This man was 55 years old at time of presentation. No history of violence, self-injury, or poisoning. Was unemployed, had two wives, and twelve children. Inability to provide for his family was reason given for attempt at suicide. Surgical intervention was required to repair tissue damage, tetanus shot was given, antibiotic treatment was given.
In third-world countries, late presentation of wounds is common, for many factors (distance, money, stigma, distrust of Western medicine, etc). Similar patient required extensive debridement of tissues due to infection that developed in intervening days between attempt and initial presentation.
Curiously, though suicidal patients often receive substandard psychiatric observation and evaluation after discharge, two studies found that African males who attempted suicide had a significantly higher 5-year survival rate than comparable patients living in New Zealand and Australia. One study speculates that since many eventually found employment after discharge, the major stressor (lack of funds to provide for family, the most common reason given by African male suicide attempt patients) was removed, and the patients did not have significant psychiatric illness. Similar New Zealand patients had high incidences of underlying psychiatric disorders, many of which were refractory (resistant to treatment).
The studies were not large enough to draw definitive conclusions, but display an interesting etiology that should be further explored.