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#syringes#injections#syringe#pakistan#needle#cost#disposable#more#https#patients

Discussion (94 Comments)Read Original on HackerNews

satya71about 5 hours ago
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...

Marsymarsabout 4 hours ago
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.

Aurornisabout 3 hours ago
> > 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,

This seems like an excessive number of doctor visits, too. I can’t imagine a household where someone is going to the doctor almost every week. 45 doctor visits a year and they’re getting injections (of what?) most of the time?

ceejayozabout 4 hours ago
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.
Aurornisabout 3 hours ago
Antibiotic overprescribing was a problem in the past, but in my experience providers around me are very resistant to giving antibiotics at all.

My doctor’s office even has a big sign in the waiting room saying they don’t prescribe antibiotics for common infections.

The last time I got strep throat the urgent care clinic was resistant to testing me but finally gave in. When it came back positive the doctor acted oddly like he was reluctantly willing to prescribe antibiotics for it.

loegabout 1 hour ago
We don't give these hypochondriacs saline injections with dirty needles, though.
shigawireabout 4 hours ago
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.
thayneabout 4 hours ago
More than that, it's often easier to just prescribe something than to figure out if it is bacterial or viral.
gib444about 3 hours ago
In the UK, nothing is ever bacterial lol

I had a horrible tooth infection that anyone with a nose could tell was a bacterial infection yet I was massively gaslit and denied antibiotics until I went to the hospital at 11pm after a week of horrendous pain

Doctors very rarely do any kind of test in my experience (I would have thought oozing stinking green stuff would have been easy to test...)

Later

I am somewhat against antibiotics as I have a fragile/already destroyed gut. But there are times when I don't know what other solution there is after exhausting home remedies, other medication and waiting it out

LorenPechtelabout 3 hours ago
Probably patient demand for *something*. The problem of antibiotics for viral infection is well known but the problem with needing to do something is far more widespread. I wouldn't be surprised if a lot of saline is getting injected.
loegabout 4 hours ago
> 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.

Ferret7446about 3 hours ago
The reason we switched is because it's cheaper (including the logistics overhead costs). Sterilization and transport isn't free
SoftTalkerabout 2 hours ago
It's also not perfect. Sure you can throw instruments into an autoclave or even boiling water but they have to be kept sterile after they come out, which is probably harder to do especially in underdeveloped, resource-poor areas.
SanjayMehtaabout 5 hours ago
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

CGMthrowawayabout 4 hours ago
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
bastawhizabout 4 hours ago
I have orders of magnitude more cups of Dunkin each year than I get injections at a doctor
wildzzzabout 1 hour ago
Median household income in US is $83k so 0.04/125 * 83k is about $26, much more than cup of coffee. If you're sticking like 15 kids a day with the same needle, that's like $400 a day saved.
crazygringoabout 3 hours ago
Which would be entirely reasonable cost as part of a healthcare visit.

When people complain about healthcare costs, they're not complaining about things that cost the same as a cup of coffee locally.

i7labout 5 hours ago
Do you know why they couldn't switch back to glass syringes?
ButlerianJihadabout 5 hours ago
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.

cromkaabout 4 hours ago
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.
LorenPechtelabout 3 hours ago
There is also the reality that a sealed package is more of a guarantee of sterility than something that should be autoclaved. Even in the US there have been cases of nasties being passed by inadequate cleaning.

And we had a big scandal locally. Were they doing a shoddy job of colonoscopies? Probably. But genetics left no doubt that they were using one needle per jab, but one syringe per patient. And drawing up from multi-use vials. Stick the hep C patient, in pulling back a bit ends up in the syringe. Discard needle, syringe is still infected. New needle, old syringe, draw from the vial again, vial is now infected.

SoftTalkerabout 2 hours ago
You can still get rigid gas-permeable lenses that last basically forever, I wear them every day. You have to take them out at night and clean them, but you only buy them once (unless you damage or lose them, or your prescription changes).
strattsabout 4 hours ago
Daily isn't the only option - you can still get monthly lenses.
jonahxabout 4 hours ago
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.
nulld3vabout 4 hours ago
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.
faangguyindiaabout 5 hours ago
If you forget to autoclave them or not done properly you end up with infected patients, risk is just too much
seb1204about 4 hours ago
Sounds like the same risk as this situation of reusing them.
jjk166about 3 hours ago
We sterilize plenty of other common tools like scalpels so that doesn't seem like a valid reason. Obviously the disposable design is not even an adequate solution to the risk of cross contamination. I would imagine if it were a real concern you could easily add something like a color changing strip that would indicate whether the needle has been autoclaved since its last use without rendering it useless.
NDlurkerabout 5 hours ago
Prions aren't destroyed by autoclave
kqgnkqgnabout 4 hours ago
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?
themafiaabout 3 hours ago
> The unit costs are...high in the US

