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!

Yoga may offer benefits beyond flexibility and stress relief, with doctors from the All India Institute of Medical Sciences (AIIMS), New Delhi, ahead of International Yoga Day 2026, saying that studies have shown the ancient practice could help improve outcomes in conditions ranging from unexplained male infertility to autoimmune disorders such as rheumatoid arthritis and fibromyalgia.

This year marks the 12th International Day of Yoga, observed annually on June 21. The theme for this year, "Yoga for Healthy Ageing," highlights the practice's potential to enhance mobility, balance, flexibility, and mental well-being, helping people maintain health and independence at every stage of life.

Yoga And Unexplained Male Infertility

Dr. Rima Dada, Professor at the Laboratory for Molecular Reproduction and Genetics, Department of Anatomy, AIIMS Delhi, told HealthandMe that cases of unexplained male factor infertility have increased in recent decades. In many of these cases, standard sperm parameters appear normal, but sperm cells are affected by oxidative stress and DNA damage.

According to Dr. Rima, studies conducted in men with unexplained infertility found that regular yoga practice reduced oxidative stress, decreased sperm DNA damage, and normalized the expression of genes critical for early embryonic development. These benefits, however, generally require consistent practice for more than six months.

Also read:International Yoga Day 2026: 10 Desk Yoga Poses That Can Undo Hours of Sitting

Dr. Rima described yoga as an “art of living” that combines

• mindful asanas,
• relaxation techniques,
• pranayama,
• meditation,
• healthy nutrition,
• adequate sleep.

According to her, such lifestyle measures may improve sperm DNA quality, motility, and overall reproductive health while potentially reducing the burden of genetic and epigenetic disorders in future generations.

Yoga And Rheumatoid Arthritis

Dr. Rima also highlighted the role of yoga in rheumatoid arthritis, an autoimmune disease that typically affects small joints initially and may later involve larger joints as well as organs such as the lungs, heart, and brain.

She described yoga as an "art of living" that should be incorporated into daily life through mindful asanas, relaxation techniques, pranayama, meditation, a whole plant-based diet, and adequate sleep.

Read More: Trying to Quit Tobacco? Yoga Could Improve Your Chances, Suggests Study

She added that research has shown that yoga, including asanas, pranayama, and meditation, can help reduce inflammatory cytokines linked to swelling, pain, stiffness, and joint damage. Pranayama practices such as Anulom Vilom, Bhramari, and Ujjayi were highlighted as particularly beneficial.

For people living with rheumatoid arthritis, she recommended beginning with gentle loosening exercises under the supervision of a trained yoga therapist and avoiding strenuous postures during acute flare-ups. Pranayama and meditation, she said, may help reduce inflammation, improve emotional resilience, and support longer periods of remission.

Yoga As An Adjunct Therapy

Dr. Uma Kumar, Head of the Department of Rheumatology at AIIMS New Delhi, explained that autoimmune diseases occur when the immune system mistakenly attacks the body’s own tissues and organs.

Conditions such as rheumatoid arthritis, systemic lupus erythematosus, Sjogren’s syndrome, myositis, antiphospholipid antibody syndrome, and IgG4-related disease can significantly affect quality of life, often leading to pain, fatigue, depression, sleep disturbances, and reduced mobility.

“All these components are improved by yoga,” Dr. Kumar said.

However, she stressed that yoga should be viewed as an adjunct to medical treatment rather than a replacement. According to her, yoga may complement conventional therapies by improving sleep, flexibility, mental well-being, lifestyle habits, and overall quality of life.

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Yoga's Benefits For Fibromyalgia

Dr. Renu Bhatia, Additional Professor in the Department of Physiology at AIIMS Delhi, said supervised yoga therapy may help improve physical activity, sleep quality, muscle blood flow, pain levels, and flexibility in people with fibromyalgia.

The experts described fibromyalgia as a condition characterized by widespread pain despite normal laboratory findings and the absence of obvious inflammation.

Dr. Renu noted that studies have shown six weeks of supervised yoga intervention can reduce tender points while improving sensory symptoms, brain function, and neural excitability. However, she cautioned that yoga should be practiced under supervision, as excessive joint movement may aggravate symptoms in some patients.

Sickle cell disease (SCD) is one of India’s most pressing inherited blood disorders, with an estimated 1 in 86 births among tribal and disadvantaged groups affected.

Despite advances in diagnostics and treatment, families continue to face uncertainty, stigma, and limited awareness.

Why Genetic Counselling Matters

A crucial distinction often overlooked is between sickle cell trait (SCT) and sickle cell disease. Carriers with one gene are usually healthy but can pass the trait to their children, while those with two defective genes live with lifelong complications.

When both parents carry SCT, each child has a 50% chance of inheriting the trait and a 25% chance of developing the disease. This is why genetic counselling must be recognized as an integral part of the care continuum.

Genetic counselling provides clarity on inheritance patterns, transmission risks, and reproductive choices. In high-prevalence communities, it serves as a preventive strategy. Counselling is equally vital after diagnosis, guiding parents on managing complications, navigating education and employment, and preparing adolescents to understand their carrier status before marriage.

Also read: Sickle Cell Disease: Why India Must Add Curative Treatment to Meet Its 2047 Elimination Goal

The Role of National Sickle Cell Anemia Elimination Mission

India’s National Sickle Cell Anaemia Elimination Mission (2023) prioritizes screening in high-burden states, with clear objectives:

• to provide affordable, accessible, and quality care to all SCD patients;
• reduce prevalence through awareness campaigns and premarital genetic counselling;
• conduct targeted screening and early detection using validated Point-of-Care Testing (POCT) kits;
• ensure holistic management through primary, secondary, and tertiary healthcare facilities;
• enable community involvement by linking patients with social security schemes.

