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!

Work, school, competition—stress appears to be inevitable these days. Across age groups, many are dealing with it in some form or the other, but unfortunately stress never stops at just headaches or fatigue. It has direct effects on an individual's health through causing disease (such as cardiovascular problems); it also has indirect effects on health by negatively influencing other health behaviors such as physical activity and sleep. It is also vital to note that stress is one of the leading health risks for people in the work environment. Healthcare professionals are advised to consider both major stressors and those that occur regularly. Further discussion about stress reduction strategies is provided.

Dr Anshuman Kaushal, Director of Robotic GI, Minimal Access & Bariatric Surgery at CK Birla Hospital, Gurugram, in an interview with Health and Me, spoke about the long-term effects of chronic stress and why it can be termed a lifestyle disorder.

Mechanisms of Chronic Stress

Exposure to certain stressors activates the HPA axis, and as a result, adrenaline and cortisol are released. While these hormones play a crucial role in survival during emergencies, they can result in serious health problems when continuously present in the body. Some of the most common consequences of stress are low immunity, insulin resistance, or inflammation. It can over time result in hypertension or heart disease.

Lifestyle as the Main Cause

With growing rates of urbanisation, competitive workplaces, financial issues, and the development of technology leading to a permanently accessible Internet, the boundaries between working time and time for rest have been blurred entirely. Moreover, an insufficient amount of sleep, poor sleeping habits, and a sedentary lifestyle cause stress as well. The young generation in India has become victims of stress-related disorders the most.

Identification of the Symptoms

One of the major challenges when identifying chronic stress cases lies in the subtlety of the condition. The list of symptoms includes constant fatigue, irritability, concentration issues, headaches, tight muscles, and insomnia. Other symptoms of the condition include gastrointestinal disorders such as acid reflux, bloating, and loss of appetite that are hardly ever associated with stress.

Long-term effects of stress

Chronic stress may appear harmless, but the truth is quite contrary. When an individual is stressed for too long without controlling it, it may result in anxiety disorders like depression. Physiological side effects of stress are:

1. Poor immunity
2. Inflammation
3. Obesity
4. Diabetes
5. Weakened memory
6. Mood swings

What makes chronic stress a lifestyle disease?

While most lifestyle disorders are caused by environmental factors and behavioural alterations, it can be termed a lifestyle disease. These disorders are progressive and require constant intervention in the form of medication or meditation.

Managing chronic stress

Doctors say that it takes a comprehensive strategy to reduce cortisol levels in the body and uplift mood. For instance, workouts like weight training or yoga are known to increase levels of happy hormones, thereby reducing stress. Breathing exercises and meditation, too, have a positive impact on mental health. Experts recommend combining them with nutrition, proper sleep, and socialising.

Early diagnosis matters

Chronic stress is not just a symptom of modern life but also a key health problem. Recognising it as a health issue and addressing it helps combat the long-term consequences well in time. And with continued changes in lifestyle habits and patterns, a lifestyle disease like chronic stress can also be brought under control for the better.

Asha Bhosle, India's veteran singer, died of cardiac arrest on Sunday. On Saturday evening, the 92-year-old was admitted to Mumbai's Breach Candy Hospital. Initially, she was admitted due to a chest infection but was later moved to the ICU the same night. The news of her hospitalisation was confirmed by her singer granddaughter Zanai Bhosle, citing 'extreme exhaustion and chest infection'.

"My grandmother, Asha Bhosle, due to extreme exhaustion and suffering a chest infection, has been admitted to hospital and we request you to value our privacy. Treatment is ongoing and hopefully everything will be well and we shall update you positively," Zanai wrote.

What is cardiac arrest?

A cardiac arrest is a medical emergency that requires immediate attention. It is characterised by a sudden halt in heart function – it stops beating and blood circulation to the brain and organs is consequently cut off. It is characterised by unresponsiveness, sudden collapse, and lack of breathing. As opposed to a heart attack, a cardiac arrest is an electrical failure caused by conditions like arrhythmia. The symptoms can include palpitations, dizziness, shortness of breath, and sudden collapse. For treatment, or as a life-saving measure, CPR must be performed.

What is CPR?

Cardiopulmonary Resuscitation (CPR) is an emergency procedure for patients who suffer a cardiac arrest. It combines chest compressions and rescue breathing to ensure oxygen flow to the organs. It is an effort to resuscitate a patient, and performing it immediately can double or even triple the chances of survival.

