Food & Water

by Max Lent.  � 2003 Max Lent

Travelers get sick from eating and drinking in foreign countries.  I hope this does not come as a surprise to you, but some countries in the world are not as clean as the U.S. By clean I mean that their water supplies may not be purified, their food may not be subject to inspection by government agencies, and their food service workers may not be urged to wash their hands when the returning from bathrooms--if there are bathrooms. 

A typical scenario regarding cleanliness is one that I saw acted out in Old Delhi, India.  Shopkeepers consider offering tea to shoppers, especially buying shoppers, hospitable.  Outside one shop I saw a little boy rush out to a running faucet in the street with cups from the shop.  He rinsed the cups in the running water and then laid them in a pan of dirty water beneath the faucet.  After all of the cups had been rinsed in "clean" water and placed in the dirty water he wiped them off with a dirty rag that had laid on the ground next to the faucet and returned them to the store.  The water coming from the faucet was also likely contaminated.  The customers in the store had no idea what I had seen and probably didn't expect anything different.  The little boy did everything he was supposed to, only in the wrong order and with the wrong tools.  If I had consumed tea from those cups stomach pain and diarrhea would have followed.  I know this from experience. 

I worked at the UCLA School of Public Health, Parasitology Department for twelve years.  My time in the Parasitology Department does not qualify me as an expert or even a serious amateur on parasitology.  However, I was exposed to lots of anecdotal stories about parasites from experts in the field.  From this experience I can tell you that eating food and drinking fluids are unsafe anywhere in the world.  I have seen hardcore meat eating military types turn into hyper-vigilant vegetarians after only a few weeks of parasitology lectures and labs. 

Touristas, Montezuma's revenge, or traveler's diarrhea

Nothing can ruin your day or even your whole trip faster than diarrhea.  At the least opportune moment your stomach rumbles a little (or a lot) and you feel this acute immediate need to evacuate.  Problem is, you are no where near a public toilet, so the drama begins.  Will you find a toilet before it is too late.  Sweating, not the perspiration you were feeling from the tropical heat, begins in earnest.  Any thoughts about art, archeology, or culture are gone.  The only thing you can concentrate on is your sphincter and the search for toilet.  You search your mind and then your tour book looking for the phrase for where is the toilet. 

If you are in Mexico City, Cancun, or Merida, your problems are over, kind of.  You will likely find a nearby toilet, perhaps with toilet paper.  If you are on a second class bus bumping on rutted roads in the countryside you are in trouble.  With each bump of the road you will feel closer to exploding.  Then there's the cramps.  Cramps can be so severe that they will make you cry from the pain and bend you over in a second.  The problem with the cramps is that they take your mind off of your sphincter and that can be eventful.  Then something new comes to mind, you feel like you are going to vomit and you do quicker than you would expect.  If you make it to the bus window in time you feel a sense of success until you realize that your vomit is being blown along the side of the bus and back into the window from the wind.  Having experienced these symptoms more times than I care to remember, I can say that I always managed to hold on until a toilet was found.  I cannot say that about fellow travelers. On one overnight ferry trip from LaPaz, Baja California to Mazatlan, Mexico I gleaned some insights the hard way.  A Chubasco (hurricane) had rolled across the cape region of Baja California during the days prior to the departure of the ship.  The Sea of Cortez was still rolling with high waves, but the sky was nearly clear.  Having just survived driving the length of the Baja Peninsula, having being stranded in another more severe Chubasco, having been very ill from severe diarrhea, and having been given up as dead by Los Angeles radio stations I was weak and nearly broke.  To save money I booked deck passage on the ferry.  The night tropical.  The air was thick with humidity and body temperature warm.  Hundreds of peasants had also booked deck passage.  Most quickly set to spreading out blankets and bedrolls  far away from the railing, near the center of the ship.  I surmised that they were worried about getting wet should waves break along side the ship or that they were afraid of being washed overboard.  Not being afraid of either consequence I rolled out my sleeping bag near the railing.  When the ship reached open seas and began to roll with the waves, the deck passengers became seasick.  People, a dozen at a time, jumped up from their bedrolls and began running to the railing to vomit.  Many ran by or over my sleeping bag and not half of them made it to the railing in time.  I rolled up my soiled sleeping bag and spent the rest of the night in the ship's cafe watching Mexican television until they closed and then spent part of the night standing at the railing on the bow of the ship.

Toilet Paper Don't leave home without it! I know from experience that toilet paper is in short supply in Mexico, India, and Russia.  If you expect that you can get off a jet and take a cab to an internationally famous museum and expect to find toilet paper in the restrooms, you are in for a surprise. Many years ago I was stranded in a toilet stall in an art museum in Guadalajara, Mexico.  It was some time before my wife found any usable paper.  Her solution was to purchase a newspaper.  It worked, sort of.  Now I carry a small packet of facial tissue with me wherever I travel.  I either carry in a jacket pocket or a briefcase. If you are hyper fastidious about bathroom cleanliness, traveling in the Third World loosen your standards.  In Mexico, for example, soiled toilet paper is usually not flushed.  It is often put in a can next to the toilet, if there is a can.  When there isn't a can it is tossed onto the floor.  In tropical areas where the heat and humidity are high.  The soiled paper attracts insects such as flies.  The presence of hundreds or thousands of flies in a small hot toilet room can become intolerable.  Under these conditions reading material is unnecessary, you won't be in there long enough.

