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!

The concept of self-medication in the case of a trivial ailment such as a headache or a small cut is generally considered responsible self-care. Nevertheless, it becomes a matter of public health concern when the process goes through two particular stages. The first of these stages is the “masking of chronic disease." When one uses over-the-counter (OTC) drugs to cover up symptoms of fatigue, acidity, or thirst, he or she ends up masking the symptoms of underlying chronic diseases, which could be type 2 diabetes or high blood pressure, for instance. By the time these symptoms are diagnosed, the condition may have caused irreparable damage to organs. Another health problem created due to self-medication is antimicrobial resistance, which poses a danger not only to the individual but also to society as a whole.

What are the risks of making a self-diagnosis?

Dr Vimal Pahuja, MD, Associate Director, Internal Medicine & Metabolic Physician, Diabetes & Weight Management Clinic, Dr LH Hiranandani Hospital, Powai, Mumbai, said, “The most serious complications include those that have no immediate effects and do not trigger pain signals. DILI is a growing concern in India and is a consequence of the persistent abuse of painkillers (NSAIDs) or even some of the herbal supplements available in the market. In the same way, ‘kidney compromise’ results from prolonged consumption of analgesics. Looking at things from the viewpoint of the endocrine system, the frequent consumption of over-the-counter steroids, which are also included in some ‘miracle’ skin creams and supplements, can affect hormones and lead to the development of secondary diabetes.”

Does it help to ‘Google’ symptoms?

Internet searches usually generate confirmation bias, where patients only seek answers that align with what they want to hear. Health-related social media sites and influencers tend to oversimplify medical issues by encouraging bio-hacking. This results in unsafe practices, such as people prescribing themselves advanced metabolic and hormonal treatments without being aware of the contraindications or the need for clinical testing.

Dr Kirti Sabnis, Infectious Diseases Specialist, Fortis Hospital, Mulund & Kalyan, Mumbai, said, “With the growing emphasis on early and accessible diagnosis, more individuals are becoming proactive about understanding their symptoms and lab reports. This has led to a noticeable rise in what clinicians often refer to as ‘Google diagnosis,' where patients arrive with self-researched conclusions based on online information or AI-enabled report analyses.”

Why is accurate diagnosis important?

The expert went on to say that interpreting symptoms and investigations is rarely straightforward. Fever, for instance, is merely a symptom and can stem from a wide range of causes, from infections to non-infectious conditions such as thyroid disorders. While digital tools and AI platforms can analyse reports and suggest possible conditions, they typically rely on common algorithm-based differentials. In some cases, this may lead to alarming or misleading possibilities such as tuberculosis or even cancer, when the underlying issue could be far less serious.

Accurate diagnosis requires more than data interpretation; it demands clinical expertise, physical examination, and years of medical experience to connect symptoms, history, and test results. Over-reliance on online searches can sometimes lead to unnecessary anxiety, delayed diagnosis, or even self-medication, which may complicate the condition further.

The importance of taking time to explain the reasoning behind prescribed medication is essential, especially when informing a patient that an antibiotic cannot cure their flu.

When it comes to heatwave-like conditions, most people worry about the risk of dehydration and sunburn. But it turns out that the scorching heat could also take a toll on your skin—according to experts, extreme summer heat can increase the risk of skin infections. Heatwave-related skin infections can be triggered by high humidity, sweat, and bacteria trapped on the skin. Some of the other issues associated with heatwaves are folliculitis, heat rash, impetigo, and yeast infections.

What makes heatwaves conducive to increased skin infections?

Talking about it, Dr. Gitika Sanodia, Consultant Dermatologist at Dr. L H Hiranandani Hospital, Powai, answered some FAQs associated with heatwaves and consequent skin infections.

The expert said that when there is an increase in temperature, there is an increase in sweating, dehydration, and breakdown of the skin barrier, which creates an environment suitable for infection development, mainly in children, the elderly, diabetics, and obese individuals. Heatwaves also cause friction, which leads to skin infections. As a result, rashes can develop and cause a great deal of discomfort.

Can sweating too much increase the risk of infection?

During summer, because of the heat, one ends up sweating far more than normal, and if you are someone who often wears tight clothes, it can be even worse. Overproduction of sweat keeps the skin constantly wet. Such an environment provides perfect conditions for bacteria and fungi to multiply. Being trapped under breast tissue, between the thighs, and in folds around the neck and armpits causes conditions such as yeast infections or folliculitis.

What are the infections associated with heat?

During a heatwave, some skin infections are likely to develop silently. These include:

1. Fungal infections such as tinea and candidiasis
2. Bacterial infections such as folliculitis and boils
3. Heat rash resulting in miliaria

Who is at risk of skin infections during a heatwave?

