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!

It can be confusing and sometimes alarming to receive different thyroid test results from two different laboratories, especially when both tests are done on the same day. A slight difference in values does not necessarily mean that your thyroid function has suddenly changed. In many cases, the variation is due to differences in how the tests are performed rather than a change in your health.

The Laboratory Can Make A Difference

One of the biggest reasons for varying results is the laboratory itself. Accredited laboratories, such as NABL-certified labs, follow stringent quality-control measures, use standardised testing protocols and have trained personnel to handle samples correctly. Laboratories with less rigorous quality standards may produce results that are less consistent.

Different Equipment Can Produce Different Results

The equipment and testing methods used can also differ from one laboratory to another. Different analysers, calibration techniques and testing kits can produce slightly different values for thyroid hormones such as TSH, T3, T4, Free T3 and Free T4.

Even the reference ranges printed on reports may not be identical because each laboratory establishes its own normal range based on the equipment used and the population it serves.

Also read: UK Approves Eli Lilly’s Foundayo: Is the GLP-1 Pill Better Than Wegovy, Mounjaro?

The Time Of Your Test Matters

The timing of the test is another important factor. Thyroid-stimulating hormone (TSH) naturally fluctuates throughout the day. It is generally higher during the early hours of the morning and gradually falls as the day progresses.

As a result, a blood sample collected in the afternoon may show a lower TSH level than one collected early in the morning.

Stress, Sleep And Medication Can Affect Results

Lifestyle and biological factors can also influence thyroid hormone levels. Stress, poor sleep, recent illness, medications and even eating before the test may affect the results.

For people taking thyroid medication, blood samples should ideally be collected in the morning on an empty stomach and before taking the daily dose. Testing after medication may temporarily alter hormone levels and make interpretation more difficult.

Also read: Why Women Want Hormonal Health Care, Not Just Pregnancy Care

Biotin And Other Medicines Can Interfere With Thyroid Tests

Certain supplements and medications can interfere with thyroid tests as well. Biotin, commonly found in hair and nail supplements, can falsely lower TSH levels while increasing Free T3 and Free T4 values.

Medications such as amiodarone, glucocorticoids, dopamine and heparin may also affect thyroid hormone measurements. During pregnancy, hormonal changes, particularly increased levels of human chorionic gonadotropin (hCG), can naturally alter TSH values.

Even Sample Handling Can Affect The Report

Laboratory handling also plays a role. Delays in processing, improper storage temperatures, differences in centrifugation timing or sample-handling errors can influence the final result.

In some individuals, thyroid autoantibodies may interfere with laboratory assays, potentially leading to inaccurate Free T3 and Free T4 measurements.

Also read: Silent Neck Swellings: Why An Unusual Lump Should Never Be Ignored

Should You Repeat A Thyroid Test?

Because of these variables, experts recommend getting thyroid tests done at the same accredited laboratory whenever possible. This allows doctors to compare results more reliably over time.

If a thyroid value is only mildly abnormal or falls within a borderline range, it may often be advisable to repeat the test before making a diagnosis or starting lifelong medication.

Ultimately, thyroid test reports should never be interpreted in isolation. Doctors consider the patient's symptoms, medical history, physical examination and repeat test results before deciding on treatment.

Consistency in where and how the test is performed can help avoid unnecessary anxiety and support more accurate clinical decisions.

By Dr Shaheen Guy, General Physician, Saifee Hospital, Mumbai

Robotic surgery has rapidly become one of the most talked-about advances in modern medicine. Yet, for many patients, the technology remains misunderstood.

The first thing to know is that the robot does not perform the operation. Every movement is directed by the surgeon. The robotic platform translates the surgeon’s hand movements into highly precise, tremor-filtered movements inside the body while providing magnified three-dimensional vision and greater instrument dexterity.

The real question, therefore, is not whether robotic surgery is better. It is whether it is the right choice for a particular patient, procedure and surgeon.

Where Robotic Surgery Can Make A Difference?

For many routine operations, conventional laparoscopy may achieve equally good outcomes. Technology should support clinical judgment, not replace it.

Patients should also recognise that outcomes depend far more on the experience of the surgical team than on the robotic system itself. Successful robotic surgery requires specialised training, structured credentialing and a coordinated operating theatre team.

Choosing an experienced surgeon can therefore be more important than choosing a hospital simply because it owns a robotic system.

Also read: 18-Year-Old In Critical Condition After Acidic Substance Allegedly Given Instead Of Anaesthetic During Surgery

Making Robotic Surgery More Accessible

Another important development is that robotic surgery is becoming more accessible. Indigenous platforms are helping expand advanced surgical care beyond a handful of metropolitan hospitals by making robotic programmes more viable for a wider range of healthcare institutions.

