Health & Life

maneka gandhi mental illness

By Lipi Mehta:

Since 2014 (with the UPA government in power then), the Rights of Persons With Disabilities Bill has not been passed in Parliament. Now with the BJP government in charge, a Group of Ministers discussed the proposed bill on January 25 where Union Minister Maneka Gandhi raised objections saying that the bill does not lay criterion for determination of mentally disabled persons. “It (bill) does not differentiate between mentally ill and mentally disabled person. But there is a difference between the two. If a person is mentally ill like schizophrenic, how can he be given a job,” Gandhi said talking to reporters on the sidelines of a function.

This comment has created an uproar in the country with citizens questioning how and why people with schizophrenia cannot be a part of India’s workforce. In her defence, Maneka Gandhi has said that this issue been “completely misunderstood”. She has added that “definition of disabilities in the Bill must be clear as persons with Disability, Illness & Disease” so that the matter of who qualifies for the 3% job reservation under the bill is not left to interpretation by government officials.

While it is important to differentiate between persons with physical and mental disabilities, in order to better treatment and healthcare for all, the statement raises further questions of whether people with schizophrenia are “qualified: to fall under the 3% job reservation. The statement also ignores the many people with serious mental illnesses who might be on the path towards complete recovery or may have showed remarkable improvement. Moreover, to ask how a mentally ill person like a schizophrenic can be given a job, undermines the value of all those who are living with schizophrenia and working.

Take for instance the Aasha Employment Project where people with mental illnesses run stationery stores and even manage a paper cup production unit. Or The Banyan, a mental health NGO that is working hard to rehabilitate its patients and get them employed. While these are two names, Mrs. Gandhi’s sweeping statement undermines the value of every other person who is working hard to mainstream people with mental illnesses in society.

It has even led to the setting up of a Tumblr blog called We Can Work where people with mental illnesses are posting powerful messages to the minister.

http://wecanwork.tumblr.com/post/138318821885/dear-mrs-maneka-gandhi-i-am-sadhana-i-am

http://wecanwork.tumblr.com/post/138316319415/dear-mrs-maneka-gandhi-i-am-pushpa-i-am

http://wecanwork.tumblr.com/post/138316430208/dear-mrs-maneka-gandhi-my-name-is-biswapratap-i

Perhaps the real question we should be asking is why it is crucial to strengthen the conversation around mental health in India.

The reality is that 50 million people with mental health issues live in India, that is 5% of the country’s population. We need around 55,000 mental health professionals to tackle this crisis, though in reality, we only have a little over 7,000! The National Platform for the Rights of the Disabled discusses a deeper problem in its letter to Mrs. Gandhi: “We feel your statement will make such persons more vulnerable. They may feel a threat to their jobs and livelihood. Many may even refrain from seeking medical and social assistance.”

That’s right, if our minister’s Disability Rights Bill doesn’t recognise the already-existing stigma faced by persons with mental illnesses in India, little can be improved when it comes to elevating their position, especially in government jobs.

In December 2015, PM Modi suggested on his radio show ‘Mann Ki Baat’ that disabled people should be called ‘Divyang‘ (with divine bodies) and not ‘Viklang‘ (with handicapped bodies). Such othering statements also do nothing to normalise and accept the presence of the disabled in society.

As for the bill, Mrs. Gandhi concluded by saying that it needs to be worked on further before presenting to the Cabinet. Well, we hope that she is right when she says the issue is “completely misunderstood”. And it would be great if the bill is worked upon further, so that we have a final draft that shows sensitivity and upholds the spirit of inclusion.

breast cancer awareness

Submitted anonymously:

Breast cancer affects 1 in 8 women in the USA according to the American Cancer Society. The number is expected to rise within the next 5-10 years. Although the disease is more likely to occur in women carrying the BRCA1 or BRCA2 gene or with a family history of the disease, sporadic cases exist. This information comes with an understandable baggage of fear and anxiety. But, it also comes with an appeal to all women. More often than not, you might have experienced your mothers, fathers, aunts or uncles reluctance to get an all-around health check-up because “everything is fine” or “nothing seems wrong”.

This isn’t uncommon. As humans, we have an inherent tendency to not pay attention to things that aren’t tangible – things we don’t see or feel. If symptoms of a health issue are noticeable – say joint pains, we immediately give it attention. But breast cancers can start with few to almost no symptoms. Hence, getting oneself checked seems without cause. Not paying heed to something that ‘could’ happen, or something that we can’t ‘see’ or ‘feel’, is an epidemic in itself.

breast-cancerExempting ourselves from possibilities that apply to us, also adds to the problem. Thinking that one day someone you love could be diagnosed with cancer might be incomprehensible. Co-relating or associating the 2 words is difficult for many because it is too striking or frightening. We say “It won’t happen to me”.

My mother was recently diagnosed with a sporadic case of breast cancer (there is no history of the disease in the family). After her diagnosis, 3 women in the family got themselves checked.

They didn’t associate with the disease and didn’t take statistics seriously enough to follow measures. But, a firsthand experience changed the dynamic and the unrelenting reality seemed probable. This is a behaviour commonly observed in many spheres – and it continues to take shape in health and wellness.

Do we have to wait for someone close to us to get diagnosed to begin looking after ourselves?

There are things we can do to prevent/aid in early diagnosis of the disease. Here are a few:

1. Thinking “It could be me” is scary and painful. But using it as an invitation to get check-ups regularly and pay attention to symptoms, means it can do more good than harm. Following guidelines from medical agencies to get required check-ups is helpful. If breast cancer is in someone’s books, regular check-ups that could result in an early diagnosis will change “it could be me” to “it was me”, or “it won’t be me”. We need to be precautious.

2. Some of our family members or parents are reluctant to get checked. If your mother or any female in your family falls in the category in which check-ups can be conducted and symptoms may be identifiable, take the responsibility upon yourself to have them follow guidelines from medical practitioners, however reluctant they may be.

If someone you care about has been diagnosed with breast cancer:

1. Give yourself time to feel sad and scared. But try to limit this to a phase. There are powerful things that can be learnt from the experience if you allow yourself to. In fact, I believe the best way to deal with pain is to give it purpose.

In my experience, I learnt about God and spirituality. These were ideas I had previously dismissed as visions of the cowardly. I also learnt the power of science and medicine have to transform a single life and hence generations. I found myself looking up, saying “Please” the night before my mother’s biopsy results were to come out, and saying “Thank you” when I heard her voice after surgery. I saw the gratitude and respect patients showed doctors when they walked the halls of the hospital. Looking back, it is intriguing how my experience revamped by beliefs so profoundly.
What happens to someone you love isn’t in your control, but what you make of your experience can be.

2. Prioritize her happiness and comfort. Going through treatment is emotionally and physically challenging. Surrounding her with positive energy and an overall optimistic environment goes a long way.

Watch TV shows or movies that make her laugh. Try to avoid sad ones when the mood already seems tense. We generally perceive actions as a result of emotions, but it works in reverse as well. Laughing can spark a change in the way someone feels too.

Although there are plenty of restrictions on diet, there are some dishes you can create with some extra effort. Ice cream sundaes with biscuits and chocolate, steamed vegetables, homemade – pizza, cakes and custards are some clean and healthy options. (Be sure to check what foods are permitted)

Have positive and optimistic conversations not just about the disease and what she is experiencing. Talk about topics that excite her – fashion, science, art, or politics. These conversations give her a sense of normalcy and also act as a distraction from continuous demotivating thoughts.

Think about the impact of what you say before saying it. You might want to avoid sensitive information like – “My friend’s relative died of cancer at age 30” or “cancer is a scam the government created” or “there is no cure for cancer”. Keeping her around family or friends who are supportive and positive is important.

It is understandable that you are concerned about her well-being, but don’t smother her. Independence is empowering. Being dependent especially for those who exercise a lot more independence than the average person is emotionally challenging. If she wants to do something that wouldn’t cause her harm, let her go ahead.

3. Every person has a different way of dealing with the news. For some, it may be through activism, and for some it might be by avoiding the word ‘cancer’ itself. Although you might not agree with her coping mechanism, if she is happy and comfortable with it, don’t enforce your ideas on her. If the approach she chooses is doing her more harm, try to gently guide her on a path suitable to her personality and outlook.

4. Breast cancer is a disease with several variables. Sometimes, the Internet doesn’t cover them all. Try to understand most of the disease from a doctor and not the Internet. This allows for case specific information and not generalizations. Before you believe or follow anything on the internet, fact-check it with a doctor.

5. The side effects of chemotherapy are subjective. It differs from person to person based on their overall physical well-being, age, medicine, dosage of medicine, etc. When you meet someone going through chemotherapy, you could avoid sharing with them side-effects you have heard of from unsolicited sources. It saves the person starting treatment from unnecessary anticipations, anxiety or fear. There is a set of symptoms the patient is oriented with by doctors before treatment so they are familiar with potential effects. The extra information from unqualified sources may do more harm than good.

6. It is easy for this disease to come in the way of your relationship with her. It could either bring you closer to her or take you farther from her. I don’t think that it is any one’s place to tell you what is right and wrong. But my advice is – take a step back after hearing the news. Think about how you feel and how she feels. Letting her in means you are going to be vulnerable when situations get tough. Distancing yourself from her could mean you would feel lesser pain. It is going to be more hurtful for her if you jump in and out of the relationship, or if you walk from her when the journey gets harder. If you decide to stay close to her, giving her your continuous support, and letting her in your heart completely allows her to build faith and trust in your presence.

Breast cancer is a journey of tribulations and challenges. Empathy and support go a long way.

Thank you, Amma for teaching me that beauty lies in strength and spirit.
Thank you, Amma for teaching me to share stories for change, not sympathy.

Source: Flickr

By Rahul Bhardwaj:

Source: Flickr
For representation. Source: Joe/Flickr

I am writing this article after my first 21 km run and hope to inspire others to do so in the process. I have done treks, runs before in my life but this particular event was the most unique experience of my life and after going through the whole process, I realised why it was important for me to run now and my whole life. No matter how many pitfalls came before the event, there was always a voice inside me that said not to give up and just move ahead. What was this voice? Why did this event have such a huge significance?

As marathons are becoming more and more popular among Indians, sceptics have come up to call this interest as to gain some bragging rights among friends. But those who really enjoy running will tell you it’s the battle inside which matters the most and not the world. And this battle inside motivates you to run faster and farther. While running, you leave behind all the tensions, worry, jealousy, envy, etc because the battle does not concern the world or anyone else except you. There are no factors other than you, your body and the path. That is a time in your life where your brain will not think anything, and you will be at complete peace.

Events That Happened Before The Run

Since it was a half marathon, I decide to train well for this, otherwise, I would fail to even complete the event. And it is always better in these events to go with someone, as it gives you the added motivation to participate in the run. So I decided to go with a friend and we decided that we will discuss how much we trained and how many kilometres we ran every day.

So 2 weeks before the run, I planned to run 10 km (half of the actual event) to test my strength and fatigue. It was a good run and I was feeling happy after the session. But as I was walking towards home, an agonizing pain started to build on the lower-middle part of my feet. The strange thing about the pain was that it kept on increasing for like 10-15 minutes and then it remained constant. I was sure it was a muscle pull due to practise and it will go away if I soaked my feet in warm water with salt and applied a sprain bandage. But the pain didn’t go away so easily, and there was a voice inside me which kept on telling me to endure the pain and just get ready for the marathon.

While I was dealing with the pain I got sick with a viral infection (10 days before the event) and it took me solid 4 days of bed rest and medicine to be normal. After I recovered from the viral I finally decided to see a physiotherapist and she explained that the problem was due to my shoes. So here I learnt a very hard lesson that if you are a runner and you do these kinds of events regularly, changing your shoes every 2 years is a good practice.

My ultrasound therapy session started 6 days before the run and after 3 sessions my pain reduced by 80% and I was feeling confident to run again. But 2 days before the run I met with an accident when my bike skidded off the wet road and I injured my left hand and knee. I was lucky to not get any serious injuries since I was wearing proper riding gear. While returning from the hospital after addressing my wounds, that voice kept telling me to not quit.

