Poo, Pills and Parasites: Around the World Travel Health Tips

An around-the-world traveler’s guide to diarrhea, malaria, altitude sickness, motion sickness, headaches, birth control, eggy burps, cuts, scrapes, and green snot.

During my first journey outside of North America in 1997, I flew from India to Australia. On that flight, courtesy of some of Mumbai’s most phenomenal street food, my bowels turned to liquid, so much so that the flight attendants officially changed my seat from 24G to Lavatory Aft.

When I arrived in Sydney, I was totally unprepared to enjoy such a beautiful city. All I could do was poop. Actually, it was more akin to peeing, but out of the wrong orifice. And it wouldn’t stop. So I called one of the travel doctors listed in the Lonely Planet who promptly paid a house call to my hotel and charged me $90 to issue me this phenomenal bit of insight: “Oh, you just have a tummy ache.”

He grabbed his doctor bag and whistled out the door without dispensing any advice, medication, or course of action. And I whistled back to the toilet.

At best, this “travel doctor” was totally unprepared for a traveler from India. At worst, he was a hack who had somehow lucked his way into the Lonely Planet.

This guy didn’t know sh** — quite literally.

So what?

After you’ve traveled all over the creation, battling and dodging a few bugs, you come to know a few things. Or at least you think you know a few things. Or your readers think you know a few things. And they send you emails asking some very good questions over and over again about how to travel the world and avoid and treat various illnesses.

Then finally one day, you write down the answers to their questions and you put it in one place.

This is that place.

So here goes. A list of common travel illness scenarios, where they are likely to occur based on our limited experience, how you might want to treat what is going on, and some secrets on how to acquire drugs inexpensively.

Disclaimer: We do not advocate unyielding doctor avoidance and rampant self-medication. Sometimes there can be something seriously wrong, but quite often, there are some simple ways to treat what ails you without spending a lot of cash on piles of medicine at home or an overpriced doctor abroad.

Common Travel Ailments and What To Do About Them

1. I’m pooping too much! (or, It’s coming out of both ends!)

What it is: Difficult to diagnose over the internet, but most traveler’s diarrhea or vomiting comes from an intestinal bacteria or viral infection. Could pick this up from food, water, dirty glass, anything.
Where and when it happens: Countries throughout Asia and Latin America (we suppose Africa too, but we haven’t been there yet on this journey). Do your best to prevent getting sick from food with these simple tips.
What to do: But if you do get sick, the answer comes in several stages:

a) Treat the urgent: Here’s the scenario – you board an overnight bus in Kazakhstan with a queasy stomach (and it just so happens to be your birthday) and you know the toilet stops will be few and far between. From your money belt, you take a Lomotil (a tiny pill that in most cases turns your insides to concrete) or an Immodium to stop you up for the ride. Disaster averted for a few hours.

b) Address the root cause: If you’ve got it bad or your traveler’s diarrhea doesn’t go away in a day or two, it’s likely you’ve got a bacterial or viral infection. We carry a supply of Ciprofloxacin (Cipro) — an antibiotic easily found almost anywhere in the world — as our first line of treatment. Often, you’ll see your body recovering in a day or two. Once you begin taking an antibiotic, you MUST take the full course. Never stop after you feel good.

Antibiotics and Rehydration Drink
Traveler’s Medical Tool Kit: Rehydration powders, Ciprofloxacin and Amoxicillan

If you have a virus, antibiotics will not help you. Period. If what you have lasts more than a couple of days without reprieve or improvement, a doctor is in order.

If your body won’t let you keep anything down, including medication, focus on (c) below until you can.

c) Hydrate, hydrate, hydrate: Don’t just drink plain water, but find yourself some packets of hydration salts or buy some light Gatorade and cut it with water. This will help replenish your system with salts, sugars and minerals that your body has purged in response to the bacteria. And don’t take this advice lightly; it’s all too easy to end up in the hospital from dehydration.