This gradual decentralisation means patients in Tier II and Tier III cities can increasingly access advanced minimally invasive surgery closer to home, reducing the need to travel long distances for specialised treatment.

Also read: Osteoporosis Drugs Offer New Hope For Back Pain By Blocking Disc Mineralisation: Study

Could Robotic Surgery Work Across Long Distances?

Innovation is also extending beyond the operating room. Robotic telesurgery, demonstrated successfully using Made-in-India robotic platforms, has shown that expert surgeons can operate across vast distances using secure digital networks.

While widespread adoption will require robust infrastructure and regulatory frameworks, the technology represents an important step towards improving access to specialised surgical expertise.

Also read: Surgeon Barred From Practice After Connecting Wrong Parts of Patient’s Bowels During Emergency Surgery

What Should Patients Ask Their Surgeon?

Patients should look beyond the hype and ask informed questions:

• Is robotic surgery appropriate for my condition?
• What experience does my surgeon have with this procedure?
• What are the expected benefits?
• What are the limitations and risks?
• Would conventional laparoscopy or open surgery be equally suitable?

With indigenous platforms helping decentralise robotic surgery, advanced care is becoming more accessible beyond major metros. The technology has also demonstrated the potential of interhospital telesurgery, enabling expert surgeons to operate across distances and potentially helping bridge gaps in access to highly skilled surgical expertise.

Ultimately, the future of surgery will not be shaped by machines alone. It will be shaped by skilled surgeons using intelligent technology to deliver safer, more precise and equitable patient care.

A cigarette after stress. Chewing tobacco during the day. Smoking to “calm the nerves”

But modern science is forcing us to confront the difficult truth; Tobacco does not treat mental health symptoms, in fact it quietly deepens it.

As Oncologists and physicians, we often see patients who say, “smoking makes them feel normal.” However, in reality, what they are experiencing is nothing more than the temporary relief from nicotine withdrawal not genuine emotional regulation.

Nicotine Creates A Cycle of Temporary Relief And Dependence

When we smoke or chew tobacco, nicotine stimulates dopamine release in the brain, creating a short-lived sense of relaxation or control. But overtime it leads to brain depending on nicotine to achieve the same baseline feeling again and again. The result is a vicious cycle of dependence, irritability, anxiety, and worsening emotional resilience.

Several large studies now show that long-term tobacco use is associated with higher rates of anxiety, depression, sleep issues and substance dependence. A 2023 review published in BMJ found that smoking cessation will result in improvements in both anxiety and depression and an improved mood with benefits comparable to antidepressant treatment in some individuals.

Also read: Lung Health After 40: Natural Changes, Warning Signs And Ways To Protect Your Lungs

Tobacco May Worsen Anxiety, Depression And Sleep Problems

This has serious implications for the urban Indian population in regard to the increasing prevalence of mental exhaustion, lack of social support, digital overload, work-related stress and lack of sleep. Tobacco often enters quietly during vulnerable moments of college pressure, workplace stress, loneliness, grief and gradually shifts from “social habit” to psychological crutch.

Although they think they believe in tobacco, many of them use it, thinking that they are using it to cope with their emotional symptoms, when in fact they are making the symptoms worse.

Also, recognize the biology of tobacco use. For example, the use of nicotine will result in long-term changes in how well your body handles emotional stress because of the role of long-term nicotine exposure in altering the system of cortisol regulation and the stress response pathways in neurons. So, with time, it will become harder and harder for a person to control his/her emotional response to stress because his/her body will not be able to do it. Thus, tobacco has a negative influence on the recovery process from emotional responses to stress, rather than a beneficial one.

Also read: Air Pollution May Increase The Risk Of Painful Rheumatoid Arthritis Flares, Study Finds

How Nicotine Alters The Body’s Stress Response?

Tobacco is a significant preventable risk factor for oral, head and neck, lung, oesophageal, pancreatic and bladder cancers. When many patients arrive at cancer centres, the addiction to tobacco is already set, and it is even more difficult to quit while receiving cancer treatment.

This is why it is important to help move the conversation on tobacco beyond cancer. Now, it's more than just a public health issue; it also includes issues of mental health. Individuals experiencing emotional difficulties should not think that they are being judged. They have to learn to find alternative coping strategies, get psychological support early on in their lives, sleep well, exercise, be part of the community, and access timely medical support. The goal of this care is not just to support someone in quitting tobacco, but to provide support for them to stop needing tobacco in order to feel good.

By Dr Amit Chakraborty, Consultant Oncologist, Saifee Hospital, Mumbai