At a time when temperatures are rising constantly, heatwave-related infections are likely to affect certain groups more than others. These high-risk groups are:

1. Children
2. The elderly
3. Overweight people
4. People with diabetes
5. People who wear tight or non-porous clothes during summer

How to prevent heatwave-related skin infections?

In order to prevent heatwave-related skin infections, you need not make major changes to your lifestyle or wardrobe. Rather, some simple, cost-free methods can also do the trick. Here are some expert-recommended tips to beat the heat:

1. Keep your skin dry, especially skin folds
2. Wear loose-fitting cotton clothes
3. Bathe after sweating
4. Do not share towels or undergarments with anyone
5. Use an antifungal dusting powder on susceptible areas
6. Keep yourself hydrated

With the increasing number of heatwaves, these problems have become more than just seasonal. However, with the right choices in terms of diet, lifestyle, and clothing, you may be able to avoid skin infections during a heatwave.

Persistent back pain in young adults is often dismissed as poor posture, long hours at a desk, or muscle strain. But doctors are warning that in some cases, it could be a sign of ankylosing spondylitis — a chronic inflammatory autoimmune disease that affects the spine and can silently progress for years before diagnosis.

In India, 16.5 lakh people suffer from the condition, with an average diagnostic gap of nearly seven years from the time symptoms first appear. During that window, the disease continues to silently progress, and the burden is far from small.

“Ankylosing Spondylitis is one of the most underdiagnosed conditions we encounter in clinical practice, and the consequences of that delay are real,” Dr. Arvind Mehra, Senior Director and HOD - Orthopaedics at Paras Health Gurugram, told HealthandMe.

Moreover, “It takes several years of pain and stiffness before people seek treatment, and by then, the diagnosis comes too late, and there has already been damage to the spine,” added Dr. Ashish Tomar, Director - Orthopaedics & Minimally Invasive Spine Surgery at Sarvodaya Hospital, Faridabad.

What Is Ankylosing Spondylitis?

Ankylosing spondylitis, also known as axial spondyloarthritis, is a type of arthritis that primarily targets the spine but can also affect other joints. The term “ankylosing” means stiff or rigid, “spondyl” refers to the spine, and “itis” indicates inflammation.

The inflammatory disease causes some of the bones in the spine to fuse over time. This fusing not only makes the spine less flexible but can also cause issues while breathing.

Ankylosing spondylitis leads to inflammation in the spine and large joints, causing stiffness and pain. It can also impact the joint between the spine and the hipbone, potentially resulting in additional symptoms such as digestive issues, rashes, and weight loss.

Not Your Typical Back Pain

What makes ankylosing spondylitis difficult to spot is that it often feels like ordinary back pain — but there are warning signs that set it apart.

According to experts, ankylosing spondylitis-related pain typically:

• Causes maximum stiffness early in the morning
• Gets worse after long periods of rest
• Improves with physical activity or exercise
• Persists for months rather than days or weeks
• Often begins in young adults, especially in their 20s and 30s

This pattern is very different from mechanical back pain, which usually worsens with movement and improves with rest.

Pain Beyond The Spine

Dr. Tomar told HealthandMe that ankylosing spondylitis is not simply a musculoskeletal problem — it is an autoimmune disease, where the body’s immune system mistakenly attacks healthy tissues, particularly around the spine and joints.

“Ankylosing spondylitis is not just another musculoskeletal disease. It requires the attention given to autoimmune disorders because it may affect the chest, hips, shoulders, and even the eyes, while also causing severe posture problems in advanced stages,” he said.

Beyond the spine, the disease may affect:

• Chest joints
• Hip joints
• Shoulders
• Eyes
• Posture, causing severe problems in the advanced stages

Who Is At Most Risk? How To Treat?

Young adults, typically in their twenties, are more likely to experience this condition because people often overlook its existence or mistakenly identify it as something else.

The combination of early diagnosis, structured physiotherapy, and suitable medications allows for effective disease progression control.

“When a young adult presents with inflammatory back pain, especially in the gluteal area, that persists beyond three months, the reflex should not be to prescribe a painkiller and wait. It should be investigated further. That shift in approach can make an extraordinary difference to someone’s long-term quality of life,” Dr. Tomar said.

Common treatments for ankylosing spondylitis include:

• Regular physical activity can reduce stiffness and prevent worsening of ankylosing spondylitis
• Over-the-counter painkillers for pain and inflammation
• Biologic DMARDs to reduce inflammation and pain, potentially halting disease progression.
• Corticosteroids are prescription anti-inflammatory medications
• Surgery is rarely suggested for severe symptoms unresponsive to other treatments.