How to perform CPR?

To perform CPR on an adult, follow the given steps:

1. Begin by checking if the collapsed patient is responsive
2. Check if the patient is breathing or not, even if he or she is only gasping
3. Lay the patient on the ground with their back on a firm, flat surface
4. Place the heel of one of your hands on the centre of the chest and place the other hand on top of it
5. Start delivering chest compressions – hard and fast
6. Push at a rate of 100 to 120 compressions per minute and allow the chest to return to normal
7. You may combine 30 compressions with two rescue breaths until an ambulance arrives, or till the patient wakes up

Simply performing this can double the odds of survival, which is why CPR training is a must for all. However, doctors say that if not trained in CPR, then only perform compressions.

The prevalence of diseases and disorders in the gastrointestinal tract has increased within the last decade due to significant lifestyle modifications. Patients suffering from gastroenterological diseases exhibit high levels of depression, stress, anxiety, and dysfunction in the central nervous system. The name "functional gastrointestinal disorder" refers to numerous diseases manifesting symptoms related to GI problems (for example, pain in the abdomen, difficulty swallowing, indigestion, diarrhea, constipation, and bloating) but lacking detectable physical anomalies during standard diagnostic tests. There are 20 different diseases categorized as FGID in children. FGIDs have an extremely high frequency. Almost every other individual has met the criteria for FGIDs.

Dr. Anukalp Prakash, Director, Gastroenterology, CK Birla Hospital, Gurugram, in an interview with Health and Me, spoke about the rising incidence of

Prevalence Trends of Functional Gastrointestinal Disorders in India

Functional Gastrointestinal Disorders (FGIDs) occur frequently among adolescents, causing significant morbidity. Nevertheless, the actual prevalence rate is not well-defined yet. FGIDs are commonly encountered in school- and college-going adolescents, with most FGIDs being functional abdominal pain disorders.

Lifestyle Issues that Influence the Health of the Gastrointestinal System in Adolescents

1. Diet: Overconsumption of fast foods, junk foods, and sweet drinks leads to disturbances in the gut flora. Frequent consumption of oil-containing foods and spices raises the risk of heartburn and inflammation. Irregular meal times lead to indigestion.
2. Sedentary Lifestyle: Increased periods spent sitting because of online classes and remote working have adverse effects on intestinal motility. Inadequate physical activity leads to obesity and insulin resistance—the main causes of liver diseases.
3. Stress and Sleep Disorders: Educational and occupational stress affect brain-gut interactions. Stress causes irritable bowel syndrome. Sleep deprivation has a negative impact on liver function.
4. Substance Abuse: College alcohol abuse causes liver diseases like fatty liver and hepatitis. Cigarettes and energy drinks are detrimental to the GI tract and the liver.

Youth Lifestyles and Liver Disorders

1. Non-Alcoholic Fatty Liver Disease (NAFLD): NAFLD was uncommon among the youth previously but is becoming more prevalent nowadays. This is highly associated with obesity, insulin resistance, and bad dietary habits. The condition has no symptoms and develops gradually from benign fatty liver to cirrhosis.
2. Liver Injuries due to Alcohol Abuse: Binge drinking is common nowadays among the youth, especially among university students and city dwellers. Consumption of large amounts of alcohol in short periods of time leads to fatty liver or hepatitis. Persistent abuse leads to cirrhosis that develops earlier than usual.
3. Metabolic Disorders among Youths: These include several disorders such as obesity, diabetes, and high blood pressure due to lifestyle changes. These conditions have increased in prevalence in India as well as across the globe and result in NAFLD and heart ailments.

Management and Prevention Techniques

1. Dietary Modifications: Intake of whole grains, fruits, and vegetables along with drinking enough water should be suggested. Refined foods, beverages, and fast food should be reduced.
2. Daily Exercise: Doing moderate exercise for at least 30 – 45 minutes daily is suggested. Spending less time on the screens and opting for more exercise is recommended.
3. Stress Reduction and Sleep Patterns: Yoga and meditation practices enable better connection between the brain and intestines. Eight hours of sleep each night contribute to better regeneration of the liver.
4. Avoidance of Risky Behavior: Not consuming any alcohol, smoking cigarettes, or drinking energy drinks. Instead, recommending stress-reducing physical activities is suggested.
5. Frequent Screening for Illnesses: Liver screenings should be performed for young people who are at risk of health issues.