Intestinal troubles
Diarrhoea is the most common bane of travellers. When mild and not accompanied by other major symptoms, it may just be your stomach reacting to unfamiliar food. Accompanied by cramps and vomiting, it could well be food poisoning. In either case, it will probably pass of its own accord in 24–48 hours without treatment. In the meantime, it is essential to replace the fluids and salts you’re losing, so take lots of water with oral rehydration salts (commonly referred to as ORS, or called Electrolyte in India). If you can’t get ORS, use half a teaspoon of salt and eight of sugar in a litre of water, and if you are too ill to keep it down, seek medical help immediately. Travel clinics and pharmacies sell double-ended moulded plastic spoons with the exact ratio of sugar to salt.
While you are suffering, it’s a good idea to avoid greasy food, heavy spices, caffeine and most fruit and dairy products. Some say bananas and papaya are good, as are kitchri (a simple dhal and rice preparation) and rice soup and coconut water, while curd or a soup made from Marmite or Vegemite (if you happen to have some with you) are forms of protein that can be easily absorbed by your body when you have the runs. Drugs like Lomotil or Imodium simply plug you up – undermining the body’s efforts to rid itself of infection – though they can be useful if you have to travel. If symptoms persist for more than a few days, a course of antibiotics may be necessary; this should be seen as a last resort, following medical advice.
Sordid though it may seem, it’s a good idea to look at what comes out when you go to the toilet. If your diarrhoea contains blood or mucus and if you are suffering other symptoms including rotten-egg belches and farts, the cause may be dysentery or giardia. With a fever, it could well be caused by bacillary dysentery, and may clear up without treatment. If you’re sure you need it, a course of antibiotics such as tetracycline should sort you out, but they also destroy gut flora in your intestines (which help protect you – curd can replenish them to some extent). If you start a course, be sure to finish it, even after the symptoms have gone. Similar symptoms, without fever, indicate amoebic dysentery, which is much more serious, and can damage your gut if untreated. The usual cure is a course of Metronidazole (Flagyl) or Fasigyn, both antibiotics which may themselves make you feel ill, and must not be taken with alcohol. Symptoms of giardia are similar – including frothy stools, nausea and constant fatigue – for which the treatment is again Metronidazole. If you suspect that you have either of these, seek medical help, and only start on the Metronidazole (750mg three times daily for a week for adults) if there is definitely blood in your diarrhoea and it is impossible to see a doctor.
Finally, bear in mind that oral drugs, such as malaria pills and the Pill, are likely to be largely ineffective if taken while suffering from diarrhoea.
Bites and creepy crawlies
Worms may enter your body through skin (especially the soles of your feet) or food. An itchy anus is a common symptom, and you may even see them in your stools. They are easy to treat: if you suspect you have them, get some worming tablets such as Mebendazole (Vermox) from any pharmacy.
Biting insects and similar animals other than mosquitoes may also aggravate you. The obvious suspects are bedbugs – look for signs of squashed ones around beds in cheap hotels. An infested mattress can be left in the hot sun all day to get rid of them, but they often live in the frame or even in walls or floors. Head and body lice can also be a nuisance, but medicated soap and shampoo (preferably brought with you from home) usually see them off. Avoid scratching bites, which can lead to infection. Bites from ticks and lice can spread typhus, characterized by fever, muscle aches, headaches and, later, red eyes and a measles-like rash. If you think you have it, seek treatment (tetracycline is usually prescribed).
Snakes are unlikely to bite unless accidentally disturbed, and most are harmless in any case. To see one at all, you need to search stealthily – walk heavily and they usually oblige by disappearing. If you do get bitten, remember what the snake looked like (kill it if you can), try not to move the affected part, and seek medical help: antivenins are available in most hospitals. A few spiders have poisonous bites too. Remove leeches, which may attach themselves to you in jungle areas, with salt or a lit cigarette: never just pull them off.
Altitude sickness
At high altitudes, you may develop symptoms of acute mountain sickness (AMS). Just about everyone who ascends to around 4000m or higher experiences mild symptoms, but serious cases are rare. The simple cure – descent – almost always brings immediate recovery.
AMS is caused by the fact that at high elevations there is not only less oxygen, but also lower atmospheric pressure. This can have all sorts of weird effects on the body: it can cause the brain to swell and the lungs to fill with fluid, and even bring on uncontrollable farting. The syndrome varies from one person to the next but symptoms include breathlessness, headaches and dizziness, nausea, difficulty sleeping and appetite loss. More extreme cases may involve disorientation and loss of balance, and the coughing up of pink frothy phlegm.
AMS strikes without regard for fitness – in fact, young people seem to be more susceptible, possibly because they’re more reluctant to admit they feel sick and they dart about more energetically. Most people are capable of acclimatizing to very high altitudes but the process takes time and must be done in stages. The golden rule is not to go too high, too fast; or if you do, spend the night at a lower height (“Climb High, Sleep Low”). Above 3000m, you should not ascend more than 500m per day; take mandatory acclimatization days at 3500m and 4000m – more if you feel unwell – and try to spend these days day-hiking to higher altitudes.
The general symptoms of AMS can be treated with the drug acetazolamide (Diamox) but this is not advised as it will block the early signs of severe AMS, which can be fatal. It is better to stay put for a day or two, eat a high-carbohydrate diet, drink plenty of water (three litres a day is recommended), take paracetamol or aspirin for the headaches, and descend if the AMS persists or worsens. If you fly direct to a high-altitude destination such as Leh, be especially careful to acclimatize (plan for three days of initial rest); you’ll certainly want to avoid doing anything strenuous at first.
Other precautions to take at high altitudes include avoiding alcohol and sleeping pills, drinking more liquid, and protecting your skin against UV solar glare.
HIV and AIDS
HIV/AIDS is as much of a risk in India as anywhere else, and in recent years the government has heeded WHO advice by setting up its own awareness and prevention campaigns. As elsewhere in the world, high-risk groups include prostitutes and intravenous drug users. It is extremely unwise to contemplate casual sex without a condom – carry some with you (preferably brought from home as Indian ones may be less reliable) and insist upon using them.
Should you need an injection or a transfusion in India, make sure that new, sterile equipment is used; any blood you receive should be from voluntary rather than commercial donor banks. If you have a shave from a barber, make sure he uses a clean blade and don’t undergo processes such as ear-piercing, acupuncture or tattooing unless you can be sure that the equipment is sterile.
