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!

Unlike most serious medical conditions, where outcomes depend almost entirely on what happens inside a hospital, cardiac arrest is different in one important respect: the person with the greatest power to change what happens next is almost never a doctor. It is whoever is standing closest. The heart can be restarted. Brain damage can be prevented.

India records more than 700,000 cardiac arrest deaths each year. Across South Asia alone, an estimated 5.5 million cardiac arrests occur annually. What separates a death from a recovery is not the sophistication of the care that eventually arrives. It is what any individual knows to do in the minutes before it does.

Not a Heart Attack. Something Faster

Sudden cardiac arrest is frequently confused with a heart attack, but the two are different events. A heart attack occurs when a blocked artery cuts off blood supply to the heart muscle. Cardiac arrest is categorically different: the heart stops beating entirely, and with it, all circulation to the brain and body ceases. A person can have a heart attack and still have a pulse.

In cardiac arrest, there is none. Every minute without CPR or defibrillation reduces the chance of survival by roughly 10 to 12 percent. In India's major cities, an ambulance takes between 15 and 20 minutes to arrive; in rural areas, over 60 minutes. These numbers place the first line of response where it has always been: with whoever is already in the room.

Also read: Women’s Heart Health May Start Changing In Late 30s, Way Before Menopause

India's Distinct Risk Profile

The epidemiological picture in India has a distinctly local character. Data from South India show that the average cardiac arrest victim is 48 years old, predominantly male, and often without any prior diagnosis of heart disease. Lifestyle factors including physical inactivity, smoking, and alcohol consumption are consistent contributors, particularly among younger patients.

Perhaps most significant, 41 percent of autopsied patients with confirmed cardiac muscle damage showed no severe arterial blockage. Standard cardiovascular risk screening, designed primarily to detect blocked arteries, may therefore be missing a meaningful portion of those most at risk in India's population.

Also read: Why Are Heart Risks Rising Among Hispanic Adults? New AHA Report Points To Diabetes, Obesity & BP

The Most Solvable Gap

The most immediate opportunity lies not inside the hospital but in the space between a collapse and an ambulance. Only 1.3 to 9.8 percent of bystanders in India attempt CPR during a cardiac emergency, and fewer than 15 percent of urban Indians have received any formal training. These figures are the primary reason India's survival rate for out-of-hospital cardiac arrest sits below 2 to 3 percent.

CPR requires no equipment and no medical degree. Steady chest compressions from anyone nearby can sustain blood flow to the brain until professional help arrives. Schools, workplaces, residential societies, and places of worship each represent a real and scalable training opportunity.

Where public health frameworks establish the groundwork, private sector partners have the infrastructure to extend that reach across the country. This is precisely the kind of challenge that structured public-private collaboration is designed to meet.

The Opportunity Ahead

Cardiac arrest incidence in India is projected to rise by 30 percent over the next decade as diabetes and hypertension rates continue to climb. That is a known trajectory, which means it is also a manageable one. AI tools now predict cardiac arrest up to 24 hours in advance using routine ECG data, and these technologies are already being developed with India's specific healthcare constraints in mind. What those tools ultimately do, however, is buy time.

The biological window of the first few minutes will always depend on whoever first responds to the patient. The country's greatest lever is not a device or a drug. It is an informed bystander who takes immediate action.

The word dialysis can stir up anxiety and fear for many. It's often seen as a sign of life never being the same again or it's considered a "last resort. I see many patients every day who assume that dialysis is their only choice. In fact, dialysis is a life saving therapy which takes over some of the functions of the kidneys which are unable to perform them properly. Knowing about the dialysis that it will require in the future, how dialysis works, and whether it can be delayed or avoided will help you avoid unnecessary anxiety and make informed decisions.

The kidneys are incredible organs that constantly filter out excessive fluid, toxins and waste products from the blood and help to keep the body's electrolyte balance, blood pressure and red blood cell production in check. As kidney function decreases substantially, these functions are disturbed and allow the build-up of harmful substances in the body. Dialysis mimics some of these filtering functions, and works to keep a patient healthy when their kidneys no longer do so.

Dialysis is not started just because of a laboratory value as is often thought. Many people think that dialysis is meant as a next step when kidney function drops below a certain percentage. But it depends on the results of kidney function tests, symptoms, and fluid overload, as well as electrolyte problems and patient clinical condition. Some people with an advanced stage of CKD may be able to do just fine and have no indication of needing dialysis for months; others might need urgent dialysis in case their kidneys are failing very quickly or they develop very serious complications that put their life at risk.

The most frequent indications for initiation of dialysis are: very high potassium levels, symptoms of fluid overload such as breathlessness, nausea and vomiting caused by accumulation of toxins, confusion, extreme tiredness, loss of appetite or condition where the dialysis cannot be managed with medication alone. In these cases, dialysis is not a choice but a lifesaver.

Also read: When Cholesterol Isn't the Only Culprit: The Hidden Threat of Calcium in Arteries

How The Two Main Types Of Dialysis Work?

