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%)
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.
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.
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.
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
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.
> > 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?
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.
Member of household = significantly bigger. I believe your numbers suggest a household size of 1 person. I also would suggest that most likely old people live with their families, and skew towards "which member" of the household went to the doctor.
Well, with such a low mean age it could also be very young people skewing the number, im fully speculating.
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.
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).
> 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.
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.
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.
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.
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
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.
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.
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.
All the Americans/Westerns telling Pakistan is a poor country, it's your governments which are responsible. For the context, US/EU has been sponsoring military governments by toppling Democratically elected governments because some democratically elected Politian's are not as submissive as a corrupt Army general.
Latest case, in which an elected Prime Minister Imran Khan was removed from the office due to US sponsored regime change operations by Pakistan Army. Trumps current favorite Field Marshal Asim Munir as he is serving US as Imran Khan could not (US demanded air bases after it exited US from Afghanistan, which was denied by the elected PM and soon after he was ousted). And later, US kept silence over the election delayed in 2023, And then election was stolen in 2024, and everyone knows that Pakistan Army did still US/EU kept silence. Here people talking about poverty and low income about Pakistan.
Since US/EU sponsored government directly ruled by Army and Trumps favorite field marshal Pakistan has not progressed even 1% since then. People income fallen more than 50% more than 60% people is living below poverty. All because of the hypocrisy of US/EU governments. If you guys care so much about people, at least force your governments to not support such regimes. That would be enough for the people of the country. Instead of telling them that they are poor or xyz.
What I described is just a recent history, we go deeper in the history, history is full of such incidents. And I further do not take it as if I am putting total blame on foreign powers, Pakistanis are to be blame as well. But foreign powers sponsor such regimes all the over the world to have control on certain regions.
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.
117 comments
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'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
https://ourworldindata.org/grapher/life-expectancy-vs-gdp-pe...
Been poor is your biggest health risk.
https://www.un.org/sustainabledevelopment/
When people complain about healthcare costs, they're not complaining about things that cost the same as a cup of coffee locally.
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?
> 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.
> > 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?
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.
Well, with such a low mean age it could also be very young people skewing the number, im fully speculating.
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.
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).
> 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...
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.
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.
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
>
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?
> 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.
> 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.
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.
Latest case, in which an elected Prime Minister Imran Khan was removed from the office due to US sponsored regime change operations by Pakistan Army. Trumps current favorite Field Marshal Asim Munir as he is serving US as Imran Khan could not (US demanded air bases after it exited US from Afghanistan, which was denied by the elected PM and soon after he was ousted). And later, US kept silence over the election delayed in 2023, And then election was stolen in 2024, and everyone knows that Pakistan Army did still US/EU kept silence. Here people talking about poverty and low income about Pakistan.
Since US/EU sponsored government directly ruled by Army and Trumps favorite field marshal Pakistan has not progressed even 1% since then. People income fallen more than 50% more than 60% people is living below poverty. All because of the hypocrisy of US/EU governments. If you guys care so much about people, at least force your governments to not support such regimes. That would be enough for the people of the country. Instead of telling them that they are poor or xyz.
What I described is just a recent history, we go deeper in the history, history is full of such incidents. And I further do not take it as if I am putting total blame on foreign powers, Pakistanis are to be blame as well. But foreign powers sponsor such regimes all the over the world to have control on certain regions.
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-...