| Take measures to avoid an uncomfortable and potentially embarrassing situation on a holiday
Summer is here and India is on the move. Examinations are over and the vacations have begun. “Heading home” is now blasé. Exotic holidays are advertised in every nook and corner for the jet set as well as the economy traveller. In addition to the tickets and bookings, it pays to take a few health precautions. After all, it makes no sense to sniffle or sneeze throughout the trip or shift your entire focus to the distance and availability of the nearest toilet!
An emergency medical kit needs only a few over the counter (OTC) purchases —
• An antiseptic cream (Neosporin, Bactoban, Povidone or iodine)
• A pain relieving ointment (Relaxyl, Capsigyl)
• A few band aids
• 10 tablets of paracetamol (Metacin, Crocin, Calpol)
• 6 anti-histamines
• 10 antacid tablets (Digene, Gelusil)
• 3 ORS (Oral Rehydration Solution) packets
• A torch
Diarrhoea can ruin a holiday. It can set in as travel may expose our friendly resident intestinal bacteria to sudden changes in temperature and nutrition. They may be killed and replaced by disease-producing alien viruses, parasites or bacteria. The changes may also cause them to mutate and become virulent. The result is nausea, bloating, vomiting and diarrhoea, separately or in various uncomfortable combinations.
It is possible to avoid this potentially embarrassing situation by keeping in mind some simple guidelines.
• Avoid raw foods. Fruits cut and peeled and attractively presented can be contaminated. Fresh salads can tempt the calorie conscious, but their hygiene is questionable.
• Partially cooked or grilled “medium rare” meats or fish can be a hotbed of disease-producing bacteria.
• Sea fish if stored in less-than-ideal conditions may be “spoilt” and may contain biotoxins. These can produce profuse, watery diarrhoea and sometimes tingling of the nerves and muscle weakness. Some have a high level of histidine which can be converted by the body into the rash-producing histamine.
• Unpasteurised milk and milk products such as cheese provide a fertile medium for diarrhoea-producing bacterial growth.
• Food from the roadside should be eaten only if it is piping hot.
• Only mineral or bottled water or hot tea or coffee should be drunk. If this is unavailable, water can be made safe for drinking by boiling it for a full minute. Alternatively, five drops (0.3 ml) of a 2 per cent solution of iodine tincture can be added to a litre of water. This should then be allowed to stand for 30 minutes before it is consumed.
• Sometimes the outside of the bottle, can or cup may be contaminated. In such cases, water can be safely drunk by pouring it into the mouth from a distance.
• If a waterborne epidemic like cholera is prevailing, even the water used to brush teeth can cause the disease. It is better to use “safe water” for everything other than bathing.
• Airlines or railway food is not necessarily safe.
Despite these precautions, diarrhoea can set in. The typical “traveller’s diarrhoea” is non-infective and subsides on its own in 24 hours. If the condition worsens, hydration must be maintained at all cost. Enough fluid must be drunk to replace the loss from vomiting and frequent stools. If the hydration is adequate, the intervals between successive urinations will not be more than six hours. Thirst is an early sign of dehydration.
Fluids that can be safely drunk are:
• Weak black tea with a little sugar.
• Carbonated drinks (colas) diluted with 50 per cent clean water.
• Plain soda.
• Reconstituted commercially available ORS sachets. The instructions on the packet should be carefully followed while reconstituting the solution to maintain the electrolyte balance.
• ORS can be made with six teaspoons of sugar and half a teaspoon of salt dissolved in a litre of water.
• Rice gruel (conjee) made with double cooked rice and salted to taste.
OTC (over the counter) anti-motility agents like lomotil or lomofen can decrease the frequency of the stools. They suppress the symptoms but do not cure the problem. They can actually prolong the disease process as they delay the elimination of the causative organisms. If excessive amounts (do not take more than one or two tablets a day) are injudiciously used, they can cause complications like bloating.
Anti-motility agents are contraindicated —
• Under the age of 12 years.
• In pregnant and lactating women.
• If there is high fever, lethargy, dehydration or blood in the stools.
Dysentery is different from diarrhoea. It produces fever and stools mixed with blood and mucous. It will usually respond to a three-five day course of prescription antibiotics.
Some traveller’s diseases can be prevented by immunisation. Vaccination against cholera should be taken if there is an epidemic. Typhoid can be prevented with a single injection, immunity from which lasts for three years. Hepatitis A (the common infective jaundice) can be prevented with two doses of the vaccine taken four-six months apart. The immunity lasts lifelong.
Prepare adequately. Enjoy your holiday.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at firstname.lastname@example.org