Health is Wealth

End of Inca Trail 1999 – Photo by Lisandro

I’ve had traveler’s diarrhea on at least a handful of occasions that I can remember in the last 16-and-a-half years.   Yes, I’ve been traveling on and off for at least that long.

It started back in ’94 in Istanbul. I awoke at around 4 am with a violent bout of the runs.  I remember running from my hostel room, down the hall and to the toilet every few minutes.  All the energy I had was sucked out of me.  Nothing more would come out even though my body was still trying to push fluid through.  It was my first ever occurrence with this discomforting and wretched watery bowel movement.  I didn’t know what was happening.  I didn’t know what diarrhea was because it was my first time dealing with it.

I went to the front desk and tried to explain my situation.  A woman with an English accent overheard and said:

You poor thing, you need anti-diarrhea medicine.  I have some but it’s in my bag and my taxi to the airport is outside.  I have to go right now. Oh you poor thing.”

I asked two guys who were working in the hostel.  They said that they wouldn’t be able to unlock a cabinet that had these stoppage pills until 8 am.  I pleaded with them but it was to no avail.  I went back to the room and woke up an Irish kid that I’d been hanging out with the night before.  He got up and dug deep in his pack for a tablet.  After rehydrating for a day and taking it easy for another, I was better.

In ’98 in Ecuador it happened to me again.  In Otavalo, I was vomiting while my bowels pushed loosely and often.  My fortitude was sucked dry.  I forced myself to drift slowly and painfully to a store to get fluids.  I spent a day in bed and was better in only 24 hours.

In ’99, the morning that I was to start hiking the Inca Trail in Perú, it started again.  I took a Cipro that the travel doc at Mt. Auburn Hospital had prescribed just in case.  Thanks to the medication, the loose bowel movement was gone in an instant and I was able to hike comfortably, save for the commonly occurring altitude sickness.

In ’02, in Luang Prabang, Laos, I awoke in the middle of the night to find myself with a fever.  I ran to my private bathroom to find myself violently shaking while vomiting and having bad bowel movements simultaneously.  This was perhaps my most hellish life experience to date.  Fortunately I had a Lao phrasebook that allowed me to purchase a fever reducer at a pharmacy the next morning.  The fever dropped quickly. Rehydration cured me in two days.

At the beginning of this year, I ate some delicious Baho at a market in León,  Nicaragua.  This is probably what caused the stomach discomfort and mild runniness that I had for a few days.  My remedy was to pound water.  In this case it was probably just my body getting used to the tropical bacteria.

After devouring the streets of Delhi just over two months ago, I blew chunks and dropped a few loose stools.  I was nauseous and bed ridden for about a day and all better after three or four.

A Chiang Mai vendor making Som Tam

Then, about a month ago, on the island of Koh Chang in Thailand, near the Cambodian border, I ate fish and the ubiquitous and delicious Som Tam, or
papaya salad, both from a roadside stand by the beach.  This was just after gluttonously feasting on street food in Chiang Mai and Bangkok for over three weeks without problems.

The next morning I had mild diarrhea and thought almost nothing of it, except:  I’ll just flush the virus through my system with a lot of water,  just like I did in Nicaragua six months ago.

It didn’t work.  I wasn’t real sick but my energy level wasn’t quite normal.  I still didn’t think too much of it.  The diarrhea came and went over the course of a couple of weeks when I decided I needed to attempt a cure.  I visited a pharmacy in Cambodia’s capital of Phnom Penh.  After explaining the situation with words and gestures, the worker who was sporting a white coat said:

Amoeba.”

He sold me five days worth of Flagyl or Metronidazole and instructed me to take 500 mg three times a day for five days.  On the morning of the fourth day my stool was solid, but there was still discomfort.

I decided to visit the English doctor Gavin Scott, who’s recommended in Lonely Planet.  He assured me that I was on the right med and that his only concern was to see a solid stool, which I now had.  He said that he would have suggested the dosage to be 750mg three times a day for five days instead of the 500 that the pharmacy worker had recommended.  He told me to immediately up my dosage to 750mg and to take the Flagyl for four more days, making a total of eight days.  He’s the doc so I took his advice.