2. My burps smell like eggs.

What it is: When you’ve got a case of burps that smell and taste like eggs, rotten eggs or sulfur, there’s a good chance you are dealing with a water-borne parasite like giardia.
Where and when it happens: Latin America, Asia, Africa.
What to do: Take a full dose of Tinidazole (4 tablets at the same time). If you can’t get tinidazole, try flagyl. If you in fact have this particular parasite, the burps will go away and you’ll feel better pretty quickly. If they don’t, get yourself to a doctor.

3. I can’t poop!

What it is: Con-sti-pa-tion.
Where and when it happens: This is usually never a problem in places like India or Thailand, but it can slow you down when you hit the pasta, bread and dumpling belt of Central, Eastern and Mediterranean Europe.
What to do: What can we tell you? We don’t carry pills for this one. Back off the pasta, dumplings, bread, and cheese. Down as much fruit, greens and water as you possibly can. If that doesn’t work, bring out the big guns and eat a bag of Chinese salted prunes (with another few liters of water). And if that still doesn’t work, find your way to a pharmacy and have fun charading your problem.

4. I don’t want to get malaria.

What it is: A parasitic disease transmitted by the bites of infected mosquitos.
Where it happens: Africa, parts of Asia, select parts of Latin America
What to do: Once you have a rough itinerary, consult the CDC malaria map to determine malaria risk for the regions where you are traveling. Two things will matter most: where you are going and in what season.

Not all malaria is created equal, so you’ll need different medication for different parts of the world.

Doxycycline: Usually good for places like India and Bangladesh. Insanely cheap when purchased locally. Two things to note: doxycycline tends to make people more sun-sensitive. It can also conflict with some birth control pills.

Malarone: We’re carrying it for an expected trip to Africa. It’s outrageously expensive, but its chemistry supposedly messes with your mind and body less than larium or mefloquin, the traditional malaria prophylactics used for Africa.

On the cutting edge of malaria remedies is the Chinese artemisia plant (or qing hao, “sweet wormwood” or “sweet annie”). Although we’ve heard it’s possible to get herbal concoctions of artemisia (or artemisinin) in Africa, it appears to be commercially available from Novartis as the drug Coartem (Artemether 20 mg, lumefantrine 120 mg). It’s apparently now on the WHO essential medical list.

Dengue fever? There is no prophylactic medicine for dengue. The best thing you can do is avoid being bitten — particularly during the day, as dengue mosquitos are usually day-biters.

5. I’m going to puke on this bus/boat.

What it is: Motion sickness
Where and when it happens: On windy buses in the mountains of Bolivia, Peru, Myanmar, and Laos. Or crossing the Drake Passage on the way to Antarctica.
What to do: If you’re prone to motion sickness, keep a stash of Dramomine or similar in your money belt and take it 30 minutes before departure. If you take it once you’re on the road, it’s too late. As a side benefit, Dramomine will usually knock you out so you don’t have to watch the death defying acts of the bus.

Purchase a pair of pressure point wrist bands (usually go by the name of Sea Bands). Not sure if their effect is psychosomatic or real, but I’ve found them helpful in the past.

6. I’ve gone too high. My head is going to explode.

What it is: Altitude sickness.
When and where it happens: Hiking or walking anywhere above 2500 meters, particularly if you’ve just arrived by air, train, or bus. The worst we’ve ever experienced was taking the bus from sea level in Lima to Huancavelica, Peru over South America’s highest pass. Flying into Lhasa, Tibet from Kathmandu was also bad. Cold sweats and a feeling like our heads were going to blow right off.

Taking a Break - Day 2 of Salkantay Trek, Peru
Feeling the altitude on the Salkantay Trek in Peru.

What to do: If you can, take altitude slowly, acclimatize. Outside of that, we prefer local remedies like garlic soup (recommended in the Nepali Himalayas to thin the blood) or coca leaves (recommended in the Andes, chewed or in served in coca tea) before resorting to traditional altitude sickness drugs like Diamoxx.

