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!

Heart attack is the world's number one killer, yet its symptoms differ for both men and women, leading to varied outcomes.

A heart attack typically occurs when cholesterol plaque builds inside the walls of arteries and causes damage to the major blood vessels.

While men typically develop plaque in the largest arteries that supply blood to the heart, in women, it accumulates in the heart’s smallest blood vessels, known as the microvasculature.

A study published today in Circulation: Cardiovascular Imaging, an American Heart Association journal, showed that women report less artery-clogging plaque. Yet, it did not protect them from heart disease compared to men.

The study showed that women faced increased heart risk at lower levels of plaque compared to men. For total plaque burden, women’s risk began to rise at 20 percent plaque burden, while men’s risk started at 28 percent.

The increasing plaque levels led to a sharper risk for women than for men.

How Heart Attack Symptoms Differ Between Men And Women

According to global studies, women are more likely than men to die from a heart attack. The major reason is the late onset of symptoms of a heart attack in women.

During a heart attack, men are likely to experience sweating, pain in the chest, arms, and legs, and shortness of breath.

While the experiences are common among women, they also tend to suffer a combination of less-recognized symptoms such as nausea, indigestion, fatigue, dizziness, and pain in the neck, jaw, throat, abdomen, or back.

The obvious chest discomfort is also sometimes absent during heart attacks in women.

Other common reasons for heart attacks in women include:

• High testosterone levels before menopause
• Hypertension during menopause
• Autoimmune diseases such as rheumatoid arthritis
• Stress and depression

Can Heart Attacks Be Prevented?

Cardiovascular diseases are mostly preventable by targeting traditional risk factors common to both women and men, which include obesity, smoking, diabetes, high blood pressure, family history and metabolic syndrome -- the co-existence of high blood pressure, obesity, and high glucose and triglyceride levels.

The American Heart Association also advises at least 150 minutes a week of moderate-intensity aerobic activity (such as brisk walking) or 75 minutes of vigorous activity (such as jogging), or a combination of both.

Include fruits, vegetables, lean proteins, whole grains, low-fat or fat-free dairy, nuts, and seeds in your diet.

Limit processed foods, added sugars, sodium, and alcohol.

Seeing your child suddenly screaming at night, with wide eyes and thrashing limbs, can be deeply unsettling. However, remaining calm and focusing on safety is crucial for parents during the sleep terror episodes, said health experts.

Sleep terrors, also known as night terrors, are episodes of sudden fear, screaming, or intense distress that occur during sleep.

The condition is more common in children, especially between the ages of 3 and 8 years, as their sleep patterns are still maturing.

Unlike nightmares, which usually happen during dreaming (REM sleep) and are often remembered, sleep terrors occur during deep non-REM sleep.

Dr Preeti Singh, Senior Consultant, Clinical Psychology, Max Super Speciality Hospital, Dwarka told HealthandMe, that while it may be frightening to witness, especially for parents, sleep terrors themselves are usually not harmful.

Although most kids outgrow this naturally, if the episodes are violent or very frequent, consult a specialist, added Dr Sudhir Kumar, a neurologist at Apollo Hospitals, Hyderabad.

What Are Sleep Terrors

During sleep terror, the child may sit up abruptly, shout, appear frightened, sweat, breathe rapidly, and be difficult to console. In most cases, they do not recall the episode the next morning.

Sleep terrors typically occur in the first third of the night, during deep sleep (slow-wave sleep). They are considered a type of parasomnia, meaning an unusual behavior during sleep.

Dr Kumar, in a post on social media platform X, explained that unlike a bad dream, a sleep terror happens in deep sleep (Stage N3).

It is characterized by abrupt sitting up/screaming, with physical signs that include a fast heart rate, sweating, and dilated pupils.

"It is 11 PM. Your child suddenly sits up, screams at the top of their lungs, and looks terrified. They are not responding to you, and they seem to be looking right through you. This is likely a sleep terror (night terror), a common NREM sleep parasomnia in children aged 3-12,” said Dr Kumar, popularly known as the Hyderabad doctor, on X.

The expert noted that the children are unlikely to recognize the parents and be "consoled" during the episodes.

What Factors Trigger Sleep Terrors

• Sleep deprivation or irregular sleep schedules
• Fever or illness
• Emotional stress or anxiety
• Major life changes or trauma
• Family history of parasomnias
• Certain medications

For children, sleep terrors are often developmental and tend to reduce as the nervous system matures, Dr Singh told HealthanMe.

