Tending to Business: Facing Your Feces in Exotic Countries

During my lifetime, I have become a fairly experienced traveler. As a youngster, I was an Air Force brat, which took me to England, my first foreign country. While we lived in England, my family visited the Mediterranean country of Tunisia, where I quickly became a tasty treat for the local mosquitoes. As a young woman, I journeyed to the Republic of Armenia, a former Soviet country, where I lived for a little over two years and once battled diarrhea fierce enough to knock me to my knees while wandering around a rural village. It was also in Armenia that I encountered my first "squat toilet", an interesting experience for any red-blooded westerner. Just last September, I came back from a two year stint living in Germany, again, courtesy of the U.S. military. Only this time, instead of a bratty Air Force kid, I went as a bratty Army spouse. And yes, my husband and I got to enjoy all sorts of exotic travels when we lived in Germany, too.

While I was living in Germany, I happened upon a very interesting and informative book written by Dr, Jane Wilson-Howarth. The book, entitled How to Shit Around the World, caught my attention, not just because of the provocative title, but because it very bluntly tackles an issue that every human being faces-- going to the bathroom. This book, coupled with another, Toilets of the World, by Morna E. Gregory and Sian James, started to make me think about how important it is to protect one's health when traveling abroad and how, by taking a few simple precautions, travelers can achieve that end.

Rule #1- Try to avoid traveler's diarrhea

Most of us have heard about so-called "Montezuma's Revenge", otherwise known as traveler's diarrhea. If you get traveler's diarrhea, you will be faced with potentially explosive feces that will make you feel terrible, complicate using the toilet in your new country, and, perhaps force you to do laundry when you'd rather be taking in the sights and sounds of your new exotic locale.

When you travel to a foreign country, you will encounter new food and, more importantly, new water. The water may actually be perfectly safe for the locals to drink. That's because the local folks are used to the local germs that are in the water. On the other hand, the water may be unsafe to drink because of poor sanitary conditions or contaminated water supplies. Regardless of whether or not the water is actually safe, as a newcomer, there's a very good chance that if you drink it, you will get diarrhea. I experienced this phenomenon firsthand during my first week as a Peace Corps Volunteer in Armenia living with a host family. I gamely drank water from the tap and paid for it within the first days living in my new home. I eventually got over the miserable diarrhea and was even able to drink water like a local, but it wasn't without pain.

Even if you do get used to the water, you can still end up getting sick later. When I was in Armenia, a pipe broke in the local water system and I picked up a bad case of giardia that required antibiotic treatment for two weeks. If you will be living in the new country, it may be worthwhile to suffer the diarrhea for a couple of days, because it will help your body acclimatize to the new location. Of course, if you're just visiting for a few days, you (most likely) won't want to get sick. If you don't want to risk traveler's diarrhea, be very, very careful what you eat and drink and be sure to wash your hands with boiled water before you eat.

* Peel all fruits and vegetables before you eat them. Try not to eat food that hasn't been thoroughly cooked, washed with boiled water, or peeled.

* Boil all drinking water, including the water you use for brushing your teeth and, perhaps, even for washing your hands. Don't take ice in your drinks.

* Wash your hands before eating and after defecating. Use soap and a clean source of water or, if no soap is available, use mud or ash. If no water is available, consider using stones or leaves (though be careful what kind of leaves you use). Rubbing your hands together removes microbes, so be sure to rub them at least four times. Rinsing with water alone is not sufficient. You might consider carrying wet wipes, if you know you're headed to austere conditions.

* Choose freshly cooked, very hot food. You may be safer eating something from a roadside stand where food is being prepared to order than eating from a lukewarm buffet in an international hotel. If you're eating in a hotel, you should consider ordering food that is made to order.

* Avoid eating salads unless you know where and how the produce was grown. Leafy vegetables like lettuce may be good for you in terms of nutrition, but in some places, they're grown in unhygienic conditions. According to Jane Wilson-Howarth, people who don't have toilets may relieve themselves in vegetable gardens. Lettuce leaves have many crevices in them that can be hard to clean. For the same reason, you should avoid eating fruits or vegetables that grow low to the ground, like strawberries.

* Avoid mayonnaise or other creamy dressings or spreads. Ice cream may also be a risky food, though sorbet is usually acidic and fairly safe to eat.

* You may also have less trouble with diarrhea if you avoid eating meat. Improperly cooked meat can lead to food poisoning.

* Boil milk before you drink it. Yogurt may be a much safer choice than milk.

