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900 Children Test Positive for H.I.V. in Pakistani city of Ratodero

nytimes.com

21–30 of 103 posts

Re: 900 Children Test Positive for H.I.V. in Pakistani city of Ratodero

#21
post #4

I mean not exactly surprising. We literally just had a measles outbreak in Brooklyn last year. Vaccination rates are basically a prediction market on events like this happening.

What does measles vaccination in Brooklyn have to do with syringe reuse in Ratodero?

Lack of proper understanding of healthcare science?

Re: 900 Children Test Positive for H.I.V. in Pakistani city of Ratodero

#22
post #11
post #2

This news report makes my mind boggle. Reuse of syringes? In this century? The doctor says he was too poor to afford syringes! So reuse of syringes is the solution? Bill the cost of the syringe to the patient. Ask for donations. Do whatever it takes but never reuse a syringe. How can a doctor find reuse of syringes remotely acceptable?

The doctor says the parents of the patient were too poor to afford syringes; and the family was already starving in order to pay for the medicine. Wouldn’t it be nice if patients could afford anything. Reality doesn’t work that way though, and some first world people just can’t imagine what real poverty is like (I can’t either). > When Mr. Jalbani protested, he said, Mr. Ghanghro snapped at him and told him he was us…

I still for the life of me can't understand how anyone with any medical training at all could reuse a syringe. Some other shortcuts I could imagine, but reusing a syringe is like eventually guaranteeing this kind of outbreak.

Re: 900 Children Test Positive for H.I.V. in Pakistani city of Ratodero

#23
post #4

I mean not exactly surprising. We literally just had a measles outbreak in Brooklyn last year. Vaccination rates are basically a prediction market on events like this happening.

What does measles vaccination in Brooklyn have to do with syringe reuse in Ratodero?

My point was that the cluster of unvaccinated folks in Brooklyn shows an uptick in people betting that the risk of something like this happening surpassed the risks of measles. Many/most people in Brooklyn eventually got vaccinated after the outbreak started, showing that they weren’t philosophically opposed to vaccines, but rather were making a bet based on perceived risk.

That said, the epidemic itself is thought to have started as an offshoot of the epidemic in Israel. And right before the epidemic in Israel there was one in Pakistan, so there may be a direct connection as well.

Re: 900 Children Test Positive for H.I.V. in Pakistani city of Ratodero

#24

In some jurisdictions, auto-disposable needles are now required to be used to prevent things like this: https://en.wikipedia.org/wiki/Safety_syringe

One of my dad's first jobs out of college was designing needle-grinding machines for BD. they have a relatively complex 3-facet cutting edge, but the plastic hub allows you to accurately orient them on the grinder. I can imagine collecting, cleaning, sterilizing, and resurfacing needles could be a cottage industry in the developing world. 23G 1.5" becomes 23G 1.25", and so on.

https://www.google.com/search?q=micrograph+of+hypodermic+nee...

https://www.ncbi.nlm.nih.gov/pubmed/2773053

Re: 900 Children Test Positive for H.I.V. in Pakistani city of Ratodero

#25
post #11

Earlier quoted context omitted.

The doctor says the parents of the patient were too poor to afford syringes; and the family was already starving in order to pay for the medicine. Wouldn’t it be nice if patients could afford anything. Reality doesn’t work that way though, and some first world people just can’t imagine what real poverty is like (I can’t either). > When Mr. Jalbani protested, he said, Mr. Ghanghro snapped at him and told him he was us…

I still for the life of me can't understand how anyone with any medical training at all could reuse a syringe. Some other shortcuts I could imagine, but reusing a syringe is like eventually guaranteeing this kind of outbreak.

Between this and no treatment, the choice is easy for most people. Although I do find “rummaging through the trash” for syringes astonishing. If you’re gonna reuse it, at least sterilize it (failing that, rinse it) and store it somewhere clean?

Re: 900 Children Test Positive for H.I.V. in Pakistani city of Ratodero

#26
post #11

Earlier quoted context omitted.

The doctor says the parents of the patient were too poor to afford syringes; and the family was already starving in order to pay for the medicine. Wouldn’t it be nice if patients could afford anything. Reality doesn’t work that way though, and some first world people just can’t imagine what real poverty is like (I can’t either). > When Mr. Jalbani protested, he said, Mr. Ghanghro snapped at him and told him he was us…

I still for the life of me can't understand how anyone with any medical training at all could reuse a syringe. Some other shortcuts I could imagine, but reusing a syringe is like eventually guaranteeing this kind of outbreak.

Because you don't know what real poverty is like (neither do I)? I remember a story from one of Atul Gawande's books (was it Complications?) about how rural Indian surgeons operate. As he described it, they were missing many kinds of equipment that western surgeons consider absolutely indispensable in doing their work. They replaced it with whatever was available, stuff like plastic piping from the nearest plumbing store, which then comes into contact with the entrails of the patient, so to speak.

Re: 900 Children Test Positive for H.I.V. in Pakistani city of Ratodero

#28
post #2

This news report makes my mind boggle. Reuse of syringes? In this century? The doctor says he was too poor to afford syringes! So reuse of syringes is the solution? Bill the cost of the syringe to the patient. Ask for donations. Do whatever it takes but never reuse a syringe. How can a doctor find reuse of syringes remotely acceptable?

This is how poverty works - they probably genuinely have no way if getting the needed stuff even if they knew how important it is.

Poverty exacerbated tremendously by financial and social corruption all around.

Re: 900 Children Test Positive for H.I.V. in Pakistani city of Ratodero

#29
What's (not) shocking is how stigmatized the HIV-positive population is. Authorities are literally segregating the HIV-positive children into a different side of the room from the rest.

An obvious effect of this is that people will be terrified to get tested at all, as it's all downside with the possible upside of treatment being a distant dream. And that makes it both harder to evaluate the spread of the disease, and also harder to prevent further transmission of it.

As a selfish aside, I will never get a shave from a barber who doesn't have an autoclave.

Re: 900 Children Test Positive for H.I.V. in Pakistani city of Ratodero

#30
post #5

>Health officials now say that Mr. Ghanghro is unlikely to be the sole cause of the outbreak. Visiting health workers saw many cases of doctors reusing syringes and I.V. needles. Barbers take the same razor to the faces of multiple customers, they said, and roadside dentists crack away at patients’ teeth on sidewalks with unsterilized tools.

Even here in Melbourne the barber offers to use a cutthroat razor to give the neck a clean shave after a haircut. He's always a little puzzled when I'm "no thanks" to the razor.

Genuine question, if the razor is soaked in barbosol(?) between uses, is it not thoroughly disinfected. Aren't most medical tools metal? If a barber used an autoclave, would it be acceptable then?
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