What Happened During The Run

The day finally arrived and as it was a midnight marathon the cold breeze started to show its effect as all were waiting for the start whistle to blow. After a motivational speech from the legendary Milkha Singh we were off and then, there was just the path and me. It felt great that so many middle-aged and old timers were running the race, it gave me added motivation to run faster and at the same time maintain my energy levels.

There is always one thing that happens in every marathon, you make an unknown marathon buddy. You will not say hi or know that person’s name but you will make sure you are not far behind that person or at least at reaching distance and at the final stretch you will try your best to beat that particular person.

The first 10 km were quite easy as I had properly trained for it but after 15 km the excruciating pain in the lower feet came back and it was worse than ever as there was no option to stop at this point of time. Now, I had to make a decision right there on whether to run the last 6 km or to stop as the pain was too much to continue. Based on the intensity of the pain I decided if it crosses a certain level then I would stop, otherwise I will keep running and not worry about it.

What The Run Taught Me

1. Perseverance: No matter how bad the situation is in life there is always a way to push through the troubles and come out as a winner.
2. Testing own limits: If you run you can test your own limits every time. Remember it’s not a fight with others but it’s the fight within that counts the most.
3. Me time: While running there is not a single thought inside your mind. I guess many have achieved this via meditation but for me running does the trick!
4. Inspiration: When you go on runs you will meet people much older than you running much better. This inspires me to remain fit all my life and automatically gives me motivation to atleast match their performance if not beat them.

At last I would like to say, I have experienced a lot of highs in my life but a runner’s high is the best feeling in the world; when you go beyond your own limits and achieve something which you thought is not achievable. So go for it, stop listening to the world, train your body and just run!

organ donation

By Sanita Pillai:

organ donationOrgan transplant is a surgical procedure to replace a diseased organ with a healthy donor organ. It is often the only treatment for organ failure. In the entire process, first the patient enrols himself/herself on the waiting list for transplant. Only after getting enrolled and getting an appropriate organ, the diseased organ is replaced by the healthy one donated by a donor.

It was a great achievement in medical history when organ transplantation was introduced to us; new hope for the people who were suffering from organ failure.

Unfortunately, only a few of the people in need of a healthy organ have received benefits from the medical procedure. Yes, that’s true and with that let’s face some other bitter truths about the scenario of organ donation in India:

1. Nearly 500,000 people die due to unavailability of organs each year.

2. Every year, nearly 150,000 people await a kidney transplant, but only 5000 get one.

3. In India, the country of 1.2 billion people, the PMP i.e. persons as organ donor per million population is just 0.08 which is extremely low compared to other countries.

4. Every year, nearly 1,000,000 lakh people suffer from blindness and await transplant.

Apart from these hard-hitting facts, black marketing is another harsh truth of which you will not feel proud. India has become one of the major black markets for organs. Despite organ trading is illegal in India, every year nearly 10,000 organs are traded of which kidneys hold 75 percent.

Now after knowing these facts, questions may arise in your mind such as: Why there is an unavailability of organs? Why are people not willing to take part in such a noble thing that can save many lives? Why is black marketing happening?

The answer to all these questions is a lack of awareness, which always confuse people for this noble cause. Hence, it is now time to clear all the confusions as getting rid of them can help save lives.
A few questions that always come in between us and organ donation are:

1. I am under 18, or I am too old. Am I eligible for organ donation?

There is no age limit for organ donation. Organs can be donated by someone as young as a newborn or as old as a 75-year-old.

2. I have a history of medical illness. Can I donate my organs?

The decision to donate or use an organ depends on strict medical criteria. It may turn out that certain organs are not healthy enough for donation, but other organs and tissues may be fine. The medical professionals are the best people who can determine whether your organs and tissues are suitable for transplantation.

3. If I get admitted to a hospital due to some medical issues, and doctors find that I want to be a donor. Will they try to save my life?

If you are admitted to a hospital, the number one priority for the doctors is to save your life. The transplant team will not make any move until all lifesaving efforts have failed and death has been determined. They will also not take any step until your family has consented to donation.

4. What organs can be donated while alive?

It has become common to donate organs or partial organs while alive. Kidneys are the most common organs donated by living donors. Other organs that can be donated by living donors include partial liver, a lobe of a lung, pancreas or intestine. Also, living donors can donate fluids or tissues that can be regenerated such as blood, bone marrow, and parts of the liver.

5. What will happen to my health after donating an organ?

Organ transplantation has same complications/ risks as all major surgeries such as infection, blood clots and pain. In fact, it sometimes also has long term complications. But it depends on many factors such as health condition of the donor, donated organ and the procedure.

Few of the long-term complications based on specific organs are:

Kidney: Kidney failure, Hypertension
Liver: Renal failure, Gastric problems, Intra-abdominal bleeding
Pancreas: Diabetes

Recovery time depends on the same factors as complications after organ donation; health condition of the donor, organ and the procedure. It can take weeks to months.
Hence, before undergoing the procedure, make sure you ask every possible thing about risks, side-effects and recovery time to your doctor or transplant team.

Now when you have finally decided to become an organ donor, the only remaining question is: where to go? There are many health care organizations where you can donate organs and save lives. One of these organizations is Manipal Hospitals.

Pledge to Donate” is an initiative driven by Manipal Hospitals to encourage people for organ donation and to ensure that the patients, suffering from diseased organs, can easily undergo early organ transplantation.

Remember, one donor can save 8 lives!

pregnant-woman baby belly

By Ritika Potnis:

Pregnancy is portrayed as one of the happiest times of a woman’s life, but for some, it is heavily characterized by stress and anxiety. Current Studies show that 4%-20% pregnant women face depression worldwide.

Depression is a mood disorder, distinguished by loss of interest, guilt, low self-esteem and negative thoughts. In India, 16% women face depression during the gestation period. Reports from Indian hospitals suggest that in the past two decades such cases have risen drastically.

It is tough to identify depression as in most cases the mood swings, cravings or lack of cravings is taken as a positive sign of a healthy pregnancy. But if unchecked a mother’s gestational depression can harm the baby and the mother.

World Health Organization estimates that by the year 2020, Depressive disorders will be the second leading cause of global disorders. Therefore, it is important to correctly identify the condition and get immediate help for a healthy mother and baby.

If you are pregnant or know anybody who is expecting, make sure you keep them away from the blues by following simple measures given below.

7 Measures To Deal With Depression During Pregnancy

From Visually.

 

A mother feeds her malnourished child in the Nutritional Rehabilitation Centre of Sheopur district in the central Indian state of Madhya Pradesh April 6, 2010. India ranked 65th out of 84 countries in the Global Hunger Index of 2009, below countries including North Korea and Zimbabwe -- hindering India's ambitions to channel its demographic dividend to fuel its global economic ambitions. Picture taken April 6, 2010. REUTERS/Reinhard Krause (INDIA - Tags: HEALTH SOCIETY) - RTR2D0JX

By Komal Ganotra: 

A mother feeds her malnourished child in the Nutritional Rehabilitation Centre of Sheopur district in the central Indian state of Madhya Pradesh April 6, 2010. India ranked 65th out of 84 countries in the Global Hunger Index of 2009, below countries including North Korea and Zimbabwe -- hindering India's ambitions to channel its demographic dividend to fuel its global economic ambitions. Picture taken April 6, 2010. REUTERS/Reinhard Krause (INDIA - Tags: HEALTH SOCIETY) - RTR2D0JX
Source: REUTERS/Reinhard Krause

India represents one of the largest number of malnourished children in the world and performs dismally on all child nutrition indicators. Under-nutrition in infants and young children leads to growth failure, lowered resistance to infections, increased rates of morbidity, increased risks to survival, impaired growth and poor school performance. Thus, a lack of proper nutrition during childhood has tangible long-term impacts on the mental and physical development of individuals.

The ages 0-6 lay the foundation for the growth of children into healthy and productive adults. It marks a crucial phase for a child, as 80% of the brain development takes place during this time. An emphasis on proper and effective nutrition in this age is not only important but necessary. This involves a commitment both to the children and the mothers. The inter-generational cycle of under nutrition ensures that an undernourished mother gives birth to an undernourished child, experiencing cumulative growth and development deficits largely irreversible in nature. Ensuring a healthy start for children in this age group requires a multi-dimensional approach centered around nutrition, comprehensive immunisation and medical care, pre and post natal healthcare for mothers while focusing on social development and capacity building.

Recognising the crucial importance of a holistic emphasis on the age group 0-6, the Integrated Child Development Services (ICDS) Scheme, a centrally sponsored national flagship scheme of the Government of India, aims at addressing health, nutrition and the development needs of young children (0-6 years), pregnant women and nursing mothers.

However, despite government efforts and schemes, the nutrition figures in the country pose a grave concern.  Under the ICDS Scheme, the Anganwadi Centres aims to provide the requisite nutrition, health services and care to children and mothers. According to the Ministry of Women and Child Development, in 2012-13 while 13,73,349 Anganwadis were sanctioned, 34,617 were still not operational and 33 % of the children in the country were not covered under the Anganwadis.

This comes to prominence all the more in remote areas. To highlight the gravity of the scenario, we consider the story of Pancho, a 6-year-old girl who belongs to the Saharia tribe, living in a village in district Baran, Rajasthan. Pancho was diagnosed to be severely malnourished. The village is 40 km away from the block headquarter in Shahabad and about 120 km away from district headquarter in Baran. The primitive tribe has been residing in Baran district for years now after being forced to move out of their original habitat, the forests. The abject poverty that the tribe lives in is striking.

Children bear the brunt of the deprivation, and as families struggle for sustenance, providing nutritious food to children is a distant reality.

The village has an Anganwadi which is accessible as well as operational yet there is no visible impact of its services in changing the nutritional status of children like Pancho. The problem lies not only in the irregularity of services and a lack of access but also the ignorance of the parents, who often fail to understand the severity of the condition of the child. It was only when a local NGO, Prayatna Sanstha, which works in partnership with CRY, noticed Pancho in one of their community visits early last year, did her condition come to light. After being counseled by the NGO, the community collective and Child Protection Committee the parents took to the child to the Malnutrition Treatment Centre (MTC).

While the treatment and special care at the centre lead to improved nutrition status of the child, she fell back into the malnutrition trap after 2-3 months, owing to inadequate nutrition and care at home. It was only after convincing her parents and prolonged treatment at the District Hospital in Baran, that Pancho is on the road to recovery.

The cases of malnutrition in Baran have been reported multiple times in the past yet children like Pancho suffer from nutritional deficits and there is little state intervention. This does raise questions on the nature and outcomes of growth monitoring and the required intervention thereafter.

To reach out to such children effectively, what we need is a well-defined system for management of malnutrition, which would involve the convergence of all stakeholders; not just Anganwadis but the health care centers, hospitals and MTCs as well. While ICDS is a well-designed programme and we have functional Anganwadis running in most places, bottlenecks in service delivery and community outreach pose a challenge in its proper implementation. The quality of services needs to be improved, with strict emphasis on growth monitoring of children and flagging off possible cases of malnutrition.

With improved service delivery of ICDS, preventive rather than reactive approach to tackle malnutrition, better community outreach, the nutrition status of children in the country will surely witness a significant change. Investing in our children in the age group of 0-6 will translate itself into long-term positive returns, and pave the way for a healthier and happier nation.

Sanitation-india-garbage

By Prachi Salve and Saumya Tewari, IndiaSpend.com:

Sanitation-india-garbageThe north-eastern state of Mizoram has reported a 13 percentage-point decline in stunting (below normal height for the age) and five percentage points decline in underweight children (underweight and short), according to a new report.

The reason: Improved access to sanitation. As many as 92% households in Mizoram had access to sanitation at the end of the 2011 Census, against 82% during the 2001 census, the India Health Report for Nutrition Security in India, 2015 released last month said.

As many as 522 million people gained access to improved sources of drinking water between 1990 and 2000, said the report, published by the Public Health Foundation of India (PHFI).

Open defecation and inadequate hand washing have been cited as reasons for poor health among children, leading to undernourishment.

India’s 40 million stunted and 17 million wasted children below the age of five are a challenge for a country whose health indices lag its economic growth.

This is the third part in our series on child malnutrition in India based on the PFHI report, where we track the states with worst and best nutrition figures and sanitation data to examine the relation between poor nutrition and hygiene.

