Dr Helen Darling advises how to avoid the dreaded Delhi Belly.
Many of us love to get off the beaten track and explore countries, cultures and cuisine far removed from the safety Aotearoa.
But exploring developing countries can come at a cost in terms of comfort and exposure to potential health risks.
Most seasoned travellers have experienced the horrors of food poisoning — or Delhi Belly — at some stage in their adventures. But where are you most susceptible to foodborne illness — and what precautions can you take? The answers certainly provide food for thought.
Foodborne illness differs between nations: in the US, where the population hovers around 326 million, the cost of foodborne illness each year is estimated to be US$15.6 billion (NZ$24.8b), with one in six people getting ill (which is much worse than the global rate of one in 10 people).
In India, population 1.339 billion, the cost of foodborne illness is estimated by the World Bank to be around US$28 billion and, according to the World Health Organisation, around one 12 people get sick each year. There are obviously differences in food, health and reporting systems between the two countries. However, the risk for a tourist is supposedly greater in India than it is in the US, yet the rate of illness in the US is higher.
Travellers' diarrhoea is a stomach and intestinal infection; the reason it afflicts travellers more than locals is that locals have often developed a natural immunity to the pathogens that cause us to double over or be confined to our beds. It is said to affect between 20 and 50 per cent of people travelling to developing countries. And although it will pass (sorry, bad pun) without too much long-term effect, the difficulty is that you are travelling and don't have access to the normal medical or personal support that you would expect in your home country.
You can, however, take precautions.
The golden rule of not eating anything washed in tap or local water is a good one — including things such as watermelon or cantaloupe that may have been washed and then cut (the cutting can transfer bacteria from the outside of the fruit to the flesh). Drinking bottled water and careful handwashing are a good foundation for safe travel. (And, of course, good handwashing and hygiene should not be limited to only when you are travelling.)
It is also often recommended that you venture into the unknown with appropriate medications. To be forewarned is to be forearmed. So, check with your GP or pharmacist before heading to the airport.
It's easy to dismiss travellers' diarrhoea as something that afflicts only those travelling in developing nations and to use it as a reason to avoid those countries. I take a different approach — foodborne illness is present everywhere and the precautions required to avoid it are fairly universal. What does differ is the extent of our local knowledge (what places have a good reputation, where to avoid) and our ability to be independent with food (cook or prepare foods ourselves).
It's not all land-based: enter the cruisers' curse.
There are some occasions when it is not possible to self-cater; on cruise ships, for example.
Norovirus, the word you don't want to hear while cruising, is highly contagious and spread through contaminated food or water. It is also possible to become infected through proximity to an infected person. It means that when it strikes a cruise ship it often makes the headlines as cruises are cut short and passengers are quarantined.
Although the symptoms usually last one to three days (and onset happens 12-48 hours after exposure) recovery can be difficult for some people, particularly the very young or old and those with underlying illnesses.
Reports from the US-based Centres for Disease Control show around 10-15 cruises a year suffer from an infectious outbreak and although these are often well publicised, the risk of contracting norovirus is considerably greater on land — especially in crowded environments such as schools, hospitals and aged-care homes.
The upshot is: it doesn't matter where you holiday in 2020 — without the correct precautions for food safety you are exposed to risk of foodborne illness. Whereas the likelihood may increase in places where sanitation is more challenging (back-street food markets, for example) the risk is always present whenever food is served.
Helen Darling is co-founder of FoodTruths.org, a New Zealand based start-up that is reimagining food systems.