When I returned from my overseas trip, I soon became stricken with gas, bloating, cramps, fatigue and severe diarrhea. For 4 hellish days, I couldn't eat any solid food -- I survived on water and Gatorade. I slept continuously, waking up every several hours to spend quality time in the bathroom. When I had enough energy to listlessly do things around the apartment, I would have to run to the bathroom at random intervals. After two days, I had to seek treatment at the local emergency room because I could no longer drink the Gatorade without vomiting.
Thankfully, I am fully recovered and now feel fine, but it was one heck of a wake up call. It could have been worse... a lot worse.
Therefore, I started researching how to effectively prevent this in the future. What could I buy that would render putrid foul smelling water into tasty safe water? The soft-core camper and gadget freak in me cried out to go shopping for some insurance that I could throw in my suitcase.
The budget? The equivalent of my emergency room visit -- roughly $400 or less.
Defining the Mission
I quickly found that most advice on water purification given on backpacking and survival forums seems to be biased towards the biological threats found in the North America. In North America, you will rarely encounter viruses in streams in lakes. The number one threat here is Giardia or bacteria (and from what I heard and read about you definitely don't what Giardia).
Worse yet, I found some advice on traveler forums that was ridiculous, conflicting, or simply harmful.
So I started my research -- I need a portable method of purifying water that would get rid any threats I would face: viruses, bacteria, and protozoa (Cryptosporidium, Giardia, etc). It is assumed that the water is free of chemical toxins and may have one or more of the following:
- Viruses. There are over 140 extremely small (0.004 to 0.1 microns) enteric viruses known to infect humans, including hepatitis A, Norwalk, poliovirus and rotavirus.
- Protozoa. There are several very nasty single celled microorganisms (Giardia Lamblia, Cryptosporidium parvum, Entamoeba histolytica (amebic dysentery), and Cyclospora cayetanensis) some of which are associated with death.
- Bacteria. Bacteria range in size between 0.2 and 10 microns, and are the likely culprit behind your travelers diarrhea and gastroenteritis. Significant bacteria include: E coli, Brucella melitensis, Leptospira icterohaemorrhagiae (spirochaetales), Pasteurella pseudomallei, Salmonella typhosa (Typhoid Fever), Salmonella paratyphi (Paratyphoid fever), Salmonella schottinulleri, Salmonella hirschfeldi C., Shigella flexneri (Bacillary dysentery), Vibrio comma (Cholera) and Vibrio cholerae.
But before I start, here is some generalized advice for travelers.
Prevention (Better Living Through Chemistry)
- Bismuth subsalicylate (2 oz t.i.d.). Studies from Mexico have show when taken on arrival at the destination (three times a day) can reduce the incidence of travelers diarrhea from 40% to 14%. That's right, taking Pepto-Bismol -- 2 oz of liquid or 2 chewable tablets can increase your chance of not getting TD, but you have to take it before you get TD. Note: this won't work it you encounter a virus.
- Probiotics (Lactobacillus GG and Saccharomyces boulardii) don't work. All studies to date have been inconclusive.
- Halogenated hydroxyquinoline derivatives, enterovioform, and other substances are effective, but may cause "neurologic adverse events" and best should be avoided. I'm not sure what a "neurologic adverse event" is, but I'm betting it might land you in a difficult spot in a country where you don't speak the language.
- Antibiotics are effective (attack rate reduced from 40% to 4%), but only on pathogenic bacteria which are sensitive. However, the medical community in recommends against prophylactic antibiotics except for short-term travelers who are high-risk hosts (immunosuppressed travelers).
- Antimicrobials have no effect on viral illness. Hepatitis A and Typhoid vaccinations are a good idea before traveling abroad.
Prevention (Better Living through Common Sense)
This should be common sense for most of us, but for those who have never traveled extensively:
- First, try to figure out if the water is potable. In most of the U.S., Canada, and western Europe tap water is generally safe to drink. In the rest of the world, the reverse is probably true.
- Avoid ice, since it probably is made from tap water.
- Do not brush your teeth with tap water (no matter what anyone says). Use bottled or boiled water. This is especially true if the hotel has labeled the water "not fit for drinking" above the sink (as I saw this in Macau and in a hotel in the Philippines). Also, use bottled water or boiled water to wash your contact lenses or dentures (if you have them).
- Coffee and tea are generally safe. However, cream and milk are not. If you must have light coffee, bring non diary creamer with you.
- US and European chains (such as McDonalds) and large hotel restaurants are also usually safe choices. Avoid street vendors.
- Don't drink from or brush your teeth with the water in the aircraft's rest room. They are filled with regular tap water in whatever country they happen to be in. A recent EPA study showed the bacterial contamination of various water samples taken from aircraft were extremely high in bacteria.
- Check to see if the bottled water you just purchased has an unbroken sealed cap. In some countries, unscrupulous vendors will refill used bottled water containers with tap water and sell them on the streets.
- Stick with name brand water. In some countries, some water companies bottle unfiltered tap water.
Labels: business travel
