A report by Swachh Bharat Mission says that 74.5 per cent of public places are equipped with toilets. Another report by the Ministry of Jal Shakti states that there are 2.23 lakh Community Sanitary Complexes built across all States and UTs under the Swachh Bharat Mission (SBM) since October 2014. Over 92 lakh toilets have been constructed since the launch of SBM Gramin (SBM (G)) in April 2020.

While toilets are there, are they accessible? This is the question one should ask. The National Family Health Survey (NFHS) focuses on 131 health indicators, but not until the NFHS 5 survey did they include the question of accessibility of toilets in the survey. This happened after the inputs from the Department of Drinking Water and Sanitation (DDWS) and the Ministry of Health & Family Welfare questioned the accessibility.

One might ask, why is the question of accessibility so important? The answer is quite simple. Access to water, sanitation and hygiene is the most basic human need and is also included under the Sustainable Development Goals by the UN.

Are These Numbers Real?

This thought crossed my mind because back in 2021, I went on a solo trip, on a bus to Udaipur from Delhi. There, the bus made two stoppages. This was done so people could get a quick dinner and freshen up, relieve themselves and be prepared for the rest of the journey. This was a nightmare. The bus only stopped for 10 minutes. While some men used the washroom, others went to the bushes.

For the women, there were three cubicles. One of them was broken, and the other one did not have a light bulb, which meant only one was usable. There was a long queue for that cubicle, and time was short. There was no point in trying to find an isolated corner, because it was past midnight, in an unknown area.

I waited anxiously. When finally, my turn came, I saw an overused, dirty washroom. The toilet seat is in a horrible condition. I wanted to touch nothing there. But I had to pee. So, I used my mask to cover my nose from the odour, folded my pants so they did not touch the floor and squatted. It was quite a task to balance.

On my way back to Delhi, I made sure to not drink any water for over a 13-hour bus journey. I dehydrated myself so I did not have to use the washroom. When I did reach, I was severely dehydrated and was sick for three days.

I shared my experience with my friends only to realise that many women have faced the same. There are no washrooms for women.

A friend of mine told me that it is because these roads and dhabas are mainly designed to serve men. They are the ones who travel at night or are on the roads most of the time. As a result, the few women who do travel or are on the road suffer.

Health Risks Women Are Prone To

Well, it is true, but partially. While holding your pee for too long can lead to health risks, peeing on a dirty toilet seat cannot lead to infections unless your urethra is in contact with the bacteria present on that toilet seat. However, nobody wants to sit on a dirty toilet seat, even if you do not get an infection. A safe and hygienic toilet is a basic need.

One of the regular saleswomen, Usha, who visits my house shared her experience with me. “Being on the road constantly means I must use the dirty public washrooms. But I do not want to use them. So, sometimes I ask my regular customers to let me use their washrooms. Some say yes, and some say no. I understand they are also concerned about their safety and privacy,” she says. As a result, Usha spends most of her day not drinking enough water and holding her pee when she is at work. Due to this, she also suffered from a Urinary Tract Infection (UTI).

Her friend, Halima too faced similar problems and due to increased levels of uric acid in her body, she suffered from Hyperuricemia.

Other health risks are kidney stones and other kidney problems, headaches, dull skin, xerostomia or dry mouth, fatigue, and urinary incontinence, which means losing control over your pelvic floor muscles leading to uncontrolled leakage of urine, seizures and weakness.

What Can You Do?

Wear comfortable clothes and capris. Capri pants are comfortable and are short in length, which means this won’t touch the toilet floor when you squat or sit.

Carry Essentials

Even though you cannot get a UTI alone from sitting on a toilet seat, it is always safe to carry a toilet seat sanitiser. If nothing, it can help you get rid of the bad odour so you can use your stand and pee device inside the toilet. You can also use disposable toilet seat covers if your knees are weak, and you cannot squat. Always flush with your seat down.

Always keep disposable gloves, a portable bidet (fill it with water before use), a pocket liquid handwash, wet wipes, tissues and sanitiser handy. Do not forget to keep extra sanitary pads. It might sound a lot, but I promise that it all fits in one pouch. Use this travel-friendly pouch every time you are on the road, or using a public washroom.

What Can We Learn From Others?

However, in case we do not get these technologically advanced toilets here, you can always pack a travel-friendly toilet kit!

