Discussion

Hospital at centre of child HIV outbreak caught reusing syringes in undercover filming

t1234s: death penalty

satya71: 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...

calmworm: Or maybe better education?

ceejayoz: > 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.

dwa3592: 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!!!

mothballed: 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.

halperter: https://archive.is/a9p1XDoes 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-...

corndoge: > They are highly distrustful in particular of people offering vaccinesFTA> 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

mothballed: 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.

corndoge: 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

mothballed: 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.... because as I cited they have. In part because they have been used as CIA operations.

i7l: Do you know why they couldn't switch back to glass syringes?

faangguyindia: If you forget to autoclave them or not done properly you end up with infected patients, risk is just too much

nameconflicts: 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?

jabedude: Are you claiming that Pakistani nurses and doctors are not educated on the dangers of needle reuse?

plutomeetsyou: or the lack of education is the cause of such denial of science.

SanjayMehta: 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

NDlurker: Prions aren't destroyed by autoclave

ceejayoz: If he lacked the education he wouldn’t be claiming it was fake footage.

ButlerianJihad: 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 looks at me like I am a Martian when I request permanent contact lenses instead.

jaypatelani: US should rather sanction Pakistan than getting IMF loan to it.

aussieguy1234: 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.

stratts: Daily isn't the only option - you can still get monthly lenses.

CGMthrowaway: These are hospital volunteers reusing the syringes. There's no telling they even went to middle school.

seb1204: Your cost claims need to be considered with the perspective of the country or location of the clinic.

supjeff: 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.

jjmarr: Does the BBC even have a paywall that needs to be bypassed so people can pirate news?

mlmonkey: 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.

ETH_start: The parent comment is suggesting sanctioning them, not giving them IMF loans.

cromka: 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.

seb1204: Sounds like the same risk as this situation of reusing them.

malfist: How would sanctions help?

CGMthrowaway: 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

calvinmorrison: expect nothing less from a country that has the largest slave population in the world.

seb1204: Cost, or availability due to cost. Still a driver in developing countries.

mothballed: 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.

SanjayMehta: 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.

Loughla: No but viruses and bacteria are. What's your point and how common is transmitting prions?

ButlerianJihad: Like I said, with proper care and disinfection, permanent lenses could last for years, not days or months!

kqgnkqgn: 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?

Marsymars: 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 hospitalsOn 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.

ceejayoz: 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.

SanjayMehta: 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...

loeg: > 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.

esalman: 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.

jonahx: 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.

nulld3v: 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.

shigawire: 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.

Marsymars: They can "survive" autoclave cycles that render other pathogens dead/inactive, but there do exist autoclave cycles that seem to pretty reliably inactivate prions.

Loughla: 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?

mothballed: I must be so intensely racist that I have no idea what I even said there that was racist.

ceejayoz: I've been getting one intermittently in recent weeks on the BBC site from the US.

NDlurker: My point is disposable is superior

bastawhiz: I have orders of magnitude more cups of Dunkin each year than I get injections at a doctor

alex43578: You can't characterize a country where: - dozens of people just got HIV from syringe reuse - that ranks 168th out of 193 countries in HDI - ranked 136th out of 182 countries in corruption as backwards, underdeveloped, or corrupt. /s

geor9e: 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.

thayne: More than that, it's often easier to just prescribe something than to figure out if it is bacterial or viral.

kube-system: Well if you’re going to infect people, might as well save money while doing so :)

kube-system: Weren’t those the hard plastic ones with low oxygen permeability? They’re not as good for your eyes.

kube-system: There is more effort today to avoid overprescribing antibiotics, but in cases where diagnosis is not certain, most providers will oblige

Ferret7446: The reason we switched is because it's cheaper (including the logistics overhead costs). Sterilization and transport isn't free

aussieguy1234: Wherever you are, the cost of the said items is always much cheaper than the infection

jjk166: 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.