7. My snot is green.

What it is: When that cold or cough starts producing thick mucous, then yellow mucous, then green, it’s possible you’ve probably developed a sinus infection.
Where it often happens: After a lot of hand-shaking or holding onto stuff in public, not washing your hands. In heavily polluted cities where air quality is poor and there is lots of stuff floating around the air. Dhaka, Bangladesh and Beijing, China come to mind.
What to do: After 7-10 days with no improvement, go for a round of an antibiotic like Amoxicillan. It seems like Amoxicillin has fallen out of fashion in the U.S. (probably because it’s been overprescribed and is no longer terribly effective) but it is easily found around the world and has worked for us.

A note on antibiotics: We try to avoid taking antibiotics if we can because they kill all the bacteria in your body, including the good bacteria in your gut (yes, there is such a thing and it helps keep you alive). Additionally, over-prescription of antibiotics in recent years has helped lead to drug-resistant supergerms.

8. There is a little man pounding inside my skull.

What it is: Depending upon the intensity and location of said little man, you could be experiencing a garden-variety headache or a migraine.
Where and when it happens: After a series of overnight buses with blaring music (especially Tibetan music) and jerky stops. Sleeping in cheap hotels with oversized pillows and people yelling outside your room during the night.
What to do: For regular headaches, Tylenol or Advil will usually do the trick.

Audrey experiences debilitating migraines with such intensity that it makes her stomach turn and she feels as though her head is no longer connected to her body. For these, she uses Saridon (Paracetamol 250 mg, Propyphenazone 150 mg, Caffeine 50 mg), an over-the-counter medication (in Czech Republic, that is).

9. Help! I’ve got blood oozing from my arm/leg.

What it is: Scrape, cut, road rash.
Where it happens: While riding motorbikes around Koh Samui, Thailand or juggling knives. Or an Italian porcupine quill stabs you from the depth of your backpack.
What to do: Until recently, we had only used band-aids for topical cuts and blisters. Then, I wiped out on a motorbike and we had to dig a bit deeper into the medical kit.
a) Saline solution – for disinfecting and cleaning wounds
b) Povidine – anti-infective
c) Antibiotic cream (polysporin) – after cleaning, put on top to fight infection
d) Cortisone cream – for bad bites and skin rashes

Medical Kit: For Scrapes, Cuts and Blisters
First Aid for Scrapes and Cuts

Note: After my motorbike incident in Thailand, my first instinct was to take a shower and scrub the wounds with antibiotic soap. We later learned that this was unwise. Water in Thailand is full of bacteria (as it is in many places). I could actually have made my situation worse by infecting my open wounds.

10. I don’t want to get pregnant (umm, that’s Audrey writing here)

What it is and where it happens: Me hopes you should be able to figure this one out on your own.
What to do: Contraception options are many, but if you choose to take birth control pills, here’s some advice:

Before you leave home, ask your doctor to put you on a pill with a hormone formula that is more universally known (i.e., you do not want cutting edge technology). Drugs are known by different names around the world, so write down the commercial name of the drug as well as its chemical and hormone structure.

In our experience, many countries outside of North America and Europe (and I assume Australia) will sell birth control pills without a prescription. Along your journey drop into pharmacies and ask if they carry your particular pill. Birth control pills were rather expensive (especially by local standards) and choice was limited in many Central and South American countries. However, they were relatively inexpensive and easy to find in Argentina. Same goes for Thailand. So, when you find yourself in a country that carries what you need for a good price, stock up.

How do you score all these drugs on the road?

We’ll let you in on a little secret. Most pharmacies outside Europe, North America and Australia will sell you whatever you need without a prescription and at a much lower cost than you’ll find at home. Our advice: if you’re going on a long journey, travel first to a country where prescriptions are not required for basic medications.

Thai Pharmacy - Koh Samui
Pharmacy in Thailand.

For example, when we arrived in Thailand in December 2006, in anticipation of a trip to Central Asia, we took the recommended medications page from our Lonely Planet Central Asia guidebook to a pharmacy in Bangkok. Within a few minutes we had a counter covered with everything we needed.

