Democrats, indefinitely.

At a minimum, the ickle boy babies should be suckled until they're old enough to start shaving.

12:42 PM, December 15, 2006  
Anonymous bugs said...

Nursing a hangover, I mean...

12:44 PM, December 15, 2006  
Anonymous Anonymous said...

"There IS NOT a lot of stress on many mothers who CHOOSE, as a private family decision, how to raise their children"

Excuse me but there was A LOT of stress on my wife due to breast feeding.

It was indeed her choice to make and was very stressful to her so I DO NOT agree with your opinion.

4:39 PM, December 15, 2006  
Anonymous Anonymous said...

Reread:

It is an individual thing.
This statement is incorrect, and the one objected to; "There is a LOT of stress due to breast feeding on the mother."

Many mothers do not have such stress. If you have freedom in your schedule, and plan and stick to a routine, not every breastfeeding mother experiences such stress. I am sorry your wife did. Still, I stand by what I wrote to deny the myth that breastfeeding must be stressful for the mother:

"There IS NOT a lot of stress on many mothers who CHOOSE, as a private family decision, how to raise their children"

Again, many mothers, especially repeat nursing mothers, find this to be true. Who the hell is Dr.Helen to question that 2 1/2 is too old for breastfeeding? It is a personal decision and does not mean a woman is filled for 2 1/2 years with stress (again, it's all in the scheduling -- you can't do it all). That is just a myth being perpetuated, that those women who choose to continue are potentially suicidal. Perhaps its envy, or Helen not seeing in her line of work children who have nursed for extended periods.

4:51 PM, December 15, 2006  
Anonymous Anonymous said...

"That is just a myth being perpetuated, that those women who choose to continue are potentially suicidal."

I see.... you discount someones actual personal experiance as "a myth."

I find that rather insulting.

5:23 PM, December 15, 2006  
Anonymous bugs said...

Just curious: Is the stress from nursing supposed to be mostly mental or physical? Or maybe both, since presumably nursing can affect the mother's body chemistry which in turn might affect her mood?

From what little I've read and heard on the subject, I was under the impression that nursing was a relaxing and mutually satisfying activity for mother and infant. One of the anonymouses, however, seems to have had a different experience.

So which is it: happy bonding time or living hell?

As for the age limit - I agree that it should be the choice of mother and offspring.

Having said that, I confess I would be a little grossed out if I were in a waiting room with Mom and her three-year-old stated his desire for a quick snack and instead of giving him some nice, healthy granola or a raisin she unlimbered her...ok, even though I'm making this up it's still more info than I need.

5:39 PM, December 15, 2006  
Blogger Cat said...

What a sad story. Choose the antidepressant. Better not to breastfeed than be a danger to yourself and create an orphan or kill both.

I think to breast feed or not is up to the mother. Yes for some it's a glorious experience, for others difficult, painful (one infection or problem after the other) or impossible (don't produce enough milk).

You want to breast feed until your kid is 4 or 5? Knock yourself out. Who cares. Just don't talk about it lie you're "Saint Lactacia" or get all defensive when an eyebrow is raised when 4 year old Johnny walks up and latches on while like your a milk despenser during a public discussion(an acq. at my church at coffee hour).

I just wonder why with breastfeediing in a post formula world at a high and it's such an amazing antidote there are so many chronically sick children with this and that and getting tubes in their ears, etc. Don't recall this when I was a kid or when I was babysitting for every baby in town - and feeding them formula - when I was a teenager. Has anyone else noticed this?

10:59 PM, December 15, 2006  
Blogger tomcal said...

Bugs: You may be making it up, but I am not (see my post above).

As to the biting thing mentioned in posts after mine, that was always punished by a 10 minute "Time Out" as the mother tended to her wounded nipple.

11:11 PM, December 15, 2006  
Anonymous Anonymous said...

I see.... you discount someones actual personal experiance as "a myth."

I find that rather insulting.


It is a myth that breastfeeding over extended periods causes suicide. Sorry.

The lady in the article presumably had mental troubles before or at the same time. Perhaps the pills would have helped her. But any woman thinking, and able, to continue breastfeeding privately at home, perhaps as part of a quiet routine supplementing the child's regular meals, who thinks that continuing causes suicide... it does not. hth

Dr.Helen does a disserice with her question in the initial post. She is viewing it more as a career woman, I think.

2:25 PM, December 16, 2006  
Anonymous Anonymous said...

"It is a myth that breastfeeding over extended periods causes suicide."

Now your just being rediculous and playing with words.

Did anyone state that breast feeding *CAUSED* suicide?

No.

I'm sorry but you are wrong- Not all woman find breastfeeding a comfortable and happy experience.

It can and does make some women's lives more stressful and depressing.

9:43 AM, December 17, 2006  
Blogger Helen said...

Not all women find breastfeeding as wonderful as the Le Leche league would have them believe. My problem with groups like this is that they get cult-like in their belief that it is always good to breastfeed for as long as possible. For some women, breastfeedomg is not a good thing, for others it is--but racking women with guilt for not breastfeeding is not healthy either--a woman should choose what she wants to do and not let the Le Leche league or anyone tell her what is best for herself or her child, she should make the decision. My problem with the woman in the article is that she was sick and her guilt over not being able to breastfeed may have led to her decision not to take the medication. By the time a child is two and a half, my opinion is that it is probably safe to wean them. I don't give a rat's ass if some women want to breast feed a two and a half year old if they do not need medication etc. However, they should be prepared for other people to think it is getting to be a bit much.