Delhi's air quality deteriorated significantly after Diwali. Several monitoring stations recorded ‘severe’ air quality on Monday morning (November 9) after a night of Diwali festivities which resulted in widespread emission of firecracker smoke. It worsened the situation in a city already grappling with soaring air pollution due to vehicular exhaust, construction dust and stubble burning in neighbouring states.

Due to this, Delhi residents, who continue to breathe polluted air, may face symptoms like scratchy throat, coughing and irritation. But how can you tell whether your sore throat is caused by pollution or an infection that needs medical attention?

How Does Air Pollution Cause A Sore Throat?

Polluted air contains particulate matter, including PM2.5, as well as gases and other irritants. When inhaled, these pollutants come into contact with the lining of the nose, throat and respiratory tract, triggering irritation and inflammation.

Dr. Rahul Sharma, Director, Pulmonology & Critical Care, Fortis Greater Noida told HealthandMe, “People exposed to high levels of pollution may experience throat irritation, dryness, a burning sensation, frequent coughing and discomfort while swallowing. These symptoms may be more noticeable in people who spend long hours outdoors and are difficult to control.”

People with asthma, allergies or existing respiratory conditions may be more sensitive to these pollutants.

Dr Sharma added, “Pollution can also aggravate existing respiratory conditions like asthma and allergic airway disease. It is important to remember that a sore throat is not always due to infection; environmental exposure can also be a cause.”

Also read: El Niño Could Worsen Dengue, Malaria And Heat Illness: Why WHO Declared A Health Emergency

Pollution-Related Sore Throat Or Infection?

The symptoms can overlap, so a sore throat alone cannot establish its cause. However, certain accompanying signs may offer clues. Experts help us understand when a sore throat is a result of inhaling particulate matter.

Dr. Sushil Upadhyay, Consultant Pulmonologist, Kailash Deepak Hospital, Delhi told HealthandMe, “Throat irritation as an early sign. A scratchy throat is the canary in the coal mine for lung inflammation. It is the first sign that your airways defenses are overwhelmed and deep inflammation is starting.”

A pollution-related sore throat is more likely to involve dryness, scratchiness, coughing and irritation of the eyes or nose.

Dr Samir Garde, Director of Dept of Pulmonology and Lung Transplant, Gleneagles Hospital, Parel, told us, “Pollution-related irritation usually causes a dry or scratchy throat, coughing and eye irritation, which may worsen outdoors or during periods of poor air quality.”

An infection, on the other hand, may be accompanied by fever and other symptoms. They may include body aches, swollen lymph nodes, painful swallowing, tonsil inflammation or white patches on the tonsils. Viral infections can also cause a runny nose, cough and fatigue.

Dr Upadhyay said, “The flu brings high fever, body aches, and extreme exhaustion. If staying inside an air-conditioned, filtered room clears your throat, it's pollution. Otherwise, think of it as flu.”

A bacterial infection such as strep throat may cause sudden throat pain, fever and difficulty swallowing, sometimes without a cough.

Also read: New COVID-19 Variant PJ.2.1 Spreads Globally: WHO Says Symptoms Resemble Cold, Flu

When Should You See A Doctor?

A mild sore throat often improves within a week. However, medical evaluation is recommended if you have difficulty breathing, cannot swallow, are drooling because you cannot swallow, or experience rapidly worsening symptoms.

Dr Upadhyay said, “Do not ignore a sore throat if it moves to your chest. If you develop wheezing, severe breathlessness or a fever, you need a medical evaluation immediately. Seek help right away if you are gasping for air or cannot finish a single sentence in one breath.”

Persistent hoarseness, a lump in the neck or a mouth ulcer lasting more than three weeks should also be evaluated.

Dr Garde recommended, “Seek medical attention if there is chest tightness, high fever or persistent symptoms. Severe breathlessness, bluish lips or difficulty speaking due to breathing problems require immediate emergency care.”

Also read: Delhi AQI Crosses 2,000 Mark After Diwali: What Happens To Your Body Within Hours Of Exposure?

How Can You Protect Your Throat During Severe Pollution?

According to the doctors, while pollution levels remain high, reducing exposure is important. They recommend:

• Avoid outdoor exercise and limit unnecessary time outside.
• Wear a well-fitting N95 or N99 respirator when going outdoors.
• Keep windows closed during periods of high outdoor pollution and use a HEPA air purifier if available.
• Drink enough water to prevent throat dryness.
• Gargle with warm salt water to soothe irritation.
• Avoid smoking, incense and other indoor sources of smoke.