After day eight I still didn’t feel any better.  I had discomfort in my abdominal region and some mild nausea.  By then I’d arrived in Siem Reap and decided that I’d better buy a bus ticket for Bangkok so that I could get world class care.

Since I had a bus ticket for early the next morning, that afternoon I purchased a one day pass to the temples of Angkor and hired a driver.  I was blown away by the fairy-tale setting and wanted very much to spend more days exploring.  However, my first priority was to get over whatever it was that was causing this mild nausea, weakness and discomfort.

So that I could stay in Siem Reap, and not return to Bangkok so soon,  I canceled my bus ticket and decided to seek the help of a clinic in Siem Reap.  I ended up at the Friendship Khmer China Hospital where a young Cambodian woman translated everything I said to the Chinese doctor.  He immediately performed an ultrasound that showed spots in my midsection.  Two nurses and the translator told me that they could easily fix me up on the spot through an intravenous solution.

I’d never been on IVs so didn’t know much about it.

Is this going to be painful?  Will it be expensive?”

No pain and compared to your country it’s very cheap.”

Foolishly, I didn’t get a quote, as my only concern was for this problem to go away.  I asked them why the English doctor in Phnom Penh hadn’t done any tests.

Because he doesn’t care about you.”

After a two-and-a-half hour morning session and an hour and a half of IV solution  that evening, the two bills totaled $480.  I had no idea that that’s what the nurse had  meant by cheap.  I had to walk across a flooded street in that floating city to retrieve money from an ATM as they didn’t accept plastic.  The same nurse who spoke some English assured me that I’d be fine the next day.

The cocktails of intravenous fluids contained Genyamycin Sulfate, Raceanisodamine hydrochloride, Omeprazole sodium, Qingkailing Zhusheye, Lactated Ringers, Luhusjia Zhusheye and Coenzyme A for Inosine Adenosine disodium Triphosphate.

The Chinese doc also injected my butt with a Rotndine Sulfate compound,  Aminophenazone and Barbital.  He then prescribed Collodidal Bismuth Pectin Capsules, Sanjiu Wwitai Keli and Amoxicillin, the latter being yet another antibiotic for me to take for seven more days.

Besides the amoxicillin, I don’t know what the rest of the stuff means either.

Two days later I wasn’t better.  The team at the hospital was surprised.  I was out $480, but much more importantly I was worried about my health.

The next night I was off to Bangkok to seek real medical attention at the world class Bumrumgard International Hospital.  This would prove to be the plushest medical facility I’ve ever seen.

There I’ve been assigned to Dr. Rujapong Sukhabote.  I told him about the Flagyl:

For some reason they like to prescribe Flagyl for everything in Cambodia. I don’t know why.”

I then told him about the ultrasound and showed him the concoction list that you may have attempted to read above.

An ultrasound is not going tell you what’s wrong.  They gave you many different things for many different problems without identifying what the problem is.  Stop everything you’re on right now.”

He had me take a stool sample.

I’ve thought many times:  Why didn’t I just drop Cambodia in the first place and head to Bangkok for a stool sample and get treated accordingly?

I also sometimes think:  Life is too short to learn how to always make the right decisions.  I have to make foolish mistakes like not shuffling my feet in an estuary and getting bitten by a stingray and not burning a tick off of me in time, causing the antenna to get stuck in me for over four months.

The antenna came out on its own in June.  The toe where the stingray chomped into me feels to be about 99 percent healed.

Yesterday the stool sample came back negative.  There was no bacteria.  I’ve still got discomfort.  Dr. Rujapong thinks that I’ve got some sort of post infection.  He said that these things can take some time to heal.  I’m now on 10 days worth of three different stomach medications, Colofac, Motilium and Prevacid.

The knowledgable pharmacist in the Digestive Diseases Center  thinks that all the antibiotics I took killed the bad bacteria as well as crucial good bacteria.

As mentioned at the end of my previous post, losing $100 wasn’t my only recent travel write off.   I’ve also had to write off the $480 for all the services provided by the Khmer Chinese clinic, $50 to the English doctor Gavin Scott and about $200 to the Digestive Diseases Center at Bunrumgard in Bangkok.