ButlerianJihad: No, they were soft, “hydrophilic” or for astigmatism, toric. The hard ones were old, old technology, and largely superseded.

themafia: > 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 actI'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.

themafia: > The unit costs are...high in the USSo many products are bundled into purchase agreements at hospitals that you can't, in general, sensibly talk about per-unit costs.

kube-system: 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.

Dusseldorf: It took me 5 rereads before I properly read "should" instead of "would", which totally flips the implication!

garbawarb: But Pakistanis don't.

crazygringo: 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.

LorenPechtel: 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.

gib444: In the UK, nothing is ever bacterial lolI 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 painDoctors very rarely do any kind of test in my experience (I would have thought oozing stinking green stuff would have been easy to test...)

bastawhiz: The point is that if the analogy of a $0.04 syringe is supposed to be as expensive as a cup of coffee, it's still not expensive even if you do it often. Maybe they have too many injections. Either way we have a bunch of kids with a disease that can kill because someone thought something as expensive as a cup of coffee was too expensive.

LorenPechtel: 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.

SoftTalker: 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).

SoftTalker: 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.

dzhiurgis: A friend passed away few months ago in London from kidney infection.UK seems very to be very cautious of over diagnosis, while my experience in Eastern Europe was opposite - my infant received 3 different kinds of steroids (potentially what stunned his growth).

heffert: That's terrible. We should import millions of these people to our own countries, where many of them will work in healthcare.

Aurornis: 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.

ButlerianJihad: I don’t know how widespread it is, but some people will beg for antibiotics when they definitely have a viral infection.My friend who always used a naturopath would go on endlessly trying to diagnose herself with viral or bacterial to decide whether she should ask for antibiotics, but I definitely got the point.I suppose many patients simply don’t know the difference.

hgoel: My dad in India gets prescribed antibiotics whenever he's sick. Despite my constant explanations, he insists that this is how it should be, because when you're sick your immunity is lowered.On the other hand, the last time I got prescribed antibiotics was probably almost 10 years ago when I ended up in the hospital from an abscess.Granted, my dad is old, but that part of the world still seems to expect doctors to do more for a common cold than just tell you to rest for a week and take an acetaminophen or phenylephrine if/when needed (even when that's really all you need).

technion: Surely there is a cost to sterilising too.

loeg: We don't give these hypochondriacs saline injections with dirty needles, though.

gib444: [delayed]

wildzzz: 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.

Marsymars: > 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.For strep in particular, wiki indicates that not treating with antibiotics isn't unreasonable (presumably opinions will vary by doctor): https://en.wikipedia.org/wiki/Streptococcal_pharyngitis#Anti...

Marsymars: > Granted, my dad is old, but that part of the world still seems to expect doctors to do more for a common cold than just tell you to rest for a week and take an acetaminophen or phenylephrine if/when needed (even when that's really all you need).FYI phenylephrine is effectively a placebo and the FDA has proposed ending its use in OTC drugs. (There've been HN threads on the subject, with many comments.)Pseudoephedrine works great though.

cookiengineer: 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? /sThis 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?

Gud: It’s not going to fix this individual, but it certainly will fix the society.

Gud: What do you mean, go wrong? God willed it.

MagnumOpus: You are comparing monthly individual wages in Pakistan to annual household income in the US. That results in your numbers being nonsense.

KetoManx64: If you find it unacceptable why don't you go fly over there and do volunteet work and donate your money to fund schools and education?

chimineycricket: Women are allowed full education in Pakistan.

themafia: I had sort of hoped our Democracy would afford for a more effective approach. If you find those generals so onerous why don't you go fly over there and assassinate them?

Aurornis: > > 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?

londons_explore: I, as someone broadly healthy and who has barely used healthcare services, asked to see my health records recently.I was shocked to see 500+ 'interactions' between me and the healthcare provider! However it turns out the majority of those interactions are very minor things - ie. "Patient received text message reminder about appointment". "Patient was sent letter with test results" etc.When you count interactions like that, you can get a big number fast.

cookiengineer: > What do you mean, go wrong? God willed it.Was it God, or was it one of the 18 different prophets, who each have promoted their own interpretation of the Quran? ... and who each of them, btw, have the annihilation of followers of the competing prophets as their destructive goal.Does that sound like the will of a deity to you? .. or more like the will of a petty, narcissistic and greedy human being?I don't know if deities exist, but I'm pretty sure they don't promote the killing of humans.