How Can Parents Respond?

Parents often feel alarmed during a sleep terror episode, but the key is to remain calm, the experts said. They said during an episode:

• Do not try to fully wake the child, as this may increase confusion and agitation.
• Gently ensure the child is safe and cannot injure themselves.
• Speak softly and reassuringly, even if they do not respond.
• Wait for the episode to pass, which usually happens within a few minutes.

Other preventive measures include:

• Maintaining a consistent bedtime routine
• Ensuring the child gets adequate sleep
• Reducing screen time before bed
• Managing stress during the day
• Creating a calm and secure sleep environment

How To Manage

Most children do not require medical treatment, as sleep terrors usually resolve on their own with age. Treatment is considered when episodes are frequent, severe, cause injury, or significantly disrupt family life.

However, addressing sleep deprivation, treating any underlying medical conditions (e.g., sleep apnea), counseling or stress management strategies can help.

Hypertension or high blood pressure, a major risk for stroke, is preventable and treatable. Yet it accounts for about 14 per cent of cases of stroke among young adults aged below 45 years.

High blood pressure can be defined as the increasing pressure in blood vessels marked as 140/90 mmHg or higher.

Uncontrolled hypertension can burst or block arteries that supply blood and oxygen to the brain, causing a stroke.

A recent study by the Indian Council of Medical Research (ICMR) found that hypertension (74.5 percent) was the most common risk factor for stroke and related deaths (27.8 percent) and significant disability (about 30 per cent) across India.

“Blood vessel walls can be damaged through uncontrolled high blood pressure, making them prone to blockage or rupture. The good news is that hypertension is preventable through regular monitoring, reduced intake of salt, exercise stress control, and medication when required,” Dr. Rajul Aggarwal, Director - Neurology, Sri Balaji Action Medical Institute, Delhi, told HealthandMe.

How Does Hypertension Increase The Risk Of Stroke?

Chronic high pressure forces the brain to compensate, leading to vessel remodeling, narrowing, and eventually rupture or clotting.

The ICMR study reported that ischemic stroke accounted for 60 percent of cases.

The experts explained that in the case of ischemic stroke, high blood pressure damages artery walls, fostering plaque buildup (atherosclerosis) or allowing clots to form and block blood flow to the brain.

On the other hand, with hemorrhagic Stroke, constant strain caused by high blood pressure weakens artery walls, causing them to burst or leak blood into the brain. This can result in severe damage or life-threatening emergencies.

“When blood pressure stays high for years, it slowly strains the blood vessels -- nothing dramatic at first, which is why people ignore it. The arteries become stiff and fragile, sometimes narrowing, sometimes tearing,” Dr. Gunjan Shah, Interventional Cardiologist, Narayana Hospital, Ahmedabad, told HealthandMe.

"This makes clots or bleeding in the brain more likely, leading to ischemic or hemorrhagic stroke, even in people who otherwise feel perfectly fit and busy with daily life," Dr. Shah added.

Importance of the ‘Golden Hour’ In Stroke Care

In stroke-related cases, the golden hour -- referred to as the critical first 60 minutes after symptom onset -- is very much critical. Early medical treatment during the window can prevent death risk as well as boost health outcomes.

However, the ICMR study, published in the International Journal of Stroke, showed that just 20 percent of patients arrived in the hospital after 24 hours of the onset of symptoms.

Dr. Aggarwal said treatment within the first 60 minutes can significantly reduce the brain damage and improve survival as well.

“In a stroke, time moves very differently. Brain cells begin getting damaged within minutes when blood flow stops. If someone reaches the hospital quickly -- within the golden hour -- we have a real chance to restore circulation and limit disability. Recognising symptoms early and not waiting at home can truly change how well a person recovers,” added Dr Shah.

How Can Hypertension And Stroke Be Prevented?

Hypertension is a modifiable disease, and the risks can be reduced by:

• Cutting down and managing stress
• Checking blood pressure regularly
• Treating high blood pressure
• Eating less salt
• Staying active
• Managing stress
• Sleeping properly
• Avoiding tobacco

Dr Shah said that many young patients delay care because they feel fine, but taking medicines on time and correcting lifestyle early can prevent serious problems later.