This is common practice in much of developed world. Long ago, they used to have re-usable glass syringes that could be sterilized. Unfortunately, people switched to disposable syringes. The unit costs are...high in the US, unreasonable in developing countries.
It's not just this hospital, it's widespread ([1] report 38%)
That article also makes it seem like patients in Pakistan are receiving what seems to me like a wildly high number of injections:
> An injection was provided during 53% of patient visits in Rawalpindi and 92% in Tando Allah Yar
> Patients from Tando Allah Yar reported a mean 3.8 visits to a healthcare provider by a member of their household during the previous month, compared to 2.5 by those from Rawalpindi (Table 2). During all such visits, an injection was given. Overall, 56% patients felt that an injection was necessary. Such perceptions were higher in Tando Allah Yar than in Rawalpindi (79% vs. 39%) (Table 2). Providers reciprocated such perceptions in that 44–56% of providers felt that an injection was required for common ailments such as fever, influenza, body aches or diarrhoea.
> Patients expect to receive injections for minor ailments such as fever or influenza-like symptoms and willingly pay for these, on the mistaken belief in the efficacy of injections to overcome common symptoms that eventually abate with time (10). Healthcare providers comply with such wishes and are convinced of the necessity of injections.
> We have previously demonstrated that the total national supply of syringes in Pakistan is sufficient to meet the demand for the ~1.1 billion syringes used annually for immunization, diabetes, laboratory testing and drug administration in clinics or hospitals
On the last point, I did a bit of a search to look for the total number of syringes used worldwide. I'm actually questioning whether that number is using similar methodology to arrive at the ~1.1 billion number, since I'm seeing numbers around 15 billion for the annual number of injections - meaning that Pakistan would be using over double the average per-capita number of syringes (and re-using many of them) while simultaneously having a population that's much younger (23 vs 31 median age) and poorer ($7k vs $26k median PPP/capita) than average.
If those numbers check out, the simple solution would just be to stop giving unnecessary injections, money would be saved, and there'd be no need to reuse syringes.
Is that true or just a rumor? All the family medicine people I know would not do that. Only in a case where it is 50/50 bacterial or viral like an ear infection in a young kid.
Equipment that can be sterilized has been forced out of the market by these disposable things. It is far easier to push disposable product on medical providers and encourage rent-seeking and subscriptions to such things.
It’s exactly the same way with contact lenses. When I was in college in the ’90s, I could get a pair of permanent contact lenses. They would cost a few hundred bucks, but they would last me several years if the prescription didn’t change. They were the same as glasses. You would clean them everyday and disinfect them, and they would serve quite well permanently.
But the contact lens industry decided that wasn’t good enough, and decided that they could sell subscription services for contact lenses that you would need to discard every night.
And those daily wear contact lenses, the disposable kind, basically forced out of the market the permanent ones and now the optometrist regards me as a Martian when I request permanent lenses instead.
You completely ignored human error aspect. Before the blood donation centers used one time use equipment, donors were getting infected with something nasty every now and then. You can sure as hell expect people to commonly forget to properly sanitize those syringes.
I share your hate of rent-seeking and subscription culture, but tbf disposable contact lenses are legitimately a nicer product to use. I've done it both ways.
They can "survive" autoclave cycles that render other pathogens dead/inactive, but there do exist autoclave cycles that seem to pretty reliably inactivate prions.
If you can't trust them to follow the very easy directions of "throw away the single use syringe", how likely is it that they are going to follow the much more complicated process of properly sanitizing the glass syringe?
It's my experience in bumfucklandia in the third world it can be less about cost of products and more about the fact when you run out it costs you 50 bucks to drive into town, 50 bucks to pay the guy at the checkpoint, whatever it costs to ship them / make it worth the time of the shop keep to keep them. And then deal with the fact you're riding 20 people in one Hilux with barely enough room for anything and stuffed into some contorted shape for 20 hours while you go to town and back on the world's bumpiest road.
That could have been said without the massive racism.
It's less about the money and more about the logistics of transporting and stocking these goods in a country that doesn't have decent basic infrastructure.