I now think: Compared to having your health, money means nothing.  My only concern is to get back to normal.  Health is wealth.

The three things I’ve learned the hard way that maybe you can learn the easy way through me are:

● Be careful with street food.  Make sure you can see them cooking it.  If you have any reservations, skip it.  Don’t eat salad from the side of the road in a tropical land.  Don’t eat fish that’s been sitting, even if the vendor insists on reheating/cooking it, like in my case.  I’ll never be sure that the fish is what made me ill, but my intuition tells me that it more than likely was.

● If you have irregular bowel movements for more than a few days, seek medical treatment.  Insist on a stool exam.  If you’re in SE Asia, get yourself to Bangkok for world class treatment.  Make that your priority over everything.

● I’m not invincible. Neither are you. Don’t travel without travel insurance as I have.
You never know when something can go awry.

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8 Responses to Health is Wealth

  1. Shing says:

    Sounds horrendous! Proper medical care is always a concern when travelling. But you’re right, money is a small price to pay for your health, it’s just annoying that you were subjected to bogus treatments… and after all who are you to question when they’re the doctor! It’s a shame street food is so criminally delicious, otherwise I think many people would avoid having the dreaded ‘Delhi belly!

    I hope you can finally sit on the toilet with pleasure! (one of my favourite places to sit down and think :) )

    • EarthDrifter says:

      SHING: Thanks! The digestion has been fine for a long time now. That bad street food on Ko Chang was a rare occurrence. I ate street food hundreds of times before that and have eaten it many times after in South America including Ceviche (almost raw seafood) even. I only recommend that if your intuition tells you not to eat something, then don’t. Otherwise, it would be awful to not be able to enjoy street food while traveling.

  2. earthdrifter says:

    PINKY: Thanks for your concern. I was what felt to be almost completely better. However, I’ve realized that I probably need to stick to a better diet. It’s very hard in India and Thailand. As you probably know, they’re not good at modifying things. For example, people are obsessed with adding sugar to shakes and fruit drinks. I get weird gestures from people when I say: “No sugar.” In Kanchanabury a woman refused to serve me a fruit shake w/out ice.

    I’m taking a VOLVO from Goa (Panaji) to Pune tonight. From there I’ll more than likely be booking a flight to the states either from Bombay or Delhi. While there I hope to implement a virtually perfect diet and then get back to some traveling/blogging. I felt very good a few nights ago so decided to test my health by eating spicy Goan specialties and drinking delicious 50 Rupee single malt scotches from India. Thus I’ve got a little bit fo discomfort again. I’ve travelled a lot and this hasn’t happened before.

    Have you been to Rajastan? I may try to see a little bit there on the way to Delhi.

  3. pinkybinks says:

    OMG dude! That is hardcore. Are you fully back to health now?

  4. jean says:

    Always take lactobacillus acidophilus when you take antibiotics to restore the good bacteria in the gut!

    • earthdrifter says:

      JEAN: Thanks for the stellar advice. I can’t believe that the docs who recommended the antibiotics hadn’t thought of that. I hope that I don’t need to take antibiotics again but if I do I’ll surely refer back to your message. :-)

  5. earthdrifter says:

    ANNIE: Thanks for your comment and well wishes. Honestly, I can’t keep track of who’s told me what and when. Actually the pharmacist told me about how the antibiotics kill good bacteria, not the doctor and I can’t remember if it was you or him that told me first. I hope that both of you are correct. While I was taking the antibiotics and still now, I haven’t been able to figure out if the discomfort is from the original problem or caused by the nasty drugs.

  6. Annie says:

    When I read your list of drugs in the IV I was like huh? Then I read amoxicillan and thought: Finally one I know Then I read I don’t know what any of that means either. I laughed out loud! That list is scary.

    When the doctor told you your good bacteria was killed as well as the bad bacteria, did you think: Wow, Annie said that to me last night?

    I hope the stomach meds help you recover and you’ll feel better really soon.

    Take Care!

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