A travel health guide to the basic sicknesses and ailments that travelers often face on the road — diarrhea, malaria, altitude sickness, motion sickness, headaches, birth control, eggy burps, cuts, scrapes, green snot, blisters, and more. Plus how to research the travel vaccinations you need for your next trip and where to find other travel health resources.
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.
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 common 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 sickness 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 medicines 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.
Travel Health: Basic Travel Sicknesses and What To Do
1. Traveler's diarrhea: 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. You could pick this up from food, water, dirty glass, anything really.
Where and when it happens: Everywhere, actually. But, in countries throughout Asia, Latin America and Africa it tends to happen more often. 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. But, this is not a cure for what's ailing you so move on to b) below.
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 azithromycin (affectionately known as “z-pack”)
Ciprofloxacin (Cipro) (update: the FDA has released information on more severe side effects for cipro and other fluoroquinolones, recommending taking it only for severe bacterial infections) — an antibiotic easily found almost anywhere in the world — as our first line of treatment. Often, you’ll see your body recovering almost immediately, in a day or two. Once you begin taking an antibiotic, you MUST take the full course to kill the bacteria. Never stop after you begin to feel good.
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. In some countries, pharmacists are highly trained and can also provide helpful advice and treatments.
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 (they taste gross, but are good for you) or buy some 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. Giardia: 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. Constipation: I can't poop!
What it is: Con-sti-pa-tion. You know that unpleasant feeling.
Where and when it happens: This is usually never a problem in places like India or Thailand where there are ample servings of vegetables in most dishes. 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. Mosquito borne diseases: 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 Center for Disease Control (CDC) malaria map of the country you are visiting to determine malaria risk for the regions where you are traveling.
Two things will matter most: where you are going and in what season. In some countries malaria is only present in certain regions and during the rainy season or at certain times of year. So, if you are traveling outside that region or period then you can avoid taking malaria prophylaxis.
Also, not all malaria is created equal. In some parts of the world mosquitos and the malaria parasite they carry have mutated to become immune to some common malaria prophylaxis. You’ll need different malaria medication for different parts of the world.
Note that depending upon the medication you choose to take you'll need to continue taking it for weeks after you return home as the malaria parasite can usually live in your system for up to 4-6 weeks.
It's also important to mention that the best protection is not getting bitten at all. This means wearing long sleeves and pants with ample bug spray, especially at dusk when malaria mosquitos are most active.
Doxycycline: Usually good for places like India, Bangladesh, Madagascar. Insanely cheap when purchased locally and this is usually what we take when our research tells us it is effective in that country. Two things to note: doxycycline tends to make people more sun-sensitive. It can also conflict with some birth control pills.
Malarone: We've used this in certain areas of Africa that are Doxycycline resistant and have particularly strong strains of malaria. It’s outrageously expensive, but its chemistry messes with your mind and body less than larium or mefloquin, some of the other traditional malaria prophylactics used for Africa.
Artemisia: On the cutting edge of malaria remedies is the Chinese artemisia plant (or qing hao, “sweet wormwood” or “sweet annie”). This now is commercially available from Novartis as the drug Coartem (Artemether 20 mg, lumefantrine 120 mg) and we were able to pick up a pack in Tanzania on a recent visit in case one of us caught malaria. This is not a prophylactic (meaning, you don't take it to prevent malaria), but instead it is used to treat malaria once you have it. The pharmacist told us it works almost immediately and it's apparently now on the WHO essential medical list.
What about dengue fever? Unfortunately, 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. And if you do think that you've come down with dengue, get yourself to a doctor or hospital as soon as possible.
5. Motion Sickness: I'm going to puke on this bus/boat.
What it is: Motion sickness
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.
We also find that not having an empty stomach helps. As does drinking a fizzy soda (e.g., Coke or Sprit). This is something we usually avoid because of all the sugar, but it can do wonders for your stomach on a crazy bus ride.
6. Altitude Sickness: 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.
What to do: If you can, take altitude slowly: acclimatize for several days, drink tons of water, move around calmly. 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.
If you do decide to take Diamoxx, follow the instructions carefully and drink tons of water.
7. Sinus Infection: 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 around 7 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 well for us.