Prescriptions: not necessary.

Prices: much cheaper than back home in either the Czech Republic or the U.S..

Medicines (at least based on our experience): authentic.

The pharmacist spoke English well and reviewed indications and dosage for everything we bought. We were good to go. Thus, our portable pharmacy was born.

Our Portable Pharmacy
Audrey and Our Portable Pharmacy

Advice on Buying and Restocking Medicines Abroad

  • Write down the chemicals (and percentages) that go into the medication you need instead of just the commercial or generic name of it. The chemical names translate roughly the same in all languages even if the medication is called by another name in that country.
  • If you fear purchasing fake or sub-par medicine, find yourself a major pharmacy chain (e.g., Boots or Watsons in Thailand), ask locals where they buy their medication or go directly to a reputable hospital to buy from the onsite pharmacy.
  • Be aware that if you require highly specialized or newly released medication, you may not be able to find it on the road. In that case, you should purchase a supply for the length of your trip from your pharmacy at home. Also ask your doctor if there is a similar medication or formulation which might be more widely available around the world and switch to it instead.

So, that’s the low down on a few of medications we carry with us on our travels. What do you do? What’s in your portable pharmacy?

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Comments

  1. Tony says

    Doctors or druglords? You decide. Although, Dan has always had some hypochondriac-tic tendencies, this is a useful argument, albeit somewhat irregular.

    Thanks for the sidetrack bitches!

    T

  2. says

    That doctor is either the worst or the smartest I really cant tell. If I could get people to pay me $90 just to tell them they have a stomach ache well go figure. Seems like you have almost everything under control I need you along when I travel.

  3. says

    Hey guys, great post, lots of helpful info.

    I have had malaria twice and both times used coartem as emergency treatment. Worked great. Started to see relief within 12 hours. It is a very powerful drug owing to the fact that, as you mentioned, it has both artemether and lumefantrine in it.

    As far as the traveler’s diarrhea, I would note a few things:

    If there is blood, get to a clinic asap. I had amoebic dysentery in timbuktu last fall and, not knowing what it was, tried to treat it with cipro. This of course did not work and extended my misery. When I did make it to a clinic I was given Metronidazole and Paromomycin.

    A word of caution about cipro. There is a lot of evidence suggesting that overuse of cipro is contributing to rapid bacterial resistance. Best to use cipro as a last resort. I will use the rehydration salts, let the diarrhea run its course, and if it’s still around after a few days, then I will start taking cipro. Another thing is that cipro destroys all your intestinal flora, good and bad, and it’s a good idea to take a probiotic after, or eat yogurt :)

    Be well,
    Phil

  4. says

    One thing we loved about South America was the easy access to drugs/medical treatment. We had a lab test, doctor visit and bought drugs for treatment of parasites in Ecuador and the whole process took less than an hour and cost $15 total.

    We joked that it would never have happened that fast or cheap back home in the USA – but then again, we probably wouldn’t have gotten parasites from the water there, either. :)

    I will also second what you said about using time/natural remedies to adjust to altitude. I took the pill when going from sea level to 10,000 feet and was really sick before we even arrived and my fingers went numb (you take it 12-24 hours ahead). Better to just plan on a few days of easy activity and lots of water.

    We get sick a lot more on this trip than we did back home, but it is usually of the minor variety from adjusting to new foods/water/environment all the time. With the right kit like you describe, you can usually be back on your feet in no time.

    Thanks for being brave and talking about your poop!

  5. says

    I was given Septrin here (in Chile) as an anti-malarial, because at least here, Malarone was not available in 2005. Also, antibiotics are not available without a prescription here in Chile (theoretically and for practical purposes for gringos, though there are exceptions), so people should stock up before they get htere or be prepared to go to the doc for around $30 to get the prescriptions.

    Also, any chance of you doing a vaccine post? Let me know, and I can send an email with my experiences. Hint: first yellow fever shot makes you feel like death. Subsequent ones, not so bad!