Do not start antibiotics just because your throat hurts. Antibiotics do not treat throat irritation due to pollution or viral infections. They should only be used when prescribed for a confirmed bacterial infection under doctor’s supervision.

Delhi AQI After Diwali

The city's average Air Quality Index (AQI) reached 406 on November 9, placing it in the 'severe' category, according to the Central Pollution Control Board (CPCB).

But private monitoring platform AQI.in reported an AQI of 2,283, classifying the air quality as ‘hazardous’. The reading showcased a grim post-Diwali pollution peak, an issue that has turned into an annual environmental crisis.

The stark difference in readings is because India’s AQI scale is limited to 500 while other private air quality monitoring platforms measure higher readings. So even if CPCB’s data shows 500 AQI, it can mean that the amount of harmful pollutants could be much higher.

The Supreme Court had implemented restrictions on celebrating Diwali with firecrackers by limiting time between 6 am and 7 am and 8 pm and 10 pm on November 7 and 8 and allowing only green crackers. However, firecrackers were reportedly burst beyond permitted hours.

Ahead of World Diabetes Day observed on November 14, singer Nick Jonas recently opened up about living with type 1 diabetes for almost 21 years. Diagnosed at the age of 13, Jonas spoke about his daily decision-making that revolves around managing the condition. From monitoring blood glucose levels to adjusting insulin doses around meals and physical activity, Jonas expressed the emotional challenges of living with the disease.

In an open letter written for Dexcom's A Letter to Diabetes campaign, Jonas described the condition as an ongoing part of his everyday life. “Twenty-one years, and you haven’t changed a bit,” he wrote, addressing diabetes.

He also explained how frequently he has to monitor his glucose levels and make treatment decisions. “Staring at my phone to see where my glucose is. Reaching for my pump to bolus because I’m about to eat something with 17 carbs. Those are just a couple of the hundreds of little decisions I make every week,” Jonas wrote.

He described diabetes as “an ongoing conversation between your body, your mind, and your devices.”

The singer also recalled the emotional challenges of living with a chronic condition. However, he said that speaking openly about diabetes helped him find a sense of community and connect with others experiencing similar challenges.

What Is Type 1 Diabetes?

Also read: Can Ozempic, Mounjaro Drugs Protect The Brain? What A New Review Found

Type 1 diabetes is a chronic autoimmune condition in which the body's immune system mistakenly attacks and destroys beta cells that produce insulin in the pancreas.

Insulin is a hormone that helps move glucose from the bloodstream into cells, where it is used for energy. When the body produces little or no insulin, glucose builds up in the blood, resulting in high blood sugar levels.

Type 1 diabetes is different from type 2 diabetes as the latter occurs due to insulin resistance and can be a result of genetic and lifestyle factors. In short, type 1 diabetes is not caused by eating excessive carbohydrates and sugar, obesity or leading an inactive lifestyle.

Type 1 diabetes can also develop at any age, although it is frequently diagnosed during childhood or adolescence.

Symptoms Of Type 1 Diabetes

Also read: High-Fibre Diet Outperforms Metformin In Blood Sugar Control And Weight Loss, Study Finds

Symptoms can develop quickly, sometimes over a few weeks. Common warning signs include:

• Excessive thirst: Constantly feeling thirsty even after drinking water.
• Frequent urination: One may feel the urge to urinate frequently as the kidneys attempt to remove excess glucose through urine.
• Unexplained weight loss: The body starts breaking down fat and muscle for energy when it cannot use glucose properly.
• Increased hunger: Cells are unable to access enough glucose for energy.
• Extreme fatigue: High blood glucose and reduced energy availability can cause chronic tiredness.
• Blurred vision: Changes in blood glucose can affect the fluid balance in the eyes.

If type 1 diabetes is not diagnosed and treated on time, it can lead to diabetic ketoacidosis (DKA), a life-threatening complication.

Warning signs including nausea, vomiting, abdominal pain, deep or rapid breathing, fruity-smelling breath and confusion need immediate medical attention.

Management Of Type 1 Diabetes

Managing type 1 diabetes involves maintaining blood glucose levels within a specific target range to reduce the risk of both high and low blood sugar. Treatment includes:

1. Insulin Therapy

People with type 1 diabetes need insulin throughout their lives. It may be administered through multiple daily injections or an insulin pump which delivers insulin continuously.

2. Regular Glucose Monitoring

Blood glucose can be monitored using instant finger-prick tests or continuous glucose monitoring (CGM) devices. CGM systems use a sensor to track glucose levels throughout the day and night.

