Chutney’s Deadly Charms (Guardians Part 5)
Posted by Richard Conniff on April 16, 2013
Men are far less likely than women to seek health advice before a trip, and that may be one reason they account for 71 percent of travel hospitalizations. It’s smart to visit a travel clinic to be certain that you have the right immunizations and to make sure false assumptions don’t get you into trouble. For example, some parents forgo measles immunization for their children because measles is no longer a big problem in the United States. Or they avoid the vaccine because they mistakenly believe it’s more dangerous than the disease. But even an ostensibly safe destination like France reported 14,000 cases of measles in 2011, and some unprotected American travelers brought the disease home with them.
You may also mistakenly regard immunizations and antimalarial drugs as superfluous if you are one of the 13 percent of U.S. residents born abroad. “You don’t even think about it,” says Rish Sanghvi, a 36-year-old biotech market researcher in California. He grew up in India until he was 16, and on a return trip there in 2011 he figured he was just going home to visit family. So he didn’t take any precautions, except to avoid raw foods and drink only filtered water. “I guess if I were going to Africa, I’d be more careful.” But it turns out that his risk was real enough.
One day early in his visit, Sanghvi was playing soccer with friends and he felt exhausted. “I thought I was going to pass out,” he says. Then the stomach problems started, followed by mild hallucinations. His brother, a physician, recognized typhoid fever and immediately put him on antibiotics. Even so, Sanghvi couldn’t keep his food down, and he was laid up for a month. Back in the States, with his weight down 30 percent, he spent another 2 months unable to do more than “sit at home and chill. Man, that’s the last time I don’t take my drugs,” he says.
Sanghvi figures he picked up the disease from the less visible things—the dairy products in a lassi drink, the chutney served with a dosa pancake, the raw onions in a sandwich. Even for experienced epidemiologists, it’s not always easy to follow the familiar advice for eating in foreign countries—boil it, cook it, peel it, or forget it. “We commonly work in refugee camps and remote settings,” says the CDC’s Dr. Clarke, “and sometimes the only food to come by is some goat stew and rice, and you may not have full control over how it was prepared.”
Foreign visitors also often end up feeling social pressure to fit in by drinking the water or eating the food. “It’s a 100-degree day, and somebody’s offering you a nice tall glass of iced lemonade, and it’s a big deal for them to offer ice because it’s hard to get,” says Jason Love, a Portland, Oregon, resident who was a Peace Corps volunteer in the Dominican Republic. “It’s hard to turn down from a desire point of view, and it’s hard to turn down for social reasons.” But Love ended up with a 6-month case of giardia, a nasty way to say goodbye to a quarter of your body weight.
For those kinds of emergencies, a travel clinic will typically send you out with a powerful antibiotic like ciprofloxacin. But antibiotics can also cause serious side effects. You may just want to wait it out. Carry salt packets and mix them with clean water to help you retain fluids. As for the social pressure, Cyrus Shahpar, M.D., M.P.H., another EIS officer, tries to make his preference for his own water bottle seem quirky rather than rude.