  6. says

    If that’s the case, medicinal kit isn’t enough. You should also know how to medicate by natural means in case no prescription drugs in available in that area. Sometimes, we get sick on the water that we drink so even it’s a bit pricey, we need to drink bottled water instead.

  7. says

    I get really terrible altitude sickness, so I packed a bottle of gingko biloba before coming to Bishkek, seems to work well for me. My first week here though, I caught something awful that sounds related to whatever Dan caught in Mumbai and my first stop was to a local pharmacy for some Cipro. One pack cost about 25 cents! I’m still not sure if it was authentic but it certainly did more harm then good, I ended up getting a shot of painkillers and a “prescription” for rehydration salts from a sweaty Kyrgyz doctor at 4am.

    I don’t know how widespread it is outside of Kyrgyzstan or Central Asia, but the go-to pill for any sort of stomach bugs is a pro-biotic thing called Linux, which also greatly helped once I was hydrated enough to keep it down.

    Yeah, definitely not a pleasant topic but totally helpful!

  8. says

    Hi there!

    Great article, you seem to have covered the bases and given me a better idea of what to pack on our upcoming cycling expedition to Oz.

    I would love to purchase the medications ‘on the road’ but since many of the roads we’ll be cycling along may well be pretty barren I’m going to play safe and fork out for the majority of my medical kit from blighty.

    See you on the road!

  9. says

    @Tony: Wow, dude. Sounds like you need a hangover remedy. I’m leaving those two comments there for posterity.

    @Kirk: I’d say the Sydney doc was pretty clever. Yep, and he kept repeating, “Oh, you just have a tummy ache.” He was like a robot. Great accent, though.

    At the moment, under control. But it’s just at that point when the world pulls the rug out from under you.

    @Phil: Terrific comment. Thank you. Qualifies as a must read addendum to this post.

    Excellent to hear that Coartem works. The question now is where in the developing world to get it? Is it widely available?

    Good advice regarding gut bugs, parasites, amoebas. Basically, you have to wait a bit (usually 24-36 hours, unless you are clearly dying) to figure out if it will pass on its own. Then from there, it’s a matter of trying to sort the symptoms. Blood in the stool qualifies as “get to a doctor” territory. Thankfully, not something we’ve had to deal with…yet.

    I’m not surprised to hear about cipro resistance and overuse. It seems to be happening, in time, to just about every antibiotic.

    Your points about yogurt, well taken. See items 6a and 6b:
    http://www.uncorneredmarket.com/2009/08/ten-tips-for-staying-healthy-on-the-road/

    Again, thanks for the comment and the perspective. Absolutely relevant and agreed.

    @Betsy: Isn’t it amazing how doctor and hospital visits can be so economical outside of the United States. Gotta wonder how that is.

    I’ve heard terrible things about Diamoxx. Applying Phil’s principles above, it should be used as an absolute last resort. Our guides in Nepal told us that. I’ve heard (not sure if this is correct) that Diamoxx imparts some kind of effervescence in the bloodstream. That is enough for me not to use it, unless it happens to be the only thing between me and death by altitude.

    I can’t believe you thanked me for talking about my poop! Love it. Glad I/we could be of service.

    @Matt: Cool. Glad we could help.

    @Andi: Let’s hope.

    @Eileen: We will write a vaccine post. We were thinking of cramming into this post, but thought it wise to split them up.

    Will email you about your vaccine experiences, but yes, please send.

    @Kendal: Agreed, natural remedies are preferable to all drugs and chemicals. Particularly in the case of stomach and intestinal bugs, the natural path often means waiting it out.

    And yes, we completely understand bottled water while traveling. While it’s more expensive and we’re not pleased about plastic bottles, it could mean a world of difference to one’s trip.

    @Claire: A vaccine post is coming.

    @Kirstin: Gingko biloba for altitude sickness. Didn’t know about that connection.

    Regarding your experience with cipro, it sounds like it might have been fake. 25 cents sounds a little too inexpensive. Or, as Phil suggested, if you had a parasite, cipro might have made things worse.