While the first part looked at public spending on child health and nutrition, the second part looked at the impact of maternal health on child nutrition.

Not enough being spent on drinking water and sanitation

Poor sanitation makes for unhealthy children, susceptible to water-borne diseases such as diarrhoea, cholera and jaundice.

The United Nations’ Millennium Development Goals (MDGs) had set a target of halving the population without sanitation facilities by 2015. UNICEF launched the Water, Sanitation and Hygiene (WASH) programme in 2006 to promote this goal.

The Government of India has been focusing on improving drinking water and sanitation facilities across the country since 1999.

The Total Sanitation Programme was launched in 1999 by the Atal Bihari Vajpayee government. It was changed to Nirmal Bharat Abhiyan (Clean India Mission) in 2012 and renamed Swachh Bharat Mission in 2014.

Rs 25,387.5 crore ($3.8 billion) has been spent on drinking water and sanitation since 1999-2000, the data show. For comparison, Tamil Nadu Chief Minister J Jayalalithaa sought more money, Rs 25,912 crore, from Delhi, to address the ravages of the state’s December 2015 floods.

More than 93 million households still don’t have toilets

Almost 90% of child deaths from diarrhoeal diseases are directly linked to contaminated water, lack of sanitation or inadequate hygiene, a UNICEF report said.

India’s infant mortality rate (IMR) has come down from 66 deaths per 1,000 live births in 2001 to 42 in 2012 but it is still equal to poorer African countries, such as Senegal (42), Malawai (41) and Ethiopia (43).

Only 47% households in India had toilets, according to the 2011 Census data, an improvement of 11 percentage points over 2001 figures.

As many as 181.5 million rural households were surveyed in 2012 to assess the requirement of toilets in individual households; this survey served as the baseline for the Swachh Bharat Mission.

As on December 22, 2015, 93.1 million households in rural India had no toilets, according to government data.

As many as 46% households in India defecated in the open as of 2013-14, according to data from the Rapid Survey on Children (RSoC). This was an improvement of nine percentage points from 2005-06 data, when it was 55%.

Mizoram’s progress reflected in healthier children

The states that were better-off in terms of child nutrition show a strong co-relation between sanitation and child nourishment.

The best example is Mizoram, where the prevalence of stunting declined by 13 percentage points, and underweight children by five percentage points between 2006 and 2014.

The worst states in terms of nutrition parameters had fewer households with toilets.

 

 

 

 

 

 

There has been little progress in sanitation facilities in the worst-performing states. Figures for stunting have only improved eight percentage points in Bihar, three percentage points in Jharkhand, and there was no improvement in Chhattisgarh. However, there was a decline of 10 percentage points in stunted children between 2005-06 and 2013-14.

After the Swachh Bharat Mission, since 2014, Bihar, Jharkhand and Chhattisgarh have managed to fulfill about 44%, 52% and 50% of the requirement as per the baseline survey.

Sanitation is only one factor affecting nutrition; for instance, data from what was once Andhra Pradesh show that the proportion of wasted children increased by six percentage points between 2006 and 2014, despite an improvement in sanitation.

Studies conducted in the past decade have emphasized on the need for sanitation to improve nutrition.

The example of Bangladesh is often cited. Between 1990 and 2012, open defecation dropped from 34% to 2.5% in that country, accompanied by a reduction in undernourishment, according to a report by International Food Policy Research Institute (IFPRI), the Washington-based think-tank.

smoking video

By Aiman Zehra

While some people cringe at the very thought of smoking and contact with smokers, others embrace the habit and consider it a good pastime, and a cure-all. With more and more women smoking now than ever before in India, discrimination toward women smokers seems to be fading away. But is it all for good?

This vox-pop video, produced by students of Aligarh Muslim University, captures the attitudes of the public with respect to smoking ‒ both passive and active. The video has been shot in and around the city of Aligarh in the northern state of Uttar Pradesh in India. Interviews throw light at the underlying psychological reasons for smoking, level of understanding of the medical impacts of smoking, and associated attitudes of risk taking and/or indifference among smokers, and strong negative opinions of non-smokers with respect to smoking generally as well as publicly.

‘Sutta Nation’ was adjudged first in Experimental Film category of 8th Film Saaz (2015), an International Film Festival organized by Aligarh Muslim University.

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Indian members of National Cadet Corps (NCC) hold placards during an AIDS awareness rally in the northern Indian city of Jammu December 1, 2005. India, with the world's second largest number of HIV/AIDS cases, must shed its inhibitions and start talking openly about safe sex to protect itself against the epidemic, Prime Minister Manmohan Singh said on Thursday. REUTERS/Amit Gupta - RTR19SKU

By Shreya Chatterjee

The year is closing on a rough note with the tragic terror attacks in Beirut and Paris and the heavy downpour that lashed our Chennai people. With few days still to go, I now wake up praying, ‘No more mourning morning’.

Indian members of National Cadet Corps (NCC) hold placards during an AIDS awareness rally in the northern Indian city of Jammu December 1, 2005. India, with the world's second largest number of HIV/AIDS cases, must shed its inhibitions and start talking openly about safe sex to protect itself against the epidemic, Prime Minister Manmohan Singh said on Thursday. REUTERS/Amit Gupta - RTR19SKU
Image source: REUTERS/Amit Gupta

This evening while catching up with season’s last discounts my eyes fell on a hoarding that authorities put up this AIDS day. Reminded me of the last month when while scrolling down the Facebook news feeds I came across- ”Reports: Charlie Sheen HIV Positive“. Further scrolling down had more of Charlie Sheen. The incident was a live example of how our awareness is lagging behind time. Biasedly clicking on one of the links opened the Pandora’s Box. The actor was diagnosed HIV positive four years ago. My greatest sympathies go to him. But what hit me hard was he paid hefty amounts to people to keep the news under wraps and still continued to engage with sex workers risking their lives too. He reminds me of the age-old HIV-AIDS stigma that still lingers in our society after thirty years, when the first cases of immunodeficiency virus HIV were recognised.

Know The Virus First

The dreadful virus gradually destroys the immune system by destroying the T-helper cells (a type of white blood cells). Firstly, T-helper cells (also referred as CD4 cells) release certain chemical substance that attracts other white blood cells (WBCs) to the infected area. Secondly, they release chemicals that help the WBCs to multiply which the rate the recuperation on the site of infection. These new WBCs create antibodies which attach itself to bacteria/virus/fungi for WBCs to identify and kill them. But when a body is attacked by HIV, the virus multiplies inside body targeting the T-helper cells itself and hell breaks loose. The infected T cells damage other cells. So basically the cells, which protect us from any infection caused by foreign bodies, lose their ability to protect the body. The infections gulping our body at that time are called Opportunistic Infections (OIs). To name a few we have meningitis, pneumonia, tuberculosis, cancers, and lymphoma.

When To Know Whether One Has AIDS?

HIV + Opportunistic Infection = AIDS

The Center for Disease Control and Prevention (CDC) has prepared a list 20 OIs which are also ‘AIDS- defining conditions’. So if someone has HIV and is infected by one or more OIs, the person will be diagnosed with AIDS.

Humans first acquired HIV with blood contact with apes and gradually the disease got transmitted to more people through unprotected sex, used syringes, childbirth, breastfeeding. The virus can only stay alive in a fluid medium. So the transmission of virus through touch is overruled. Still, there are some myths regarding the disease that circles our society. The epidemic created such a cloud of fear that there still exist people who outcast HIV/AIDS infected and mistreat them. Even some hospitals and doctors are reluctant to treat people with HIV. In our land of laws, when it comes to HIV/AIDS infected people there is yet no specific law to curb the discrimination. But articles 14, 15, 16 and 21 of the Indian Constitution, which deal with basic fundamental rights, protect those infected with the disease to a large extent.

As of now, HIV/AIDS is not curable, but by starting treatment at an early stage keeps the virus from multiplying and destroying the T-cells. But we do have anti-retroviral therapy which can help increase T-cells and protect from OIs, thereby delaying AIDS.

India houses 2.1 million people living with HIV that makes it third-largest in the world. Nationally, there are more men than women as HIV positive. But on a positive note, more and more volunteers are coming up to join the various awareness and welfare programs organized by the Indian Red Cross and various NGOs. It is important for the society to know how the deadly virus affects our body. Even our infinitesimal support can give them the courage to face the world and speak what they experience. They should be encouraged to speak their HIV status and not keep it in a veil. They should not miss out on basic amenities or be bullied or kept isolated. Let’s not make their battle rockier. This New Year let’s resolute to be the stigma buster.

A bartender pours Haywards 5000 strong beer, a product of SABMiller, into a glass at a restaurant in Mumbai August 28, 2013. Strong beer, with alcohol content of 5-8 percent, accounted for 83 percent of all beer sold in India last year, according to research firm Mintel, a figure industry players say is the biggest strong beer share of any major market. Brewers expect that to grow to 90 percent over the next three to five years. Picture taken August 28, 2013. To match INDIA-BEER/ REUTERS/Danish Siddiqui (INDIA - Tags: SOCIETY FOOD) - RTX13XH6

By Abhishek Jha

A bartender pours Haywards 5000 strong beer, a product of SABMiller, into a glass at a restaurant in Mumbai August 28, 2013. Strong beer, with alcohol content of 5-8 percent, accounted for 83 percent of all beer sold in India last year, according to research firm Mintel, a figure industry players say is the biggest strong beer share of any major market. Brewers expect that to grow to 90 percent over the next three to five years. Picture taken August 28, 2013. To match INDIA-BEER/ REUTERS/Danish Siddiqui (INDIA - Tags: SOCIETY FOOD) - RTX13XH6
Image source: REUTERS/Danish Siddiqui

Punjab Health Minister Surjit Kumar Jyani on Monday was quoted as saying that he does not consider alcohol an intoxicant because “the government gives licences for manufacturing liquor,” they auction liquor vends, and because “liquor is consumed in the Army” and also at parties. To make matters worse, the Minister made this statement after inaugurating a de-addiction centre.

NSSO’s 2011-12 consumption data shows that, on an average, per capita alcohol consumption in Punjab is 141mL per week for toddy and country liquor and 50 mL per week for beer, foreign liquor, and wine. With respect to other states and UTs, Punjab stands 15th in the toddy and country liquor category and 14th in the beer, foreign liquor, and wine category. With the state already ailing from a serious drug problem (the Narcotic Control Bureau said earlier this year that the state accounts for half of the total drug-related cases in the country), this endorsement of sorts from the Health Minister himself can only harm the state more.

Moreover, given that harmful use of alcohol has serious health impacts, the comment by Jyani shows little commitment or leadership by him towards his duties as the Health Minister. Since policy interventions are helpful in reducing harmful use of alcohol, the WHO too identified leadership, awareness, and commitment as important for the reduction in a Global Status Report On Alcohol and Health published in 2014. Regulation of endorsement and advertisement- both of which might get a boost by the Minister’s statement- is another preventive measure noted in the report. Harmful use of alcohol is a serious problem that the Minister needs to take cognisance of. In 2012 alone, the WHO report says, “about 3.3 million deaths, or 5.9% of all global deaths, were attributable to alcohol consumption.” Moreover, the report identifies harmful use of alcohol as a component cause of “more than 200 disease and injury conditions in individuals, most notably alcohol dependence, liver cirrhosis, cancers and injuries.”

Apart from committing a factual error in denying that alcohol is an intoxicant, stating that he had a different opinion about alcohol was against even the policies that the Minister is supposed to follow. The Minister of State for Social Justice and Empowerment Vijay Sampla, for instance, had informed the parliament in April this year that India was the first country that adopted a national framework for prevention and control of Non-Communicable Diseases (NCD) in line with the global framework. This global framework was endorsed by the World Health Assembly in May 2013 and had targets and indicators for each country and included a 5% relative reduction in alcohol use by 2020 and a 10% relative reduction by 2025 beginning from 2013.

Popular opinions and glamourising alcohol consumption is also a reason why young people take to alcohol. Drunken driving could be a fallout of this, despite being punishable under the Motor Vehicles Act, and the statistics for deaths due to drunken driving in India are alarming. The Ministry of Road Transport and Highways told the Parliament in August this year, in response to a question, that drunken driving led to around 6,000 to 11,000 deaths country-wide every year between 2009 and 2013. There were also around 20,000 to 30,000 lakh accidents every year due to drunken driving between 2009 and 2013.