As with most adventures a bad experience often has a bright side if you look for it.  While standing at the bow and looking into the water I began to see what looking like greenish blue depth charges going of below the surface.  Each time the ship would pound into a big wave the explosions of light would flash.  I was seeing the bioluminescence of jellyfishes.  Had I been asleep in a cabin or near the rail, I would never had seen this wondrous sight.

Mexico deserves its reputation for being a great place to pick up some vacation ruining abdominal infection.  Hygiene is not a first priority in Mexico.  You can get sick from eating or drinking just about anything found there.  Travelers to Mexico also deserve some of the blame for getting sick. 

The opportunities for consuming contaminated food or drink in Mexico staggers the imagination.  Use my advice as a starting point.  Remember that I am not a healthcare professional.  For medical advice consult The Center for Disease Control and Prevention (CDC) Travelers Health Web site.  

Water

• The tap water is most likely contaminated no matter where it comes out of the tap. 

• Bottled water is not always a safe bet.  We slept in one morning in our upper class hotel in Mexico City.  Walking to the elevator we saw the maids collecting empty bottled water containers from the rooms and refilling them at a sink.

• Drinks consumed with ice in glasses may sound like a good idea until you consider that where the ice came from and what it does to your drink as it melts.  Drinks served without ice, but in a glass can also be a problem if the glass was washed with contaminated water and dried with a damp towel of unknown cleanliness.  A drink consumed directly from the bottle or can may be contaminated if it was cooled in an ice cooler.  The melted water in the cooler can contaminate the exterior of the can.

• Frozen bar drinks also use ice which is likely contaminated.

• Travelers often express how careful they are about not drinking the water and blithely rinse their toothbrushes with tap water.

• Travelers who shower often admit to opening their mouths or licking their lips while showering.

• The only safe water is boiled water or unopened bottled water.

Food

• There is a myth that if you eat at a nice hotel you can eat with impunity.  Wrong.  A lettuce salad at a nice hotel can send you to the toilet with cramps just as fast as one from a small cafe.  Salads may be healthy at home, but not in the tropics.

• Don't eat salads.

• Don't eat raw fish.

• Don't eat freshwater fish.

• Don't eat fruit that you have not personally peeled with washed hands.

• Don't eat runny eggs.

• Don't eat rare or raw meat.

• Don't drink milk.

• Don't eat yogurt.

• The only moderately safe food is fully cooked food.

Travelers often make themselves sick and then blame their condition on the local water or food.  They accomplish ruining their vacations by:

• Drinking massive amounts of alcohol.  Being drunk anywhere is a problem.  Being drunk when you are hot, sweating, and eating unfamiliar foods can lead to all kinds of stomach and other problems.

• Heat stroke can become a real issue for travelers from the north.  Pasty white tourists pile out of planes, disrobe, and head directly for the beach.  They get hot, absorb massive amounts of radiation, drink dehydrating alcohol, get sun burned, and become ill.  Again the water or food gets the blame.

• Jet lag can also cause a variety of problems that can mimic water or food borne contaminate exposure.

Dealing with diarrhea

Somewhere along the way, you made a mistake in your food or water intake and now you have diarrhea, probably the worst diarrhea you have ever had or even read about.  You are so sick that you don't have the energy to leave your hotel room.  Some vacation.  You find your self rushing to the toilet every few minutes.  Sometimes it is hard to decide whether to need to vomit or defecate first.  Your stool is pure liquid.  With each trip to the toilet you feel a little worse.  It is hard to imagine that you could feel worse now than you did an hour ago.  It is even harder to imagine that you will feel much worse an hour from now, but you will.  You are hot and cold at the same time.  Your mind tells you that you don't have the mental energy to tell your body to get out of bed and run to the toilet again.  You become depressed.  You start hallucinating.  You are hungry, but the thought of food makes you sick and sends you off to the toilet again.  You may think that you could die in your hotel room.  I once wrote a will under these conditions. 

What you are experiencing along with the agent that is making you sick is an electrolyte imbalance.  Your body is filling your intestine with water faster than you are replacing it.  You drink water, but it goes right through you and you don't feel better.  You may even continue to feel worse.

What I carry with me on every trip to the tropics is Gatorade or some other electrolyte replacement.  As soon as the diarrhea starts I start taking an anti-diarrhea medication and drinking Gatorade.  You have two main objectives in dealing with the diarrhea.