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Travel medicine

In preparation of the Debconf6 conference in Mexico, the question has to come up how to prepare for the hygienic circumstances in developing countries. While Mexico was also described to be on the top end of the developing countries, certain issues are still left to be addressed.

I have travelled to developing countries a bit and have gathered some experience, which I would like to share. However, keep in mind that I am not a doctor, just a globetrotter with a strong interest in pharmaceuticals.

Let me address the most common problem first: "Delhi belly", as travellers' diarrhoea is sometimes referred to (because almost no traveller makes it through India without dysentery). I know of three preventative and four reactive treatments.

The best preventative in my experience is to stay well above the necessary level of hydration by drinking lots more than you usually do, especially when it's hot. Prefer bottled water and juices, stay away from ice and fresh juices and shakes (as hard as it may be). Hygiene (i.e. hand disinfectant) is important, but you cannot control what's in the pot that way, especially not in restaurants (though upscale ones are generally safer, so don't be greedy). In extreme cases (when you have no other choice), another approach worth a shot is to drink enough high-percent alcohol with anything you take in orally. It's no guarantee and often not a very preferable solution (especially when it's hot), but it's kept me running a bunch of times before.

Instead of growing paranoid about it, consider the treatments: the most common two treatments I have seen among other travellers were Loperamide ("Immodium") and Ciprofloxin (or Ciprofloxacin), an antibiotic. Both are suboptimal and to be used as emergency medication only (and many traveller's don't know that). While Loperamide regulates your urge to go to the toilet by blocking and binding that which comes out the behind, it also prevents the body from ejecting the bacteria which caused the digestive system to malfunction. Thus, Loperamide should only be used when you cannot get to a toilet as often as necessary (e.g. on a bus ride), and it must not be used for more thantwo or three days without medical advice from a doctor.

Ciprofloxin, the antibiotic, is almost always a sure-fire cure against diarrhoea, but it must be taken for around seven days, usually up to four days after the symptoms faded, or else the body can build up a resistance to the chemical. During this time, you should not consume alcohol (or other drugs), and limit the amount of physical exercise, which makes it not suitable for e.g. hiking or trekking trips. Note that Ciprofloxin is a prescription-only medication.

Apart from staying hydrated, my favourite cure is medical coal (tablets at 250mg each; "Kohle Compretten"), which have negligible side-effects and can thus be used on-demand. If I feel my stomach going a little wobbly, I pop two of them 2-4 times a day, and that settles it after 24 hours. If the diarrhoea does come through, double the dosage. It'll help regulate the need, but at the same time won't block it.

If you do get unlucky, try to rest, switch to food known to be safe (e.g. packaged food), and drink a lot, ideally electrolyte solution, but a slight salt-sugar solution will also do. I actually like fresh orange juice with sea salt, which will do the trick.

I am generally not a big fan of taking pharmaceuticals, but I always have some important ones with me:

Other stuff you may want to carry along includes wound disinfectant (Dexapanthenolum; also any high-percent alcohol would do), fruit/grape sugar (Dextro-Energen), stuff against sickness on cars/boats/etc. (Vomex), bandages, Diclofenac gel, ice spray, a fever thermometer, a bunch of wet hygienic towels, single-use eye drops, steroid-based ear drops, and so on. Your pharmacy will have a complete list.

Anyway, given the proximity of medical assistance to the conference campus in Mexico, most of the above won't be necessary. Nevertheless, I think it's important that travellers to countries with lesser hygienic standards than their home countries are familiar with the above, and if only to consciously decide for or against a treatment. In general, I think it's always best to try to isolate and treat the cause rather than the symptoms. And surprisingly often, dehydration is (one of) the cause(s), so electrolytes are among the most important to have with you, in my experience.

But again, I am not a doctor.