As a legislator and politician, Jyani can make and change opinions by his work and speech. As the Health Minister, he has even more of a mandate for driving opinion on alcohol and he should refrain from making such irresponsible statements.

vagina

By Rohini Banerjee for Cake

vaginaAlthough it’s an extremely important organ for those who have it, we often don’t talk enough about vaginal health and hygiene. Talking about vaginas is as much a taboo as talking about sex is, and hence, in our efforts to keep it all “hush hush”, we forget to take proper care of this organ, which might lead to various diseases and complications. From douching to avoiding an annual vaginal exam, there are tons of common misconceptions about what you should do to maintain a healthy vagina. So, here’s breaking down some common myths, and telling you what you should actually know in order to achieve good vaginal health:

Vaginal pH

pH refers to the vagina’s acidity level. Vaginas naturally contain a balance of different bacteria (these are the good guys!), that protect the vagina from external bacteria and fungus. They provide natural disinfectants and help maintain a healthy vaginal pH of 3.5-4.5. A vaginal pH in this range indicates that there is a perfect amount of good bacteria (lactobacilli), and no overgrowth of the bad bacteria that can cause odor, irritation and sometimes infection.

Myth: Every vagina has the same pH, and hence requires the same amount of care.

This is absolutely untrue. Vaginal pH varies from person to person, day to day, depending on your cycle, your diet and many other external factors. And hence, one’s pH can be either high or low, depending on various factors. Just as every person is different, every vagina is different, and requires different amount of care!

Smell

All vaginas have a scent, and no two vaginas smell the same.

Myth: Vaginas Should Smell “Fruity” or “Floral”

Absolutely freaking not! These are nothing but patriarchal myths made to appease the heterosexual male gaze. However, if you are worried about your scent, you can place an organic fragrant oil to an area around your vulva but not on it (places like between your thighs or on your lower stomach, for example). But remember, all vaginas have their own unique scent, and if yours doesn’t pander to what is conventionally considered “aesthetic”, there is nothing wrong with that.

Discharge

Your body secretes natural fluids, which is commonly known as ‘discharge’.

Myth: Discharge is Something “Abnormal”, and Something to Worry About

This is totally and completely wrong. Discharge is how your vagina self-cleanses and it is completely normal and vital to healthy vaginal function! Discharge can vary in amount, colour, texture and scent depending on your cycle. Don’t be frightened at all if you see those white stains in your underpants often. However, if you feel that your discharge is unusual or abnormal (green, grey, very yellow, smelly, itchy, chunky, and so on), definitely go visit a doctor. In case you experience abundant discharge, you can remove the excess discharge in your shower by inserting one clean finger into your vagina, moving it from one side to another and ‘scooping’ the discharge out.

Cleansing

Cleansing your vagina properly is extremely important for healthy vaginal function. Dead skin cells, oil and germs can build up between your clitoris and your clitoral hood, as well as inside your vagina, so it’s important to lift your hood up and rinse thoroughly so it doesn’t harden and cause infections or diseases.

Myth: “Douching” is A Good Way to Cleanse My Vagina

Do not, and I repeat, do NOT douche. Douching is a method to wash out the vagina with a mixture of water and vinegar. ‘Douches’ are sold in drugstores and supermarkets and come in a bottle or bag which is sprayed through a tube upward into the vagina. You may think it helps, but it only masks any problems while causing more! Douching throws off your natural scent, alters your PH and forces bacteria into your cervix. Water and a soft, clean washcloth is actually all you need to clean your vulvar areas that contain a mucous membrane.

Myth: Soaps and Conditioners Are Nice Too

Nope with a capital N. Remember those helpful bacteria? Soaps and conditioners will remove them and the natural necessary lubricants that protect the vagina. They may also cause irritation, inflammation, major discomfort and dryness. There should always be some amount of moistness present in your vagina, and soaps take that away.

Myth: Vaginal Washes Sound Like a Great Thing

Nowadays, you see a variety of vaginal washes (such as V-Wash) in pharmacies, which claim to cleanse your vagina without disturbing the pH balance. But that’s just capitalism trying to fool you, all over again. A vast majority of vaginal washes, even those touted as hypoallergenic, still contain dyes and fragrances which are known irritants, so it is important that you read the label before you use them. While vaginal washes are used to cleanse “bad” bacteria from your vulva, they might often wash away the “good” bacteria too. To be safe, always consult a trusted gynaecologist before we use something like a vaginal wash.

Myth: To Ensure It Gets Properly Cleaned, I Should Insert The Cleaning Agent Inside My Vagina

Never, EVER do that!! Inserting cleansing agents into your vagina—and this applies to any gels, deodorants, perfumed products and wipes, too—can MAJORLY disturb your vagina’s natural balance. Always apply these externally, around your vulva, and never inside it. While they still pose a possible risk of irritation, unscented baby wipes are the lesser of evils if you want to “freshen up” your vagina. However, always pay attention to your irritants and triggers while using any external cleansing agent.

Myth: Tight Thongs, Lacy Underwear Are Cool

While they may look good aesthetically and often make you feel sexy and beautiful, they can affect your vagina adversely! It is important to allow your vagina to breathe, so don’t wear clothing that is too tight in the vaginal area. Cotton panties are the best option, as they are both comfortable and healthy.

A Few More Important Mythbusting Tips:

  • Use the washcloths and towels you use to clean and dry your vagina on a rotation basis, because they might accumulate germs that can have unfavourable effects.
  • Wiping from ‘front to back’ keeps rectal bacterial away, and is also an easy method of cleansing.
  • Another extremely important thing that many people aren’t aware of is the fact that urinating after masturbation or sex reduces the amount of bacteria in your urethra. This in turn, can prevent diseases such as UTI or vaginal infections.

Diet

The food you eat affects your vagina too!

What To Eat, What to Avoid:

Balancing your diet in general and including things like pineapples, strawberries, yogurt, soy (the list goes on!) can influence your pH balance in positive ways. Beverages like water, cranberry juice and pineapple juice are also proven to improve vaginal health, and keep it moist and hydrated. Adding a probiotic supplement to any part of your diet can increase the amount of “good” bacteria in your vagina called lactobacillus. So, eat healthy, and your vagina will thank you!

The less ideal your vaginal pH balance is, the more susceptible you are to infections, STDs and other diseases, and hence, it is important for all of us to take care of this wonderful, organ. Our biology books and sex education classes often don’t teach us more about our vaginas, and more about how to keep it healthy. So, through this piece, I hope I have been able to introduce you to the important aspects of vaginal hygiene. Apart from following the tips that I have talked about, it is also important to go for regular vaginal exams to a trusted gynaecologist, and not be afraid or hesitant to do so. You are beautiful, and your vagina is beautiful, so let’s show it some love, yeah?

This article was originally published here on Cake.

lisa haydon kangana ranaut

By Ananya Saha:

Apollonian? Good. Dyonisian? Bad. The mind is a yes, but the body is a big no. Never mind the words in the lexis related to the act of sex; uttering the very names of the sexual/erogenous/reproductive parts of the body, especially female body are still considered to be a taboo in an alarming number of households in the present times. I am aware that there are quite a few demographic factors to be taken into consideration here; such as rural v/s urban, affluent v/s impoverished and so on. But for the sake of sheer convenience and a holistic overview; let us keep those aside for a moment.

The female body has always been a site of polemics in the historiography of social orders. The female desire is a threat to hierarchy, and, therefore, must be curbed or labeled hysteric. A million contributions to this discourse have been made but nothing is ever enough. But this piece is not about female sexual rights par excellence. It is a step before that, the rights to knowledge of the body.

One will be alarmed if they check the number of queries that are generated by the primary search engines (Google and Yahoo as reference here) regarding the anatomy of the vagina from females themselves. Though partially arbitrary, one can common sensibly guess from the approach, attitude, language and even the usernames that many of these are from females belonging to younger age groups of India, if not exclusively so.

One would be alarmed about the lack of knowledge in basic biology, which should be a part of every school curriculum within the tenth grade. There are actually questions such as, ‘How many openings does the female genitals have? Is it two or three?‘ ‘Are the vaginal and the urethral opening the same?‘ Or, ‘I am not a whore to sleep around or something, but when the time comes, would he know what goes where?‘ Which ensued a rough debate about the use of the word ‘whore’. Thus, the original question remained sidetracked. As any reader with knowledge of Biology 101 would know that there are three, and no, the vaginal and the urethral orifices are not the same. But the fault does not lie with them. It is in the predicament that they are brought up in.

Image source: Flickr/Kayla Kandzorra
Image source: Flickr/Kayla Kandzorra

Leave alone indulge in the pleasures of the body; to talk about the body in open, to write about the body, to utter words such as ‘vagina’ and ‘clitoris’ inadvertently invites body or slut shaming. Girls are often taught not to indulge into the knowledge about their sexual organs because it would be ‘immoral’. Hence the aforementioned questions. If one would refer to this article, one would find that the talk about ‘birds and bees’ is still not a common phenomenon in many Indian households. Children usually learn from their peers through debatable sources, which often result into confused half knowledge. I have actually encountered some pre-teen girls who believed a kiss on the mouth would impregnate them.

Yes, it is a rite of passage to talk about the body and share little secrets with same-sex friends as a phase of growing up. But it should also be the duty of the parent to disseminate clear information to the growing child about the anatomy, hygiene and functions of the private part. Especially the female child, as our genitalia is not as outwardly situated as the male one. Ladies, our ‘inner plumbing system is high maintenance’, as Amy Farrah Fowler from The Big Bang Theory would say. Hence, grab a mirror, refer to the online health posts, take the help of the GYN/OBG (An annual visit is a must by the way); but familiarize yourself with your body. In this stage, especially if pre-teens and adolescents are concerned; it does not have to do necessarily with sex. Hence, alarmed parents, there is no need to be alarmed even more. It is essential to encourage a healthy body image without excluding or eliding over any part of it. It is not something dirty. It is completely OK to talk about it as well. One cannot protect their darling girl child from unsafe sex through a lack of knowledge. But a thorough set of information about the pros and cons might do the trick.

Being a scholar of literature, I am reminded of the 20th-century novelist Ford Madox Ford’s work, Parade’s End in this context. Herein, the young Valentine Wannop, the games teacher of a girls’ school in London finds a book about sexual health and knowledge in the changing room. The other teachers are in favour of finding and punishing the owner of the book, as, according to them, it is unsuitable for the students.

Valentine argues with her colleagues that the title suggests that it is for girls who are to be married which some of the students would soon be old enough for. She convinces others that the lack of knowledge would make the soon to be married girls unhappy in matrimony and it is better if they are informed well about both the male and the female body. This is the first half of the twentieth century that we are talking about. And if we peruse through another article, where it has not been clearly mentioned; but a lack of knowledge of the body can still be a prominent reason for divorces caused by sexual dissatisfaction. Some, of course, put up with it still as the ‘good wife’ is supposed to do, which is hardly ideal. The temples of Khajuraho, the caves of Ajanta and such other sites have celebrated the erotic beauty of the female form. One must not praise them and shame the woman curious about her body in the same breath. Know thyself; said Socrates and body need not be alienated from the discourse.

A villager undergoes an eye examination at a camp organised by Aravind Eye Care System in a village outside Madurai, in India's Tamil Nadu state March 3, 2010 to screen for eye problems which will then be treated at one of their hospitals. From a rented house with 11 beds in 1976, Aravind, whose mission is to eliminate needless blindness, has grown into a network of hospitals and clinics that provides eye examinations, surgery by keeping its costs extremely low and by subsidizing care for poor people through fees for paying customers and the sale of eye-care products. Picture taken March 3, 2010.  REUTERS/Reinhard Krause (INDIA - Tags: HEALTH SOCIETY) - RTR2B9T5

By YKA Staff

A woman receives treatment at a free eye-care camp set-up by a voluntary organisation in the eastern Indian city of Siliguri June 14, 2009. According to a World Health Organisation report, 90 percent of the world's blind people live in developing countries with at least 9 million of them in India, where they are often the victims of poverty and lack of access to quality eye care. REUTERS/Rupak De Chowdhuri (INDIA SOCIETY HEALTH) - RTR24NO1
For representation only. Source: REUTERS/Rupak De Chowdhuri

The Madhya Pradesh government has shut down all eye camps, an annual affair in the state, until further orders according to reports after a botched cataract surgery in a district hospital in Badwani. Around 45 patients are reported to have lost vision in the eye camp organised between 16th and 23rd of November. The government has also offered a pension of Rs. 5,000 for the victims and set up a panel for a probe, which may lead to an FIR.

