by Miriam Meijer

The most common travel-related ailment is Traveler's Diarrhea or TD. About a third of the tourists from developed countries get diarrhea when visiting developing countries, whereas third-world travelers going to developed countries rarely suffer TD. This is due to the ineffective sanitation systems that still abound in our world. The word diarrhea derives from the Greek "to flow through," but almost everyone would rather use the favorite euphemisms: "Montezuma's Revenge," "turista," "Tutankhamen's curse," "Delhi Belly," "Kathmandu Quickstep," or "Tasmanian Two-Step."

The eating rules for travelers, usually condensed to "boil it, peel it, or forget it," do help but they do not guarantee that TD will be avoided. The cause for TD is almost always from eating organisms that have grown in someone else's intestines. While no sane person would consciously eat someone else's stool, on a microscopic level the substance can be strewn in drinking water, on the street, on people's hands, on flies, and on the food itself.

In the developed world, the organisms that cause TD are carefully kept out of the water supplies and the general environment. Strict rules for restaurant management and hygiene aim at interrupting the flow of microorganisms from the food chain to the intestines of customers. The principles of not storing food at room temperature, frequent cleaning of counters and machinery, separate "clean" and "dirty" preparation areas, etc., work very well. These principles were developed less than a century ago in the industrialized West.

Travelers' exposure to infectious organisms in developing countries of Latin America, Africa, the Middle East, and Asia is, unfortunately, very high. Most of the Southern European countries and a few Caribbean islands have an intermediate risk for TD. Public health enforcement protects Canada, Northern Europe, Australia, New Zealand, the United States, and a number of the Caribbean islands. However, it is clear from the many signs in American bathrooms, "Employees: Wash Your Hands—It's the Law," that hygiene is a never-ending learning process.

TD is not life-threatening except for infants, who may become dehydrated. Sadly, diarrhea is a major cause of infant death in developing countries. Less common causes of TD are jet lag, altitude changes, medicines, or changes in diet and eating pattern. In developed countries, infectious diarrhea is so rare that physicians look for other causes like nervousness, alcohol, surgery, use of various medications, or as a symptom of an underlying illness. If the diarrhea persists with a fever, vomiting or blood in the stools, it is essential to find a doctor or other medical professional. What seems to be TD could be dysentery or cholera, which must be treated by a physician.

On the lighter side, Mary Ann Racin recently launched a web site that allows travelers to search a database of the world's most tourist-friendly toilets. David Wallis interviewed her by telephone from her Virginia headquarters. He asked her why Americans always whine about Turkish toilets. Racin's answer: "I don't want my Web site to seem culturally superior or xenophobic. It's not meant to change the way the world goes to the bathroom. I'll certainly list peoples' favorite Turkish toilets. When I worked at the International Monetary Fund, sometimes there would be footprints on the toilet seat, so I think that people just prefer what they're used to. Also, it's too much of a physical effort for Americans to squat after spending so much time on the couch watching TV." Wallis asked her to predict the future for http://www.thebathroomdiaries.com. Racin hopes that as technology advances, that one will be able "to link to a global positioning satellite and beam information to a traveler's Palm Pilot, which would beep louder and louder as the person gets closer to clean public bathrooms." So much for bathroom humor!


Racin, Mary Ann. http://www.thebathroomdiaries.com

Shaw, Terri. "Steering Clear of 'Tutankhamen's Curse'," The Washington Post (August 16, 2000): Health, p. 9.

Shlim, David R. "Understanding Diarrhea in Travelers," MedicinePlanet.com

Wallis, David. "The Word Onů," The Washington Post (August 13, 2000): E03.

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