On Monday night, a magnitude 6.6 earthquake struck Japan, leading to a tsunami warning. Fortunately, authorities reported minimal damage, and the warning was soon lifted. According to local media, there was only one minor injury involving a man who fell at his own home.

Japan, located in the Pacific Ring of Fire, experiences approximately 1,500 tremors annually. However, these quakes have a long-lasting impact on one's health—both physical and mental.

Health Impacts Of Earthquakes

1. Wound Infections

Earthquake-related injuries range from cuts and bruises to fractures and crush injuries. If not attended to on time, these wounds can lead to infections like sepsis, tetanus, or even amputations if untreated. Regions with scarce medical resources face higher risks of untreated injuries and antimicrobial resistance. Ensuring prompt medical care and deploying teams to assess building safety is critical to preventing further injuries and fatalities.

A recent study examined infections in 225 earthquake survivors with musculoskeletal injuries treated between February and April 2023. It found that gram-negative bacteria were common in the wounds of the victims. Acinetobacter baumannii (49.4%) and enterococci (28.6%) were the most prevalent. Many pathogens were multidrug-resistant, with 76% from wound cultures and 58% from deep tissue cultures showing resistance. Common infections included surgical site infections (32.8%), urinary tract infections (5.3%), bloodstream infections (5.7%), and pneumonia (0.4%). Intensive care was required for 35.6% of patients, with a mortality rate of 2.7%.

2. Infectious Diseases

Earthquakes disrupt water supplies, leading to unsanitary conditions that spread waterborne diseases such as cholera. Meanwhile, it also pushes people to take shelters in dingy places, which can outbreaks of measles, respiratory illnesses, and parasitic infections like leishmaniasis. Cold conditions and stress suppress immunity, increasing the risk of disease spread.

3. Chronic Conditions

Access to medication and medical care is often disrupted by earthquakes. Studies show increased rates of heart attacks, strokes, and diabetes following earthquakes due to stress and disrupted routines. Destruction of health records and facilities exacerbates these issues, especially in disaster-prone regions.

4. Healthcare Disruption

Damaged medical facilities and transport links hinder healthcare delivery. Pregnant women and individuals with chronic diseases face heightened risks. Refugees and displaced populations encounter accessibility barriers to healthcare services.

5. Psychological Trauma

Survivors of these earthquakes often suffer from anxiety, depression, and Post Traumatic Stress Disorder (PTSD). Tailored mental health programs are crucial for recovery, especially for those already living in conflict zones or displacement.

On April 14 2010, a 7.1-magnitude earthquake struck Qinghai Province, China, devastating Yushu County. A psychological relief study, published in the Journal Of Affective Disorders in 2011, assessed the mental health of 505 survivors three to four months post-disaster. Using tools like the PTSD Checklist-Civilian version (PCL-C) and Hopkins Symptoms Checklist-25 (HSCL-25), the study found prevalence rates of 33.7% for probable PTSD, 43.8% for anxiety, and 38.6% for depression, with one-fifth of participants experiencing all three. Key risk factors included being female, experiencing intense fear during the quake, and having limited social support, as measured by the Perceived Social Support Scale (PSSS).

An eclectic approach combines therapeutic frameworks according to an individual's symptoms, personality, developmental history, cultural and socioeconomic context, coping patterns and readiness for change—while keeping the therapeutic relationship and client participation central to recovery.

Psychological difficulties rarely exist in isolation. Anxiety, depression, relationship difficulties or trauma-related symptoms may be influenced by cognitive patterns, emotional regulation, personality, developmental experiences, relationships and social circumstances.

This is why psychotherapy cannot always follow a single therapeutic model. Eclectic therapy allows clinicians to draw from established approaches such as CBT, psychodynamic therapy, trauma-informed interventions, attachment-based approaches, emotion-focused work, mindfulness and behavioural strategies, based on the individual's clinical needs.

Importantly, eclectic therapy is not an arbitrary combination of techniques. Each intervention should have a clinical rationale and be linked to the individual's psychological formulation.

Treatment begins with understanding the individual

A clinical formulation considers more than symptoms or diagnosis. Personality factors, developmental history, attachment patterns, family dynamics, cultural expectations, socioeconomic circumstances and social identities may all influence how psychological distress develops and is maintained.

For example, the same anxiety symptoms may reflect perfectionism and conditional self-worth in one person, while being associated with attachment insecurity or previous adverse experiences in another.

Therapeutic readiness is also important. A client experiencing significant trauma-related dysregulation may initially require safety, stabilisation, psychoeducation and emotional regulation before deeper trauma processing is appropriate.