A similar case of negligence had emerged in Ambala earlier this month, where 15 patients had lost vision during eye operations at the Sarvakalyan Eye and Charitable Hospital. In March this year, 14 people had developed infection during cataract operations at Navjeewan Hosptial in Panipat in Haryana.

One is reminded here also of the sterilisation tragedy in Chhattisgarh where about a dozen women had died because guidelines had not been followed. A similar incident in Angul in Odisha, where a bicycle pump was used to dilate the cervix of women, had led to more stringent guidelines in the state according to reports. The state had decided to allow health camps only after permission was sought from authorities a month before the camp.

A villager undergoes an eye examination at a camp organised by Aravind Eye Care System in a village outside Madurai, in India's Tamil Nadu state March 3, 2010 to screen for eye problems which will then be treated at one of their hospitals. From a rented house with 11 beds in 1976, Aravind, whose mission is to eliminate needless blindness, has grown into a network of hospitals and clinics that provides eye examinations, surgery by keeping its costs extremely low and by subsidizing care for poor people through fees for paying customers and the sale of eye-care products. Picture taken March 3, 2010.  REUTERS/Reinhard Krause (INDIA - Tags: HEALTH SOCIETY) - RTR2B9T5
Representation only. Source: REUTERS/Reinhard Krause

However, similar procedures do not seem to have been implemented or considered in other states, despite the sterilisation camp tragedy in Chhattisgarh grabbing the Prime Minister’s attention. What is more appalling about the incident in Madhya Pradesh is that the camp was organised by the authorities and is a regular affair. According to an Indian Express report, the result of the operations was brought to attention only after a report was submitted to the Indore-based Joint Director (Health) Sharad Pandit by the district’s chief medical and health officer. Although there have been suspensions following the incident, the authorities must seek to evolve a method to prevent any more mass scale cases of negligence like this. The loss of vision of 45 people does not speak of negligence but systemic failure and that needs to be addressed with changes in the system.

reuters obesity

By Charu Bahri, IndiaSpend.com:

Broadening girths are expanding India’s battle against malnutrition, a new Indian study has revealed, setting off a host of so-called lifestyle ailments.

This is happening as India fights a losing battle with the bulge, hosting as it does the third-most number of obese people in the world, 61 million and growing.

Malnutrition is commonly associated with emaciated, undernourished people, not with being obese or overweight—or over-nourished, as it is called in dietary parlance.

Actually, the ‘over’ in over-nourished relates only to calories, or energy intake. Getting those excessive calories from fat- and sugar-rich, nutrient-poor foods can lead to significant micronutrient deficiencies in obese people, said Carlyne Remedios, senior nutritionist, Centre for Obesity and Digestive Surgery, Mumbai and co-author of the study published in August 2015 in the journal Obesity Surgery.

Of 2,740 people with a Body Mass Index (BMI) more than 30 kg/m2, the cut off for obesity, forming the study group, 43% suffered from iron deficiency, 56.7% from vitamin B12 deficiency, 11% from calcium deficiency, 35% from vitamin D3 deficiency and 10% from protein deficiency.

Micronutrient Deficiencies In Obese People In India
Micronutrient Deficiency in obese people (%) Deficiency in general population (%)
Iron 43 60-80
Vitamin B12 57 35-75
Calcium 11 8-40.6
Vitamin D3 35 44-90

A new US study has arrived at a similar conclusion as Remedios. One in five obese patients of that study had insufficient levels of three or more of these micronutrients: vitamin A, vitamin B12, vitamin D, vitamin E, iron, folate (vitamin B9) and thiamine (vitamin B1).

Clearly, abundance of food and nutrition are not synonymous.

Overweight Indians: Growing Almost As Fast As Malnourishment Is Contained

India’s new face of malnourishment is likely to belong to the urban and affluent, those who can afford to choose their diet.

Three times more obese and overweight people live in urban areas than in rural areas, as per the National Family Health Survey III. Their numbers are growing almost as fast as the number of undernourished Indians is being contained.

Consider:

  • In 1990, 23.7% of India’s population was undernourished while 15.8% was over-nourished.
    Today, 15.2% of the population is undernourished while 22% is over-nourished.
overweightobese

Source: World Health Organisation Obesity & Overweight data.

 

undernourished

Source: Food and Agriculture Organization

Diets Gone Awry Are Broadening India’s Girth

A 28-year-old man, 5 feet 4 inches tall, weighed 100 kg. His diet was overloaded with bad carbohydrates and bad fats, and low in protein. Severely obese, he complained of persistent body ache and pain in the thighs and around the knees. His vitamin B12 levels were low.

Investigations showed that the patient was suffering from vitamin D deficiency and high uric acid, findings that are “typical of overweight people”, said the consulting doctor Anil Arora, head of unit and lead consultant, Department of Orthopaedics, Max Super Speciality Hospital, Patparganj, Delhi.

A 13 year-old girl, 5 feet 4 inches tall, weighed 114 kg. She consulted a dietician for a weight-loss programme.

“Dietary assessment revealed she ate no vegetables, just high-fat and high-carbohydrate foods and a lot of meat, mostly chicken. Overall, her intake of calcium, iron and other micronutrients was low,” said Sherin Verghese, manager, dietetics, Malabar Institute of Medical Sciences, Kozhikode.

Blood tests showed the young teen to be borderline diabetic, despite her young age.

Research and the experience of dieticians across the country trace a clear correlation between faulty diets and excess weight.

A 2010 study in Gujarat compared the daily diet of overweight people and normal weight people. Overweight people were consuming almost 10% more grams of oil per day and 20% fewer grams of vegetables.

In a 2013 survey focussed on women conducted in Delhi, obese women identified fried food as the leading cause for their condition, while overweight women attributed excess weight to overeating.

Most overweight and obese people consume a surfeit of energy-dense foods rich in saturated fats and simple sugars“, said Karishma Chawla, Mumbai-based nutritionist and founder, Eat Rite 24×7, a nutrition consultancy, “We call them empty calories for being nutrient poor.”

To add to this, metabolic changes associated with obesity can compromise the absorption of micronutrients from food.

Technically, obesity is a kind of inflammation, which research has shown impairs iron absorption or iron utilisation.

A recent Indian study at St. John’s Research Institute in Bengaluru showed that obese women face an increased risk of iron deficiency, and they also absorb less dietary iron.

Research is yet to fully confirm but we believe that adipose (fat) impedes the utilisation of micronutrients—iron and potentially other micronutrients—by the tissues,” said Remedios.

From Fatness To Disease—Via Micronutrient Deficiencies

Raised BMI is a major risk factor for non-communicable diseases such as heart disease and stroke, the leading cause of death in 2012, diabetes, musculoskeletal disorders and some cancers—endometrial, breast, and colon, according to the World Health Organisation.

Less commonly reported is the association between obesity, nutritional deficiencies and disease.

A US study has traced a link between obesity, diabetes and deficiencies of vitamin D, chromium, vitamin B7 (biotin), vitamin B1 (thiamine) and vitamin C.

A 2012 study of 1,765 North Indians diabetics, pegged the overall vitamin D deficiency rate at 76%. It identified progressively worse deficiency in those with higher BMI: 65% in those with BMI less than 23kg/m, 75% in those with BMI 23-27.5 kg/m and 81% in those with BMI greater than 27.5 kg/m.

This is highly plausible.

Overweight people are at higher risk of developing vitamin D deficiency because the vitamin is fat-soluble, which means it gets stored or ‘locked up’, so to speak, in fat cells, with less available to the body for use,” said Seema Gulati, head of the Nutrition Research Group, Center for Nutrition & Metabolic Research (C-NET).

Conversely, when fat people lose weight, their serum vitamin D level may increase, said Gulati.

Lower vitamin B12 and folic acid levels are characteristic of hypertensive overweight and obese people as compared to hypertensive people of normal weight, according to a 2009 study in Mumbai. Even among people with normal blood pressure, those who were overweight or obese had lower vitamin B12 and folic acid levels than those of normal weight.

Why Watching Your Weight Is The Only Way Out—And Why It Is So Hard

Obesity can shave off up to eight and a half years of an adult male’s lifespan and six years of an adult female’s lifespan. Obese people also lose two to four times more healthy life years than a person of normal weight.

While that is reason enough to lose weight, shedding kilograms isn’t so easy.

In the last 33 years, no country has significantly reduced obesity, according to the Global Burden of Disease Study 2013.

With the prevalence of overweight people in India estimated to increase to 27.8% by 2030, and with the most population growth expected to occur in urban India where obesity is expanding the fastest, experts said public policy should focus on malnutrition at the other end of the spectrum—that presents its own challenges because in India, over- and under-nutrition are not simply a problem of the rich or the poor.

“Often, over- and under-nutrition overlap and coexist in the same household even in rural and periurban areas as a result of ‘urbanicity’,” said Sutapa Agrawal, epidemiologist, Public Health Foundation of India.

Dual burden households make public health interventions tricky.

Strategies to address under-nutrition—such as increasing household food supplies—could contradict obesity curtailment programmes while interventions to address obesity—like recommendations of a low fat diet—may adversely effect any underweight members, said Agrawal.

So what is the best way forward?

Catch them young before the fat creeps on: create awareness in children through school education programmes that simultaneously address both types of malnutrition, she said.

This article was originally published on IndiaSpend.com, a data-driven and public-interest journalism non-profit.

ellie-620x413

By Shambhavi Saxena for Cake:

It’s a lot like any other doctor’s office. The walls are an unassuming shade. There’s a biggish sofa. And your therapist asks you short questions in an even tone of voice. Except you’re sitting at a screen and the therapist is a finely programmed bit of software. Don’t worry, we didn’t just cast you some odd mash up of Lisa Kudrow Web Therapy and Spike Jonze’s Her. We’re talking about some very real technology. With funding from the DARPA, “Ellie”, the virtual therapist, owes her existence to the University of Southern California’s Institute for Creative Technologies.

Ellie relies on super intense voice and facial scan, as described here in this NPR article. One of the cool things she can do is analyse smiles, comparing them with “a database of soldiers who have returned from combat”, in order to detect depression and post-traumatic stress disorder (PTSD) in her ‘patients’.

One of the major blockages people have with seeking therapy is stigma – it can cling like a pesky bit of toilet paper on the shoe. The medium of the Ellie program itself makes it feel a whole lot more approachable. As a software, it offers distance and anonymity, which can be a comfort requirement for a lot of people. But Ellie is also human enough to draw out responses from the ‘patient’.

The International Medical Corps, which works particularly in the area of humanitarian crises, has said that “mental illness is one of the great invisible burdens on all societies, accounting for 4 of the 10 leading causes of disability worldwide.” But it just isn’t being openly addressed like it needs to.

In this video, Fusion’s digital producer Cleo Stiller looks at this diagnostic tool as a natural progression from other electronic means of therapy – over telephones, or through emojis. The stigma around mental health is gradually being countered, especially with Mental Health Awareness activities on university campuses. But until such time as seeking help can be as easy as buying coffee, maybe a privately accessed, affordable software can make it easier to get the help we need.

This article was originally published here on Cake.

A health worker attends to a patient at the maternity ward in the government hospital in Koidu, Kono district in eastern Sierra Leone, December 20, 2014. Health workers at the hospital are in full protective gear as part of increased precautions since the outbreak of Ebola in West Africa. Sierra Leone, neighbouring Guinea and Liberia are at the heart of the world's worst recorded outbreak of Ebola. Rates of infection are rising fastest in Sierra Leone, which now accounts for more than half of the 18,603 confirmed cases of the virus. REUTERS/Baz Ratner (SIERRA LEONE - Tags: HEALTH DISASTER) - RTR4ISTF

By Alexandra Calmy, Eric Goemaere and Gilles Van Cutsem, Doctors Without Borders:

This article was originally published here

On 6 January 2015, in an Ebola treatment centre run by Doctors Without Borders, a patient was discharged from the so-called ‘triage area’ with a certificate to attest that he was ‘not a case.’ However, he did present clinical signs of advanced HIV disease. When asked about his reaction to the HIV diagnosis, he replied, ‘I am so happy it may just be AIDS.’

