Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Preparing for the trip: Travel to a developing country requires careful planning.
From a health standpoint, most travelers should contact their doctor at least six weeks prior to travel.
Adventure travelers, those who plan prolonged stays, and those who will leave the usual tourist routes should contact their doctor six months prior to travel.
Advice may also be obtained from the Centers for Disease Control and Prevention (CDC) or the World Health Organization. Although vaccinations may be recommended or even required for travel to a developing country, no vaccines are required for re-entry into the United States.
Food and water precautions: Both food and water can be contaminated with bacteria or parasites. Light contamination may not affect the taste or smell of the material but may still cause disease. The usual admonition of "don't drink the water" is good advice in developing countries.
Tap water may contain organisms that could cause days of diarrhea or, less commonly, more serious illnesses. Some hotels will provide a carafe of drinking water at the bedside. This is often filled from the tap in the kitchen and is not reliable.
Bottled water is usually safe, especially if carbonated. Check the seal on the bottle: Some bottles are re-used and refilled from tap water to be sold to unwary tourists. Boiled water and drinks made with boiled water are usually safe. This includes coffee and tea.
Ice is no safer than water. It is usually best to stick with bottled water, boiled water, or sodas.
What about brushing your teeth? Basically, use bottled water or no water when brushing your teeth. However, the risk of disease is proportional to the amount of water consumed. So some experts feel that it is all right to brush your teeth with small amounts of (hot) tap water.
Foods that are safest are those that are fully cooked and served hot.
Fruits that you peel yourself, such as bananas, are usually safe. The exception is watermelon, which may be injected with tap water to increase its weight at market.
Human waste (also called night soil) is a common fertilizer in developing countries. Fruits grown near the ground, such as strawberries, are more often contaminated than those grown on trees. Lettuce is also risky for the same reasons. Its crevices are almost impossible to clean, and the water used to do so is often contaminated.
Spices do not kill bacteria. Sushi that is so spicy as to burn the tongue is no safer than unseasoned sushi. Shellfish are notorious causes of disease because they are often grown in contaminated water and build up high concentrations of bacteria.
It may seem like the prudent traveler's menu is limited. Certainly, prudence must be tempered with practicality. Part of the fun of travel is to experience new dishes. The goal of food and water precautions is to help travelers make informed choices. There is nothing wrong with eating sushi in a developing country if you are aware of the risks and are willing to take them. For many travelers, a little bit of common sense and keeping some medications on hand will result in an enjoyable experience.
Insect precautions: Insects spread many tropical diseases.
For most travelers, the biggest insect danger comes from mosquitoes. Travelers to developing countries should carry an insect repellent containing the ingredient DEET. Mosquitoes can spread very serious diseases, including malaria and yellow fever. This is not a time for herbal preparations or mild lotions (such as Skin-so-Soft). Insect repellents should be applied and reapplied according to package directions. Remember that the malaria mosquito bites at night. In malarious areas, wear insect repellent to bed and use mosquito netting if it is available. Room sprays containing permethrin may also be used. For prolonged travel, clothing may be treated with permethrin to serve as a long-term repellent.
During the day, wear light protective clothing. Long sleeves and pants help reduce the risk of bites. Ticks are also a concern in many developing countries. If traveling in fields or woods, tuck your pant legs into your socks. At the end of the day, check yourself for ticks. The risk of disease increases if ticks are allowed to attach for more than 24 hours. Insect repellents reduce the risk of tick attachment.
The traveler's medical kit: In developing countries, even simple medical supplies may be hard to find. For this reason, pack some basic supplies.
Keep prescription drugs in their original bottles. Customs officials are not pleased to see plastic bags full of loose pills. For travelers with complex medical problems, a letter from a doctor or a copy of a recent electrocardiogram may be helpful.
The American Embassy or Consulate usually will be able to provide a list of doctors who speak English if you need a doctor.