    Anyhow, it sounds like the 4AM sweaty Kyrgyz doctor sorted you out.

    Linux probiotic. Great tip. Don’t know about it, but am definitely going to do some research.

    Yogurt (and fresh probiotics) are wonder drugs for the stomach. We’ve met other travelers who say that when they become ill, they eat fresh yogurt. Sounds odd, but I get it.

    Travel sickness(es) are unpleasant, but they are realities of the road.

    @Andy: Am hoping you won’t have to resort to any of this on your trip. Safe and healthy travels.

  10. Colleen says

    What a fantastic blogpost! I can totally relate. I am going to have to link this to my blog. Good stuff! Lima misses you guys!!

  11. Louisa says

    Great post; it’s very useful information.

    I’m heading to Tibet soon so altitude sickness is something that I’m worried about. The guides of the tour company I work for say sucking on some hard candy or chewing gum to help combat the symptoms. I haven’t tried it but they claim it has helped some of the people on their tours to Tibet and Yunnan.

  12. says

    Its funny all the things that you don’t really think about when you are travelling and having to be prepared for all cases of sickness is essential. Elise my better half got altitude sickness whilst in Nepal Trekking and I never knew have dangerous it could of been. Unfortunately we didn’t make it to Base Camp as she was throwing up and had major headaches. Good to be prepare with the necc drugs though. We try and stay as natural as possible and only take antibiotics when you really need them. Great info in this post ;)

  13. says

    @Phil: Thanks for replying. Excellent to hear about Coartem in Africa.

    @Colleen: Great to hear from you! We miss you…and Lima too. (By the way, you were on that head-wrenching bus with us from Lima to Huancavelica. I get heart palpitations just thinking about how my body reacted to that journey.)

    @Scott: Everyone poops. I know that because I read it in a book. As for this article, poo was the hook. Useful travel information is what I hope readers leave with.

    @Louisa: Hmmm. Sucking on hard candy sounds like it might work for a rapid decline in altitude (for the pressure). Maybe add “drinking a lot of water” to that list. Would be interested to hear how it works out for you.

    @Anthony: My sense is that altitude becomes dangerous if your body tells you should stop ascending, and in response you ignore it or mask the symptoms. Sorry to hear about Elise’s experience.

    Taking antibiotics only when you need them (or really, as a last resort) is the way to go.

  14. says

    Great tips here. Cipro and dramamine are our essentials. I could find my birth control pill in South America but annoyingly my brand was a lot more expensive than others (and being a Brit I’m not used to paying!) so that’s a good idea to switch to a common brand.

  15. says

    @Erin: South America was definitely hit and miss on the birth control pill front. Am glad to hear that cipro has worked for you, and that you didn’t have any episodes where you took it and things ended badly (as it did for others above).

    I hear you about dramamine, but I’m finding that as susceptible to motion sickness as I used to be, I’m getting better these days and usually don’t need pills. I probably should have mentioned above (and I’ll probably add it) that it’s important to make sure that you have a pretty full stomach before you get on the bus. It sounds counterintuitive, but an empty stomach seems to bring on motion sickness a lot faster for the two of us.

  16. says

    Smelly subject; great article! Can I add another tip – don’t be fooled into thinking that un-cooked food – eg salads – is safe. One of my worst bouts of heevie-jeebies in a lifetime of travelling came after eating a harmless-looking lettuce leaf salad in Turkey (at a three star hotel too!!). Yes, they had washed it beforehand, said the manager … but ugh, it was the water they washed it in that did the damage. PS: same goes for ice in your drinks; think where it might have been before it got into your vodka and coke!
    Happy travels, Richard

  17. says

    @richard: Funny you mention raw food and its safety. Ice. Ugh. In India, it’s sometimes wheeled around on the poop-stained burlap. And unless we are talking about meat that’s turned, it’s never about the vegetables (or the food in general), but the water it comes in contact with. Cooked is better than fresh. A previous article we wrote about staying stomach healthy on the road talks about all of this:
    How to Travel Without Hugging the Bowl

  18. says

    ref # 25 … Daniel, great to get your reply – and even better to find that you are still travelling ( and still talking to each other!) after so long. Maybe you remember me – and co-driver Phil – in Turkmenistan in the Aston Martin (yeah, yeah)! Your tip that cooking is better than fresh is so true, although it may not always seem that way. Strange too, that you should mention India … with any luck that will be my next travel adventure! I’ll keep you posted. Meanwhile, happy travels to you both!