Embedding counselling into primary healthcare ensures every positive test is followed by culturally sensitive, professional support.

Sickle Cell Disease: Tackling Stigma and Misconceptions

SCD is often misinterpreted as a curse or lifestyle issue, leading to stigma and blame. Such misconceptions not only deepen emotional distress but also delay timely medical intervention. Genetic counselling reframes the condition as a scientifically understood, inherited disorder, shifting the narrative from superstition to evidence-based care.

By normalizing dialogue, it drives empathy-centered healthcare conversations and strengthens community resilience.

SCD is also often misinterpreted as a curse or lifestyle issue, leading to stigma and often blame. Such misconceptions not only deepen emotional distress but also delay timely medical intervention.

Genetic counselling reframes the condition as a scientifically understood, inherited disorder, shifting the narrative from superstition to evidence-based care. By normalizing dialogue, it encourages empathy-driven healthcare conversations and strengthens community resilience.

Sickle Cell Disease: Why Genetic Counseling Is Important

Sickle cell care cannot stop at diagnosis; counselling must accompany patients across every life stage from childhood through adolescence, marriage, pregnancy, and adulthood. This continuity transforms care from reactive to proactive, ensuring families are never left alone in their journey.

At the same time, awareness, education, and collaboration among clinicians, policymakers, patient groups, and communities are essential. Genetic counselling serves as the bridge between science and lived experience, enabling informed choices, reducing stigma, and promoting compassionate care that strengthens both families and the wider community.

(The author is Dr Manisha Madkaikar, Director - ICMR-National Institute for Research on Blood and Immune Disorders – Mumbai).

In today's busy routines, acidity is a common complaint — almost one in five people take an acidity tablet. Most of us don't think twice before reaching for one.

A little heartburn after dinner, some burning in the chest, a feeling of heaviness - one pantoprazole tablet and the problem seems solved. And for many people, it quietly becomes a habit that they continue taking for weeks and sometimes even months.

Why This Matters for Cancer Patients

In limited doses and under medical guidance, an acidity tablet is largely considered safe. But this is not true for everyone. For patients undergoing immunotherapy for kidney cancer, that small tablet may be doing more than just controlling acidity.

A patient comes in for follow-up. The scans look encouraging. Treatment is going as planned. And then, almost casually, they mention that they have been taking pantoprazole every morning for acidity for several years without proper medical advice. Most patients genuinely don't think it's important enough to mention. But newer research suggests it might be.

The Gut Microbiome Connection

It is because the digestive system holds trillions of bacteria collectively called the gut microbiome. Once thought to help only with digestion, they are now known to be deeply connected to the immune system.

Our gut bacteria are a training ground for our immune army. If that ecosystem is disturbed, the immune response may not be as effective as we want it to be.

This is where these proton pump inhibitor medicines, such as pantoprazole, omeprazole, and rabeprazole, can also alter the balance of gut bacteria by suppressing acid production in the stomach. This seemingly minor change may have a stronger effect.

What Does Research Show

A study published in the Journal of Cancer Research and Clinical Oncology looked at patients with advanced kidney cancer receiving immunotherapy, comparing those who regularly used PPIs with those who did not.

The difference surprised many oncologists. Patients who were not taking daily PPIs had a progression-free survival of around 9.7 months, and for regular PPI users, it was around 6.4 months. When overall survival was measured, the gap was even wider — about 14.6 months for daily PPI users compared with roughly 30 months for non-users.

And this is not a one-off finding. When researchers pooled fourteen studies covering 6,716 cancer patients on immunotherapy, PPI users still carried roughly a 39 percent higher relative risk of death and a 29 percent higher risk of the cancer progressing. A larger 343-patient kidney cancer study echoed the very same direction. Although not every analysis agrees on how big the effect is — some of the most recent data suggest it may be more modest — but the arrow keeps pointing the same way.

An Important Caveat

One important caveat runs through all of it: these are observational studies, not controlled trials. PPI users are often older and have more illnesses, which can independently worsen outcomes, so the pill cannot yet be said to cause the difference.

A finding this consistent cannot simply be ignored. It deserves to be part of the discussion before treatment starts. He added that PPIs are also recognized, quite separately, as an occasional cause of kidney injury — one more reason their use is worth reviewing rather than continuing on autopilot.

Don't Stop Your Medication Suddenly

At the same time, stopping acidity medicines overnight is not the solution. When patients suddenly stop PPIs, they can experience severe rebound acidity. That's why any change should happen only after discussing it with the treating doctor.

Simple Steps Patients Can Take

A practical piece of advice would be to carry a complete list of medicines to every oncology appointment — not just cancer medicines, but everything.

Prescription drugs, over-the-counter tablets, supplements, and even home remedies. Sometimes alternatives are available. Sometimes simple dietary changes help — smaller meals, less spicy food, avoiding late-night eating. Simple measures, but often effective.

Remember, cancer treatment is not only about the drug. It is also about everything happening around the drug. The food people eat. The medicines they take. Their daily habits. Small things can sometimes influence big outcomes.

(Dr Veenoo Agarwal, Head of Medical Oncology at Shalby International Hospital, Gurugram)