India

How do you end a 16 year hunger strike safely?

Indian political activist Irom Sharmila picks up a bottle of honey to break her fast in Imphal, north-eastern Indian state of Manipur, India, Tuesday, Aug. 9, 2016 Image copyright AP

How much time will it take for a person to return to a normal diet after more than a decade of hunger striking?

In the case of Indian activist Irom Sharmila, who has been described as the world's longest hunger striker, doctors say it could be anything between four and six weeks before she can eat normally again.

The 44-year-old activist's campaign against a controversial security law had led to her being detained in a hospital room in Imphal, the capital of India's restive north-eastern state of Manipur, for most of 16 years.

In detention, she was surrounded by armed guards and a team of doctors and nurses who would force-feed her liquid nutrients through a nasogastric tube.

Once a year, she'd be released because the maximum sentence for attempting suicide is one year - but police would quickly re-arrest her after she continued her fast.

On Tuesday, she symbolically ended the fast by tasting some honey, saying she would end the hunger strike in order to enter politics.

How does nasal force feeding work?

A nasogastric tube is a feeding pipe inserted through the nose, past the throat and into the stomach. Feeding through the tube prevents dehydration and starvation, and maintains the person's body weight.

Doctor say feeding through the tube is common for people in coma over a long period of time or patients in advanced stages of degenerative neurological diseases. They are fed with tubes because they cannot eat or swallow and food can get stuck in their windpipe.

Image caption Ms Sharmila has spent most of the last 16 years in judicial custody in a hospital in Manipur's capital, Imphal

Patients suffering in coma have been fed through tubes for decades. A nurse, who spent 42 years in a persistent vegetative state after being raped and strangled, was fed through the nose to keep her alive. She died last year in a hospital in Mumbai.

Through the tube, Ms Sharmila was force fed a carefully calibrated liquid diet containing protein, carbohydrates and vitamins up to three times a day - reduced to two times in recent years. The diet included food supplements, apple juice and vitamin syrups. Doctors say they altered the dosage if she lost or gained weight.

"You can maintain a balanced diet through liquid food fed through a nose or directly to the stomach through an incision in the abdomen," says Dr Randeep Guleria from All India Institute of Medical Sciences, who treated Ms Sharmila once when she was admitted to hospital in 2006.

Doctors reckon a total of around 800ml-1000ml of liquid nutrients providing fats, proteins and carbohydrates, divided into three to four dosages every day is sufficient to keep the patient on a nutritious, nasal-fed diet.

Image copyright AP
Image caption She tasted honey to symbolically break her fast in front of journalists in the hospital

Can she eat normally again?

People who have not consumed solids in more than a decade will have to be careful when they go back to eating normally.

"Ms Sharmila will have to slowly graduate to a solid diet. Since she's not eaten orally for long, her chewing can be slow, and her muscle of mastication used for chewing may have wasted a bit. So she will have to begin with semi-solid food and graduate to solids," says Dr Guleria.

Image copyright AFP
Image caption Her campaign against a controversial law had led to her being detained and force-fed through a tube in her nose

Doctors have to keep a close watch on her during this period. Doctors say she could suffer from acidity and gastric problems if she consumed too much solids too soon.

"Ms Sharmila should be under the supervision of a nutritionist as she returns to a normal diet," says Dr Rommel Tickoo.

"She will begin with semi-solid food which is easy to digest like mashed potatoes and bananas, and have curd. Her sodium and potassium levels have to kept in control."

But, if that goes well, Ms Sharmila will finally be able to eat - including her favourite curry, made from fermented soya bean and vegetables, again.

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