There are two types of dialysis: In hemodialysis, the blood is pumped through a dialysis machine that removes waste products and excess fluid from the blood and returns the cleaned blood to the body. It's typically done three times a week in a dialysis center, but a few patients have home dialysis as an option. The process is usually a four hour per session process.

Another option is peritoneal dialysis, which involves using the patient's own abdominal lining to filter the blood. The abdominal cavity is filled with a cleansing solution, waste products and excess fluid are carried in to the solution through a permanent catheter, and the solution is drained. This treatment is often available at home and can provide a patient with more flexibility and independence. Medical suitability, lifestyle, home support and patient preference will all influence the decision on whether to undergo hemodialysis or PD.

Also read: Cefepime: Antibiotic Used For Pneumonia, UTI Linked To Higher Death Risk In Adults

Can Kidney Disease Be Slowed Or Dialysis Delayed?

A major concern patients have is if they can avoid dialysis altogether. The answer is dependent on the cause of kidney disease and the timeliness of diagnosis. However, in many cases, the kidney disease is a progressive condition over many years and there is a chance to slow the progression of the disease with appropriate medical treatment and lifestyle changes. Well managed diabetes and hypertension, avoiding unnecessary pain killers like non-steroidal anti-inflammatory drugs (NSAIDs), healthy weight, salt reduction in the diet, smoking cessation and frequent visits to a nephrologist can have a huge impact on slowing the deterioration of the kidneys.

An early diagnosis is very important. Sadly, a major drawback about chronic kidney disease is that most of the time, people don't have any symptoms in the initial stages of the disease. People are often diagnosed when they have significant kidney damage already. Routine screening is particularly important for those with diabetes, hypertension, cardiovascular disease, obesity and a family history of kidney disease. A number of simple blood and urine tests can detect kidney disease before symptoms occur.

Acute Kidney Injury And Chronic Kidney Disease Are Different

It is also crucial to differentiate acute kidney injury from chronic kidney disease. Acute kidney injury can occur if the kidneys become severely dehydrated, if the body be

“It’s only because I use my phone so much” We all know the excuse. It’s true that texting too much or using your hand in a certain way when holding your phone can be irritating and temporary. But not all your symptoms are the screen’s fault! Symptoms like tingling, burning or pins-and-needles may be due to a pinched or irritated nerve.

When Tingling And Numbness May Point To A Nerve Problem

A familiar example of such a condition is carpal tunnel syndrome, wherein pressure gets on the median nerve at the wrist, causing finger and hand numbness and tingling of your thumb, index and middle finger as well as part of ring finger, which are usually felt mostly at nighttime, or when you’re using the phone for too long.

An alternative would be compression of the ulnar nerve leading to symptom production with the little and part of the ring finger. Remaining with a bent elbow for prolonged durations can lead to increased symptoms, for example if using a telephone.

Also read: Ozempic, Wegovy, Mounjaro and Zepbound May Fuel Rare Brain Disorder, Study Finds

The Problem May Actually Start In The Neck

The pain doesn't always come from the hand. We could have some irritation of the nerve from a little higher up, right to from the neck. Problems with the cervical spine can be referred around the neck, and down the arm and into the hand as pain, and tingling or numbness or weakness.

That’s why just cutting back on screen time won’t help if an nerve issue is also going on. A second common error is to let your numbness progress so much that the cause becomes obvious before looking for medical care. Initial symptoms often come and go after the amount of time your nerves are compressed and can be worse if your nerves are compressed while you sleep or play an activity. Eventually, if nerve compression worsen, your symptoms may occur more often and may be paired with a weakness of the hand, or problems with the more precise dexterity manoeuvres.

Also read: Scientists Grow Human Brain Tissue Inside Mice: Could This Help Cerebral Palsy, Epilepsy & Autism Research?

Dropping Objects Or Weak Grip Are Warning Signs

Warning signs People also need to be aware of early signs of damage like dropping objects; problems with buttoning a shirt; having weakened grip strength or feeling like your hand feels weak when you hold something tight; or an ongoing general weakness. Those should never be ignored. There can be a link with phones because you hold your hand in the one position when holding and looking at it for a while your wrist, your elbow, your neck. But the problem isn't necessarily the phone itself.

Whether it is a repetitive motion or it comes on from something that has already occurred such as finding out you have diabetes or even have an already injured and pinched nerve in your wrist or at your elbow or even at your shoulder. Some simple stretches, an altered grip, keeping your elbow bent at just about 90 degrees and trying not to bend your wrist way backward will all work to your benefit.

When Numbness Needs Medical Evaluation

If numbness continues or weakness is increasing, pain is intense, or the sensations spread from the neck into the arm, you may need to see a physician for further examination, including possible nerve conduction studies, imaging, or blood tests based on their findings.

Not all sensations or tingling in your hand are "phone related", although it might seem obvious. A perceived annoyance can occasionally be the start of significant nerve compression requiring evaluation.

By Dr. Nasli Icchaporia, Director Neurology, Sahyadri Super Speciality Hospital, Nagar Road, Pune - A network hospital of Manipal Hospital