3. Dietary Management

People with type 1 diabetes need to understand how carbohydrates affect blood glucose levels so they can adjust insulin doses accordingly.

4. Physical Activity

Exercise is encouraged, but physical activity can affect glucose levels depending on its intensity, duration, timing and the amount of insulin in the body. People may need to adjust their food intake or insulin doses to reduce the risk of hypoglycaemia.

5. Regular Medical Follow-ups

Routine assessments help monitor glucose control and identify complications affecting the eyes, kidneys, nerves and cardiovascular system.

Type 1 diabetes diagnosis does not mean a person has to give up their career, travel, exercise or other ambitions. But living with this condition involves planning and attention to blood glucose levels, food, medication and physical activity.

Jonas has spoken about the importance of not allowing the condition to define his life. In an earlier interview with NIH's MedlinePlus Magazine, he shared a message for others living with type 1 diabetes, “Know that you can still do anything you want to do with your life.”

There is no cure for type 1 diabetes currently but advances in insulin delivery, glucose monitoring and research into therapies that preserve or replace insulin-producing cells are expanding treatment possibilities.

Pregnancy is often something women prepare for months in advance. They discuss nutrition, exercise, supplements, medical check-ups and what to expect as their bodies change. Menopause, however, rarely receives the same attention. It is often treated as a stage that women will simply reach one day and somehow manage along the way.

But menopause is also a major transition in a woman’s life, and being prepared for it can help make the experience easier to understand and manage.

Menopause itself is defined as the point when a woman has gone 12 consecutive months without a menstrual period. However, the transition usually begins earlier, during perimenopause, when changing hormone levels can lead to irregular periods, hot flashes, night sweats, sleep problems, mood changes and other symptoms. These changes can begin several years before menopause itself.

Preparation does not mean trying to prevent menopause or “balance” hormones before it happens. Most healthy women do not need supplements or hormones simply because menopause is approaching. Instead, preparation is about understanding what is happening and building a strong foundation for health.

What can women do before menopause?

Also read: At 58, She Mistook Memory Lapses For Menopause Brain Fog, But Tests Revealed Alzheimer’s Risk

Regular physical activity is one of the most useful habits to establish. Weight-bearing and resistance exercises can help maintain bone strength and muscle mass, which become increasingly important in midlife and beyond. Exercises that improve balance, coordination and proprioception, or the body’s awareness of its position and movement, can also support mobility and help reduce the risk of falls as women age.

Nutrition is equally important. A well-balanced diet should provide adequate protein along with essential vitamins and minerals. Calcium and vitamin D are particularly important for bone health, while a varied diet rich in vegetables, fruits, whole grains, pulses, nuts and other nutrient-dense foods can support overall health. Maintaining a healthy weight is also beneficial during this transition.

It is equally important to pay attention to cardiovascular and metabolic health. Regular checks of blood pressure, cholesterol and blood sugar can help identify common non-communicable diseases early. Avoiding smoking, staying physically active and maintaining healthy lifestyle habits can also support long-term health.

Preventive healthcare should not be overlooked either. As women enter midlife, keeping up with age-appropriate cancer screenings and routine health check-ups becomes an important part of looking after their health. The appropriate screening schedule can vary depending on age, family history, personal risk factors and local guidelines, so these should be discussed with a healthcare provider.

Just as importantly, women should become familiar with their own symptoms. Changes in periods, sleep, mood, body temperature, sexual health or concentration should not automatically be dismissed as “just ageing.” Keeping track of symptoms can help women recognise patterns and have more productive conversations with their healthcare provider.

Medical support is also an important part of preparation. Not every woman will experience menopause in the same way, and treatment is not automatically necessary. However, when symptoms begin to interfere with sleep, work, relationships or everyday life, hormonal and non-hormonal treatment options can be discussed with a doctor.

Perhaps the biggest change we need is in how we talk about menopause. It is not an illness, nor is it something women should simply suffer through in silence. It is a natural stage of life, but that does not mean its symptoms or its wider effects on health should be ignored.

Preparing for menopause is ultimately less about predicting exactly what will happen and more about entering this stage with knowledge, healthy habits and access to the right medical support. Women spend years preparing for major changes in their bodies. Menopause deserves that same attention.

By Dr Ponny M S, Consultant - Gynaecologist & Laparoscopic Surgeon, Apollo Adlux Hospital, Keralam