Toilet ki ek aur katha- Personal hygiene and Prevention of Cervical cancer

I am so glad that ‘toilets’ are receiving the importance thanks to the movie ‘toilet ki ek prem katha’. Here ‘s the reason why toilets should be demanded by every lady !

Cervical Cancer incidence and mortality is decreasing steadily.

However most of the reduction happened in the developed countries as this graph shows.(GLOBOCAN)

All this happened even before HPV vaccine was introduced . Even pap smear screening was not total in some countries.

How did this happen?

Its clear that improved personal hygiene due to access to toilets with privacy was an important factor . Personal genital hygiene in both men and women can reduce cervical cancer.

Just compare with the countries with least number of toilets per capita ( WHO/UNICEF)


All  in the areas with high cervical cancer.

Of course there are other factors like unprotected sexual activity and HPV does spread due to poor habits. There was a nice study way back in 1999 from Kerala, in a survey based in Trivandrum centre,  that highlighted the correlation of cervical dysplasia to  lack of access to hygiene with toilets, sanitary napkins etc .

Expensive vaccines and even more expensive population screening are not suitable for large rural populations like India and Africa.

The fact however is that the rural and urban poor ARE AWARE of the ill effects of poor hygiene but have no access to clean toilets

That’s a preventable tragedy!

Its time for action !! It’s time this basic need is ensured in every household

Conflict of interest:

I know Akshay Kumar but was neither influenced or approached to write. The  thought developed for sometime in discussion with Dr Anita Borges.

Good ‘Old’ generation!


Yesterday was a very interesting day. I saw 4 patients who are over 70. When I started my surgical career, more than 3 decades ago, we had a fairly unwritten rule that above 50 years be careful and after 60 avoid risky surgery. Some of the major surgeries which we performed on the younger patients were not offered to the elderly patients as there was a fear that there would be some complications and they would not be able to stand the complications.

In the west it has been proven recently that even older patients have the same kind of resistance and power to heal  and tt does not really depend on the age.

‘Physiological age’  is more important than the ‘Chronological age’

Mr. Mehrotra came into my room with a spring in his step. The first thing I asked was “Are you really 79”? He said, “Of course I am 79 and I even have great grandsons.”

I generally do not base my assessment on the biochemical values or numbers.

So I asked him “What do you do in a day and what time do you get up in the morning?” He said, “I am up by 5 in the morning”.

“Oh, and then ? “.

“I go for a walk for about an hour”,

I asked, “how much distance” and he said, “about 5 km.”

(I said to myself “I don’t do that”)

He said, “then I come back and may be have some juice and fruit, a bit of yoga and then I have my breakfast”.

I said, “Fantastic routine, what else do you do, can you go up a flight of steps?” He said, “of course I can because when I go for a swim in the evening, I do go up and down the steps.”

So I said,”oh oh, that means you swim also?”

He said, “of course I swim or go to the gym.”

Well this man is certainly great, at 79 he is fit and is definitely not overweight. I look at the people who came with him, his nephew (who well certainly looked pretty uneasy with the whole conversation) because it was clear that he never walked, forget about gymming and swimming and he was easily 10 kg overweight.   I had to do a major liver surgery for him so I said, “there is a risk in surgery”, he said, “so what, I am ready for it.” I think it is not only the physical fitness but also the mental attitude of the older generation which is remarkable.

Second gentleman was again 75, the same story except that he does not gym and does all the things which normally should have been done by someone who is much younger than him.

I had no hesitation in clearing both the patients for both liver and pancreatic surgeries respectively. Yes, there are some risks involved but it depends on how you take care of your body.

Then came a 75 year old whom I had operated upon for rectal cancer. He said, “doctorsaab, can I go for my walks?” I said, “of course, you can.” He said, “what about the treadmill?”

( Oh, I also have a treadmill but I do not seem to be using it much).

“Yeah, why treadmill, why not just go for a nice walk in the lawns or outside?”

He said, “yes, that I do everyday, I used to do for an hour but now it is 1/2 an hour, but in the monsoon season, if it is raining, I still want to do my exercise and that is why I am asking if I can go on the treadmill”

I said, “of course you can do it but just be careful”.

So, in short, when I look at the older generation it is so enlightening. They are right in front of us- they take care of their health. Their physical fitness is far far better than the younger generation. In fact, I feel that the ‘father’ coming from a small town will do far better than the ‘son’ who is a busy executive in the city. In small towns and villages the people have to walk, there are no fancy cars. They have fresh vegetables, fresh produce, plenty of clean air and certainly they are far healthier than their city bred sons who are either stressed out, stuck in the traffic, no exercise and plenty of excuses not to do so.

Are we going to see a kind of reversal of the longevity which we have achieved over the years and have younger people having lifestyle related diseases in their prime. May be yes, unless we take quick corrective steps. There is no great science involved in this. Just see your father. Ultimately it is the genes which determine your own health and see your father and follow his habits and that itself is going to make you a healthier person.

Old is gold is a saying which is worth remembering every time. It is so true!