  19. says

    @richard: Of course we remember you and Phil. (My reply should have been more personal.). In fact, when sharing travel stories, we refer to meeting you guys often. That was a phenomenal journey for so many reasons, not the least of which was the opportunity to meet two guys driving (speeding?) across Asia in an Aston-Martin — and one of them being fined for smoking in the car!

    India? Can be epic. Enjoy it!

    Still traveling we are. Occasionally, we still speak to each other ;)

  20. says

    Daniel and Audrey; your travelog is certainly one of the best there’s ever been (no bullshit) and your stamina for travel simply amazing. I’d like to put a link across from my publishing website if that’s OK so hopefully more folk can learn from, and enjoy, your experiences. About India? Yes a place of fascination and frustration in equal measure. I have been there three times now and still cannot get it out of my system. They have not many tigers left(nor has anyone else for that matter) as you probably know – which is why I am thinking of going there again soon on another adventure … watch this space! Meanwhile, love and luck to you both.

  21. says

    @richard: Thank you! Your compliment really means a lot to us. By all means, please link to us. And if there are any questions that ought to be answered here (besides what medicines to take with you on the road), just let us know.

    India: When you are there, you’re dying (sometimes quite literally) to leave. And when you’re gone, you’re dying to get back. That’s just the way India is.

    Good luck with the tiger “hunt”. If it doesn’t pan out in India, we can recommend a honey-hunter tiger trip in the Sundarbans, Bangladesh. OK, enough of me here. Am going to send you an email!

  22. says

    This post made my stomach churn and my skin crawl. In a good way, of course!

    Extremely useful (not to mention well-timed) information as I leave for an India-Thailand duo with an ending in Mediterranean Europe next month.

    One question, though. Bugs LOVE my blood…any suggestions on what to use to avoid the nasty bites?

  23. Cheryl says

    I’ve found that, as dietary aids/remedies (particularly in tropical/sub-tropical countries), green mango calms diarrhoea, while papaya relieves constipation.
    Also, hot rice water (the water that rice is cooked in) or cooked rice with hot tea poured over it to make a kind of soup will go a long way in alleviating gastro problems.
    Thanks for a great article.

  24. says

    @Sarah: Tummy health in Mediterranean Europe should be easy. Thailand less so, but still relatively safe and easy. India, that’s a whole different tummy health and bug ballgame. Everyone reacts differently. We stayed healthy in India, in great part thanks to following the travel food rules in a piece called How to Travel Without Hugging the Bowl.

    Regarding mosquitos, they love me, too. I’ve tried everything. The key is not to get bitten. Light fabric and light color long sleeve shirts and pants are best. Outside of that, be sure to spray your ankles and elbows when you go out around dusk. That’s when the mosquitos are the worst. And those are the prime parts of my body that they love to eat. As a natural mosquito repellant, you can also try Vitamin B6.

    Hope that helps!

    @Cheryl: Thanks for the tips! Green mango and papaya. I never knew. Usually when tummy troubles strike, the last thing I’m thinking of are fruits and vegetables of any kind. Next time, green mango.

    Hot rice water makes a lot of sense. A good friend of our who lived in Chennai, India for a couple of years said that yogurt rice was the food of the gods when it came to being sick or just recovering from tummy problems.

  25. Cory Annis, MD says

    Great practical post! May I add a few tips to your wonderful post?

