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!

A stroke can happen suddenly and without warning, making every minute count. The first 60 minutes after the onset of stroke symptoms are crucial because timely medical treatment can help reduce brain damage and improve recovery.

What is a Stroke?

A stroke happens when the blood flow to an area of the brain is cut off due to either the blockage of a blood vessel supplying that area or the bursting of the said blood vessel. Without adequate blood flow, brain cells are deprived of oxygen and nutrients and begin to be damaged within minutes.

What Happens During the Golden Hour?

The first hour after a stroke is focused on rapid assessment and treatment. Once the patient reaches the hospital, doctors evaluate the symptoms, determine when they started, and perform an urgent brain scan, usually a CT scan, to identify the type of stroke.

This step is important because treatment depends on whether the stroke is caused by a blocked artery (ischemic stroke) or bleeding in the brain (hemorrhagic stroke). For eligible patients with an ischemic stroke, clot-dissolving medication or a procedure to remove the clot may be considered.

Although treatment windows may extend beyond the first hour for some patients, reaching the hospital as early as possible offers the greatest chance of saving brain tissue. In most patients, clot-dissolving medication is given within 4.5 hours of symptom onset, while selected patients may be eligible for treatment up to 9 hours. Mechanical clot removal is generally performed within 6 hours, although carefully selected patients may benefit from the procedure up to 24 hours after symptoms begin. However, earlier treatment is associated with better protection of brain tissue and improved outcomes.

Know the Warning Signs

Recognizing stroke symptoms early can help save valuable time. The BEFAST acronym is a simple way to remember the common warning signs:

B – Sudden loss of balance or coordination

E – Sudden vision loss or changes in one or both eyes

F – Face drooping

A – Arm weakness

S – Speech difficulty

T – Time to call emergency medical services

Other symptoms may include sudden loss of vision, dizziness, difficulty walking, numbness on one side of the body, confusion, or a sudden, severe headache.

Why Every Minute Matters

During a stroke, brain cells continue to be damaged as blood flow remains interrupted. Delays in reaching the hospital can limit treatment options and increase the risk of long-term disability. Seeking medical care as early as possible gives doctors the best chance to provide appropriate treatment.

What Should You Do?

If you notice stroke symptoms in yourself or someone else, do not ignore them or wait for them to improve. Call emergency medical services immediately and note the time the symptoms first appeared, as this information helps doctors decide the most suitable treatment.

The golden hour is a critical window during which timely action can significantly improve outcomes. Recognizing the signs of stroke and seeking immediate medical care can make a meaningful difference in recovery.

Massive wildfires have ravaged several parts of Canada and other regions of the world, filling the air with hazardous smoke. This has triggered health warnings far beyond the fire zones.

While most people experience immediate breathing problems during and after wildfires, experts say that some health effects can persist long after the skies clear.

Why Is Wildfire Smoke Harmful?

Wildfire smoke is composed of harmful gases and microscopic particles known as PM2.5. These tiny particles are small enough to travel into our lungs and enter the bloodstream, where they can trigger inflammation throughout the body.

Unlike typical air pollution, wildfire smoke also contains toxic substances released from burning homes, plastics, furniture, vehicles, electronics, and industrial materials, making prolonged exposure particularly harmful.

Long-Term Health Risks After Wildfire Exposure

Also read: Delhi's Poor AQI, Monsoon Conditions Put Children's Lungs at Risk: Ways to Keep Kids Safe

Lung And Chronic Respiratory Disease

Prolonged exposure to wildfire smoke can have long-term effects on the respiratory system. Possible health effects may include:

• Persistent cough
• Poor lung function
• Worsening asthma symptoms
• Increased COPD episodes
• Greater risk to respiratory infections

Children, older adults, and people with existing lung conditions face the highest risk because their lung function is already compromised.

Heart Disease

Also read: Phones, Pollution, AI: What Is Driving Cognitive Decline In Humans?

The tiny particles in wildfire smoke don't just stay confined to the lungs. Once they enter the bloodstream, they can affect the cardiovascular system. In the long run, research says wildfire smoke exposure can lead to:

• Heart attacks
• Stroke
• Irregular heart rhythms
• Elevated blood pressure
• Increased inflammation in blood vessels
• Effects on Brain Health

With frequent incidences of wildfires, scientists are looking into how wildfire smoke affects the brain. Emerging evidence suggests smoke exposure may contribute to:

Headaches

• Difficulty concentrating
• Memory problems
• Cognitive decline
• Increased inflammation affecting brain function

Mental Health Consequences

Wildfires can affect mental health in more than one way. Besides the stress of evacuation and property loss, smoke exposure itself may contribute to mental health problems directly. One is at the risk of the following mental health issues after exposure:

• Anxiety
• Depression
• Post-traumatic stress disorder (PTSD)
• Sleep disturbances

Communities repeatedly exposed to wildfire events may experience prolonged psychological distress that could often go undetected.