A note on antibiotics of any kind: 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. Headaches or Migraines: 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. Cuts or Scrapes: 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. Or scratching your knee against a protruding rock or branch while hiking.
What to do: Until recently, we had only used band-aids for topical cuts and blisters. We carry a basic anti-bacterial cream for cuts and we also find that tea tree oil can also do wonders for cuts to be sure they don't get infected and dry quickly.
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
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. Blisters: My feet hurt too much to walk!
What it is: Blisters can take many forms, shapes and sizes. While they often appear on one's feet, they can appear anywhere that you've had something rubbing against your skin for a long period of time. For example, when we walked the Camino de Santiago in Spain I developed blisters all over my feet after a week of heavy walking while my nephew developed them on his hips as the waist strap on his backpack wasn't properly sized and it rubbed against his skin.
Where it happens: Anywhere in the world, really. Usually from doing a lot of walking or hiking, especially in shoes that are not properly broken in.
What to do: When I first feel a hotspot the first thing I do is put duct tape on it. Sounds weird, but it can work well to prevent that hotspot from becoming a full on blister. Once you've gone into blister mode, however, then skip the bandaids and go straight to Compeed. This is magical stuff. It essentially protects your blister and will absorb the ooze into the bandage. Leave it on until it falls off on its own as a new layer of skin will grow underneath it.
11. Boosting Immune System: I really don't want to get a cold.
What it is: When your immune system gets low (e.g., from lack of sleep, stress, exposure to bugs) and you are susceptible to picking up a cold or similar.
Where it happens: Everywhere, but often your body is more sensitive when you're on the go a lot on a trip with limited sleep and exposure to new germs.
What to do: None of this is scientifically proven, but it works for us. The moment I begin to feel that my body is compromised or weak I take zinc (always on a full stomach) combined with massive dose of vitamin C (we usually travel with Emergen-C packets). In addition, I'm a big fan of Umckaloabo drops to help give my immune system an extra boost (Audrey thinks I'm crazy).
In addition, if we're in a place where we can swing it, we'll drink a big glass of water first thing each morning with half of a lemon squeezed in it. Another natural vitamin C boost and keeps you well hydrated.
12. Birth Control: 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 buy medicines 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.
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.
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.
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.
Travel Vaccinations: How do I find out which vaccinations I need for my trip?
The first place we always go to research vaccinations is the CDC Destinations page. Select the country (or countries) where you are traveling and you'll find a list of required and recommended vaccinations for that country. Then, visit a travel clinic to double check and confirm which vaccinations you should get. This is also important to review whether you need to a booster or a new round if it's been a long time since your last vaccination.
Here are some of the basic travel vaccinations that are useful in many parts of the world: Hepatitis A & B, tetanus, typhoid, MMR (measles-mumps-rubella), polio.
Some countries will require you to show proof of a Yellow Fever vaccination to enter (e.g., Bolivia), especially if you are traveling from countries that are known to have yellow fever (usually, countries will post this list as part of their visa entry requirement). This vaccine needs to be administered at least 10 days prior to departure and often lasts for life.
Travel Health and Medical Evacuation Insurance: Do I really need it?
Short answer: yes. Really, why take the risk to save a few dollars? Just like at home, sometimes freak things happen when you're traveling and you want to get the best medical care you can without worrying about the cost. We've been fortunate to have only needed to use our travel health insurance for emergency dental work, and we were thankful we had it for peace of mind and to mitigate costs.
In addition, be sure that your coverage include medical evacuation protection in case you have to be moved to another place or country to get the medical care you need. If you don't believe us, then read this medevac experience by our friend, Dave, who broke two vertebrae in the Amazon and needed to be medically evacuated to Canada for surgery, treatment and physical therapy.
We currently use German travel health insurance as it comes with our basic plan, but previously we used World Nomads Travel Insurance for basic health and equipment insurance for over six years. World Nomads covered us everywhere except if we were within 150 miles of our home base (i.e., address used on application). We only two dental claims to replace a broken crown and one camera theft claim, but they were easy to work with for reimbursement and the coverage is relatively inexpensive.
So, that’s the low down on our travel health tips and a few of medications we carry with us on our travels. What do you do to stay healthy on the road and treat basic travel illnesses?