We have come a long way from the first days of the AIDS epidemic. Since the beginning of the latest Ebola outbreak, several comparisons have been made between Ebola and HIV. Both viruses jumped species in the West African forest and both have generated panic and discrimination. Twenty-five years ago, with an initial death sentence, HIV caused fear and stigma to an extent that is still difficult to understand, with proposals in some countries to isolate patients in dedicated centres.

Some hypotheses suggest that the first patient became infected through contact with infected bush meat, such as a fruit bat or primate, followed by person-to-person transmission. Isolation and quarantine have been part of the public health response in many countries, including in the latest epidemic. When the first health workers returned from Ebola-affected countries, they were isolated and traced, even those who were asymptomatic, despite no scientific evidence supporting isolation of asymptomatic individuals. AIDS activists and HIV researchers were at the forefront in denouncing the paranoia that led to the isolation of health workers out of fear, having learnt long ago that HIV transmission cannot be limited through health-related discrimination. Nevertheless, there are still many countries that restrict travel for individuals with HIV. Similarly, stigma is affecting also the lives of health workers in West Africa. In Freetown, Sierra Leone, national staff working in the Prince of Wales treatment centres reported in many instances not to be able to tell their families that they were working with Ebola patients. Many convalescent patients volunteering to give plasma did so while hiding from family in Conakry: instead of heroes, they were outcasts. Among several other examples, survivors were unable to find a taxi willing to take them home and extended families were unwilling to care for orphans out of fear that they would bring Ebola back home. As with other infectious diseases, notably plague epidemics in the past centuries or, more recently, drug-resistant tuberculosis, the policy of quarantining patients has the potential to increase stigma and drive the epidemic underground.

ebola adThe mobilization of HIV-related actors in the fight against Ebola disease has been substantial. Many HIV researchers and clinicians have volunteered to work in treatment centres or clinical trial sites. Prominent HIV researchers have also presented on the Ebola response in several HIV conferences. Indeed, the results of the first trial assessing the efficacy of favipiravir were presented during the 2015 edition of the Annual Conference on Retroviruses and Opportunistic Infections whose main objective is to share the latest studies on HIV/AIDS and related infectious diseases. Clearly, the Ebola outbreak has resonated strongly with HIV actors because of numerous similarities and lessons that can potentially be drawn from HIV to support the Ebola response. Even the HIV prevention ABC strategy (Abstinence, Be faithful and use Condom) has been twisted to fit with the Ebola prevention messages (Avoid Body Contact) in Sierra Leone. Interestingly, before a cure for syphilis was available, this type of poster campaign was also used as a weapon in the fight against the illness.

According to the WHO, many health workers have suffered from the epidemic with more than 800 dying from Ebola disease. Although personal protective equipment can prevent accidental exposure, the exact risk assessment for some exposures (e.g. contact of an infectious material with intact skin) is unclear and post-exposure prophylaxis is unavailable for many local health workers in the three affected countries.

By contrast with HIV, Ebola patients with no clinical symptoms do not transmit the virus. The transmission window is also short and the incubation period is no longer than 21 days. Therefore, the ability to contain the spread of the disease would appear to be easier and contact tracing is part of the epidemic fight. But this raises other questions. To what extent will the fight against the epidemic alleviate the need to protect the confidentiality of affected patients and families? How do quarantine measures affect the household? Another lesson learned from HIV is the paramount importance of involving the communities in the fight against the disease. Innovative ways of involving the community and peer educators have proven very effective in the HIV field. As an example, Ebola survivors with a persistent immunity have been involved as caregivers in the care of young children in some Ebola treatment centres and have been critical in providing essential quality healthcare.

An Ebola survivor has been quarantined in India after his semen tested positive for the virus. The latest patient diagnosed with Ebola in Liberia is the wife of a cured patient. There is a theoretical plausibility for sexual transmission of Ebola virus. However, further research is needed to consider if, and if yes, to what extent, sexual activity contributes to the epidemic in order to inform individuals with regards to avoiding acquisition or transmission by those recovering from Ebola virus disease.

Ebola causes a severe, often fatal disease, and timely diagnosis is critical both for individual benefit and public health concerns. For example, the early symptoms of Ebola infection are difficult to distinguish from malaria, influenza or typhoid fever. In August 2014, the US Food and Drug Administration issued an Emergency Use Authorization for an Ebola diagnostic test developed by the Department of Defense, the Ebola Zaire Target 1 (EZ1) real-time reverse transcription PCR (TaqMan) assay. The use of rapid tests should improve the detection of cases and help control the Ebola epidemic in the same way that large-scale HIV testing helps to curb the HIV epidemic by promoting rapid access to prevention and treatment.

Access to antiretroviral drugs has been a 15-year battle and 12 million individuals are now on anti-HIV drugs worldwide. The availability of an effective treatment was a critical factor in increasing the uptake of testing and enhanced health behaviour as evidenced by low test uptake when access to antiretroviral therapy was scarce. Early phase of favipiravir and blood-based therapy (’convalescent’ plasma) trials started recently in Guinea. The admission rate suddenly increased in these sites, possibly because of the changing paradigm of the treatment centres (from isolation to treatment). How is it possible to speed up the access to antiviral drugs in the Ebola setting?

In the case of Ebola disease, the determinant of access to quality care appears to differ from HIV. First, nearly all patients treated in high-income countries had accessed experimental drugs. Despite the WHO declaration stating that it would be ethical to offer unproven interventions as potential treatment or prevention in the current context (11 August 2014), none of these drugs were used in African treatment centres until late 2014. The design of such a clinical trial for an innovative intervention, such as immune blood transfusion or ZMapp (Mapp Biopharmaceutical Inc., San Diego, California, USA) led to debate about whether a placebo-controlled trial in the context of a disease with at best a 50% case fatality rate was ethical. Although the first anti-HIV drugs had been compared with placebo in initial trials, the time taken to approve them was contested by treatment activists who were successful in ensuring fast track approval. Almost all clinical trials since then have tested one drug against another. However, the major difference between the two diseases is the fact that no cure is in sight short term for HIV, but Ebola is a curable disease and several drugs may affect the disease outcome; the reconciliation of scientific fast tracks and ethical concerns is urgent.

syphillis posterThe controversy related to the methodology used for evaluating the efficacy of new drugs can be extended to the evaluation of vaccine efficacy. As the epidemic declines, is it a good use of resources or even ethical to expose volunteers to an experimental vaccine through a large phase III trial as the chance of being exposed to Ebola – and thus determining vaccine efficacy – will become almost zero? On the contrary, is it justifiable to mass vaccinate in a future epidemic based on the sole basis of a phase II trial? Vaccine trials just started now in all three countries will potentially lead to a new Ebola vaccine commercialization, which is still not the case in the HIV setting, despite more than two decades of research.

Point-of-care diagnostics, early antiviral treatment and vaccines will radically change the community approach to Ebola. Ebola has had an impact on both the use of healthcare facilities and specific HIV care. Recent studies have shown that the Ebola epidemic resulted in a major drop in attendance of general outpatient services, in new HIV-positive diagnosis and in new HIV-infected patients entering care. In most affected countries, access to basic care was dramatically impaired by the fear of accepting an Ebola patient in a healthcare facility. Both diseases affect all sectors of society and reach far beyond the healthcare system, ranging from economy to education, but also with an impact on cultural practices, such as circumcision for HIV and burials for Ebola. The fight against HIV has led to a massive increase in resources which have benefited health systems in resource-limited settings beyond vertical programmes. The mobilization of the international community around Ebola has the potential to similarly benefit health systems in West Africa, a region long abandoned after years of civil war. Let us not fail in the opportunity to succeed in post-Ebola recovery.

There are over 2 million Indians who are HIV positive, the key to tackling this is awareness. Here are 11 Facts About HIV/AIDS That You Must Know, If You Don’t Already

Featured image source: Reuters/Baz Ratner

manual scavenging India

By Radha Patankar, IndiaSpend.com: 

Mumbai: Hot water, sanitary pads and bottles are flung at them when they work in filthy, obscure Mumbai gullies (lanes), but although manual scavenging is illegal, Maharashtra employs 35% of 180,657 Indian families whose livelihood depends on unblocking excreta-packed sewers in those dank lanes.

“Aamhi lokancha jeev wachavto ashi kama karun pan aamcha jeev wachwayla konich nahi (We save lives by doing our job but there is nobody to save us),” a worker told IndiaSpend, requesting anonymity for fear of official retribution.

The Indian state does not officially recognise the employment of manual scavengers, almost all of whom are Dalits. They are officially hired as “cleaners” in Maharashtra. The state does, however, acknowledge that thousands make their living doing manual scavenging.

Maharashtra has more than 63,000 households dependent on manual scavenging, followed by Madhya Pradesh, Uttar Pradesh, Tripura and Karnataka, according to a question answered by Minister of State for Social Justice and Empowerment Vijay Sampla in the Lok Sabha.

Railways Largest Employer Of Manual Scavengers

Since they do not have a proper system of disposing excreta, the Indian Railways are the largest employer of manual scavengers, with an unknown number on their rolls.

Most of the ‘sweepers’, as they are called—thus making them hard to identify as scavengers—with the railways are employed through contractors, and they earn around Rs 200 per day. Although the workers get gloves, hygiene awareness is so low that they hardly use them. If they do use protective equipment, a new draft law says such workers can then no longer be classified as manual scavengers.

In September, the Delhi High court ordered a survey in the capital to determine the extent of manual scavenging. The Ministry of Railways told the court that manual scavenging cannot be completely eradicated until stations get washable aprons and sealed toilet systems.

“While the (railway) ministry denies employing manual scavengers officially, the affidavits it has submitted in the court in the past nine years suggest that barring a few trains, the railways does not employ any technology to keep its 80,000 toilets and 115,000 kilometres of tracks clean,” according to Down To Earth magazine.

On The Margins, Now You See Them, Now You Don’t

Progress for a people who come from the lowest castes and whose jobs do not officially exist is slow, and protest is almost impossible.

Brihanmumbai Municipal Corporation (BMC) “conservancy workers”—a euphemism for manual scavengers who clean lanes—told IndiaSpend that they started getting gloves recently. The BMC has also started giving them medical insurance up to Rs 500,000. Since the premium is deducted from their salary, more than half have not signed up.

“There are four to five deaths every month,” a worker told IndiaSpend. “Most of us suffer from tuberculosis. BMC owns a hospital but all we get is Rs 10 case-paper free.” That means they don’t have to pay consultation fees, but they must pay for their own medicines and wait six months for sonography tests, four months for x-rays.

Almost all of Mumbai’s conservancy workers in BMC are Buddhists or neo-Buddhists, converts from Hinduism’s lowest castes. Kept to the margins, it is hard for them to break the status quo.

One contractor told IndiaSpend that machines now cleaned sewers and workers did not descend manholes. However, workers said contractors sent people down manholes almost every night.

Workers take turns entering manholes, lathering bare bodies with coconut oil to keep away the odours of the sewer.

Why do they continue doing what they do?

Housing, Jobs For Families Key Reason To Continue

In Mumbai, one of the main reasons why manual scavengers continue doing their jobs is that they do not have the education to do much else. Working as a scavenger means that they get housing from the BMC and their jobs can be transferred to family members.

Although their “official” income varies from Rs 7,000 to Rs 25,000, what they actually get in hand is Rs 5,000 to Rs 15,000, after deductions for education and marriage loans—some taken from landlords—and insurance premia.

A new law, The Prohibition of Employment of Manual Scavengers and Rehabilitation Act, 2013, talks about rehabilitating conservancy workers by giving them one-time cash assistance of Rs 40,000. After talking to BMC workers, it was clear they had not heard of this.

