The patients who have tried to kill themselves arrive at all hours in troubled Venezuela.
"We live between terror and impotence," said Ignacio Sandia, who heads the psychiatry department at the university hospital in the Andean state of Merida. "We constantly think we can't do what we should in the moment we're able to, and we're terrified that patients commit suicide and there's nothing we can do for them."
Suicides are rapidly rising across this once-wealthy nation, but particularly in Merida, where they are hitting levels never seen. The Venezuelan Violence Observatory, a nongovernmental organization, estimates that the state's suicide rate was more than 19 per 100,000 in 2017. Only 12 nations have a rate so high.
Such deaths are becoming ordinary in a population plagued by hyperinflation, hunger and mass emigration. Xiomara Betancourt, a neurologist who heads mental-health services at Corposalud Merida, the public health system, blamed scarcities of antidepressant and anti-anxiety medicine and loneliness as loved ones leave. "It's a cocktail, a multitude of factors that have all converged," she said.
Merida, just smaller than Connecticut, is known for farming towns and snow-capped peaks and has about 1 million residents. Blackouts roil the region; gasoline and public-transportation shortages force residents to hitchhike through trash-strewn streets. Students at the University of the Andes have fled, taking any contagious optimism with them.
Absent reliable official figures, the Violence Observatory combed press clippings and police and hospital registries to document more than 190 suicides in Merida last year.
The death of Angel Isol Mendez, 75, ended a decline that mirrored the state's. His bodega ran out of goods. Hunger withered his body and a lack of insulin riddled his feet with diabetic sores. On Aug. 23, his son found his body in the store's barren anteroom.
"There wasn't anything left to sell, nothing, not even a piece of candy," said his wife, Sonia Arellano. "Everything was going wrong. He felt like a prisoner. I figure it forced him to make a decision."