Diarrhea is the number one medical complaint of travelers in the first 2 weeks away from home. It is prevalent in countries with underdeveloped water purification and sanitation systems, and it attacks nearly everyone who visits the Khumbu for any amount of time. BUT it is preventable if you are careful and practice good hygiene.

Bacterial infection is only one cause of diarrhea. Viruses, protozoa, certain medications, food intolerances, allergies are among the myriad other causes of this ailment. This important to remember, because there is no one pill that takes care of all of them. And if you indiscriminately take antibiotics (which only work on bacteria), you can actually make any of the other causes of diarrhea even worse by knocking out all of your body’s natural “good” bacteria. Diarrhea is a complicated problem, and if it persists for days or is associated with bleeding, fainting, severe dehydration, high fevers, severe pain, you should see a doctor for professional evaluation and treatment.

Some people take prophylactic (preventative) medication to prevent diarrhea, but this may be a very risky practice. The potential side effects from some of these medications range from slightly annoying to deadly, not to mention the alteration of your natural bacterial flora and potential development of antibiotic resistance. You should make the decision to take prophylactic medications with your personal physician. I don’t advise it in most situations.

Diarrhea causes dehydration and disturbance of the mineral balance in your body. Drink plenty and add electrolyte supplement (ORS packets are widely available in pharmacies throughout the world.)

Travelers in areas with questionable potable water sources should pack antidiarrheal medications like loperamide (Imodium®) to halt it. You should be careful with these aids though. If you have a bacterial infection, diarrhea is your body’s way of getting rid of the bad bacteria. Use Imodium or the equivalent only when you really have to.

If you can carry a water filter with you, you can prevent a lot of these problems before they start. The most effective way to remove coliform bacteria from water is by using a reverse osmosis filter. This type of filter uses a semipermeable membrane to remove all the impurities from the water, including the bacteria. Unfortunately, they’re big and mostly unsuitable for travel. The best water filters for coliform bacteria are portable and use a combination of ceramic, activated carbon, or granular activated carbon filters. These filters use a variety of methods, such as adsorption and oxidation, to trap and remove the bacteria from the water. However, they are not as effective as reverse osmosis filters.

Again, prevention is key:
– WASH YOUR HANDS after using the toilet and before eating.
– Treat your water with a good filter or UV or by boiling or by using chemicals like iodine or chlorine
– and don’t slip up! – Avoid raw food. Boil first or wash and peel before eating.
– Avoid unpasteurized dairy products.
– Avoid drinking products with ice that is made from untreated water.

For more up to date information about treatment of diarrhea in Nepal, follow the link to diarrhea discussion on the CIWEC website, www.ciwec-clinic.com

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