One-time Cash Assistance For Manual Scavengers, FY 2014-FY 2016
State/UT Manual Scavengers Identified Beneficiaries Expenditure (Rs crore)
Andhra Pradesh 124 45 0.18
Bihar 137 131 0.52
Chhattisgarh 3 3 0.01
Karnataka 302 196 0.78
Uttar Pradesh 10,016 5252 21
Uttarakhand 137 124 0.49
West Bengal 98 95 0.38

Source: Lok Sabha; Note: Data for FY 2016 up to June 30, 2015

The Self Employment Scheme for Rehabilitation of Manual Scavengers (SRMS) was introduced by the Ministry of Social Justice and Empowerment in 2007, and implementation supposedly began in November 2013. Andhra Pradesh, Bihar, Chhattisgarh, Karnataka, Uttar Pradesh, Uttarakhand and West Bengal have received cash assistance to rehabilitate scavengers identified by the government.

Maharashtra has given no cash to manual scavengers it has identified.

(Patankar is a second-year M.A. student in Public Policy at St Xavier’s College, Mumbai, and an intern at IndiaSpend)

This article was originally published on IndiaSpend.com, a data-driven and public-interest journalism non-profit.

mental health illness stigma discrimination

By Jhilmil Breckenridge

For anyone with a mental illness “label”, they know only too well that they are judged with that label forever. Whether they are a functioning individual or not isn’t considered. If she is singing one day, she must be manic. If he is quiet sometimes, oh he must be in depression. It’s as if people are not allowed to have normal moods anymore, and worse is how the stigma attached to mental health diagnoses affects you outside, at work, in relationships, how society views you. I have a friend, who never discloses at work that she has an issue or takes medication for the fear of being judged. Or another who hides his illness from his children. All of these things are done precisely because of the constant judging, the stigma and discrimination that surround anyone with a mental illness label.

mental health illness stigma discrimination
For representation only. Image source: Trauma and Dissociation/Flickr

In simple terms, mental health issues can be caused by life stresses, psychosocial issues, sometimes it may be genetic and some people are more predisposed to being affected. It’s often a temporary condition and recovery is very, very possible in many cases, especially if the person affected wishes to take an active part in his or her healing. In my case, I read extensively on the subject and embarked voluntarily upon a CBT (cognitive behavioural therapy) model of help, also the fact that I had been incorrectly labeled did not help! In other cases, it may be a lifelong management of a condition and there are several ways of dealing with it. But even years after recovery, now that I am a fully functioning and productive person, I am continually judged with the label I had years ago, “oh she is bipolar,” as though that is the only thing that defines me.

Discrimination at the workplace is also widespread. With many employers unwilling to take on people with mental health issues, this is one of the largest groups of any disability that is unemployed. Often people have no option but to resort to hiding the fact that they have any issue just to get work. In many cases, it is discrimination that prevents people from getting help. “I’m not crazy,” they say, when they think that perhaps they should go see a therapist or get help. And it’s precisely the conditioning we have all had growing up, from our parents or society around, “oh, you know, that person is crazy” and talking about what they did in hushed whispers. If we grow up thinking that to have any mental health issue is being crazy and that is the last thing we want, obviously it is hidden for as long as possible. Why can’t it be treated like a medical condition, which is what it is, and be casual? “Oh, I have diabetes, so no sugar, please,” is treated much differently to “I have anxiety disorder.”

In a survey of over 1700 adults in the UK, Crisp et al. (2000) found that: (1) the most commonly held belief was that people with mental health problems were dangerous – especially those with schizophrenia, alcoholism and drug dependence, (2) people believed that some mental health problems such as eating disorders and substance abuse were self-inflicted, and (3) respondents believed that people with mental health problems were generally hard to talk to . People held these beliefs regardless of their background, education or position in society and when questioned about whether they would employ people with mental health problems, the answer was less likely.
Stigmatization comes in many forms, distrust, avoidance, pity, gossip, etc. Stigma is also prevalent in the classroom where teachers expect sufferers to underperform and this may not be the case!

A lot of the common beliefs about ‘mad’ people stem from media. Cinema often portrays schizophrenics in stereotypical and violent roles, which reinforces what people generally believe about people with mental illness. These go a long way in continuing to make people behave in a discriminatory way towards anyone affected.

Worse than the external stigma and discrimination around mental health is the internal stigma. It’s a condition that often affects people’s self esteem and their own beliefs of recovery are linked to the self stigmatization. If they believe they can’t recover, all the medication and therapy in the worlds will not help. There is often increased social isolation, and this is often linked to a self belief that they will not be liked.

In the UK, there has been a huge campaign to end stigma. A similar approach will be needed in India, one of the worst countries in the world when it comes to how it deals with those affected with mental health conditions.

Mental health issues originate in the mind. So does stigma and discrimination. Let’s work hand in hand to eradicate what we can to make recovery faster and make our society more inclusive.

Note: In this article, I speak about mental health illness as that is how the term is commonly understood and referred to. But I am of the firm belief that a lot of these labels are simply wrong, over-diagnosed and cause more problems than they solve. People are people, and just as there are different colours, so do people vary… we cannot all be the same, react the same, and have the same moods. And to simply label someone without any tool for looking into their brain seems wrong. Until there are better diagnostic tools, I think the world needs more love and tolerance!

TRDLOGO1

yp foundation sex and reproductive health study cropped

By Manasa Priya Vasudevan:

sex clinic - yp foundationYou may have spotted posters from train windows, as you enter stations, or at traffic signals that offer to solve your ‘sex problems’. Right from these unremarkable flyers touting unregistered medical practitioners, to over-the-counter (OTC) contraceptives that are dealt, as though, to fugitives, and the dark coloured polyethene bags that seal off sanitary napkins from the outside gaze, the enigma that surrounds transactions of sexual and reproductive health (SRH) services in the country, is only comparable to that which surrounds illicit drug trade. Social and cultural practice is to regulate even the most basic conversation on sexual and reproductive health and rights (SRHR), and bring it within the axes of ‘marriage’ and ‘procreation’, so much so that we have prominent judges of the high courts issuing ‘marriage’ as a sentence for rapists, post-conviction, as if submitting to matrimony is the ultimate atonement. This systemic epidemic of sex-shaming equals to most of us having no information whilst growing up, or being ashamed of our curiosity about our bodies, sex and desire. The utter absence of comprehensive sexuality education (CSE) also contributes to high maternal mortality rates, rampant early and child marriage, a strapping HIV-positive population as well as a significant unmet need for contraception.

It is in this climate that we at The YP Foundation decided to conduct a preliminary audit of government and non-government health centres in and around communities in the National Capital Region, where we impart comprehensive sexuality education. 18 young volunteers and staff from the Know Your Body Know Your Rights Program conceptualised and implemented an audit to assess the quality of SRH services for youth. They took on the role of …well regular young people in need of condoms, birth control, pregnancy kits, HIV counselling etc.

Here is what we found:-

Shame Games

yp foundation sex and reproductive health studyThe National Adolescent Health Programme (Rashtriya Kishor Swasthya Karyakram; RKSK) guidelines 2014, perhaps the most progressive and comprehensive of the Indian policy landscape, stresses on the importance of the presence of 3 components in every centre that provides SRH facilities: information, commodities and services. Now, regardless of the availability of commodities or services, the real challenge that the hospital and staff seemed to struggle with was information disclosure. How does one confide to staff who are uncomfortable to speak on the subject themselves?

We discovered along the way, that hospital staff had two ways of dealing with their unease. In most of our interactions, we encountered either:

Strategic silence – sometimes their limited information on the subject through clipped responses, censored the questions we could have asked or the conversations we could have pursued to build trust and thereof safe spaces.

Or, overt moralising, what I like to call the ‘circle of shame’ – shaming us for shaming them by requesting access to improper things, and subsequently bringing shame upon our family and ourselves.

Neither assuaged the experience.

“The chemist shop in the facility premises required doctor’s permission to buy a kit. Firstly, we were sent to three different rooms to get the CMO/doctor’s permission. In the third room, a female assistant lashed out at us saying, ‘Sharam nahi aati? Parents ki izzat mitti me mila di (Aren’t you ashamed of yourself? You are ruining your family’s honour).’ It would have been downright humiliating for any person let alone a distressed young girl. In the end, I wanted to be out of the hospital as soon as possible.”

Health care practitioners should ideally play the role of a facilitator. But increasingly, we began to observe that either consciously or unconsciously, they would slip into the role of a gatekeeper. A moralising ground does not qualify as a safe space, and in fact adversely contributes to mental trauma.

Sticky-Stacky Stigmas

It was also interesting to note that their stigma against talking about, leave alone treating, SRH services piggybacked somewhat comfortably on their stigmas attached to sex outside of the confines of marriage, which in turn piggybacked on their intolerance towards people of a different religion, weak academic performers, independent youth and a host of other seemingly unconnected things.

“The room was empty except for 3-4 doctors who looked like the ‘gossipy neighbourhood aunties’. And as we were about to find out, they behaved exactly in the same manner. What college, they asked. What subjects, what percentage. Do you live with parents? Are you sexually active? With more than one guy- this was not so much as asked as shouted. And then, are you Christian?”

On some occasions, the younger doctors seemed happy enough to treat the patient without passing judgement, but the older doctors and assisting nurses assumed the garb of a disciplinarian.

On other occasions, doctors were found to be selectively empathetic – privileging one SRH service over the other. There was a stark difference in the attitudes of some health care practitioners who were warm and helpful when it came to services such as contraception, HIV and STIs, but haranguing when it came to abortion.

On still other occasions, they were guilty of granting smoother SRH services to boys over girls; and upper middle class, English speaking patients, whilst reserving dispassionate judgement for everyone else – the peer educators would come out with lukewarm reports only to find a disillusioned fellow patient. So despite wielding our English-speaking class privilege, being at the receiving end of such differential treatment based on banal biases, made us sit up and think – what then, would be the treatment meted out to young girls from the communities we work in?

yp foundation sex and reproductive health study 2

Lack Of Signages

Information education and communication (IEC) material was available only partially and sporadically, across all centres!

“GTB Hospital is like a maze. It is a huge hospital and there is no clarity whatsoever as to which building one has to go to as there is a shortage of sign boards. It is not like the services are not available here, just that reaching the right place is a herculean task.”

Proactive disclosure of the gamut of SRH problems and services through intuitive flyers and sign boards that lead the way to counselling rooms and testing labs also can minimise patient-patient or patient-staff interaction, offering the former the benefit of privacy and shrouding them from harsh judgement and scrutiny of community moral police.

Due to the stigma surrounding most SRH services, especially HIV/pregnancy testing or counselling in the case of sexual contraception/abuse/violence, and the larger community’s likelihood to suppress and shame, creating safe spaces by guaranteeing privacy and confidentiality, also becomes doubly important to encourage young people to avail of these services. Unfortunately, there is no escaping nosy neighbours of neighbours anywhere in India, least of all at community health centres!

“It was an open room where all the patients stood in barely a line and just stated their problems in front of everybody. No privacy whatsoever.”

“One of the things that I didn’t like about this centre was that a patient having an upset stomach walked into the room, right in the middle of my abortion counselling session.”

On the whole, the team had mixed feelings on the pilot study. Their preliminary excitement regarding the ‘plain-clothes audit’ was short lived. The volunteers may have been assuming the
guise of young people in need of counselling, contraception or kits, but their masks were fast rendered inconsequential. The slut-shaming and unsparing character assassination that accompanied
the study was but directed at their realities. Such personal assault dampened their spirit and frustrated some of them to the point of tears. Both the government and non-government health centres were ridden with the same-old age-old, patriarchal, sexist and non-secular bigotry transmitted by staff and communities who frequented their corridors. Uninterrupted treatment was accorded only to the PEs who conformed to their narrow ideals.

In the name of patient history, a person’s identity was dissected, its markers scrutinised: starting with gender, sexuality, class, religion, academic merit, and then moving on to an avalanche of micro markers – none of which was their business. Not surprisingly, the tendency to regulate a woman’s sexuality over a man’s was painfully evident, and how. Add to this mix, a trans person, a Dalit or a differently abled person and the experience could well be traumatic. We then wonder if the singular subject of this exclusive public health system is simply – an able-bodied Hindu man.

