BY INSI

TRAVEL ADVISORY: Getting ill while travelling

Traveller's Diarrhoea (TD) is a common condition, which is likely to have affected all of us at some stage when travelling internationally, particularly in developing, conflict and former conflict countries where hygiene levels may be poor.

Symptoms may include vomiting and/or diarrhoea, and may occur in varying degrees of severity.

The effects can be devastating and it is likely that you will not be able to work whilst you wait to recover. If you are unfortunate enough to experience vomiting and diarrhoea at the same time, there is every likelihood that you will want to curl up in a ball and never want to see the light of day again!

The following travel advisory will help prevent you getting ill whilst you are away working. But in order stay healthy, you have to be meticulous and never switch off, as Traveller's Diarrhoea can sneak up on you. You often feel the effects very quickly – which will ensure that you don't get your story on time!

Why will you get sick?

Traveller's Diarrhoea is caused by bacteria entering your body. The main ways of contracting this illness are as follows:

• Having dirty hands and passing filth and germs from your hands to your mouth

• Through the food you eat

• Through your drink

Germs harbour under your nails

Scrub under your nails each day, morning and night. Travel with a small scrub brush and soap

Try to avoid touching your face/mouth with your hands whilst travelling

Wash your hands before meals and try to use hand gel when possible

Eating

Do not eat food which is not well cooked, or which you can not peel

Eat piping hot food and ensure it has not been left out where there are flies

Try to wipe your knife and fork if you can before eating

Consider avoiding salad as it could be washed in unclean water and may harbour bacteria

Eating safely under high-risk conditions:

Usually safe:

• freshly, thoroughly cooked food, served hot (i.e. heat sterilised)

• fruit easily peeled or sliced open without contamination (bananas, papayas)

• freshly baked bread

• packaged or canned food (take emergency supplies)

• bottled drinks opened in your presence - safest carbonated

• coconut water

• boiled water, tea

If there's nothing safe on the menu, ask for chips, omelettes, or any dish that must be cooked to order.

Usually risky:

• shellfish/seafood (need 8 minutes' vigorous boiling to be made safe)

• salad vegetables, unless thoroughly washed in clean water

• rare meat, raw fish

• buffets, food left out in warm temperatures

• food on which flies have settled

• food stored and reheated after cooking

• food requiring much handling - canapés

• spicy sauces, salsa, mayonnaise, left out on the table

• unpeelable fruit (berries, grapes)

• fruit peeled by others (fruit buffets)

• food handled with dirty fingers

• milk products, ice cream

• fruit juices from street vendors

• ice (in your drinks, but also in your butter dish, etc)

• utensils are often contaminated. In Asia, disposable bamboo chop-sticks are cheap, easily available, and ideal for travel

• hospitality: if food is not safe, refuse it and say that you are already sick

Drinking

Check whether it is safe to drink the water where you are travelling. In high risk areas you will have to drink bottled water and clean your teeth with it as well.

Do not drink directly from cans/bottles as the edges could harbour harmful bacteria. Consider using a straw or pouring your drink into a glass. Try to wipe the edges of your can/bottle if there is no straw available.

Ensure all water bottles are intact and the seal has not been broken – check the bottom of the bottle as well even if the seal is intact.

If the water where you are is not clean, use a PURA Bottle (a bottle which filters and sterilises your water), so that you can drink water directly from the filter bottle. These filter bottles prevent you from contracting waterborne diseases.

You could also use a water purification pump or Puritabs to purify water in emergency situations. There are lots of water purification means on the market, so have a look around.

Ensure that all water bottles have lids so that flies can not land on them and contaminate the area that you drink from.

Treatment

You can treat TD by replacing lost body fluids and salt. This becomes all the more essential if you are sweating a lot as a result of exertion, or working in a hot environment. Loss of body fluids results in listlessness, fatigue, malaise, nausea and headache (often without thirst).

Fluid is most easily replaced by drinking oral rehydration solution (i.e. Dioralyte), which are usually obtained as sachets that can be added to water. They contain salt, sugar and water in the correct proportion to achieve rapid absorption.

Drinking should continue until urine becomes clear and not yellow/brown in appearance. Drinking should continue despite any vomiting, as some of the water will remain in the body. If you sip the water you have a better chance of keeping it down.

If you wish to use drugs to control the symptoms of diarrhoea, INSI advises that you consult a doctor. If you have a mild case of TD and you need to travel there are various drugs which can stop symptoms for a short period of time. INSI can not recommend these and suggests you consult the travel guides listed at the end of this article.

Heat

Vomiting and nausea are also symptoms of suffering from the heat, so do consider this if you become ill. Check INSI's safety advisory for working in hot weather for further information.

Malaria

Diarrhoea can be a symptom of infectious diseases, including malaria. If you suspect this, you must consult a doctor immediately.

Top tips

Watch where and what you eat. Food eaten immediately after being cooked is safer. Consider that meat may be fresher in the mornings. Vegetables are safer than meat or fish.

Inspect where you are eating if you can. Do the surfaces look wiped down or grimy and full of old food? Is the cooking oil fresh or does it smell rancid?

Check out the seller/cook. Is his/her shirt or apron grimy or fresh? How about their hands? Does he/she have water available for washing up? Is he/she wiping his/her nose?

Look at the number of customers. If there are many, that means turnover is fast and that food isn't sitting around waiting for a long time. For example, do not eat food prepared at lunch time during mid-afternoon.

If you are in high risk areas, drink nothing but bottled or treated water. Don't always trust "bottled" water in some countries, as it may have been re-filled. Remember to check the seal carefully.

Eating at hotels may be better in some countries, but you still need to be careful, as the kitchens may not be clean.