    Diarrhea: Boiled GREEN bananas are also good for treating diarrhea. (There is even research to support this, if anyone’s into that). There are complex starches that act as “binders” in green bananas that degrade as the fruit ripens. Ripe bananas are still a good non-challenging food to eat when recovering from diarrhea. They just don’t stop things up as much. Boil them in the skins for 10 minutes then cut off the top and squeeze out the innards. Cool and eat.

    Culturelle (lactobacillus GG) is a stable capsule form of probiotic that travels well and can be swallowed whole or sprinkled on food. It helps restore “good” bacteria to a “scorched” colon, as does yogurt.

    To prevent dehydration: If you cannot lay your hands on premixed rehydration fluid, try a 50/50 mix of boiled water (or tea) AND fruit juice (or sugared soda) with an added pinch of salt per glass. Plain water, even if clean, is not easily absorbed by an inflamed intestine and you will pass it on through or vomit it back. Salt and sugar, however, “trick” the intestine into letting the water into your blood stream. Drink enough fluid to pee 4 or more times in 24 hours, no matter what is coming out of you elsewhere. If vomiting, try to drink only a tablespoon (15 mL) every 5-10 minutes. If you go an hour w/o vomiting, increase to 2 tablespoons (1 ounce, 30 mL) every 10-15 minutes. After an hour, go to every 5 minutes for an hour. Drink naturally after that. If you do vomit, wait 30 minutes and start again at 15 mL (1 TBSP).

    For nausea: Bonine (meclezine) which is available in any airport, will treat nausea, vertigo, motion sickness, and insomnia. It will make you sleepy,though, so be aware of your surroundings, your activity and your buddies. take anywhere from 12.5 to 50 mg every 6-8 hours, depending on the desired effect.

    For constipation; Try plain magnesium tablets are very portable and cheap. Take 250-500mg once a day at bedtime. Prunes and pears are great natural sources of sorbitol. This also is the un-digestable sugar that serves as the sweetener in sugar-free (or “dietetic”)hard candy(which makes a good portable laxative on it’s own).

    Magnesium is also a mild blood vessel relaxer, which may be how it helps ward off migraines and improves muscle cramps.

    Thanks, now that I’ve found you, I can’t wait to read more about your adventures.

    Cory Annis
    @TheUnorthodoc

  26. says

    @Cory: You may add some tips, and you have. Thank you!

    Fabulous helpful suggestions. I especially like these ideas:
    - green bananas (boiled in the skin) as a natural “stopper”
    - dehydration prevention: we know the value of salt and sugar, but not as an element of trickery. Very cool. And the idea of drinking a spoonful at a time and increasing as you can is terrific.
    - I’ve used Bonine before with similar results to Dramamine. A great sleep agent for a bus ride, too.
    - Magnesium. Another great idea. And since Audrey suffers from the occasional migraine, it’s good to know it’s good for blood vessels and therefore the head and gut.

    Exceptionally valuable advice for the traveler. Thank you again!

  27. says

    A great and sometimes necessary post, Daniel. I’ve also found medical evacuation insurance from MedJetAssist reasonably priced (and a great gift idea if your parents don’t understand your traveling habit).

  28. says

    @Annie: You are welcome. Though you have to be careful about medicines (and it’s often quite difficult to determine authenticity), we’ve had very good fortune with whatever medicine we purchased. Most of the stuff in our medicine cabinet hails from Thailand, India, Argentina, Tanzania, etc. Safe and healthy travels!

  29. L. DuBick says

    I take Cipro with me on all my trips. Extremely effective. But unlike most other antibiotics, Cipro should be taken until one feels relief (usually in just a day or two) and then be discontinued. You don’t finish all the doses in the prescription.

  30. says

    @L DuBick: The reading I have done on ciprofloxacin says that the entire prescribed course/dosage of cipro should be taken — even if you feel better or if it seems the infection has cleared up. Stopping early increases the chance that the infection will return. This behavior also helps to create antibiotic-resistant bacteria.

    Thanks for your comment!

  31. Nisa Montie says

    Thanks Audrey and Dan for the great blog–and all you awesome Commenters. I am sure these tips will help us on our trip to South America. Peace and Joy, Nisa

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