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.
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.
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.
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.
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
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.
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.
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?