A 25-year-old woman who lives in Sonipat, a town in India about 50 km northeast of the capital New Delhi, wishes to be able to sit down with her family and enjoy a humble meal of dal and rice or to enjoy the succulent flesh of a freshly picked mango. However, these simple pleasures have been denied throughout her life due to a rare condition.
Diagnosed with achalasia, a condition in which food is prevented from passing from the gullet through to the stomach, Manju Dharra cannot eat solid food and lives off only a liquid diet which is largely made up of milk.
“If I eat something, then I throw up, and I feel very, very bad. Now I feel fear when I look at solid food,” said Manju.
Every single day, Manju gets through a staggering four to five liters of milk. Because her parents are unable to afford the required treatment, they’ve made temporary arrangements to suit her needs by buying her a cow and providing her with the amount of milk that she must consume.
“Manju hasn’t eaten solid food since she was born,” explains Bhagwati Dharra, Manju’s mother. “She takes only fluids like milk, tea, water and sometimes juice. Mostly she takes milk, tea, buttermilk, water. If she eats solid food, she faces the problem of vomiting suddenly.”
Living with two sons and five other daughters who fortunately don’t suffer from the same condition as Manju, it took some time for the parents to realize that one of their children had a serious problem. Manju was on a diet of milk when she was a baby, and her mother was not concerned about it. Initially, Manju’s parents believed their daughter was just a fussy eater or that she was simply mischievous by playing with her food and not wanting to eat it.
“When she was two years old, like every child, we tried to give her some solids like rice, bread, biscuits but she cried again and again and threw up the food,” says Mrs. Dharra.
As time passed by and Manju still did not show signs of being able to hold her food down, her parents figured there had to be some sort of explanation to this.
As it turned out, Manju is medically ill all along. The family explained that they have taken their daughter to various doctors and tried various medicines, but none of the numerous treatments she’s been through have given her any respite so far.
According to the NHS website, achalasia means that your gullet has lost its ability to move food along and the valve at the end of your gullet fails to open to allow food to pass into your stomach. As a result, food gets stuck in your gullet and is often brought back up.
A ring of muscle called the cardiac sphincter keeps the opening from the gullet to the stomach shut tight to prevent acid reflux (acidic stomach content moving back up into the gullet). Normally, this muscle relaxes when you swallow to allow the food to pass into your stomach. In achalasia, this muscle does not relax properly and the end of your gullet becomes blocked with food.
The factors behind achalasia are still uncertain up to this day. “Achalasia is caused by damage to and loss of the nerves in the gullet wall,” the NHS says. “The reason for this is unknown, although it could be due to a viral infection earlier in life.”
Pediatrician Dr. Adarsh Sharma explains that the condition could be cured by an operation and says that the family needs to consult a specialist.
Surprisingly standing at 165 cm, Manju is above average regarding height for Indian women and even manages to do daily household chores. Despite suffering from occasional stomach pains, she appears otherwise healthy. On the other hand, Manju’s parents are worried about her future, wondering how she will be taken care of.
“What happens after marriage?” Mrs Dharra asks. “Who will give her four to five litres of milk per day?”