Also read: Teachers' Day 2026: How Teachers Shape Students’ Mental Health

Previous coping attempts are clinically relevant

People often arrive in therapy after already trying to manage their difficulties through self-help, lifestyle changes, support from family or friends, boundary-setting or previous therapy.

These efforts should not be dismissed simply because they were unsuccessful. Understanding what the person tried, what helped, what did not and why provides valuable information for case formulation and treatment planning.

Coping mechanisms such as avoidance, perfectionism, emotional suppression or reassurance-seeking may also have served a protective function at an earlier stage. Therapy therefore focuses not merely on labelling a behaviour as maladaptive, but on understanding its function and developing more adaptive alternatives.

Also read: Mental Health Emergency Visits Among Children Aged 6-9 Rise 62% In England

How eclectic therapy may look in practice

Relationship difficulties: A client who becomes highly distressed by emotional distance in relationships may require a combination of attachment-based psychoeducation, emotion-regulation strategies, cognitive and behavioural interventions, alongside exploration of earlier relational experiences.

Emotional disconnection: A high-functioning client who feels emotionally numb may require less emphasis on problem-solving and greater focus on emotional awareness, intellectualisation, experiential work and exploration of how emotions have historically been managed.

Cultural and social context: Anxiety or depression in a client navigating family expectations, sexuality, gender, financial pressures or minority stress cannot always be understood solely through individual psychological processes. Cognitive, emotional, relational and contextual factors may need to be addressed together.

Therapy is a collaborative process

The therapist provides clinical expertise, psychological formulation, therapeutic skills and appropriate challenge, but the client remains an active participant in the therapeutic process and recovery.

This may involve reflecting on patterns, practising skills between sessions, experimenting with new behaviours and communicating openly about what is or is not working. This responsibility should not be confused with blame; therapy is a collaborative process in which the therapist provides guidance while the client gradually develops greater agency in managing their psychological wellbeing.

The therapeutic relationship remains central. Respect, psychological safety and appropriate therapeutic challenge are particularly important in trauma-informed practice. Respecting a client's history does not mean agreeing with every decision; it means understanding the experiences and circumstances within which those decisions were made.

Eclectic therapy recognises that psychological difficulties are multidimensional and that individuals differ in their personality, history, circumstances, coping mechanisms and capacity for change.

The central clinical question is therefore not simply which therapy works? but which therapeutic approach is most appropriate for this individual, for this difficulty, at this stage of treatment?

When grounded in clinical formulation and evidence-informed practice, eclectic therapy provides flexibility without losing therapeutic structure—allowing treatment to address the person rather than simply the presenting symptom.

Recent reports of more than 7,000 people aged 18 to 25 testing HIV positive in Karnataka have put the spotlight on HIV among India's younger population.

The development has prompted the Karnataka government to expand HIV awareness, counselling, and voluntary testing initiatives across colleges. But the numbers raise a bigger question: are young people actually seeing higher HIV transmission, or are more infections simply being detected?

In an exclusive conversation with HealthandMe, Dr. Ishwar Gilada, President Emeritus, AIDS Society of India and a globally acclaimed HIV/STI/infectious diseases expert, sheds light on the recent trends and patterns of HIV cases in India in the last few years. He also explained the shifting nature of HIV awareness, sexual behaviour, testing and prevention in India.

Factors Driving HIV Risk Among Young Population

1. The Cohort Effect

According to the doctor, India's HIV epidemic initially showed a steady increase after the first cases were identified in 1986 until at least 2005. He said cases were static from 2005 to 2010 and even started going down till 2020. He said that we started seeing an increase again in the last five to six years.

The doctor attributed the sudden increase in cases to what he described as a “cohort effect” which is affecting people born around or after 2000.

He explains, "Cohort affects those who are born, whom we call millennium babies, who are born either in 2000 or after that. Millennium babies, who are now 20-25 are more vulnerable."

2. Lack of HIV Awareness Campaigns

The doctor believes another reason could be that young people today were not exposed to the intensive HIV awareness campaigns that existed during the early 2000s.

He says, “They are vulnerable because high-profile campaigns for HIV awareness were there from around 2000 to 2005. After that, they stopped as improved HIV treatment started.”

Also read: Thailand’s HIV Cases Cross 550,000 In 2026; Over 25,000 Among 15–24s

3. Changing Sexual Behaviour

The doctor said another important factor is the changing nature of sexual relationships and how people perceive risk.

“Earlier it was believed that if you frequent red light areas, you may pick up HIV from sex workers. But young people say that we don't go to red light areas.”

According to the doctor, this perception can be misleading because sexual contact can occur in many different settings like massage parlours where one may also have access to services related to sex work.

He also pointed towards sexual relationships involving multiple partners. He says that there is a lot of interpersonal sexual contact happening and without any commitment with unknown partners. He says, "They do not consider them either self or that person at risk.”

