03/28/22
This post is an amalgam of the stuff I’ve learned preparing to be prepared on this trip; its mainly from some meetings with a friend and dentist, an appointment with a “Travel Doctor” from Penn Medicine, and a book called “The Prepper’s Medical Handbook” by William Forgey. Disclaimer- since I’m not a doctor, there might be some bullshit in this post.
In my view, there are four main boogeymen:
- Diarrhea
- Disease (special shoutout to Malaria)
- Altitude Sickness
- Smashing ya self up
Diarrhea
This one is a classic- everyone knows the good old hot snakes. I expect that “Delhi Belly” is a bit of an inevitability on a first-time journey through India. I’m no stranger this sort of bi-directional liquid expulsion; there are some hostels from my dark past that I will never forget for this reason.
Catching a bug from foreign water and food can (maybe) be prevented by being careful- but nothing is 100%. In India, drinking water out the tap is a bad idea. Instead, do this:
- Drink bottled water
- Drink boiled or UV-treated water
- Run drinking water through a two-micron water filter which captures (at least) giardia and cryptosporidium
- Treat drinking water with iodine
I’ll do what I can to avoid it… but when diarrhea knocks on my door, I’m going to be prepared. Mainly with electrolyte salt, anti-diarrheal, anti-nausea, and antibiotic.
Use electrolyte salts to effectively re-hydrate while you’re being sick. Straight water often won’t do the job because when you expel liquid you’re losing salts as well. You always need to hydrate in a balanced way between salt and water. This is also a good tip for hangovers.
Imodium can be used basically as a “cork” for your butt. It will prevent you from shitting for a few hours (imagine you need to board a bus), but it can’t address the root cause (bacterial infection). Also- you want to be careful with self-administering Imodium because often diarrhea is your immune systems way of flushing out your system. You should let your immune system do its work as best you can.
Azithromycin is the heavy hitter- have this for severe cases of diarrhea and nausea which aren’t abating. This is an antibiotic which works by inhibiting growth of the bacteria that’s giving you problems.
Finally, carry dramamine to alleviate nausea. Ginger is also an effective natural alternative.
Disease (S/O Malaria)
To me, malaria is a pretty spooky one. I’ll be in a few danger zones including rural southern India & rural areas in SE Asia. The CDC lists malaria danger by country in a table at the link here:
https://www.cdc.gov/malaria/travelers/country_table/a.html
Until humanity gets their shit together and enacts Operation Global Mosquito Annihilation, we are stuck with mosquito born illnesses like Malaria.
Block mosquitoes when possible. Use long sleeves and mosquito nets treated with Permethrin.
Mosquito repellent options:
- Mosquito repellent with 30-35% DEET (N-Diethyl-meta-toluamide) on bare skin lasts for about 4 hours. This is what I have- its pretty nasty stuff.
- Picardin is another common repellent used on bare skin, which lasts up to 12 hours. Also nasty stuff
- Finally, Oil of Eucalyptus can be used for a kinder (but possibly less effective) alternative to the industrial chemicals
Other insect precautions:
- Wear khaki/tan clothing- bright colors attract insects
- Sleep in air conditioning, or using a bed net treated with permethrin
The second layer of defense against Malaria is medication- including chloroquine, hydroxychloroquine, doxycycline, mefloquine, and many others. I’ll discuss a few pros and cons of some of these medications.
Chloroquine & hydroxychloroquine are widely available and very well-known safe drugs. The problem is that its only effective for the mosquitos of Central American and the Caribbean. No help to me here.
Doxycycline is a cheap and widely available antibiotic preventative treatment to malaria. Pick this up in any Asian pharmacy (although try to buy from an established hospital pharmacy to avoid fake pills). Personally, I want my gut bacteria in full force arriving in India so I’m trying to use antibiotics very sparingly when possible.
Mefloquine is a very effective preventative course of medication for Malaria. Plus, you only have to take a pill once per week. The downside is that for some people it causes depression, anxiety, sleep paralysis or nightmares!
Sidenote- as I am writing this, I have just tried the first Mefloquine pill. I felt somewhat nervous considering the side-effects; however, so far my brain feels normal 🤞 lets see about them nightmares…
Other diseases which will get an honorable mention for my trip, at least, are: Typhoid, Hepatitis (A & B), Tetanus, Rabies, & Japanese Encephalitis. Vaccines are available for all of these and should be considered for travel. Personally, I got every vaccine except for Rabies. I figure I can just avoid rabid monkeys and whatnot. It was actually very expensive (around a thousand bucks including a $700 double dose of Japanese Encephalitis), but its hard to put a price on this sort of thing. I probably overprepared though.
Altitude Sickness
Altitude sickness takes the form of acute mountain sickness, pulmonary edema, and cerebral edema. The last two deal with fluid building up in the lungs/brain. Its an extremely dangerous situation and should be addressed with rapid descent from altitude. For this reason, its essential that trekkers & alpinists can recognize the rather sneaky progression of symptoms.
“You will not need to worry about high altitude illness of any kind unless you must depart suddenly from a lower attitude and head for the hills—the high hills, that is . High-altitude-related illnesses can generally be avoided by gradual exposure to higher elevation, with the sleeping ascent rate not exceeding 1,000 feet (300 meters) per day when above 9,000 feet (2,800 meters) . Alternatively, avoid sleeping at greater than 2,000-foot (600-meter) increments every 2 days when suddenly traveling from near sea level to 10,000 feet (3,000 meters).”
William Forgey, “The Prepper’s Medical Handbook”:
Measures to prevent altitude sickness:
- Climb slowly
- Good cardio
- Stay hydrated
- High-carb diet (at least 70% calories from carbs)
And then there’s the medication, for when the above are not enough. I got Diamox (Acetazolamide) in the holster for this trip. This is a “carbonic anhydrase inhibitor” which works by decreasing fluid production in your eye to reduce overall fluid pressure in your brain and lungs.
Smashing ya self up
This one is pretty obvious. From the New Delhi streets at rush hour to the rocky cliffs of Dolpo, the traveler needs to be able to address lacerations and contusions.
The main thing- clean out wounds before bandaging or stitching. By far the biggest risk with any laceration is infection- especially in a foreign country. Use some water to clean out dirt and dust from the wound and apply some antiseptic. Then bandage or suture as needed. I will sometimes use superglue to form a hard “shell-like” barrier on top of the tape or gauze. This is especially useful for hand injuries during rock climbing.