* If you're in a place where environmental hygiene is especially poor, try to avoid eating pork or dog. Pigs and dogs in dirty locations usually live on trash. Moreover, they may not be properly cooked or reheated.

* If you get diarrhea, try not to rehydrate yourself with alcoholic or caffeinated drinks. While these drinks may be bottled and therefore safer than tap water, alcohol and caffeine are likely to dehydrate you, which will make you feel worse and potentially put your health in jeopardy. If you can, rehydrate with boiled water or another liquid that has been safely prepared.

* If someone offers you food that looks questionable, consider rejecting it or eating as little as you can get away with without being rude.

Rule #2- Be especially careful with seafood

Eating seafood is usually very good for you, but if you're in a developing country, you should be particularly careful about enjoying the fruits of the seas, rivers, or lakes. Remember that in some parts of the world, the waters are not clean, particularly in areas where plumbing and waste treatment is primitive or non-existent. Moreover, sea water doesn't kill microbes, so that delicious fish you're eyeing may end up costing you more than money.

No matter where you are, eating raw or undercooked fish may be very risky, though some areas are much less risky than others are. If you're considering tucking into a meal of sushi, be sure to choose a restaurant that is doing a brisk business. It's more likely that the fish served in a bustling restaurant will be fresh because the proprietor is moving inventory. You may have a shorter wait for a table at a slower restaurant, but chances are better your fish will be contaminated.

If you're considering buying fish from a market, check to see that it looks and smells fresh. Be especially careful with shellfish, which can be sources of parasites. Eating mollusks that stay closed after cooking may put you at a greater risk for food poisoning, which can lead to vomiting and diarrhea.

Rule #3- Consider being offensive

Nobody likes to be the "ugly American" or "ugly wherever it is you come from". Most people don't want to offend their hosts in a foreign country. Sharing food is a big part of hospitality in many exotic cultures and a great way to get to know and appreciate a new place. However, sometimes being too polite can cause you to suffer dire ill effects which can lead to not so quality time spent on your exotic toilet.

When you're in a situation where a lot of weird or potentially unsanitary foods are being offered to you, consider taking the bare minimum and eating just a little. The less potentially unsafe food you eat, the less likely you are to be exposed to a nasty microbe that will cause traveler's diarrhea or a worse food or water borne illness. You may want to learn the local phrases for "Thank you", "Enough", "I'm full" (or appeased), "I'm allergic" and "I'm sick".

Rule #4- Pantyliners are your friends... so are a few other handy items

If you're a woman, you probably know about pantyliners. They're those individually wrapped, absorbent cotton pads that stick to the crotch of your underwear and protect them during your period. Well, they come in handy in exotic countries, too. For one thing, they help keep your underwear clean when you can't do laundry easily. For another thing, if you end up with a sudden case of diarrhea and aren't anywhere near a restroom, they can protect the rest of your clothes from a disgusting mess. Consider bringing a few extras. You never know when a fellow traveler might be able to use one. Besides, they're so absorbent, they also make great bandages.

Carrying a small package of tissues in your luggage will serve you well if you're caught without paper at a public restroom. A book of matches might be useful if you have a sensitive nose and stomach and encounter a stinky restroom. You may also want to carry a small bottle of hand cleaner or wet wipes for use when there's no safe source of water for washing your hands. In some countries, you have to pay before you get toilet paper in a public restroom, so be sure to carry a few local coins, too.

Rule #5- Learn the local words for the toilet and the symbols for men and women

When I lived in Armenia, the public toilets often announced themselves by the way they smelled. They were often so vile that people would opt to squat behind bushes before they'd use a public restroom. When I first arrived in Armenia, I didn't know the Russian or Armenian words for man and woman or what the letters in the Russian or Armenian alphabets looked like. Suffice it to say, I learned quickly. It's bad enough having to use a stinky toilet without also running into the wrong gender. In some countries, using the wrong toilet can be dangerous, particularly in places where unrelated men and women are not allowed to freely interact. So be sure to learn which toilet is the appropriate one as soon as possible!

Rule #6- Learn how to use the local toilets and the words for toilet related issues.

I mentioned that I suffered from traveler's diarrhea when I first arrived in Armenia. I lived with an Armenian family that didn't speak much English. My host mom was a doctor, but for the life of me, I couldn't tell her that I had diarrhea. When she saw me doubled over and grabbing my stomach, she thought I had menstrual cramps and offered me a tampon! When she gave me a Russian/English dictionary to help me communicate what was wrong, I found out to my dismay that it didn't include the word "diarrhea". You would do well to learn that word before you get to wherever it is you're going. It may offer you the best chance of getting the appropriate remedy quickly. You should also try to learn the local euphemisms for pee and poo. In some places, the locations and methods for toileting are different depending on what you need to do.

