PATIENTS vary widely in their acceptance of injections. Vusi Ngubane turned up monthly without fail at one of our mobile clinics way out in the bush, insisting on a jova whether indicated or not. He was the local headman, always traditionally dressed in skins, bare chested, a sacred feather embedded in his hair, bangles on the ankles, strings of dried seeds round his chest, bare footed and with a brutal-looking knobkerrie in one hand. He generated a lot of noise and disruption – I found it satisfactory for all parties to give him a large shot of vitamin B immediately on arrival, after which he shouted with satisfaction and left, still shouting, at a run.

Over the years I’ve taught countless nurses to give painless injections. Timing is crucial and the chosen site, usually a buttock, is smacked with one hand a fraction of a second before the other delivers the shot. The patients feels the smack but not the pain of the needle and often does not realise the deed is done until it’s all over.

In the past few years, doctors worldwide have become aware that the use of intravenous drips and injections has become excessive and often quite unnecessary. In many clinics in southern and east Africa, setting up a drip is almost automatic and gives the patient and relatives the impression that something is being done, whether a diagnosis has been made or not. In the wards, many medicines are given intravenously although oral tablets and mixtures are just as effective. In private medicine, one underlying reason is economic – you can charge the patient much more for a drug given by drip than orally.

After the AIDS era began, disposable needles replaced the old steel ones which were kept in surgical spirit for re-use and sharpened as required. In our part of Africa, drug addicts still re-use the disposables, their minute remaining veins often being visible as contaminants and salts damage and calcify the blood vessel wall.

Not surprisingly, health workers are wary about accidentally puncturing themselves while giving an injection or taking a blood sample from a nervous adult or child whose movements may be unpredictable. Should it happen with an untreated AIDS case, you will find yourself taking anti-retrovirals for the next month and then waiting for your own HIV test – most of us making no assumptions, I might add.

Worse still if, as in Uganda whose neighbours have had recent outbreaks, you encounter a suspected Ebola case. Several tropical diseases in their early stages are similar to Ebola but not lethal or even self-limiting; this is not a consolation if the blood test result is not available and the patient needs another blood test or a drip. Often only double gloves and masks are available, not at all reassuring if you yourself have not been vaccinated.

My younger colleagues’ jaws always drop when I tell them about exchange blood transfusions in the newborn suffering from Rhesus disease. These babies died or were brain damaged because their blood cells began to lyse or burst a few days after birth by which time they were deeply jaundiced. The treatment was to exchange the toxic blood for fresh stuff via tubes inserted up the newborn’s umbilical cord. It could take hours and spasm of the transfuser’s fingers was an occupational hazard. Today the mother at risk of a future affected pregnancy is given an injection and Rhesus disease is very rare.

Similarly, before the arrival of haemodialysis machines to treat kidney failure, we were limited to peritoneal dialysis. A small steel trochar and canula were guided into the abdominal cavity; several litres of sterile fluid followed and were drained back out after a few hours. This contained the toxins that non-functioning kidneys were unable to deal with.

Chemotherapy for certain cancers involves intravenous drugs. Some years ago I would return from the nearest oncology unit to my consulting room with a drip in one arm being fed from a cute little ball of cancer drugs nestled in my shirt pocket. The clinic staff told me that several would-be patients, observing this haggard white man with a tube coming out of his chest, muttered to each to each other, shook their heads, sighed, and left the premises.

Dr David Vost studied medicine at Glasgow University and works at a hospital in Swaziland. He and his family live on a farm in Northern Uganda near the Albert Nile.