1. They're talking about the current situation, but you're bringing up history.
2. Given the lessons from the past, why would you still want to do something this dangerous?
And what will Pakistan do with such an IMF loan? The Generals would siphon off most of it to buy their palatial Dubai houses and London condos. Until Pakistan cleans up its act, giving it more loans it throwing good money after bad.
> When we showed Buzdar our undercover footage, he insisted it had been filmed before his tenure or that it had been staged. When asked what he would say to local parents watching this footage, he said: "I can say to them with certainty, with confidence, that you should get your treatment done at THQ Taunsa."
Not gonna fix this with education if they won't admit to having a problem in the first place.
If they aren't educated, throw the whole thing away and start over. if they are educated, and decided to share HIV needles with children, throw the whole thing away, but put them all in prison.
Pakistanis are in a habit of executing circumspect people with needles after the US helped assassinate Bin Laden through a needle / vaccination campaign. They are highly distrustful in particular of people offering vaccines since it is a trojan horse rather than an act of charity.
> They are highly distrustful in particular of people offering vaccines
FTA
> Our investigation suggests that unsafe practices are in part driven by systemic pressures including a reliance on, and cultural preference for, injections as treatment.
> Pakistan has one of the highest rates of therapeutic injections in the world, many of them medically unnecessary. Members of the general public ask for them, including for their children, and doctors happily oblige, says Mir.
Vax program is common knowledge, literally everyone knows about that, and it was an intelligence program not an execution campaign. Your conclusion is made up
You're arguing against a straw man then. I didn't claim the "intelligence program" was an execution campaign against anyone but Bin Laden. The conclusion that it was a trojan horse, I think quite factual.
I did claim Pakistanis have executed vaccine workers ("circumspect people with needles").... because as I cited they have. In part because they have been used as CIA operations.
One way to think of infection control best practice with needles like this.
The cost of a new needle, syringe or new gloves is quite cheap.
The cost of an infection is high.
The cost of a HIV infection is life altering.
So, its clear that whoever did this thought that whatever small savings they obtained from not using a fresh syringe was more important to them than the high likelihood their patients would get infections, including HIV.
Does anyone have alternative archival sites? I want to switch away from archive.today because of the uncivil behavior [1] but can't find any other archival sites that can unpaywall websites.
This is common practice in much of developed world. Long ago, they used to have re-usable glass syringes that could be sterilized. Unfortunately, people switched to disposable syringes. The unit costs are...high in the US, unreasonable in developing countries.
It's not just this hospital, it's widespread ([1] report 38%)
[1] https://www.emro.who.int/emhj-volume-26-2020/volume-26-issue...
That article also makes it seem like patients in Pakistan are receiving what seems to me like a wildly high number of injections:
> An injection was provided during 53% of patient visits in Rawalpindi and 92% in Tando Allah Yar
> Patients from Tando Allah Yar reported a mean 3.8 visits to a healthcare provider by a member of their household during the previous month, compared to 2.5 by those from Rawalpindi (Table 2). During all such visits, an injection was given. Overall, 56% patients felt that an injection was necessary. Such perceptions were higher in Tando Allah Yar than in Rawalpindi (79% vs. 39%) (Table 2). Providers reciprocated such perceptions in that 44–56% of providers felt that an injection was required for common ailments such as fever, influenza, body aches or diarrhoea.
> Patients expect to receive injections for minor ailments such as fever or influenza-like symptoms and willingly pay for these, on the mistaken belief in the efficacy of injections to overcome common symptoms that eventually abate with time (10). Healthcare providers comply with such wishes and are convinced of the necessity of injections.
> We have previously demonstrated that the total national supply of syringes in Pakistan is sufficient to meet the demand for the ~1.1 billion syringes used annually for immunization, diabetes, laboratory testing and drug administration in clinics or hospitals
On the last point, I did a bit of a search to look for the total number of syringes used worldwide. I'm actually questioning whether that number is using similar methodology to arrive at the ~1.1 billion number, since I'm seeing numbers around 15 billion for the annual number of injections - meaning that Pakistan would be using over double the average per-capita number of syringes (and re-using many of them) while simultaneously having a population that's much younger (23 vs 31 median age) and poorer ($7k vs $26k median PPP/capita) than average.