He also highlighted HIV risk among homosexual men. He says, "After Section 377 has been repealed, same sex among has become more frequent. They do not consider themselves to be at high risk because they think that they are not having sex with the female or a sex worker.”

4. PrEP And PEP Awareness Are Misunderstood

The doctor also raised an interesting concern about growing awareness of HIV prevention medicines like PrEP and PEP.

“There is awareness about PEP, post-exposure prophylaxis, and pre-exposure prophylaxis. So what they started thinking even if we take a risk, there is a PEP available. If we have to take a risk, we can take a PrEP and we can have a medicine and then we can have sex.”

He also said people may selectively use prevention based on how risky they believe another person appears. The result, he said, is a potentially dangerous mismatch between perceived risk and actual risk.

5. Stigma May Stop People From Testing And Taking Treatment

The fear of being identified as someone living with HIV can become a barrier to diagnosis and treatment. For younger people, the problem can be even more difficult because they may live with their families and have little privacy. The doctor said society needs to recognise that HIV is now a manageable infection.

“Society has to accept that this is now infection, manageable, better than diabetes, better than many other diseases.”

He also argued that stigma is not confined to the public. “We have to blame medical community.”

He alleged that in healthcare, patients continue to get treated differently. He recalled a case involving one of his patients who was hospitalised.

He says, “One of my patients told me they wrote they had written HIV positive on my bed when I was hospitalised. So, if this is the way you are discriminating, that person won't be maintaining his anonymity of HIV that he did for 25 years.”

Also read: Tivicay: US FDA Approves Drug to Treat HIV In Newborns

How To Prevent HIV Transmission?

1. HIV Self-Testing Should Be Improved

The doctor identified HIV self-testing as one area where he believes India's programme could be strengthened. He says, “One of the flaws of the national program is home HIV testing kit is not allowed in the program. Though you can buy the home testing kit on Amazon,it is not available in the program. So marginalised people will not get tested.”

He also raised concerns about the price of commercially available kits. He says kits that cost Rs 700 to 800 must not priced more than Rs 100 to 200.

2. Limited Access To PrEP

PrEP, or pre-exposure prophylaxis, was another area the doctor believes requires greater attention. “PrEP is not part of the national program,” he said, adding that PrEP has been approved in India but is not sufficiently integrated into the public programme. He said if this is fixed, people who are not aware of their HIV status will also try to find out.

3. HIV Stigma Remains A Major Problem

One of the strongest messages the doctor gives is how HIV treatment has changed dramatically, but it is still stigmastised. He explained that treatment can also suppress the virus to the point where sexual transmission does not occur.

He says, “HIV treatment is so powerful that a person with HIV can stay alive for as much as the normal lifespan of any person in the.” But while treatment has transformed HIV medically, the doctor said society has not kept pace. “Currently, the major killer, if at all, we can call, is the stigma and discrimination.”

Also read: Unlicensed Injection Business Sparks Health Alert In Canada: How HIV & Hepatitis Spread Through Medical Procedures

4. People Should Not Wait For Symptoms

Another important point the doctor stressed is that HIV can remain clinically silent for years. But as the immune system becomes progressively weakened, the person becomes vulnerable to infections that would ordinarily be easier for the body to fight.

“Talking about symptoms, when virus multiplies initially, the person will have no symptoms. It takes two to four years, five or even 10 years' time. If you wait till you fall sick, then a lot of valuable time will pass.”

His message was therefore to test and start treatment before advanced immune damage occurs.

5. Prevention Should Go Beyond Awareness

When asked about prevention, the doctor divided it into pharmacological and non-pharmacological approaches. He emphasised upon safe sex and reducing exposure to multiple sexual partners.

The larger lesson from his interview is that HIV prevention cannot depend on a single intervention. It requires testing, treatment, condoms, PrEP and PEP where appropriate, harm-reduction measures, awareness and, perhaps most importantly, an environment where people are not afraid to seek care.

The Bigger HIV Challenge

India has made significant progress against HIV over the past several decades. The government has reported substantial reductions in new HIV infections since 2010, while the National AIDS Control Programme continues to focus on prevention, testing, treatment and reducing AIDS-related mortality.

But the Karnataka numbers have brought the concern of young people's vulnerability to infection. The biggest challenge is no longer simply whether HIV can be treated. It is whether people will get tested early enough, have access to prevention and treatment, continue taking their medicines, and be able to live without fear of being discriminated against.

In my years as an orthopaedic surgeon, I have operated on thousands of joints, ligaments, and bones. And if there is one pattern I have seen repeat itself more consistently than any other, it is this: two patients can undergo the exact same surgery, performed by the same surgeon, using the same technique — and walk away with completely different outcomes. The difference rarely lies in the operating room. It lies in what happens afterwards.