Possible Cancer Risk

Growing evidence suggests that long-term exposure to wildfire smoke may increase the risk of several cancers. Studies have reported possible associations with lung cancer, breast cancer, colorectal cancer, bladder cancer, and certain blood cancers

Although researchers say more studies are needed to establish a direct cause-and-effect relationship, the findings highlight the importance of limiting repeated smoke exposure.

Also read: How Air Pollution Puts Heart Patients At Risk - What You Can Do About It

Pregnancy And Infant Health

Pregnant women are among the groups considered most vulnerable to wildfire smoke. Research suggests exposure during pregnancy may increase the risk of preterm birth, low birth weight and other pregnancy complications.

Healthcare providers recommend minimizing outdoor exposure whenever air quality deteriorates.

How To Protect Yourself After Wildfire Exposure?

Even after visible smoke disappears, harmful particles may remain in the air. Experts recommend:

• Monitor local air quality before going outdoors.
• Stay indoors when pollution levels are high.
• Use HEPA air purifiers if available.
• Wear a well-fitted N95 mask if exposure is unavoidable.
• Keep doors and windows closed when it is smoky outside.
• Continue taking prescribed medications for asthma or heart disease.
• Seek medical attention if coughing, chest pain, breathlessness, or other symptoms persist.

When we think of dialysis, we often picture a machine filtering blood and keeping patients alive. What rarely comes to mind is the small blood vessel in the arm that makes the entire process possible.

For every patient on haemodialysis, the arteriovenous (AV) fistula is quite literally a lifeline. Without it, dialysis cannot be performed effectively. Yet, despite being one of the most important parts of treatment, fistula care remains one of the least understood aspects of kidney disease.

This silent gap in awareness is costing patients their lifeline.

A Growing Burden That We Cannot Ignore

India adds nearly 2.2 lakh new patients with end-stage kidney disease every year, creating a demand for over 3.4 crore dialysis sessions annually.

One of the biggest challenges we see in clinical practice is that patients often seek medical help only after the fistula has already stopped functioning.

The warning signs are usually ignored.

The vibration over the fistula becomes weaker. The arm begins to swell. Bleeding continues longer than usual after dialysis. Needle insertion becomes increasingly difficult. Sometimes dialysis itself becomes less effective.

By the time patients reach an interventional radiologist or vascular specialist, the fistula may already have developed significant narrowing (stenosis) or complete blockage.

Unfortunately, many of these complications are preventable if detected early.

In our experience, nearly 30% of patients eventually lose their fistula because they report too late, when timely intervention could have salvaged access.

Also read: COVID Spikes In India: Experts Allay Fears, Stress Vaccination And Masks

Why Does This Keep Happening?

Unlike diabetes or blood pressure, there is no widespread public awareness around fistula surveillance.

Many dialysis patients receive instructions on medicines and dialysis schedules but very little education on how to examine their fistula every day.

There is also no universally implemented patient education protocol across dialysis centres, leading to inconsistent awareness about fistula care.

The result is simple: patients unknowingly damage the very access that keeps them alive.

Your Fistula Speaks Every Day - Learn To Listen

Patients should examine their fistula daily.

A healthy fistula has a continuous buzzing sensation or “thrill.” If this vibration becomes weak or disappears, medical attention should be sought immediately.

Similarly, swelling of the arm, redness, prolonged bleeding after dialysis, pain around the fistula, or difficulty during needle insertion should never be dismissed as routine.

These are early warning signs - not inconveniences.

Also read: Omicron Sub-Lineages Likely Behind COVID Surge In India: Why Deaths Are Occurring

Five Simple Habits That Can Save A Fistula

• Feel the fistula every day for its characteristic vibration.
• Never allow blood pressure measurement, blood draws or intravenous injections on the fistula arm.
• Avoid carrying heavy weights or sleeping on the access arm.
• Maintain good hygiene around the fistula site.
• Report any change in blood flow, swelling or bleeding immediately instead of waiting for the next dialysis session.

These small daily habits can often extend the life of a fistula by years.

Early Detection Can Prevent Major Procedures

One of the greatest advances in dialysis access care is that many fistula problems no longer require open surgery.

If narrowing is detected early, minimally invasive image-guided procedures such as fistuloplasty (balloon angioplasty) can restore blood flow, preserve the existing fistula and help patients continue dialysis without interruption.

The key, however, is timing.

A fistula that is evaluated early is often salvageable.

A fistula ignored for weeks may not be.

We Must Shift Our Focus from Creating Fistulas To Preserving Them

Every successful fistula represents months of planning, surgery and healing. Losing it means additional procedures, temporary catheters, higher infection risk, increased costs and emotional distress for patients already living with chronic kidney disease.

As doctors, we have become increasingly skilled at creating dialysis access.

The next challenge is ensuring patients know how to protect it.

Because for someone living with kidney failure, the fistula is not just another blood vessel.

It is the lifeline that keeps life moving.

By Dr. Avik Bhattacharyya, Senior Consultant - Interventional Radiology, CK Birla Hospitals, CMRI