Shitty thing – tourist diarrhea or something more serious?
Is your stomach bloated, your intestines are bubbling, and no food is staying inside? Most stomach illnesses go away on their own within a couple of days – but what if there's an amoeba running rampant in your body?
Text and photos by Ville Palonen
I woke up in the early hours of the morning with stomach cramps. Luckily, the room at the budget guesthouse had its own toilet, because less than a minute later I was squatting on a stool, farting watery diarrhea and at the same time struggling to get into the sink. This food poisoning wasn’t my first; I had already learned a nickname for the situation where you vomit and have diarrhea at the same time. It’s playfully called “stereo”.
The culprit had to be one of the oysters I had eaten the night before. This was my second trip to Manila, the capital of the Philippines – and the second time I had gotten food poisoning there specifically from oysters. Both times the restaurants were high-quality and clean, and on top of that, a dozen of my friends had eaten the same oysters the night before. After a short round of phone calls, it turned out that I had pulled the short stick at dinner: no one else had gotten sick.
How to avoid traveler's diarrhea?
Traveler's diarrhea strikes everyone who travels actively sooner or later. It can be caused by bacteria, viruses, or parasites. It can be an actual intestinal infection or food poisoning.
Food poisoning strikes a few hours after eating food that has been left in a warm place, for example, where bacteria have had time to multiply. Stomach illness is sudden and severe, and it often takes away your strength for several days.
If diarrhea lasts a long time – or blood appears in the stool – you should see a doctor right away. Diarrhea and a remitting fever can also be symptoms of malaria.
Intestinal infections, the pathogen enters the body, for example, through dirty (fecal-contaminated) water or undercooked food. If you want to play it safe, you should remember the rule of thumb “boil it, peel it, cook it, or forget it”: boil it, peel it, cook it, or forget it. In addition, in many countries it is advisable to drink only bottled water.
However, you should not be paranoid about food. Tasting local delicacies, for example in street kitchens, is such an important part of traveling that you should not give it up! Most often, there is nothing wrong with the food itself, but with your own hand hygiene. You should always wash your hands with soap and warm water before eating, and you can also use hand sanitizer on your palms.
Blood in the stool
You can't always get by with just a couple of days of basic diarrhea. The food poisoning I got in Bolivia (that experience was a real "stereo") was followed by a stomach illness that lasted for several days. My stomach was bubbling and rumbling, the stomach cramps were really painful, and my stool looked like green guacamole sauce. When, after five days of torment, blood started to appear in the stool, it was time to see a doctor.
The stool test at the Bolivian clinic didn't take long, and I got the results the same day. The diagnosis sounded ominous: salmonella and shigella. To my surprise, the bugs calmed down in a couple of days with the help of the medications prescribed by the doctor - but of course I finished the course.
When I returned to Finland a month later, I went for another test just to be sure. I was given another course of medication. Travel insurance came in handy (once again), because it reimbursed all expenses against receipts without a deductible.
Stomach cramps on a tiger safari
You can't always go to the doctor when you're traveling, or you just can't bear to go. This is what happened on a tiger safari in India.
On the way from Delhi to Ranthambore National Park, I ate (probably) undercooked chicken. It paid off the next night when diarrhea started flying like Seppo Rädy's spear and I used up a whole roll of toilet paper.
I had to leave for the tiger safari in the morning.
In such situations, loperamide (Imodium), which is available from pharmacies without a prescription, often helps. The drug doesn't actually cure stomach illness, but it blocks the intestines so tightly that you don't have to worry about sudden diarrhea.
This time Imodium did what it was supposed to do, but nothing more. During the tiger safari, my stomach was churning, bubbling and rumbling. I didn't dare fart (I hardly need to explain why), so my stomach started to cramp. Under no circumstances were you allowed to leave the jeep in the nature reserve area, so all I could do was hope that buckets of watery shit wouldn't spill down my pants.
A week later, a stool test in Finland revealed that the culprit was colibacillus. That too was treated with a week-long course of antibiotics, and again, the travel insurance covered the whole ordeal.
Amoeba can hide in the body
My latest bout of traveler's diarrhea hit me in December 2015, while I was on a filming trip to South Sudan. This time, the illness started slowly – no food poisoning, no vomiting, not even the annoying need-to-go-to-the-toilet diarrhea. Good thing, because the only available things in the camp were hole toilets and bushes.
I tried to control the illness with Imodium, but this time I had to swallow the tablets like candy – with no noticeable effect. The stomach cramps made me double over in pain, and on the hour-long helicopter ride back to the capital, Juba, I was really afraid I was going to shit my pants.
I only had a couple of days until I got home, and I didn't bother to find a doctor in Juba. Instead, I started a three-day intensive course of azithromycin. It's an antibiotic that, in my experience, is very effective against respiratory infections – that's why I always keep it in my travel medicine cabinet – and I remembered the doctor mentioning that it also works for stomach ailments. The cramps disappeared quickly (the farting encouraged by the porcelain bowl may also have played a role).
When I arrived in Finland, I went to see a doctor who specializes in travel sickness and internal infections. The man was downright excited when he heard how exotic places I had traveled. He suspected an intestinal infection caused by amoeba, giardia, or some other protozoan. The doctor said that amoeba can hide in the body for months and only start to rampage long after the trip.
Six (!) stool tests showed that I had not brought any souvenirs from Africa: no amoeba or other parasites, and no old bacterial friends, salmonella and shigella. When telling me the results of the laboratory tests, the doctor sounded downright disappointed.
A visit to an expert private doctor and extensive laboratory tests cost a total of well over 400 euros. Fortunately, travel insurance saved me this time too.
Traveler's diarrhea medications
Lactic acid bacteria
A different strain of bacteria at a travel destination may confuse your intestinal function, even if you don't actually get diarrhea. As a preventative treatment, it's worth trying lactic acid bacteria.
Vaccinations
You can prepare for stomach diseases even before you travel. Typhoid vaccination should be a basic requirement for anyone who travels to even slightly remote areas or eats outside of a hotel restaurant. Cholera vaccination is a bit more stringent. It is not necessary unless you live in remote areas of developing countries in primitive conditions (for example, in aid work).
