Reflections on Delhi Belly, La Turista and the Cairo Curse

I was reading my new favorite travel blog (besides this one? yes yes, besides this one) about travel sickness, upset stomachs and all sorts of nasty things that can happen to you on the road. Thank you, Sydney Morning Herald, for introducing me to a panoply of exotic intestinal terminology: Aztec two-step, Bali (Bangkok or Delhi) belly, Cairo curse, Dakar dash and Montezuma’s revenge. To that list I might add La Turista and mal du Moroc, but I’m not one to quibble.

The point is, the article got me thinking about getting sick on the road. We all know that travel is not without risks. And probably the most common ailment among travelers is the stomach bug. It can happen anytime, anywhere, and there’s not much you can do to prevent it.

I don’t mean to be incendiary, but the advice of ‘cook it, peel it, boil it or forget it!’ seems so outdated. I’m not the kind of traveler to bust out a camp stove and cooking pot in a posh Parisian restaurant. I’m uncomfortable asking my waiter if he’s washed his hands recently. And I can’t remember the last time I boiled an ice-cream cone.

So I started doing some research on the good ol’ Internet. I was trying to sort out if ‘cook it, peel it, boil it or forget it!’ was still the common refrain for travelers. I happened upon a charmingly low-fi study on travelers’ diarrhea that summarized the situation like this: “The apparent inability of non-medicinal precautionary measures to prevent turista was surprising and disconcerting… pathogens may be so omnipresent as to make such precautionary actions worthless.” In other words, don’t bother. If you’re gonna get sick, you’re gonna get sick.

I know what you’re thinking. You’re thinking this laissez faire attitude goes against all the advice you’ve ever heard about staying healthy on the road. Ask any doctor or health professional and they’ll basically tell you to do the following:

• Don’t drink tap water and do not use it to brush your teeth.


• Don’t drink bottled water if the seal on the bottle has been broken.


• Don’t use ice unless you’re sure it’s made from purified water.


• Don’t drink milk or eat dairy products that have not been pasteurized (heated to a temperature that kills all germs).


• Don’t eat raw fruits or vegetables unless they can be peeled and you are the one who peels them.


• Don’t eat cut-up fruit salad.


• Don’t eat lettuce or other leafy raw vegetables (such as spinach).


• Don’t eat raw or rare (slightly cooked) meat or fish.


• Don’t eat food from people who sell it on the street.

So let me ask you — do you know anybody who’s ever followed that advice strictly? And if so, did you enjoy traveling with them???

I’m not sure it’s physically possible to be on your guard 100% of the time. And frankly, half the joy of traveling is about eating local foods, sampling local drinks, and not obsessively worrying if the person who’s serving you a meal has washed their hands recently!

So what can you do about it? The best advice I could find does not come from the ijustwannafeelbetter.com website, which exclaims “Find Out How I Cured My Diarrhea in Only 3 Days Using an All Natural Method… Without Needing Embarrassing Examinations or Drowning in a Mountain of Huge Medical Bills… all from the Comfort of My Own Home”. Score that website 10 points for its name and -950 points for its medical advice.

In the vast majority of cases there is nothing you should do except follow grandma’s age-old advice: get plenty of rest and drink lots of water. You may want to get rehydration packets to help you replace your lost fluids and electrolytes. Other than that most cases of travelers’ diarrhea are what’s called ‘self limiting’ and go away completely after 2 or 3 days. The only time you should be actively concerned is when you have significant vomiting, nausea or cramps for an extended period (usually defined as more than 12 hours and less than 24 hours); it’s possible you’ve caught a microbial infection like bacterial dysentery, amoebic dysentery or giardia. Again the odds are very small that you’ve caught one of these nasties, but it’s best to play it safe and see a doctor in these cases.

Let’s put this into perspective. In more than 98% of the cases diagnosed there is no microbial or parasitic infection. I don’t mean to minimize the discomfort involved, but my point is that 98% of the time your discomfort will pass relatively quickly. So don’t spend 99% of your trip trying to avoid the things – like street food, ice cream, a fruity cocktail, unpasteurized cheese, etc. – that will make your trip memorable. Be safe, be sensible, but don’t be too extreme in closing yourself off from new experiences.

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Reflections on Delhi Belly, La Turista and the Cairo Curse