Rule #7- Study the local customs

Also, understand that local toilet habits may be very different than what you're used to. Research the area where you're going and find out whether or not you'll face a regular western style toilet, a squat toilet, or just a hole in the ground. Try to find out the accepted procedures for using such facilities, too. For instance, in some cultures, the left hand is only used for going to the bathroom. If you offer someone your left hand to shake, you risk being very offensive! Even if your exotic locale doesn't have a preference for which hand to use while using the toilet, you will want to know how to operate the equipment you may run across. Morna E. Gregory's and Sian James' book Toilets of the World is an outstanding resource for this kind of research, even if you're just going to western Europe.

Rule #8- If you end up having to go outside...

Sometimes when you gotta go, you gotta go. If you have to take a dump, ideally you should bury it in the top six to eight inches of soil. That way, it's less likely to attract animals or be stepped on by anyone who comes behind you. Burying your solid waste also allows it to be reabsorbed into the nutrient cycle. You might consider stirring your turd with a stick before you cover it, then cover the hole with dirt and leaves and tamp it down. Contact with dirt and leaves helps speed up decomposition of your solid waste. If possible, you should burn your dirty toilet paper, but only if the conditions are safe.

In some areas, you are encouraged or even required to clean up your solid waste and dispose of it the way you would dispose of dog doo. You should find out what the local rules are, if there are any, for the area you will be visiting. In any case, try to do your business away from walking trails, caves, or other areas where others might find it.

For obvious reasons, you should never "go" in streams or other potential drinking water supplies. Instead, be sure to defecate in an area at least fifty yards away from a water source, so that your fecal matter does not end up in the local water supply. You don't want to be responsible for making others sick.

Be very careful where you squat. One time, while camping in Virginia, I made the mistake of squatting too low over a poison ivy patch. Needless to say, that ruined my camping experience. Another time, when I was on a long bus trip crossing the border to Armenia, I went behind a building to relieve myself. Unfortunately, there was no light and I fell into a ditch that I couldn't see. I ended up cutting my hand and still have a deep scar to remind me of that experience. In other areas, potential dangers might include wild animals, poisonous snakes, or even speeding cars. It pays to carry a flashlight if you can.

Rule #9- Medically prepare to go and consider getting a checkup when you come home

Naturally, you will want to be healthy when you travel to your country. You will want to stay healthy during your visit. And when you get home, you want to be sure you're still healthy. Therefore, make sure you get any immunizations you might need before you travel.

If you're headed to a place where certain diseases are known to be an issue, be sure to become educated on how to avoid them and take the necessary precautions. That may include taking certain preventive medications during your visit or avoiding certain activities or areas. A friend of mine, for example, put herself at risk when she visited Malawi and swam in a lake. Unbeknownst to her, that lake was the source of a potentially nasty worm infection. Luckily, she avoided getting sick, but you might not be as fortunate.

When you come home from your trip, you may want to visit your physician for a checkup, especially if you're experiencing any strange symptoms of disease. When I came home from Armenia, I was plagued with recurrent skin infections for over a year. I was lucky in that it only took some potent antibiotics to make me well. Some people fare worse than I did. Even if you're feeling okay, you might want to have a stool sample analyzed when you get home. That way, you can find out about and treat any potentially unpleasant diseases and kill any parasites that you might have accidentally picked up during your travels.

Traveling can also take a toll on your mental status. If you find yourself feeling down after a trip, find a good friend to talk to; do some journaling; or, if you're really feeling depressed, consider seeing a mental health professional.

And finally, Rule #10- Remember that everybody poops

I know that a lot of people, particularly from the west, are embarrassed about their need to go to the bathroom. But it's something that every living creature experiences. You're hardly alone in your need to relieve yourself. If you find yourself in an embarrassing situation, try to have a good laugh about it. At least you'll have a good story to share with your friends at home.

Bon Voyage!

Sources:

Wilson-Howarth, Dr. Jane (2006). How to Shit Around the World: The Art of Staying Clean and Healthy While Traveling. Palo Alto, CA: Travelers Tales.

Gregory, Morna E. and James, Sian (2006). Toilets of the World. London and New York: Merrell Publishing.