If those numbers check out, the simple solution would just be to stop giving unnecessary injections, money would be saved, and there'd be no need to reuse syringes.
A similar thing happens in the US; people demand antibiotics for a cold. It’s easier to say yes than to explain the reason it won’t work.
Is that true or just a rumor? All the family medicine people I know would not do that. Only in a case where it is 50/50 bacterial or viral like an ear infection in a young kid.
> This is common practice in much of developed world.
Do you mean "developing?" This is not common practice in rich Western countries.
Additionally, as sibling has already pointed out, sterile disposable syringes are extremely cheap.
Do you know why they couldn't switch back to glass syringes?
Equipment that can be sterilized has been forced out of the market by these disposable things. It is far easier to push disposable product on medical providers and encourage rent-seeking and subscriptions to such things.
It’s exactly the same way with contact lenses. When I was in college in the ’90s, I could get a pair of permanent contact lenses. They would cost a few hundred bucks, but they would last me several years if the prescription didn’t change. They were the same as glasses. You would clean them everyday and disinfect them, and they would serve quite well permanently.
But the contact lens industry decided that wasn’t good enough, and decided that they could sell subscription services for contact lenses that you would need to discard every night.
And those daily wear contact lenses, the disposable kind, basically forced out of the market the permanent ones and now the optometrist regards me as a Martian when I request permanent lenses instead.
You completely ignored human error aspect. Before the blood donation centers used one time use equipment, donors were getting infected with something nasty every now and then. You can sure as hell expect people to commonly forget to properly sanitize those syringes.
It's not like glass syringes are out of production though? They are still pretty cheap, I get them for $0.50 each from China.
Daily isn't the only option - you can still get monthly lenses.
Like I said, with proper care and disinfection, permanent lenses could last for years, not days or months!
I share your hate of rent-seeking and subscription culture, but tbf disposable contact lenses are legitimately a nicer product to use. I've done it both ways.
If you forget to autoclave them or not done properly you end up with infected patients, risk is just too much
Sounds like the same risk as this situation of reusing them.
Prions aren't destroyed by autoclave
They can "survive" autoclave cycles that render other pathogens dead/inactive, but there do exist autoclave cycles that seem to pretty reliably inactivate prions.
No but viruses and bacteria are. What's your point and how common is transmitting prions?
If you can't trust them to follow the very easy directions of "throw away the single use syringe", how likely is it that they are going to follow the much more complicated process of properly sanitizing the glass syringe?
A quick search found a pack of 100 disposable syringes in Pakistan for PKR 1100/- which is less than USD 4.
That's 4 cents per syringe. Seems quite reasonable to me. Seems they don't have economics as an excuse.
https://ailaaj.pk/products/apple-disposable-syringe-5ml-100s
A month's wage in Pakistan is about $125. So each syringe would feel like a cup of Dunkin does to many in the USA
It's my experience in bumfucklandia in the third world it can be less about cost of products and more about the fact when you run out it costs you 50 bucks to drive into town, 50 bucks to pay the guy at the checkpoint, whatever it costs to ship them / make it worth the time of the shop keep to keep them. And then deal with the fact you're riding 20 people in one Hilux with barely enough room for anything and stuffed into some contorted shape for 20 hours while you go to town and back on the world's bumpiest road.
That could have been said without the massive racism.
It's less about the money and more about the logistics of transporting and stocking these goods in a country that doesn't have decent basic infrastructure.
See?
I must be so intensely racist that I have no idea what I even said there that was racist.
1. They're talking about the current situation, but you're bringing up history. 2. Given the lessons from the past, why would you still want to do something this dangerous?
Cost, or availability due to cost. Still a driver in developing countries.
From the WHO article linked to by GP, the issue is that patients also insist on injections over oral meds.
That's driving the insistence on injections, and rural doctors/clinics cutting corners.
I was in middle school when we were taught that used syringes were one of the causes of HIV. Can't believe a hospital would do this!!!
These are hospital volunteers reusing the syringes. There's no telling they even went to middle school.