Illustrations by Vanika Sharma, ‘Know Your Body Know Your Rights’

caste_women_village

By Anya Vohra

Always having been slim I never thought of anaemia as the reason behind it until a few years ago. I recollect being called different names like stick and skinny and that’s the reason I hated being thin. People who met me for the first time asked me my weight instead of my name, I was subjected to name calling and teasing. People say being thin is easy but they are clearly oblivious of the underlying social and emotional cost of being slim. Diagnosed with a mild case of anaemia at an early age motivated me to delve deeper to find out more about its symptoms, causes and prevention.

I invested time researching about this disease and the numbers were a shocker! Although anaemia affects 52% of the female population in India, over 68% of the total Indian females are unaware of the condition! More than half of the pregnant women in our country are mildly anaemic and 42.6% are moderately anaemic. The situation is the worst for adolescent girls, 27.1% of whom are severely anaemic.

Anaemia is most often synonymous with being thin, and often not recognized as a medical condition. It’s almost as if you’re thin you MUST be anaemic; the casual attitude and ignorance of people towards this disease troubled me. My research showed that while many types of anaemia can’t be prevented, the most common of them, caused by iron-deficiency, can be outdone with a vitamin-rich diet. Iron-deficiency anaemia suppresses human productivity, which indirectly hampers national growth and development.

The Food Requirements

anaemia anya vohra
Image source: Anya Vohra

My deep dive into this affliction made me realize that if I, with good nutrition, can be a victim of such a disease then what about those who do not have access to the same level of nutrition as me? Thus started my Youth Anaemia Initiative born out of an incessant motivation to make a difference. My objective is to spread awareness of the disease itself and about the dietary needs to prevent it. I have developed cost effective solutions which could be incorporated by economically weaker sections of society into their daily diet. After doing comprehensive study I came up with a few budget-conscious solutions:

-Vitamin C is effective in preventing anaemia as it helps in increasing iron absorption and sources of vitamin C include lemons, sweet lime, pineapple and guava.

-A good diet must include iron-rich foods which include chickpeas, watermelon, lentils, bajra (millet), jawahar, pumpkin seeds.

-Folate synthesized from folic acid can be found in bananas, cauliflower, legumes and papaya.

-Vitamin B12 is also essential and sources include milk, yoghurt, sweet potato and carrot.

-Vitamin A is also helpful in preventing anaemia. Sources include pumpkin, milk, melon and tomatoes.

Most all of these are affordable and easily available and are a regular part of Indian kitchen menus and India being primarily agrarian a majority of the above is grown by farmers.

How Society Contributes To Anaemia

I also unearthed two unpalatable notions girls often buy into or are passive spectators too.

Firstly, that society places an optic premium on girls that are slim. To conform to these stereotypes, girls often starve themselves which also leads to anaemia due to the low percentage of nutrients and vitamins they consume.

Secondly, and this is important, girls are more often than not, especially in rural areas, fed an inferior diet vis a vis boys based on the premium placed on the boy perceived as an asset and girl as a liability.

A person should never be discriminated on the basis of either their weight or gender. I have visited a number of NGOs and taught girls from classes 6-10 about the symptoms, causes and preventions of anaemia as well the need to place health ahead of beauty and demand the same food as their brothers.

Clearly a lot needs to be done and not just about anaemia. Females at last count (despite infanticide) are over 500 million and it’s unacceptable to have a half a billion disenfranchised citizens. We have to bring about that change and I believe I am doing my small part in catalysing that metamorphosis.

Editor’s note: Feel strongly about health and well being? Email PM Narendra Modi and show your support here!

empathize this headache illustration 2

By Anonymous:

Note: Originally published on Empathize This and republished here with permission.

I woke up one morning with a headache three years ago. It hasn’t gone away.

I have been diagnosed with a condition called New Daily Persistent Headache (NDPH). This means that every day, all the time, I have a headache to some degree. I’ve seen countless doctors and had tests done and tried countless medications and other solutions, and while I have found a couple of things that significantly help, the headache never completely goes away. There are certain things that make my head hurt even worse than normal, including bright or flickering lights, loud noises, certain foods, physical exertion, and stress. As such, sitting in a classroom with fluorescent lighting is difficult. I cannot go to concerts. When my friends run, I must choose between being left behind or running to catch up and cause my headache to get even worse. Looking at a computer screen for too long is painful. There are so many things I would love to do, but I simply can’t.

My friends and family who know me well know about my condition, but very few truly understand it. I know they are trying and that means the world to me, but it’s hard when I have to either correct/remind them about it, or decide to suffer through something that is difficult for me. Some days, I simply can’t cope with the constant pain. In the moments I can cope, I feel like I ought to be working and productive, so instead of living my life, I work until the pain comes back, and spend my free time collapsed and not moving. But I cannot live that way, so I feel like a failure. I’m doing the best I can, but it will never be good enough. Sometimes I wish I had something more serious so people would try to tell me how to fix it. No one tells a cancer patient to “just suck it up,” or “take some Advil, you’re fine.” I know they mean well, but it is tiresome. It is not easy living this way, but the combination of others not knowing and trying to help is even more draining. Some people at church pray every week for me, and I have to tell them every Sunday that no, I’m still not better. Others think I am possessed by some sort of demon or am sinning against the Lord so he is withholding healing. It hurts that my pain doesn’t matter and that people I thought I knew believe I am being punished.

This is real. This is my life. I would get better if I could, I promise…

reshma valliappan

By Reshma Valliappan

We would have heard this ‘NO’ in context to the rape culture that has been going on ever since dinosaurs stopped existing and man and woman sprung up from some strange godly discourse of existence written in some scripture. Again, this scripture was written by a man and not by a woman. If she did, I really wonder what life on this planet would look like.

reshma valliappanThe word sex has been the biggest taboo ever since then. It has been the biggest power tool for repression, oppression and control ever since man realized he could only shoot climatic stars of ecstasy (orgasm) once (or maybe twice for certain gifted ones who have worked out) or several times (for those who know what they are doing in bed) as opposed to the woman who can own the sky of multiplicity. I say ‘man’ because I would agree to the feminist terms of womb and vagina envy that speaks of how men have a natural envy to the biological functions of the female body. However, this term has sprung up from the same psychoanalytic school where Sigmund Freud first coined the term penis envy. But there would be real dangers if we kept our focus on the psychoanalytical theories of gender roles and sexuality given these theories came from individuals born and raised in a different culture, society, religious and spiritual beliefs, language and existential roles but have been put on the same pedestal of gods by you.

Since I am writing this article, I would call everyone else fools for doing so. Why? Because since the birth and rise of psychiatry and psychology in the 1900, it took this one man called Freud followed by Jung and a whole bunch of other baboons to come up with many different intellectually stimulating words and spread it through the economics of mindless fascinations because they couldn’t understand themselves better. They needed to find the ‘mad people’ which mostly comprised of women labelled with hysteria for them to study and experiment upon while some even had sexual bondages with these women they claimed to help. Then this other fellow called Eugen Bleuler coined the disorders and broke them into different branches called schizophrenia, autism, bipolar so on and so forth. This further entered all the psychology books, education and social understanding of what mental illness is. And the whole world believed them and follows them. Coming from being a schizophrenic, I think everyone else are complete fools for doing so because they have no voice of their own. On this note, I am glad I hear voices, many of which are my own. But I have been treated for hearing them. I have been called crazy, lunatic, pagal, mad, insane, unsound and have been completely rejected by society and the same system claiming to help someone like me finding my way back into society.

What society fails to really understand is that mental health issues affect each one of us. No human being is discriminated on the experience of mental health breakdowns yet they choose to discriminate and stigmatize the likes of people like me along with spreading and believing that we can be violent or dangerous to others or ourselves. If they do their research and use their brains, they would find that many of us were ‘victims’ of violence and our spurts of aggression are merely defences for the acts committed on us which live in our minds.

Even in my entrance into cross-disability, many others with physical disabilities did not want to have anything to do with the ‘crazies’ for we might spread our madness to them or just the very thought of sitting in the same room with me would stigmatize them. The invisibility of the stigma and discrimination is equally proportionate to the invisibility of our pain and condition. And the only way we can bring this forward is by talking about it even if it hurts others in the process for being this honest about it all. The very fact is that mental health issues arise because nobody wants to talk about them. Nobody wants to address what is really happening inside of their heads. It is easier to fit in and brush it all under the carpet. And then it grows and gets bigger and out of proportion leading to breakdowns. It is easier to believe it is a chemical imbalance that needs to be treated and the pills will make it all go away. How can people be so blind to treat human experiences and call them disorders? It is disabling no doubt, but it is disabling since the larger whole does not find the need to able themselves with true empowerment of their experiences and voices.

The questions we must ask ourselves are: What really are the causes of mental health issues? Is it what you think has been written and sold? If people have enough access to reading this article, they should use their discretion to do their own research and really find out because until it happens to them or someone they love they really don’t bother waking up. To me, having schizophrenia or depression or any other so called mental illness is our souls knocking real hard on our doors and telling us to wake up to our purpose because we are nothing but a populated group of consumerist dodos; extinct of our true selves. We have developed false expectations and needs of what success means to us and in the road to gaining these illusionary needs we develop such issues.

But no one is going to believe me when I say this because I have schizophrenia. If I had ‘Dr.’ prefixed to my name, the whole world would clap for me and shove degrees up to me. Then again when doctors are funded for research on how to deal with our voices – it is called a discovery. It is called the new edge of helping schizophrenia sufferers to listen to their voices and have a relationship with them. But isn’t it for the very reason that we hear voices and listen to them and have a relationship with is why we are getting treated and stigmatized? This is the double irony of the system which society does not see.

Why do I bring up this critique and how is it relevant to the topic of sexuality? Let’s be clear of the definition and oppression of independent women. That is, any woman who voices her opinions, her needs, her wants and what she does not want is called a bitch, a slut, a selfish badly influenced person who needs to be taught a lesson and this list goes on, as there are over 300 mental health disorders listed in the DSM (Diagnostic and Statistical Manual of Mental Disorders) aka The Psychiatry Bible.

What I really want to point out are the many hats and roles placed on women. Let’s take the schizophrenic woman with alternate sexuality. Both these labels and existences are not born with her but are received when she reaches adulthood. When we remove these labels we get the young adult who is rebellious, opinionated, desiring an endless list of what pleases her, saying no to authority, disliking others or their philosophies. She is actually abled by it. So we remove this label and we get the mother, the daughter, the sister, the wife, the boss, the carer, the girlfriend all of which are about owning her. Even in the attempt of telling her to ask for her rights and educate her about patriarchy, she needs a man to tell her that. This is how strong the hold is.

How is this connected to sexuality? Easy. How many heterosexual able-bodied women can tell their husbands or boyfriends openly ‘Hey, I don’t feel like having sex with you today?’ When we find out how many can say NO – then we have to ask the next question ‘Hey, I’m feeling horny let’s make out’. When we can find out how many are allowed to ASK for what pleases them is where the labels of hypomanic or sexual addiction are placed on women. They’ve classified this as disorders that need to be treated because apparently the woman loses herself to it and stops functioning for her betterment which in turn affects her life. Fair enough a point to call it something that does not allow her to function well. But if she was given the respect and choice from the very beginning to say what pleases her, the disorder won’t have to exist to make up for what she can’t ask consciously.

Therefore, before we even get into the discourse of mental illness, psycho-social disability, sexuality, alternate sexuality, choices and rights, legal privileges and recovery, women as a whole need to begin questioning this simple NO. The day I said NO and listened to the voices in my head was the day I discovered my wants and needs. The voices that told me ‘You’re a slut’ were the voices of authority I have heard before. But since society tells me not to question authority and moral notions by them, my psychosis made up for it.

The voices that told me ‘Watch the movie and go out and have fun’ were my innermost desires becoming so strong that they have to assume the existence of controlling voices to the point of psychosis so that I do it. So that I engage in it and know what I really want and not what I should want according to society.

I hear voices and it connects me to my various selves hence others want to control me or treat me. If others only heard their own true voices, we’ll all know who is taking me out for a date tomorrow.

This article was originally published here on the Sexuality and Disability blog. 

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