A.K. Jayasree, an epidemiologist in community medicine at the General Hospital in Thiruvananthapuram, puts last years tally of family suicides at 21, with 11 of these occurring in March. Since March is the fiscal year-end, Jayasree argues that debt is primarily responsible for pushing the cash-strapped families to suicides. This appears to be borne out by the recent trends. In the Vithura case, for instance, a suicide note left behind by Sisupalan reads: "I cannot repay my debt. My family will not survive without me. Therefore, we are leaving together."