US should rather sanction Pakistan than getting IMF loan to it.
And what will Pakistan do with such an IMF loan? The Generals would siphon off most of it to buy their palatial Dubai houses and London condos. Until Pakistan cleans up its act, giving it more loans it throwing good money after bad.
The parent comment is suggesting sanctioning them, not giving them IMF loans.
How would sanctions help?
death penalty
Or maybe better education?
> When we showed Buzdar our undercover footage, he insisted it had been filmed before his tenure or that it had been staged. When asked what he would say to local parents watching this footage, he said: "I can say to them with certainty, with confidence, that you should get your treatment done at THQ Taunsa."
Not gonna fix this with education if they won't admit to having a problem in the first place.
or the lack of education is the cause of such denial of science.
If he lacked the education he wouldn’t be claiming it was fake footage.
Are you claiming that Pakistani nurses and doctors are not educated on the dangers of needle reuse?
If they aren't educated, throw the whole thing away and start over. if they are educated, and decided to share HIV needles with children, throw the whole thing away, but put them all in prison.
Someone like USAID needs to support such education with funding etc.- https://www.mtapsprogram.org/our-work/health-area/antimicrob...
Too bad Elon got rid of it.
If it were China, the death penalty would be guaranteed.
Pakistanis are in a habit of executing circumspect people with needles after the US helped assassinate Bin Laden through a needle / vaccination campaign. They are highly distrustful in particular of people offering vaccines since it is a trojan horse rather than an act of charity.
> They are highly distrustful in particular of people offering vaccines
FTA
> Our investigation suggests that unsafe practices are in part driven by systemic pressures including a reliance on, and cultural preference for, injections as treatment.
> Pakistan has one of the highest rates of therapeutic injections in the world, many of them medically unnecessary. Members of the general public ask for them, including for their children, and doctors happily oblige, says Mir.
Stop making shit up
Bin Ladin vaccine program:
https://www.theguardian.com/world/2011/jul/11/cia-fake-vacci...
https://www.cgdev.org/blog/white-house-bans-cia-use-vaccine-...
killing of vaccine workers:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10185917/
Not made up. Although I would understand why people might think it's crazy enough that it would be.
Vax program is common knowledge, literally everyone knows about that, and it was an intelligence program not an execution campaign. Your conclusion is made up
GP is using "executed" instead of "lynched."
This goes back to the polio vaccination campaign started in the 1990s. Bin Laden op happened in 2010-2011.
Polio workers were being chased away and lynched longer that. [1]
Still happening BTW [2]
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC2727330/ [2] https://www.rediff.com/news/report/polio-team-attacked-in-pa...
You're arguing against a straw man then. I didn't claim the "intelligence program" was an execution campaign against anyone but Bin Laden. The conclusion that it was a trojan horse, I think quite factual.
I did claim Pakistanis have executed vaccine workers ("circumspect people with needles").... because as I cited they have. In part because they have been used as CIA operations.
One way to think of infection control best practice with needles like this.
The cost of a new needle, syringe or new gloves is quite cheap.
The cost of an infection is high.
The cost of a HIV infection is life altering.
So, its clear that whoever did this thought that whatever small savings they obtained from not using a fresh syringe was more important to them than the high likelihood their patients would get infections, including HIV.
Your cost claims need to be considered with the perspective of the country or location of the clinic.
And from the perspective of who pays the cost.
https://archive.is/a9p1X
Does anyone have alternative archival sites? I want to switch away from archive.today because of the uncivil behavior [1] but can't find any other archival sites that can unpaywall websites.
[1] https://arstechnica.com/tech-policy/2026/02/wikipedia-might-...
Have you considered paying your way through the wall?
If you're not willing to do that, it's "uncivil" to pirate their content, wouldn't you say?
Does the BBC even have a paywall that needs to be bypassed so people can pirate news?
I've been getting one intermittently in recent weeks on the BBC site from the US.
Currently only in the USA. You can read a few articles for free, then there is a $9/month or $50/year subscription.
It includes the website, the live streaming BBC News TV channel, and a library of documentaries.
expect nothing less from a country that has the largest slave population in the world.