So many products are bundled into purchase agreements at hospitals that you can't, in general, sensibly talk about per-unit costs.

nameconflictsabout 5 hours ago
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?
seb1204about 4 hours ago
Cost, or availability due to cost. Still a driver in developing countries.
SanjayMehtaabout 4 hours ago
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.

dwa3592about 5 hours ago
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!!!
CGMthrowawayabout 4 hours ago
These are hospital volunteers reusing the syringes. There's no telling they even went to middle school.
cookiengineerabout 1 hour ago
Women are not allowed to go to school in those countries, and are not allowed to receive an education.

Sharia law, what could go wrong with these sets of rules, right? /s

This is the type of system where the design fails and effects of it are purely self inflicted by that society. It's pretty obvious that a population without education is easier to control, and that's the sole reason women still have no rights in those countries. It's just stupid when you need them to take care of your population's health then, huh?

Gud2 minutes ago
What do you mean, go wrong? God willed it.
jaypatelaniabout 5 hours ago
US should rather sanction Pakistan than getting IMF loan to it.
mlmonkeyabout 4 hours ago
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.
themafiaabout 3 hours ago
> The Generals would siphon off most of it to buy their palatial Dubai houses and London condos.

Next door to other world leaders doing the same? Is that truly our motivation for not transferring the money? Some generals might illicitly buy houses?

> Until Pakistan cleans up its act

I'm sure "The Generals" are going to help there.

> giving it more loans it throwing good money after bad.

Abandoning them entirely as hostages is not acceptable.

ETH_startabout 4 hours ago
The parent comment is suggesting sanctioning them, not giving them IMF loans.
Dusseldorfabout 3 hours ago
It took me 5 rereads before I properly read "should" instead of "would", which totally flips the implication!
malfistabout 4 hours ago
How would sanctions help?
geor9eabout 4 hours ago
There's obviously terrible procedures happening at this clinic, involving contamination, but that one video doesn't seem like the culprit. Notice he removes the needle, then injects medicine into a cannula tube, not flesh. He then re-attaches the needle, draws the second dose, and injects again. That was the problem. The narrator says he then used a brand new syringe for every child, but that initial procedure contaminated the vial. Cannula tubes are primed with saline, that's kind of a long gap for blood to travel to contaminate the vial. Yes he did it wrong, but I get why he thought it would be ok.
t1234sabout 5 hours ago
death penalty
calmwormabout 5 hours ago
Or maybe better education?
ceejayozabout 5 hours ago
> 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.

plutomeetsyouabout 5 hours ago
or the lack of education is the cause of such denial of science.
jabedudeabout 5 hours ago
Are you claiming that Pakistani nurses and doctors are not educated on the dangers of needle reuse?
kube-systemabout 3 hours ago
Doctors and nurses are far from the only medical professionals who might be sticking you with a needle.

In the US your phlebotomist probably has a high school degree and a certification which required a few classes over one semester at a community college and passing an exam.

I doubt Pakistan has higher requirements than most US states do.

supjeffabout 4 hours ago
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.
esalmanabout 4 hours ago
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.

OutOfHereabout 4 hours ago
If it were China, the death penalty would be guaranteed for it.
mothballedabout 5 hours ago
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.
corndogeabout 5 hours ago
> 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

mothballedabout 5 hours ago
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.

halperterabout 5 hours ago
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-...

LeoPantheraabout 4 hours ago
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?

jjmarrabout 4 hours ago
Does the BBC even have a paywall that needs to be bypassed so people can pirate news?
ceejayozabout 4 hours ago
I've been getting one intermittently in recent weeks on the BBC site from the US.
LeoPantheraabout 4 hours ago
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.

aussieguy1234about 5 hours ago
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.

seb1204about 4 hours ago
Your cost claims need to be considered with the perspective of the country or location of the clinic.
hsbauauvhabzbabout 4 hours ago
And from the perspective of who pays the cost.
aussieguy1234about 3 hours ago
Wherever you are, the cost of the said items is always much cheaper than the infection
calvinmorrisonabout 4 hours ago
expect nothing less from a country that has the largest slave population in the world.