9:56 AM, December 17, 2006  
Anonymous bugs said...

Mention of La Leche League and, earlier, the WHO recommendations brings out another political component of the discussion (other than the one about women's/mother's rights). It's possible that some people push breastfeeding to express or feel solidarity with more "traditional" societies - you know, the ones we naughty westerners oppress on a regular basis. If third-world mothers are doing it, it must be "healthy" and "natural." Never mind that in their world extended breastfeeding may be the only alternative to letting a child starve. The WHO and La Leche may be correct in stating the health and social benefits of nursing for mothers and children in tenuous circumstances - both in poor countries and in the "developed" world. That doesn't make it a necessity for mothers who have access to alternative forms of nutrition.

People should just ease up on Mom and let her make her own decisions. Freakin' busybodies...

1:57 PM, December 18, 2006  
Blogger tomcal said...

Having spent an awful lot of time in third world countries working with the poorest of the poor, my observation is that most of the kids are weened by yhe time they are 1 or so. They have to be, as the mothers want to get on with the important business of having the next kid starving kid; and continuing to breastfeed greatly reduces the liklihood of being able to conceive.

I my experience, breastfeeding until puberty is a first world phenomena. Another luxury of the developed countries.

9:33 AM, December 19, 2006  
Anonymous bugs said...

tc - Interesting reality. I think I meant the version of healthy baby-raising pushed by well-meaning NGOs, as distinct from the facts. Maybe the idea is that if third world mums spent more time nursing, their current children would be healthier and their future children deferred until a more convenient time.

The other thing I've learned here: The attendant bitching and fretting about the pros and cons really does make nursing a stressful activity!

2:15 PM, December 19, 2006  
Anonymous Mommynator said...

This antidepressant thing is close to my heart, because after 9/11, I lost my small business and life in general just went to hell very quickly. I was MAJORLY depressed and went to my internist at the time.

She gave me a short term course of paxil, but warned me that I should also be going for some kind of counseling or therapy while I was on the drug. She said that the paxil would make my brain function correctly again, and all the things that my mental state had been shoving aside and burying would come out in full force and it might be too much to handle.

She was absolutely right. I found a counselor through my church and saw him weekly while on paxil, and for a while afterwards because the emotions that finally came alive could have been extremely overwhelming if I didn't have that vent and opportunity to put things in perspective.

Unfortunately, not all doctors are so well informed and this is why I believe there are so many suicides while on antidepressants - they really work, but you need help to make sense of it all.

Any time I hear of someone on these medications, I ALWAYS ask if they are in some kind of counseling situation - I don't care if I'm perceived as nosy, I'd rather save their life than be liked any time.

As for the breast feeding issue, my son nursed until he was about two and a half, my oldest daughter for about a year, and my youngest for about six months. I was not going to deny them the comfort of this contact, public opinion be damned. What business is it of anyone's when one decides to stop nursing? There are many reasons to do it, and medical reasons are one of them, work and family pressures, etc. It's too bad that this woman felt her baby wouldn't feel loved if she stopped nursing to take care of herself, and unfortunately, she was probably not in a state of mind to be able to evaluate this rationally.

2:25 PM, December 19, 2006  
Anonymous Anonymous said...

for others it is--but racking women with guilt for not breastfeeding is not healthy either--a woman should choose what she wants to do and not let the Le Leche league or anyone tell her what is best for herself or her child

So shut up already about nursing a 2 and a half year old, Helen.
-------
What business is it of anyone's when one decides to stop nursing?

9:58 PM, December 19, 2006  
Anonymous bugs said...

Goddammit, I'd be nursing to this DAY if Mom didn't have to be such a bitch about it! All I ever hear is, "You're too old, I stopped lactating forty-three years ago, I had a double mastectomy." If she were any kind of mother, she would stop making flimsy excuses and think about MY mental and physical well-being for a change!

2:15 PM, December 20, 2006  
Blogger tomcal said...

Me too! But then that is why I put my foot down after my wife nursed each kid for a year. I wanted my boobs back...

When they are old enough, they can go out and find women kind enough to let them enjoy that kind of thing again, but for now they will have to wait.

10:39 PM, December 20, 2006  
Blogger tomcal said...

Bugs:

Seriously I see this over and over again working with the poor in Nicaragua with whom I spend about 2 to 4 months a year (depending on my workload here in the U.S.
). Nicaragua is the second poorest country in the Western Hemisphere, after Haiti. I'd probably do what I do in Haiti instead, but I speak fluent Spanish and am too lazy and afflicted by ADD to learn another language.

Anyway, my experience is that the mothers want the baby off the boob within a year, because the goal of the family is to have 8 to 10 children during the her childbearing years (usually from about 15 to 35. Out of the 10, 6 or 7 will survive to adulthood, ensuring that someone will be around to take care of the parents in their old age.

This cultural issue falls over into education and other aspects of life as well. With the kids I support, I constantly see them selling their schoolbooks, school uniforms, bicycles we buy them to get to school, etc. in order to buy medicine for grandma whenever she gets sick. Its quite the vicious circle.

11:01 PM, December 20, 2006  
Anonymous bugs said...

Very sad situation, TC. How do you break that cycle?

11:24 PM, December 20, 2006  
Blogger tomcal said...

This comment has been removed by a blog administrator.

12:45 AM, December 21, 2006  
Blogger tomcal said...

No one knows the answer to your question. You do the best you can, one kid at a time; and every once in a while you have a success story, and it makes you happy.

12:58 AM, December 21, 2006  
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