MassiveQuasar: Could just prescribe sugar pills then instead of antibiotics for a cold.

thayne: IME, most people (in the US) don't bother going to a doctor for a cold unless it lasts a long time or is especially bad, because you'll probably get better on your own and going to the doctor is expensive.

M95D: > they have to be kept sterile after they come out, which is probably harder to do especially in underdeveloped, resource-poor areasIt's actually very easy. Sterilization takes place in a stainless steel container that has "windows" on it's sides. When the sterilization cycle ends, these "windows" are closed just as the container is taken out of the autoclave. The container will remain sterile inside until opened.Also, simply opening the container to take one syringe from it doesn't make it dangerously contaminated. As demonstrated by the article, the biggest danger comes from other people's blood (HIV, HCV, HBV), not ordinary bacteria we have on our skin.

ButlerianJihad: I was working in a church office when I came down with a runny nose and other cold symptoms.My supervisor told me I could stay home for a day, but if longer than that, I would require a doctor’s excuse.Now, that seemed fair from a labor perspective, but it is extremely unfair to someone like me. Because I do not own a vehicle, and seeing a doctor would involve boarding one or more buses and snorking the entire way there and back. Risking infection for everyone around me was exactly what I sought to avoid by staying home.So what else could I do, but come into work and carry on? It is this sort of unreasonable requirement that fuels “presenteeism”.

KetoManx64: I don't give a damn about them nor their country. They can deal with their own problems and if people want to help they can use their own money to fund it instead of using my tax dollars.

imtringued: I know antibiotics are really popular because killing bacteria seems really effective, but have you considered asking your doctor for a probiotic treatment?Oral probiotics tend to work really well (similar effect to getting rid of bad bacteria) because they don't have to survive the stomach acid.

imtringued: The unit costs per syringe are incredibly low even by Pakistani cost of living standards and the cost of reusing a syringe is extremely high.You're coming up with an extremely complicated solution that would be a complete non-issue if the yearly salary of Pakistani citizens rose by even a single dollar.

kelnos: Unfortunately, the person making the decision to save money on syringes isn't the one who has to bear the cost when something goes wrong.

kelnos: I feel like spending the cost of a crappy cup of coffee to get a clean needle so you don't get HIV is money well spent.

ButlerianJihad: There is a secured room here where I've been assigned a PIN, but the room's door is unlocked between 6am-6pm. Nevertheless, I always enter my PIN on the pad, or at least try to recall it clearly. Because if you're in the habit of pulling that door open during the day, 8 months later will come a time it is locked, and you won't remember your PIN because you've never ever used it.The same goes for sterilizing such things in a medical setting. I think HCPs are very accustomed to the disposable and pre-sterilized supplies that they don't even consider an item's sterile status or the need to sterilize it after use. So this is the pitfall that comes with all the disposable stuff: that routine sterilization is forgotten as a skill or as a necessity.

fastasucan: Why do you say oddly? Prescribing antibiotics just because is how you get resistance.

jaypatelani: If you block loans they will try and act on trading with other countries which will be more helpful overall than just throwing money at the problem

throw0101a: > My supervisor told me I could stay home for a day, but if longer than that, I would require a doctor’s excuse.You'd think the supervisor would realize it's in their own self-interest for you to not be around spreading infection (to them) by your mere presence.There are of course people who abuse systems where doctors notes are not needed, and call in and then go have fun. It's not too hard to come across stories of people getting on short/long-term disability by know the correct doctor (I know of a situation where 3 members of the same family went to the same doctor and got a note for some condition).

throw0101a: > 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.Are there placebos that could be given instead?

devilbunny: Phenylephrine is a placebo for nasal congestion, but it’s a solid drug for raising blood pressure. Used all the time in anesthesia (obviously not an OTC use).