Most patients walk into surgery believing it is the finish line — the hard part, after which everything else is just optional maintenance. Physiotherapy gets treated as something to fit in "if there's time" or "if it still hurts." This is one of the most damaging misconceptions in orthopaedic recovery.

Surgery fixes the structure. It repairs the torn ligament, replaces the worn joint, sets the fractured bone. But it does not, on its own, restore function. That has to be rebuilt — deliberately, gradually, under guidance. And that rebuilding is physiotherapy's job, not the scalpels.

The numbers bear this out. Across orthopaedic procedures, roughly one in five to one in three patients fail to reach their expected functional milestones, and inadequate rehab is consistently among the top reasons why — alongside pre-existing stiffness and delayed rehab starts. A technically flawless surgery, followed by a half-hearted recovery, routinely underperforms a good surgery paired with disciplined rehabilitation.

What's actually happening inside the body

Three things happen to nearly every post-surgical joint, regardless of how well the operation goes. Muscles begin to atrophy almost immediately — the quadriceps around a knee can lose measurable strength within a week of reduced use, and rest alone does not reverse this. Only progressive, graded loading does, which is exactly what physiotherapy provides.

At the same time, as surgical wounds heal, the body lays down scar tissue. Left unmanaged, this tissue binds to surrounding structures, restricts tendon movement, and quietly steals range of motion — tightening further with time rather than loosening on its own. And joints that aren't moved regularly through their range begin to stiffen as the joint capsule tightens around them.

A joint essentially "learns" its new, restricted range unless someone deliberately and safely pushes it beyond that — which is precisely the judgment call a physiotherapist is trained to make.

Also read: Attention Ladies: More Than 5 Cups Of Coffee Linked To Lower Bone Density; Tea May Help

Why the body can't just heal its way back

Healing and recovery are not the same thing. Biological healing — wound closure, bone union, tissue integration — largely happens on its own, on a fixed timeline. But functional recovery — strength, coordination, the confidence to move and bear weight normally — requires the tissue to be used correctly while it heals.

Left alone, the body defaults to protection. It guards the operated area, recruits other muscles to compensate, and avoids the very movements it needs to relearn. Patients typically drift toward one of two extremes: under-loading out of fear, or over-loading out of impatience. Physiotherapy is what calibrates that loading correctly, stage by stage.

There is also a less visible disruption that few patients are aware of — the connection between brain and muscle. Pain, swelling, and immobilisation can cause a structurally intact muscle to simply stop firing efficiently, because the nerve pathways that recruit it have gone quiet from disuse.

Left unaddressed, the body compensates by recruiting other muscles instead — which can look like recovery on the surface while quietly setting up problems in neighbouring joints. This is precisely what targeted neuromuscular re-education in physiotherapy is designed to correct — retraining the brain to activate the right muscle, in the right sequence, again.

Also read: 6-Year-Old Australian Kid Dies From Rarely Seen ‘19th Century Disease’: Why Is Scurvy Still A Risk Today?

When patients stop too soon

The most common reason patients abandon physiotherapy early is what I call the "pain-free equals cured" mentality. Pain typically resolves well before strength, range, and control are fully restored — and once it's gone, patients read that as the finish line. Physiotherapy at that stage feels repetitive and effortful compared to the relief of simply feeling better, so motivation drops exactly when the harder, more important phase of rebuilding begins.

The long-term cost of this is real. In my practice, I regularly see stiffness that never fully resolves, chronic weakness that surfaces years later as instability or a limp, and compensatory strain in neighbouring joints — a hip overworking for an under-rehabbed knee, a shoulder overcompensating for a poorly recovered elbow.

Some of these cases eventually need a second procedure just to release stiffness that consistent physiotherapy could have prevented in the first place. These are not failures of surgery. They are failures of the recovery process that followed it.

The real answer to "I feel fine, do I still need physiotherapy?"

Feeling fine and being fully recovered are not the same thing — and that gap is exactly where physiotherapy does its work. Pain is often the first symptom to disappear and the last thing to reflect what's actually happening inside the joint. Strength deficits, altered movement patterns, and residual stiffness can persist long after pain is gone, only to resurface later as instability, re-injury, or early joint wear.

Stopping physiotherapy because the pain has gone is a bit like stopping antibiotics because the fever broke — the underlying process isn't necessarily finished just because the most obvious symptom has resolved.

Surgery and physiotherapy are not two separate stages of treatment. They are two halves of a single continuous process, and the outcome is determined by both. Surgery repairs the structure. Physiotherapy restores the function. Patients who understand this going in don't just heal better — they move better, for years afterwards.